Internal Pelvic Floor Manual Therapy

What internal manual therapy involves

Internal pelvic floor physiotherapy involves assessment and treatment using gloved, lubricated finger inserted vaginally, or gloved finger inserted rectally (depending on anatomy and clinical indication). This allows direct evaluation and treatment of the pelvic floor muscles, fascia, and surrounding structures that cannot be reached from the outside.

It is not required for every patient. Many presentations can be fully assessed and treated without internal examination. When it is indicated, it offers information and treatment access that is simply not available any other way.

What we assess internally

• Resting muscle tone, whether the pelvic floor is too tense, or too weak.
• Voluntary contraction strength and endurance using the a standardised scale from 0 to 5
• Coordination and ability to relax on command
• Presence of trigger points or areas of heightened sensitivity
• Scar tissue from episiotomy, perineal tears, or pelvic surgery
• Prolapse support and organ position in relation to the vaginal walls

Manual therapy techniques

• Myofascial release, sustained, gentle pressure applied to restricted areas to decrease tension and improve tissue mobility.
• Trigger point release, direct pressure applied to active trigger points within the pelvic floor to reduce referred pain and restore normal muscle function.
• Neuromuscular re-education, combining manual guidance with verbal cueing to help the patient learn correct contraction, coordination, and relaxation patterns.
• Scar mobilization, gentle techniques to restore mobility of perineal, vaginal, or pelvic scars and reduce discomfort or adhesion.
• Joint mobilization, where indicated, gentle mobilization of the tailbone or the joints where your spine meets your pelvis that are contributing to pelvic floor dysfunction.