Pelvic Health FAQ

Pelvic rehabilitation is a non-surgical approach used to improve pelvic (floor) dysfunction.
Pelvic floor dysfunction may lead to urinary, reproductive, gastrointestinal, sexual health issues, as well as pain.

Interventions in pelvic rehabilitation may include:
behavioral strategies, manual therapy, biofeedback, therapeutic modalities, exercise training, education, and functional retraining.

During the initial assessment, I will explain whether evaluating your pelvic floor function is necessary.
Assessment may include pelvic floor muscle strength, mobility, coordination, and whether there is overactivity or signs of irritation.

An internal exam is one method of assessment and can provide valuable information about pelvic floor muscle condition.
However — you are never required to undergo an internal exam.
If you prefer not to, we can focus on external assessment, movement testing, and discussing symptoms to understand your condition and develop a treatment plan.

Internal examinations are recommended only when appropriate and with your full consent. Many individuals choose to proceed after some time, once they feel informed and comfortable.

No, they are different.

A pelvic rehabilitation internal exam does not use a speculum.
Its purpose is to evaluate pelvic floor muscle function.

An OB-GYN internal exam focuses on medical diagnosis, such as checking structural abnormalities, infections, or other medical issues.

A pelvic rehabilitation internal exam evaluates how your pelvic floor muscles work — including contraction, relaxation, coordination, and muscle tension.
This information helps determine the most appropriate rehabilitation approach.

During rehabilitation, when pain or symptoms improve and pelvic floor muscle function becomes clearer, some individuals may feel ready to proceed with an internal exam.
Others may rely on external assessment and functional evaluation. Both are acceptable.

If a medical condition is suspected (e.g., infection, bleeding, structural concern), we will recommend seeing an OB-GYN instead, as pelvic rehabilitation cannot replace medical diagnosis.

Not necessarily.

Most women receive a vaginal internal exam, but if symptoms are primarily related to the rectum or anal area — such as rectal/anal muscle discoordination — the assessment may be performed rectally instead.

For men, pelvic floor evaluation is done rectally, as this is the appropriate way to assess pelvic floor muscle function.

A large part of the first visit is education.
If an internal pelvic floor exam is appropriate and you feel comfortable, we may perform it to assess pelvic floor muscle function.

Many people have never seen or sensed their pelvic floor muscles before, and learning to understand and feel your pelvic floor is often the first and most important step of rehabilitation.

After discussing your medical history and understanding your goals and expectations, we will decide together whether an internal exam is necessary.
If your condition is clear and the initial findings do not require an internal exam, we may begin with external assessment and functional evaluation instead.

As patients gain a better understanding of their body and pelvic floor, treatment often progresses more smoothly.
Knowledge is empowering.

Internal pelvic floor examination is generally not recommended under the following conditions:

• Pregnancy

• Within 6 weeks postpartum

• Within 6 to 12 weeks after abdominal or pelvic surgery

• Active urinary tract infection (UTI)

• Pelvic or vaginal infection

• Any acute condition where internal examination may worsen symptoms or delay healing

During pelvic rehabilitation, one of our goals is to help patients gradually sense the presence and movement of their pelvic floor muscles, and learn how to control them. This process is called pelvic floor awareness.

Many people have never consciously paid attention to their pelvic floor—just like we rarely think about how we walk or breathe, even though these muscles work constantly in daily life. The pelvic floor is located deep within the body, making it harder to visualize or feel without guidance.

Through proper education or rehabilitation training, individuals can learn to better sense, coordinate, and intentionally activate or relax their pelvic floor muscles. Improved awareness not only enhances exercise performance and posture, but also plays a critical role in preventing and treating pelvic floor dysfunction.

Developing pelvic floor awareness is an essential first step in pelvic rehabilitation.

Pelvic rehabilitation is helpful for anyone experiencing symptoms related to pelvic floor dysfunction or pelvic-related conditions.

For people who want to stay active without pain or limitations, pelvic rehabilitation can be especially important.
For example, individuals with hip muscle weakness may find activities like walking or climbing stairs more difficult. Strengthening the pelvic and hip muscles can improve daily function and reduce discomfort.

Other examples include people with:

• Lower back, hip, or pelvic pain

• Discomfort related to posture or prolonged sitting

• Pelvic symptoms that worsen during exercise or certain movements

• Pain or tightness after long periods of stress

• Symptoms that influence daily quality of life

Some individuals prefer conservative treatment first, while others seek rehabilitation before or after surgery to optimize recovery.

Whenever symptoms arise, it is helpful to undergo an evaluation to understand the cause and determine whether pelvic rehabilitation is appropriate.

Kegel exercises, introduced in 1948 by American gynecologist Dr. Arnold H. Kegel, are designed to strengthen the pelvic floor muscles. When performed correctly, Kegel exercises can help improve pelvic floor function and are often used to prevent or treat urinary incontinence after childbirth.
Over the years, they have become widely known and promoted in both women and men. However, Kegel exercises are not suitable for everyone, and doing them incorrectly may worsen certain symptoms.

Here are situations where Kegel exercises may be harmful or ineffective:

1. Over-tightened pelvic floor muscles
   If your pelvic floor is already tense or overactive, performing Kegels may increase this tightness and worsen symptoms such as pelvic pain, painful sex, constipation, or difficulty emptying the bladder.

2. Incorrect muscle activation
   Many people mistakenly contract their abdominal muscles, buttocks, or inner thighs instead of the pelvic floor. Without proper activation, Kegels become ineffective.

3. Not appropriate for your condition
   In some people—especially those with pelvic pain, prolapse symptoms, or difficulty relaxing—the repeated squeezing of Kegels may increase downward pressure or worsen discomfort.

4. Lack of guidance or overtraining
   Performing excessive or poorly guided Kegels can fatigue the pelvic floor or create imbalances, leading to worsening symptoms over time.

To know whether Kegel exercises are right for you, it's best to receive an assessment and proper instruction from a pelvic health professional.