For many women, the words pelvic floor assessment can feel a little confronting.
Maybe you’ve been told to “just do your pelvic floor exercises” during pregnancy or after birth. Maybe you’re leaking when you sneeze, feeling heaviness, dealing with pain, or wondering if you’re actually doing your exercises correctly. Or perhaps you’ve been recommended to see a pelvic health physiotherapist but aren’t quite sure what that actually means.
At FitRight Women’s Health, these are conversations we have every single day and one of the biggest things we want women to know is this:
Pelvic health physiotherapy should never feel scary, rushed or forced. It should feel safe, respectful and collaborative.
So let’s break down exactly what a pelvic health physiotherapist does, why pelvic floor assessments can be helpful, and what your options are if you don’t feel comfortable with an internal examination.
First Things First - What Is a Pelvic Health Physiotherapist?
A pelvic health physiotherapist is a physiotherapist who has completed additional postgraduate training in assessing and treating conditions related to the pelvic floor muscles, fascia and pelvic organs.
After completing their physiotherapy degree, pelvic health physiotherapists undertake further professional development in areas such as:
- Pelvic floor muscle assessment and rehabilitation
- Pregnancy and postnatal care
- Pelvic pain
- Bladder and bowel dysfunction
- Prolapse management
Many complete advanced clinical training or postgraduate qualifications through organisations such as the Australian Physiotherapy Association in Women’s, Men’s and Pelvic Health.
At FitRight Women’s Health, our pelvic health physiotherapists are specifically trained to assess the pelvic floor muscles safely, respectfully and with your full informed consent at every step.
Why Would a Pelvic Health Physiotherapist Assess Your Pelvic Floor?
Pelvic floor exercises are commonly recommended during pregnancy, after birth, and for symptoms like:
- Bladder leakage
- Vaginal heaviness or prolapse symptoms
- Pelvic pain
- Reduced core strength
- Return to exercise concerns
But here’s something many women don’t realise:
A lot of women are unknowingly doing their pelvic floor exercises incorrectly.
Some common mistakes include:
- Tightening the abdominal, glute or thigh muscles instead of the pelvic floor
- Bearing down instead of lifting the muscles
- Holding the breath
- Not fully relaxing between contractions
- Struggling to coordinate the pelvic floor during coughing, lifting or exercise
And sometimes, the issue isn’t weakness at all.
Some women actually have an overactive pelvic floor that needs relaxation and coordination training - not strengthening.
This is why assessment matters.
A pelvic floor assessment helps us understand:
- Are you contracting the correct muscles?
- Are the muscles weak, overactive, painful or uncoordinated?
- Can you fully relax them?
- How are they functioning during coughing, lifting or bearing down?
Without this information, pelvic floor exercises can become a bit of a guessing game.
So… How Is the Pelvic Floor Assessed?
There are two main ways a pelvic health physiotherapist can assess your pelvic floor muscles.
1. Digital Vaginal Examination
This is an internal examination using one or two gloved, lubricated fingers to directly assess the pelvic floor muscles.
This allows your physiotherapist to assess things like:
- Strength
- Endurance
- Coordination
- Muscle tone and tension
- Pain
- Bearing down mechanics
- Vaginal prolapse type and stage
A digital vaginal examination is considered the gold standard assessment because it provides the most detailed clinical information.
But importantly, it is always your choice.
2. Transabdominal Real-Time Ultrasound
This option is completely non-invasive.
An ultrasound probe is placed on the lower abdomen to visualise how the bladder base moves while you contract and relax your pelvic floor muscles.
Many women find this option feels less intimidating, particularly if they are pregnant, early postnatal, experiencing pain, or simply not comfortable with an internal examination.
It can also be an excellent learning tool because you can actually see your pelvic floor movement on the screen in real time.
What Are the Pros and Cons of Each Option?
Digital Vaginal Examination
Benefits:
- Gold standard assessment
- Directly measures strength and endurance
- Assesses muscle tone and overactivity
- Identifies pain
- Assesses prolapse
- Evaluates bearing down mechanics
- Provides tactile feedback to improve technique
Things to consider:
- It is an internal examination
- Some women may prefer a non-invasive option
- It may not be appropriate in certain situations, such as active infection, immediately after birth or surgery, or if you simply decline
Transabdominal Real-Time Ultrasound
Benefits:
- Non-invasive
- Often more comfortable
- Provides visual feedback on the screen
- Helpful for learning coordination
Limitations:
- Cannot directly measure strength
- Cannot assess muscle tension or overactivity
- Cannot assess pain
- Cannot fully assess prolapse
- Provides limited information about bearing down mechanics
Ultrasound is an incredibly valuable teaching tool — but it doesn’t always provide the full clinical picture, especially in more complex cases.
What If You Don’t Want a Pelvic Floor Assessment?
This is something we really want women to hear clearly:
You are always in control of your care.
Choosing not to have an internal examination does not mean you can’t still receive support.
Without an assessment, we can still:
- Provide education
- Prescribe general pelvic floor exercises
- Use external cueing strategies
- Support exercise modifications and return-to-movement guidance
- Discuss bladder and bowel habits
However, it’s important to understand that we’re working with less information.
That means:
- Exercises may be less targeted
- Overactive or painful pelvic floors may go undetected
- Prolapse or coordination issues may not be identified
- Recommendations may be less individualised
For some women, that may be completely appropriate.
For others, particularly those experiencing symptoms like leakage, vaginal bulging, pain, or birth-related concerns, a full assessment can provide clearer answers and more effective treatment direction.
Our Approach at FitRight Women’s Health
At FitRight Women’s Health, we believe pelvic floor assessment should feel:
- Safe
- Informed
- Respectful
- Collaborative
We’ll always explain your options, answer your questions, and only proceed with your consent.
Because pelvic health care should never feel like something being done to you, it should feel like something you’re actively involved in and empowered by.
If you’re unsure which assessment option is right for you, our team is always happy to talk things through before your appointment.
