Watch out for this common error when you’re having your pelvic floor assessed – it could have a dramatic impact on your recovery

06 Nov Watch out for this common error when you’re having your pelvic floor assessed – it could have a dramatic impact on your recovery


I have had a run of people lately who have had their pelvic floor muscles assessed by ultrasound by a physiotherapist, with the physio placing a probe on their tummy. We have an ultrasound in our practice and there are times when I use it, but to assess pelvic floor function it has certain limitations. The patients I have seen really required an internal examination for a full picture of their condition, but instead were told their pelvic floor muscles were weak and to go and do pelvic floor exercises. In several of the cases, this information was incorrect.


Yes, I am shouting this. Mainly for any physiotherapist’s out there who are doing these scans, you are doing our profession disservice when you do not give someone a complete assessment. Yes, I mean doing internal exams.

This might come as a surprise to you, but there is such a thing as overactive pelvic floor muscles. We always hear about weak pelvic floor muscles, but they can also be too tight. And if the muscles are tight, they may not move with a contraction. This means you won’t see anything on a scan. It also means that pelvic floor strengthening is the OPPOSITE of what you should be doing.

Also, if someone has not yet given birth, you may not have a large range of movement in the muscles, so you may also see very little or nothing on a scan. However, someone who has had several children, may see a large movement of the muscles. This does not mean that their muscles are stronger, just that they might be sitting lower in the pelvis before contraction, and are then moving through a greater range.

This might give you some ideas of how easy it is to get the wrong information if you are relying just on a scan for an assessment of your pelvic floor muscles. In my opinion, it can only be used to ensure patients are not pushing down instead of pulling up, and it can give feedback to give something you to look at while you are exercising.

But please don’t be disheartened if you don’t see anything on a scan, this does not necessarily mean anything. If this occurs during your assessment, your physiotherapist should offer you an internal examination to further assess your muscles, and if they don’t know how, they should be referring you on to a physiotherapist who is trained in doing so.

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