Pelvic Floor Muscle Evaluation and Treatment

What Is a Pelvic Floor Evaluation? And Why Should You Have One?

If you are experiencing problems related to your pelvic floor – leaking when you sneeze or laugh,  loss of bowel or bladder, pelvic pain with or without sexual activity, – a physical therapy evaluation will help determine what is contributing to the problem. A pelvic health physical therapist (PT) will use the evaluation information to develop a treatment plan to help reduce or eliminate your symptoms. The evaluation is an important tool both for the treating PT and for you. Physical therapy evaluation and treatment is a health care benefit usually covered by your medical insurance.

Unfortunately, the pelvic floor muscles are not well understood outside of the groups of people who work with them daily. These muscles are “out of site and commonly out of mind” for many people, and because they surround the sex organs, and function during sex and childbirth, they were taboo to discuss for many years. In reality, these muscles are used every day with daily functions, but medical research indicates that after brief verbal or written instruction only 49% of women can correctly activate or contract these muscles.

A complete evaluation will help the therapist determine what treatments or exercises will work optimally to help resolve your symptoms. It will also give information that assists in teaching you which exercises to do or stop doing, and what changes to daily activities will help your symptoms resolve.

Pelvic Floor Muscles
The Pelvic Floor Muscles looking into pelvis from above

The pelvic floor muscles consist of several layers located within the bottom region of your pelvis between the two sitting bones and the pubic bone and the tailbone. Besides providing support to the bladder, uterus, vagina and bowels, they also support the spine, help manage pressure changes with coughing or heavy lifting, control the bladder/bowel muscles, and contribute to sexual appreciation.

View this  video for a detailed overview of the pelvic floor anatomy.

Why can’t you just do Kegel Exercises?

Pelvic floor muscle exercises are also known as Kegel exercises. In Pelvic Health treatment, sometimes Kegel exercises are not the most important recovery method.

Components of a Pelvic Floor Evaluation

An evaluation will assess your muscle function – the strength, control, and ability to contract and relax the muscles individually and together.  It will also examine the surrounding fascia, and the position of the organs. First, your medical history and pelvic floor function will be reviewed and discussed.  A thorough history involves reviewing your medical history and includes musculoskeletal and psychosocial considerations.  Your physical therapist wants to know your concerns about current limitations and restrictions of normal daily activities. You will be asked detailed questions about all pelvic floor functions. This allows the physical therapist to determine the appropriate tests and measures for the examination process. These might feel like personal questions, but they are important to identify problems that may be contributing to your symptoms.

A comprehensive physical therapy evaluation can also include analysis of posture, joint integrity and mobility, muscle performance and movement activities. The goal is to honor your goals and circumstances that brought you to the clinic, restore function and stop discomfort. All examinations are only performed with your consent and understanding for their purposes.

Examination Methods for the Pelvic Floor

Different types of examinations, external and internal, can assess your symptoms and functional status. This will determine a plan of care, for your specific findings. While no single examination will give a full picture of pelvic floor muscle strength or function, here are some examples of evaluation techniques.

External Techniques to Examine the Pelvic Floor

External Palpation: This means feeling for bony landmarks and muscles around the pelvic bones. This can be done through clothing.

External observation of the perineum (your external genitalia) and palpation of pelvic floor muscles: These techniques are done with direct observation and used to:

  • Examine the skin condition and mobility
  • Identify the location of your symptoms or a muscle tenderness
  • Identify your ability to work, rest and release your pelvic floor muscles.
  • Observe any changes in organ position (known as prolapse) that are visible without a speculum examination.


“Bio” means body and “feedback” means receiving information about the bodys physiological activity, like muscle contractions, breathing and heart rate.  You and your therapist can see and evaluate resting muscle activity as well as your muscle endurance and response to commands and meaningful activities. There are two types of biofeedback:

Surface Muscle Biofeedback: Surface muscle biofeedback uses sensitive computerized equipment that enables you to see or hear how your muscles are responding .During the evaluation, sensors are used to monitor the muscle activity of your pelvic floor. Sensors can be place externally around the anal opening, or a tampon-sized sensor is used internally, in the vagina or rectum. You’ll work with your PT to determine the right type of sensor for you.

Rehabilitative Ultrasound Imaging (RUSI) has been used in research and in the clinic. It can be used as both an assessment tool, and more importantly as a form of biofeedback. During ultrasound exam, a hand-held transducer is placed against the skin on the abdomen or the external pelvic floor region.  The transducer displays an image on a monitor. This is another way to identify what your pelvic floor muscles are doing during specific instructions.

 Internal Techniques to Examine the Pelvic Floor

Internal vaginal or rectal examination is different than a pelvic or prostate exam done by physician. It is performed to look at the muscles and connective tissue in the pelvic floor. The exam is done with a gloved finger placed in the vaginal or rectal canal. The exam will:

  • Identify muscle symmetry, strength, length, tone, and contraction / relaxation ability
  • Identify the main muscle(s) or fascial structure(s) that may be causing your symptoms, discomfort or tenderness
  • Identify coccyx (tailbone) and organ (bladder, uterus, rectum) positions.

If more detailed observation is needed, a half speculum can be used to improve the observation of pelvic myofascial tissue or organ positions in the vagina (with your consent).

Treatment plan

After the examination(s) your therapist will discuss the findings with you and recommend a treatment plan for your specific needs. A plan based on the evaluation will include your goals for improving your condition. By receiving a comprehensive examination and physical therapy treatment techniques you can learn to eliminate, improve or manage your symptoms.


Pelvic floor examination has many components. Each exam gives us specific information about the status of your muscles. It will helps your provider develop the best treatment plan for your condition.


Bump R, Hurt G, et al. (1991). “Assessment of Kegel pelvic muscle exercise performance after brief verbal instruction.” Am J Obstet Gynecol 165: 322-329.

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