Internal pelvic floor therapy is a specific assessment and treatment of internal pelvic floor musculature during pelvic floor rehabilitation. The purpose of an internal assessment is to determine whether muscles of the pelvic floor may be tight or irritated, causing trigger points and contributing to pain felt internally and externally. Sometimes pain from these muscles can refer to other areas of the low back, legs, abdomen or pelvis, and release of these trigger points can help eliminate the referred pain. Release of pelvic floor muscles that are stuck in a partially spasmed or tight state can also facilitate improved core activation and function as well.
Who may benefit from internal pelvic floor therapy?
- Painful sexual intercourse/sexual activity
- Pain or symptoms like that of UTI but testing comes back negative
- Urinary or fecal incontinence such as urinary leakage with coughing/exercise/squatting, urinary retention (not fully emptying bladder), urgency, or frequency (going often)
- Persistent sacroiliac joint alignment issues not resolving with external mobilization
What to expect from an internal pelvic assessment/first session:
Once patients have given verbal and written informed consent for internal pelvic therapy, an internal assessment will be performed by your physical therapist to determine which muscles of the pelvic floor may be tight or painful. This is performed a private room, though the patient may have a second therapist or their own support person of choice present it they wish. This is performed while the patient lays back on the therapy table while draped with a sheet, usually on their back with knees bent for females or on their side for males. One gloved finger will be inserted with use of a non-scented lubricant, with assessment of musculature moving in a clockwise fashion, first superficially (about one knuckle depth) before moving to gradually deeper layers of muscle. From there, if tolerated by the patient, internal myofascial release may be performed, or the assessment may stop there dependent on patient tolerance. Treatment internally involves the same arrangement as the assessment, with slight pressure and/or stretch applied with the fingertip to any trigger points or knots found to help them release. Patients may feel aching internally or referral of pain to other areas, such as mentioned above, while the release is performed, but the sensations should gradually melt away as the muscles release. Patients may or may not experience some soreness or cramping particularly with the first couple sessions of internal MFR, not unlike period pain, which is considered normal. Patients may desire to use a heating pad or ice to help with soreness initially. Over the course of several sessions, the intensity of trigger points should dissipate as muscles become more relaxed and length of relief between sessions should increase.
See our next blog post to learn how internal or external biofeedback can be used concurrently with internal pelvic floor treatment to improve pelvic floor activation and muscle tone.