Do I Need an Internal Exam for Pelvic PT?

Pelvic physical therapy (PT) is a specialized form of physical therapy that addresses issues related to the pelvic floor and surrounding structures. Many people wonder whether they will need an internal exam when undergoing pelvic PT. 

This article will discuss the importance of internal exams in pelvic PT, when they may be necessary, and what to expect during the process.

What is Pelvic Physical Therapy?

Pelvic physical therapy (PT) is a specialized branch of physical therapy that focuses on assessing, treating, and preventing conditions related to the pelvic floor and its surrounding structures. The pelvic floor is a complex network of muscles, ligaments, and connective tissues that support the pelvic organs, such as the bladder, bowel, and uterus. These muscles also play a crucial role in controlling bowel, bladder, and sexual functions.

Pelvic PT aims to address a wide range of conditions and symptoms, including:

  • Pelvic pain or pressure
  • Urinary or fecal incontinence
  • Constipation or difficulty with bowel movements
  • Painful intercourse or sexual dysfunction
  • Pelvic organ prolapse

Pre- and post-natal care, such as addressing pregnancy-related pain or postpartum recovery

Pelvic PT involves various treatment techniques and approaches, depending on the patient’s specific needs and symptoms. Some common methods include:

Manual Therapy

This involves the therapist using their hands to perform soft tissue mobilization, trigger point release,  joint mobilization, visceral mobilization, and stretching of pelvic floor muscles and surrounding supporting muscles/joints.

Therapeutic Exercises

Pelvic PTs may prescribe specific exercises to strengthen, stretch, or improve the coordination of the pelvic floor muscles. These exercises may include pelvic floor muscle strengthening/stretching, postural changes, relaxation techniques and functional exercises to help transition to family lifestyle. 


This technique uses sensors placed on the skin near the pelvic floor muscles to provide real-time information about muscle activity. Patients and therapists can use this feedback to improve muscle control and coordination.

Patient Education

Pelvic PTs play a crucial role in educating patients about their conditions, providing guidance on lifestyle modifications, and teaching self-care techniques to manage symptoms effectively.


Pelvic physical therapists may use various modalities, such as electrical stimulation, heat, or cold therapy, to help alleviate pain, reduce inflammation, and promote healing.

Pelvic physical therapy is a valuable treatment option for both men and women experiencing pelvic floor dysfunction or related issues. By working closely with a specialized pelvic PT, patients can develop a targeted treatment plan to address their unique needs, improve symptoms, and enhance their overall quality of life.

Why are Internal Exams Important in Pelvic PT?

An internal exam is a valuable tool for pelvic PTs, as it allows them to assess the function and integrity of the pelvic floor muscles directly. The pelvic floor is a complex network of muscles, ligaments, and connective tissues that support the pelvic organs and help control bowel, bladder, and sexual functions.

During an internal exam, a pelvic PT can assess the strength, tone, and coordination of the pelvic floor muscles, identify areas of pain or tenderness, and evaluate the presence of trigger points or scar tissue. This information can help the therapist develop a targeted treatment plan to address the specific issues contributing to a patient’s symptoms.

When is an Internal Exam Necessary?

An internal exam may be necessary if you are experiencing symptoms that suggest pelvic floor dysfunction or if your therapist believes it would provide valuable information to guide your treatment. Some common signs and symptoms that may warrant an internal exam include:

  • Urinary or fecal incontinence
  • Difficulty with bowel movements or urinary retention
  • Pelvic pain or pressure
  • Painful intercourse
  • A feeling of heaviness or dragging in the pelvic region

Keep in mind that an internal exam is not always necessary for every patient undergoing pelvic PT. Your therapist will consider your specific needs, symptoms, and comfort level when determining whether an internal exam is appropriate.

What to Expect During an Internal Exam

If your therapist recommends an internal exam, they will first explain the procedure and ensure you understand the purpose and benefits of the exam. They will also discuss any concerns or questions you may have.

The internal exam typically involves the therapist inserting a gloved, lubricated finger into the vagina or rectum to assess the pelvic floor muscles. The therapist will gently palpate the muscles, evaluating their strength, tone, and coordination. They may also ask you to perform specific movements or contractions to assess muscle function further.

Throughout the exam, your therapist will prioritize your comfort and communicate with you to ensure the process is as smooth as possible. If you experience any discomfort or pain during the exam, it is essential to communicate this to your therapist, who can adjust the examination accordingly.

Alternatives to Internal Exams

If you are uncomfortable with the idea of an internal exam, or if your therapist determines that it is unnecessary for your specific situation, alternative assessment methods are available. Some options include:

  • External palpation: The therapist can assess the pelvic floor muscles by applying pressure to the perineum or surrounding areas, also assessing the obturator internus and piriformis externally. An assessment of the sacrum and coccyx external could also have valuable information. 
  • Biofeedback: This technique involves placing sensors on the skin near the pelvic floor muscles to monitor muscle activity and provide real-time feedback to the patient and therapist.
  • Ultrasound imaging: Transabdominal or transperineal ultrasound can be used to visualize the pelvic floor muscles and assess their function.

Your therapist will discuss these alternative assessment methods with you and determine which option is most suitable for your needs and comfort level.

Preparing for Your Pelvic PT Appointment

To help ensure a successful and comfortable experience during your pelvic PT appointment, consider the following tips:

  • Wear comfortable, loose-fitting clothing that allows easy access to the pelvic area.
  • Arrive well-hydrated and avoid consuming large amounts of fluids or food immediately before your appointment, as a full bladder or bowel can cause discomfort during the exam.
  • Bring a list of any medications or supplements you are taking, as well as any relevant medical records or test results.
  • Be prepared to discuss your medical history, symptoms, and goals for therapy with your therapist.

If you are nervous or have concerns about the internal exam, discuss these with your therapist before the appointment. They can provide information and reassurance to help alleviate your concerns.

Key Takeaways

An internal exam can be an essential component of pelvic PT, providing valuable information about the function and integrity of the pelvic floor muscles. While not every patient will require an internal exam, it can be a crucial tool for therapists when addressing pelvic floor dysfunction and related symptoms.

If you are considering pelvic PT, it is essential to discuss your concerns and preferences with your therapist, who can develop a treatment plan tailored to your unique needs and comfort level. By understanding the purpose and benefits of internal exams and knowing what to expect during the process, you can feel more confident and at ease as you work towards improved pelvic health.

For more information, reach out to me today!