How to evaluate pelvic floor muscles during postpartum physical examination?

Postpartum pelvic floor muscle assessment is mainly judged through clinical examination, instrument testing, and functional testing. Common methods include pelvic floor muscle strength measurement, ultrasound examination, and questionnaire survey.

1. Pelvic floor muscle strength measurement

uses the perineal muscle strength grading method, and doctors evaluate muscle contraction intensity and duration through finger examination. Normal pelvic floor muscle strength is 4-5 levels, and postpartum common muscle strength decline is 2-3 levels. When accompanied by stress urinary incontinence or perineal heaviness, it is necessary to combine quantitative data from a biofeedback therapy device. Before evaluation, the bladder should be emptied to avoid testing immediately after intense exercise.

2. Ultrasound examination

Three dimensional ultrasound of the perineum can observe changes in the area of the pelvic diaphragmatic hiatus in resting and contracted states, with a reduction of more than 20% in area during normal contraction. Pelvic floor ultrasound can detect structural abnormalities such as increased bladder neck movement and rectal protrusion. During the examination, it is necessary to cooperate with the Valsalva maneuver, and lactating women should inform the doctor before the examination.

3. Urodynamic testing

determines the presence of urinary dysfunction by measuring urinary flow rate and bladder pressure. Patients with postpartum urinary retention need to measure residual urine volume, and patients with stress urinary incontinence need to measure cough leak point pressure. Medications that affect bladder function should be discontinued 3 days before the examination, and different body positions should be changed according to instructions during the examination.

4. Questionnaire survey evaluation

uses the International Advisory Committee on Urinary Incontinence questionnaire or Pelvic Floor Dysfunction Scale to quantitatively evaluate the frequency and severity of symptoms such as urinary incontinence and sexual dysfunction. A score exceeding 8 indicates the need for intervention, and the questionnaire results should be comprehensively judged based on clinical examination. When filling in, the symptoms of the past month should be truthfully reflected to avoid subjective exaggeration.

5. Functional magnetic resonance

dynamic MRI can stereoscopically display the degree of pelvic floor organ prolapse and accurately measure anatomical parameters such as bladder rectal angle. Suitable for preoperative evaluation of complex pelvic floor reconstruction, capable of simultaneously observing multi organ coordinated movement disorders. Before the examination, it is necessary to train the pelvic floor muscles to contract and scan, and inform the physician in advance about the metal contraceptive device. 42 days postpartum is the golden period for pelvic floor evaluation, and it is recommended that all mothers undergo routine screening. Daily Kegel exercises can enhance muscle strength, avoid lifting heavy objects and long-term coughing. If urinary incontinence or perineal pain persists for 2 weeks, timely follow-up should be sought. For moderate to severe prolapse, electrical stimulation therapy or suspension surgery should be considered. After evaluation, an individualized rehabilitation plan should be developed based on the results, and non-invasive methods should be prioritized for breastfeeding treatment.