The image (left) illustrates what your bladder and pelvic floor muscles look like on the screen of real-time ultrasound.

The image can be seen in real-time via your lower stomach area. Your physiotherapist may use a real-time ultrasound machine as part of their assessment.

It can also be useful as part of a treatment program to provide you with immediate live feedback. This helps improve awareness of your muscle activation technique and helps you to learn various ways of engaging your pelvic floor muscles.

It can be difficult to know if you are using your pelvic floor muscles correctly because they are a group of muscles that you cannot see. Additionally, sensation and awareness in this area can be poor. This is particularly true if pelvic floor muscles are weak or have had an injury.

Men women and children can have difficulty contracting, and at times relaxing these muscles. Real-time ultrasound helps to identify the nature of the issue with bladder or pelvic floor problems.

What is real-time or diagnostic ultrasound?

Real-time or diagnostic ultrasound is a non-invasive tool that can visualise the bladder and pelvic floor. It can be used for the following reasons:

– To check if you are using the correct muscles when you contract your pelvic floor.

– Establish that you are able to elevate your pelvic floor and are not bearing down.

– Assess coordination between abdominal muscles and pelvic floor.

Show you how to completely relax your pelvic floor muscle after each contraction.

– Measure how much your bladder is holding (and link this to how strong your urge to empty is at the time).

– Confirming that your bladder is fully emptying.

– Rule out whether constipation may be causing pressure on your bladder and contributing to the main issue.

While real-time ultrasound is an invaluable tool it does have limitations. There are some pelvic floor and bladder conditions that are more thoroughly assessed when ultrasound is combined with an internal vaginal assessment (just using gloves and gel). This provides more accurate and detailed information about the following components:

– The severity of pelvic organ prolapse.

– Pelvic floor muscles strength or how much squeeze pressure you are generating.

– Pain, sensitivity or poor awareness.

– The general health of the vaginal tissues and mucosa (sometimes thrush or hormonal changes can contribute to continence or pelvic floor dysfunctions).

Your Pelvic Health/Women’s Health Physiotherapist will be able to assess your pelvic floor or continence issue by firstly asking some thorough and detailed questions about your symptoms, then selecting the most appropriate assessment tools.

Written by Emily Shiel, MCSP, HBCE. Advanced Practice Physiotherapist, Emily has a focus on continence, pelvic health pregnancy and post-natal care. Learn more about Emily.