How to evaluate pelvic floor muscles during postpartum physical examination

Postpartum pelvic floor muscle assessment is mainly conducted through three methods: clinical examination, instrument testing, and functional testing. There are mainly methods such as manual palpation, pelvic floor electromyography, stress urinary incontinence testing, vaginal contraction force testing, ultrasound examination, etc.

1. Manual Palpation

Doctors evaluate pelvic floor muscle tone and contraction ability through finger palpation. During the examination, place the index and middle fingers into the vagina to feel the tension of the muscles at rest, and then guide the mother to perform contraction movements to observe changes in muscle strength. Palpation can preliminarily determine whether there is excessive muscle tone or decreased muscle strength, but the results are greatly influenced by the doctor's experience.

2. Pelvic floor electromyography

uses surface electrodes to record pelvic floor electromyographic activity and objectively quantify muscle function. During testing, the electrode patch is placed in the perineum, and signals are collected through contraction and relaxation movements to analyze parameters such as muscle fiber recruitment patterns and fatigue levels. This method can distinguish different types of pelvic floor muscle dysfunction and provide a basis for developing rehabilitation plans.

3. Stress urinary incontinence test

induces urinary incontinence symptoms through cough test and jump test. Cough or jump in place when the bladder of the parturient is full, and observe whether there is leakage of urine. A positive test indicates a decrease in pelvic floor muscle support function, which may be accompanied by a downward displacement of the bladder neck. This examination is simple and easy to perform, but has low specificity, and requires comprehensive judgment in conjunction with other assessments.

4. Vaginal Contraction Force Test

Use a vaginal pressure gauge to measure the maximum autonomous contraction force. After inserting the pressure probe into the vagina, guide the parturient to contract the pelvic floor muscles vigorously, and the device displays the pressure value in real time. Normal contraction force should be able to reach a certain value, and if it continues to be lower than the standard value, it indicates a decrease in muscle strength. The test results can quantify the effectiveness of rehabilitation treatment.

5. Ultrasound examination

Observe the dynamic changes of pelvic floor structure through perineal or transvaginal ultrasound. Measure the position of the bladder neck and the area of the anal sphincter hiatus in a resting state, and observe the degree of organ prolapse during Valsalva maneuver. Ultrasound can visually display changes in the anatomical structure of the pelvic floor, making it particularly suitable for early diagnosis of pelvic organ prolapse. 42 days postpartum is the golden period for pelvic floor muscle assessment, and it is recommended that all mothers complete basic screening during postpartum follow-up. Daily Kegel exercises can be performed to enhance muscle strength, avoid lifting heavy objects, and avoid prolonged abdominal pressure increase movements. If moderate or above functional impairment is found during evaluation, it is necessary to promptly refer to a pelvic floor rehabilitation center for biofeedback therapy or electrical stimulation therapy. Before undergoing rehabilitation treatment during lactation, it is recommended to consult a doctor for advice.