A Pelvic Floor Physical Therapist (PFPT) can perform an internal assessment of your pelvic floor to help you get a better picture of your strength and relaxation needs. However, it is also important for you to understand your own pelvic floor. You can do this via internal or external assessments on your own.
Note: All assessments might be easier to initially do while lying on your back with knees bent and feet on the floor. Eventually, you may want to reassess while standing, squatting, hinging, etc if possible.
Checking your pelvic floor externally
You can choose to do this fully clothed or not.
- Grab a mirror and take a look. What do you see?
- Take a big diaphragmatic inhale then exhale. What do you see? Do you notice any contraction happening? What about bearing down or pushing out?
- Do a kegel. What do you see? What do you feel externally? Do you notice any bearing down or pushing out (even slightly)? Do you notice the muscles contracting? If yes, which muscles? Just those near the labia or is it the thighs, glutes, and abs too? Do you notice your clitoris or clitoral hood nod with the kegel? Are you able to fully relax after the contraction without bearing down?
How to do your own internal (vaginal) pelvic floor exam
- Start with a clean finger.
- Take a big diaphragmatic inhale then exhale. What do you feel internally? Do you notice any contraction happening? What about bearing down or pushing out?
- Do a kegel. What do you feel internally? Do you notice any bearing down or pushing out (even slightly)? Do you notice the muscles contracting and lifting up into the body? If yes, which muscles? Is it an even contraction all the way around your finger or do you feel the contraction is isolated to one side vs the other or front vs back?
What you’re looking for with a pelvic floor exam
Ideally, you want a slight contraction and a lift with a kegel. You don’t want to see bearing or pushing down in the pelvic floor. You also don’t want to see a contraction so hard that it brings in all nearby muscles with the exception of the clitoral hood and near the vulva (ex: you don’t want to be squeezing your abs and glutes). If you see that hard contraction, try doing less next time with your kegel and see what happens.
Internally, you want to feel an even contraction that gently squeezes all around the finger and lifts inward into the body. Again, this doesn’t have to be an all out contraction (level 10/10). You’re looking for something gentle. After the contraction, you want to feel the muscles letting go and fully relaxing.
Same thing goes for when not doing a kegel. With exhale, you want to feel a slight lift in the vagina. When practicing a brace or breath hold, you don’t want to feel the bearing or pushing down into the pelvic floor. When you squat or deadlift, you also don’t want to feel the bearing or pushing down into the pelvic floor.
If you find yourself bearing down with movement, try adding in a diaphragmatic breath and exhale through the movement. See if that helps.
Bearing down with a kegel or not getting a uniform lift with your kegel? It might be a good time to book a consultation with a PFPT.
Learn everything you wanted to know about your abs, vag, and a barbell in Core and Pelvic Floor Basics for Lifters.
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