Real time ultrasound (RTUS) is a tool that allows us to view the pelvic floor and abdominal muscles in a minimally invasive way. It provides real-time visual feedback about the way that your muscles and connective tissues are moving. This can be fantastic for people who struggle to know if they are correctly engaging their abdominal and pelvic floor muscles, as we can see the muscles moving right in front of us on the screen!
Real Time Ultrasound for assessing the abdominal wall
RTUS adds a lot of value to our assessment of the abdominal muscles and abdominal wall disorders. It allows us to assess the timing and sequencing of our muscle activation. We like to think of our abdominal muscles like an onion or a Sara Lee cake – layers & layers! Our transverse abdominis is our deepest layer. We want this layer to kick in first, and be able to activate without our internal and external obliques and rectus abdominis kicking in at the same time. If we can only switch on all our muscles at once, this makes us very stiff and rigid. Imagine trying to bend, lift, push and pull with all of your muscles tensed up while holding your breath – it wouldn’t be easy! That’s why we need to coordinate abdominal activation with the breath. Over-bracing and breath-holding are activation patterns we see frequently in patients with lower back pain. For more info on this, see our blog on the relationship between core and pelvic floor: https://pivotalphysio.com.au/2022/11/01/the-important-relationship-between-your-core-and-pelvic-floor-muscles/
At Pivotal, we love to use RTUS to assess and teach abdominal activation prior to starting Pilates rehab classes. We want to teach correct movement patterns and then strengthen and reinforce these patterns. There’s no point doing it if you’re not doing it properly!
RTUS for assessing the pelvic floor
RTUS shows us how much the pelvic floor muscles are moving (or how little), if you are correctly drawing up or instead bearing down with a pelvic floor contraction, and timing and sequencing of muscle activation. We can also assess coordination of breathing with contraction. We are able to visualise the bladder via RTUS and can see what pressure and/or support the pelvic floor muscles are placing on the bladder. This can be helpful when treating urinary incontinence or other bladder conditions.
Understanding how the pelvic floor muscles are contracting and relaxing is also great in preparation for labour. Did you know that some people actually contract their pelvic floor when they are trying to relax and bear down? This can be very problematic when trying to push a baby out, can lead to longer push times and higher likelihood of interventions being required. Knowing the difference between contracting your pelvic floor and bearing down can give you confidence heading into labour.
RTUS doesn’t completely replace the need for a detailed internal vaginal assessment for pelvic floor disorders as it doesn’t allow us to assess the tone, strength, endurance or coordination of muscles. However sometimes an internal assessment is not appropriate for many reasons. These include children/ youth, high levels of pain and sensitivity around the vulva and vagina, pain with penetration, infections, religious beliefs, or simply patient comfort level and preference. When an internal assessment is not appropriate for any reason RTUS is the next best thing!
We are fully equipped with a real time ultrasound machine in clinic. Call us on 83425593 if you would like an assessment to understand how your muscles are behaving.
~ Lucy Hayes, Physiotherapist