Unlocking the Power of Real-Time Ultrasound for Pelvic Floor Health - UPLIFT

By Anmei Vuong

At Uplift, we’re passionate about supporting women through various stages of pelvic floor health, whether it’s dealing with bladder and bowel issues like incontinence, overactive bladder, or prolapse. Whether you’re pregnant, postnatal, or simply navigating life’s changes, understanding your pelvic floor is crucial. One of the innovative tools we use to assess this vital area is Real-Time Ultrasound (RTUS). If you’re new to this, let’s break it down and uncover what makes RTUS a fantastic resource to support your pelvic health journey.

What is Real-Time Ultrasound (RTUS) ?

Abdominal Real-Time Ultrasound (RTUS) is a gentle, non-invasive tool we use to get a closer look at how your pelvic floor muscles are working. It’s similar to other types of ultrasounds you may have had, like checking a baby’s development during pregnancy or assessing muscles in your arm. In this case, we place a small probe on your lower abdomen (just above the pubic bone) to observe how your bladder moves when you contract and relax your pelvic floor muscles. This allows us to assess how well these muscles are functioning and can help guide your treatment.

What to Expect During Your RTUS Appointment

Your RTUS session is straightforward and comfortable. Here’s what you can expect:

Pre-Appointment Prep: For the best results, drink 2-3 glasses of water 1-2 hours before your appointment and avoid emptying your bladder for two hours beforehand.
During the Appointment: You’ll lie down on the exam bed, fully clothed. We’ll gently place the ultrasound probe on your skin just above your pubic bone, applying a bit of gel to help get a clear view of your bladder—similar to when you have an ultrasound for an injury or during pregnancy.

What Can You See with RTUS?

RTUS provides real-time visuals of how your pelvic floor affects your bladder. For example, as you contract and lift your pelvic floor, we should see the bladder rise slightly on the screen. When you relax your pelvic floor, the bladder should lower back to its resting position. RTUS is especially helpful if you find it challenging to feel these contractions yourself, struggle to recognize when you start to fatigue, or have difficulty relaxing the pelvic floor during the day.

What Does RTUS Assess?

RTUS gives us a dynamic view of your pelvic floor function, similar to how imaging techniques are used in musculoskeletal physiotherapy to assess other areas of the body. Here’s what RTUS helps us understand about your pelvic health:

Pelvic Floor Contractions and Relaxation: RTUS allows us to assess if you can contract and relax your pelvic floor muscles, which is crucial for effective pelvic floor function. We can visualize the coordination of these movements, similar to observing muscle activity in other areas of the body, like the shoulder or leg.
Endurance and Strength: Similar to assessing the endurance of a muscle group like the quadriceps during a knee exam, RTUS helps us determine how long you can maintain a pelvic floor contraction before experiencing fatigue. This assessment is key to understanding your pelvic floor’s strength and endurance.
Pelvic Floor Relaxation: RTUS provides a view of how effectively your pelvic floor muscles relax, which is important for avoiding excessive tension and ensuring optimal function. A pelvic floor that can contract and relax well is crucial for maintaining proper function.
Bladder Volume: Just as imaging might be used to assess the volume of fluid in the knee after an injury, RTUS can measure how much fluid is in your bladder. This provides valuable insights into your bladder’s capacity and how effectively it empties, which we can assess by scanning your bladder before and after you go to the bathroom. It is particularly helpful for understanding conditions like an overactive bladder (frequent urination) or the sensation of incomplete emptying.

When RTUS and Internal Exams Complement Each Other

While RTUS is a powerful tool, it doesn’t provide the full picture that an internal vaginal examination can. An internal exam involves inserting a gloved finger into the vagina to assess the muscles directly. Here are some examples of what an internal exam can reveal that RTUS may not:

Muscle Contraction Strength: Think of this like feeling the strength of a muscle, such as the biceps, by palpating how firmly it contracts. While RTUS can indicate that the muscle is contracting (by showing the bladder lifting), only an internal exam can assess how strong and coordinated the contraction actually is.
Relaxation Quality: Similar to checking for muscle tension in the neck or back, we want to assess the pelvic floor’s ability to relax fully after a contraction. While RTUS shows that the pelvic floor can relax (by seeing the bladder lower), only an internal exam can confirm if the muscles have completely relaxed or if there is any persistent tension.
Prolapse Presence: Unfortunately, abdominal RTUS cannot assess what happens to the vaginal walls under load. During an internal examination, our women’s health physiotherapists assess (through observation and palpation) how the front and back walls of the vagina and the uterus respond under pressure. This helps identify excessive movement, which could indicate a prolapse of one or more pelvic organs.
Muscle Tone and Bulk: Just as we assess muscle bulk and tone in areas like the calf or biceps, an internal exam allows us to evaluate the health and resilience of the pelvic floor muscles. This is particularly important during the postnatal and menopausal stages of life, as low muscle tone or irritated tissue can contribute to pelvic floor discomfort and dysfunction.

RTUS: A Comforting Option for Sensitive Assessments

While an internal exam provides a more comprehensive assessment, it may not be suitable for everyone. Some people may feel uncomfortable or even distressed by the idea of an internal examination, especially those with a history of trauma or pain. RTUS offers a non-invasive alternative that can be less daunting while still providing valuable insights into your pelvic floor health. It’s a fantastic choice if you’re seeking an alternative approach to your assessment.

We hope this helps demystify abdominal RTUS and shows how it can be a valuable part of your pelvic health journey. If you have more questions or would like to learn more, don’t hesitate to reach out—we’re here to support you every step of the way!

To find out whether a real time ultrasound assessment can help you, call us on (03) 8828 4761 to chat with one of our friendly team, or alternatively you can Book a Physiotherapy appointment HERE.