How Ultrasound Can Help You Make Sense of Your Pelvic Health

You've probably been told at some point to "do your pelvic floor exercises."

Maybe it was after having a baby. Maybe your GP mentioned them when you talked about leaking. Perhaps you've downloaded an app, watched a few videos online or tried to follow advice you've found on social media.

And perhaps you've found yourself thinking:

"I think I'm doing them... but how do I actually know?"

It's a question I hear a lot in clinic.

Many women spend months, sometimes years, trying to strengthen their pelvic floor without ever really knowing whether they're doing what they think they are doing and if they are using the right muscles and starting the contraction from where they are supposed to be or whether they're relaxing properly afterwards, or whether their symptoms are even related to their pelvic floor in the first place.

The thing is, your pelvic floor is hidden away. Unlike your arm or your leg, you can't watch it move. You can't easily tell whether it's working well, whether it's working too hard, or whether it's coordinating with the other muscles around it that help it work efficiently.

That uncertainty can be so frustrating and might cause a lot of distrust in yourself, your body and ultimately might lead you to giving up on the task.

This is one of the reasons I've started using point of contact ultrasound in my clinic.

It doesn't replace good physiotherapy, but it can enhance it and it can be the light bulb moment for so many women on their pelvic health rehab journey.

What is point of contact ultrasound in pelvic health?

Point of contact pelvic health ultrasound allows us to see how your pelvic floor is moving in real time.

Rather than asking you to imagine what's happening inside your body, we can actually watch it together on the screen.

Depending on your symptoms and what we're assessing, the ultrasound probe may be placed over your lower abdomen or, alongside the vulva known as transperineal ultrasound.

It's completely external, comfortable and painless. There is no radiation and no internal examination required simply to use the ultrasound. It gives you another option in terms of understanding how your body is working.

Why can it be so helpful?

One of the biggest myths about pelvic health issues is that if you have symptoms, your pelvic floor is not working hard enough and the muscles need to be stronger. Making pelvic floor muscles stronger in itself is not that simple for everyone but moreover, the cause if a pelvic health issue is rarely down to one thing. Sometimes the pelvic floor is working too hard already and doesn't know when or how to switch off. Sometimes the pelvic floor works well but it doesn't act quickly enough or sometimes it is not coordinated well with the surrounding assisting muscles. Sometimes they are overstretched, or tethered due to scarring or not getting the right impulses due to nerve damage. And sometimes the pelvic floor is struggling because bowel health is not optimised.

Before we decide what your body needs, we first need to understand what it's already doing and ultrasound can help make this clearer.

Ultrasound helps make the invisible visible.

A great moment in clinic is when someone sees their pelvic floor moving on the screen for the first time. Sometimes it's confirmation that what they have been doing is correct and sometimes watching as I coach you through a different movement cue is all that was needed. Sometimes you see part of the pelvic floor working well and another part not so well and it becomes clear what needs to be improved. They're no longer wondering whether they're doing it right. Instead of someone explaining what they think is happening, they can actually watch it themselves.

That understanding often brings enormous reassurance because once you understand your body, it's much easier to know how to help it.

What can ultrasound show?

Real-time ultrasound allows us to observe and receive visual feedback how your pelvic floor responds during everyday movements and tasks.

We might look at what happens when you:

• breath

• contract your pelvic floor

• relax

• cough

• Laugh

• Brace

• or perform simple functional movements in different positions like standing and squatting.

  
  

For many women, it's the first time they've realised their pelvic floor is either working much harder than they thought or not quite in the way they expected. It gives more information. It can answer questions you've perhaps been wondering for years.

Does ultrasound replace an internal examination?

Ultrasound doesn't replace an internal examination, rather it confirms or improves what has been assessed and found in an internal examination. It is, however, a good alternative if someone is uncomfortable with an internal examination or cannot tolerate one.

As always, my assessments start with listening. I get the majority of the information I need from listening. Assessment is confirming what I think is going on and ultrasound is a brilliant tool to help you visualise what your body is doing.

What next?

If you've been living with pelvic health symptoms and would like a clearer understanding of what's happening, I want to help.

Together we'll build a full picture using conversation, movement assessment, breathing, strength, and where appropriate, real-time ultrasound and internal assessment.

Because the more you understand your body, the more confidently you can move forwards.