Pelvic Floor Muscle Exam for MEN Without a Finger Up the Butt

[00:00:00]Rehabilitative pelvic floor muscle ultrasound uses an ultrasound probe to scan pelvic floor structures abdominally and transperineally, meaning underneath the scrotum. This allows us to observe pelvic floor structures, pelvic floor muscle function, bladder fullness in relation to perceived urgency, and bladder and urethral support. Pelvic floor ultrasound can be helpful for people who want to defer an internal or external pelvic floor assessment, but still want to get a sense of what their pelvic floor muscles are doing and how to properly train them.

[00:00:31]Hi, I'm Dr. Susie Gronski, pelvic health physical therapist and sexuality counselor. In this video, I'll walk you through what a pelvic floor ultrasound is, how we use it in therapy, and what it looks like on a live model. And a quick heads-up, the full live model demo is exclusive to Patreon. So, there are two main types of pelvic floor ultrasound used in practice, transabdominal and transperineal.

[00:00:54]Transabdominal pelvic floor ultrasound is a 2D imaging technique used to scan pelvic floor structures with a convex transducer placed just above the pubic bone.

[00:01:07]This view allows us to see the bladder base just above the prostate gland. That's the bladder base.

[00:01:16]If the prostate is present, we assess the symmetry of the bladder base and gather additional information related to pelvic floor muscle tone and function.

[00:01:28]Indications for bladder volume measurement in the pelvic health therapy setting include post-void residual for situations such as urinary retention and assessing overall bladder capacity to assist in the treatment of urinary urgency and frequency. The bladder does need to be pretty full for the best visualization. If a lack of bladder base movement is observed, this may indicate pelvic floor muscle weakness, increased resting tone limiting further contraction, or poor coordination altogether and poor technique. We can measure bladder base displacement and use that to compare changes over time related to pelvic floor muscle excursion during contraction and bearing down. The other view is a transperineal where the ultrasound probe is placed underneath the scrotum in a longitudinal direction. Now, this gives us the side profile view of the pelvic floor structures just like this from the pubic bone to the rectum. In this view, we can identify the pubic symphysis, the urethra, striated urethral sphincter, bulb of the penis with the bulbocavernosus muscle, bladder neck, rectum, and the anorectal junction, which appears like a bent elbow created by the puborectalis muscle on the scan.

[00:02:54]Contraction and relaxation measurements can be taken objectively to assess progress as well. Now, this is where things get clinically relevant, especially for men. Currently, no robust, widely accepted normative data set for male pelvic floor ultrasound.

[00:03:09]This includes measures like bulbocavernosus muscle excursion, striated urethral sphincter movement, anorectal rectal junction displacement, and penile base movement. Most of the available research in men is based on small sample sizes, often focused on specific populations such as post-prostatectomy patients, men with lower urinary tract symptoms, or chronic pelvic pain. Because of this, the literature tends to focus more on the qualitative movement patterns rather than the strict numeric cutoffs. So, instead of relying on fixed numbers, what we really look for are how the pelvic floor muscles moving and coordinating. What we expect to see is a cranial head or upward lift of the pelvic floor with a contraction and a caudal descent or downward movement with bearing down or valsalva.

[00:03:58]We're also looking for symmetry of movement, the ability to fully relax after a contraction and no paradoxical contraction when someone is trying to bear down. Common dysfunction patterns include reduced excursion or movement which may reflect overactivity or restricted movement, excessive descent which may suggest reduced support, dyssynergia, or paradoxical contraction, delayed relaxation, and asymmetry or incoordination between structures.

[00:04:25]Pelvic floor muscle ultrasound can be especially helpful for coordination, training, strength, and endurance work without the need for internal assessment or palpation.

[00:04:36]It provides real-time visual feedback so your brain and body can better connect with what you're seeing and what you're feeling, helping improve awareness and motor control. And if you'd like to see a live model demo version of this video, join me on Patreon for exclusive demonstrations just like this one, including a live male and female pelvic floor exam.