Digital Palpation of the Pelvic Floor Muscles

Editor: Jenniffer Voelkl Guevara Last Updated: June 2018

Current ICS definition

Digital Palpation (1) - “The gloved and lubricated index finger of the examiner is introduced into the vagina (women) or the anus (women/men). Digital palpation should be performed with the patient in the supine and standing position. In the supine position, the hips and the knees should be flexed. If the knees are bent, the patient should not hold the legs herself, legs should be relaxed. Palpation is performed with one finger because two fingers may stretch the pelvic floor muscles and thereby influence the ability to contract. It is important to be very clear as to what is expected from the patient. Asking for a pelvic floor contraction will not be enough in most cases. The instruction ‘‘lift’’ and ‘‘squeeze’’ are useful. Palpation with two fingers in the supine position is used to measure the genital hiatus and to get information on the pelvic organs. For anal palpation, the patient is put in left lateral position”

Messelink and colleagues (2005) state the importance of reporting the patient´s position while the palpation was performed, time of the day and instructions given to the patient as well as the number of fingers used. (1) The articles goes on to describe the various measurements and conditions assessed by digital palpation.

Palpation: The process of using one’s fingers / hands as part of assessment, to gather information about the tissues (2)

History:

The first description was made by Kegel, asking to perform a contraction perceived as an inward and squeezing movement around the finger placed in the distal one third of the vagina; however it was used only for teaching purposes in regards on how to perform a good contraction (3) Carrier (2006) states that it is possible to discern between muscles such as puborectalis (cranial/ventral movement), or pubococcygeus (cranial and medial movement narrowing the elevation of the urogenital hiatus) and elevation of the bladder neck (placing the examining finger behind the urethra and vesicourethral junction) (4)

Controversies:

Currently, there is no gold standard for the assessment of PFM function. Although subjective, digital palpation is a clinically useful way to determine muscle function, in terms of muscle´s ability to contract and relax and to establish goals of treatment. Full assessment of the muscle involves many measurements not included in the current description. In addition it is often best in combination with instrument assessment of the PFM such as EMG, Ultrasound, manometry, and dynamometry . A current ICS standards working group is debating and coming to consensus on new definitions of digital palpation and it's components.
Reproducibility and quantification of testing is questionable, there is no validated scale to quantify contractions of the pelvic floor muscles, and no systematic research is provided to determine the quality of a contraction. Although in general Brink scale and Perfect Scheme scales have acceptable intra observer and inter-observer reliability, they have showed that they are not suitable for research purposes (5,6,) It is hoped that future definitions can be useful for both clinicians and researchers.

References:

  1. Messelink, B., Benson, T., Berghmans, B., Bo, K., Corcos, J., Fowler, C... & Nijeholt, G. A. (2005). Standardization of terminology of pelvic floor muscle function and dysfunction: report from the pelvic floor clinical assessment group of the International Continence Society. Neurourology and urodynamics, 24 (4), 374.

  2. Kari Bo, Helena Frawley, Bernard Haylen, Yoram Abramov, Fernando Almeida, Bary Berghmans, Maria Bortolini, Chantale Dumoulin, Mario Gomes, Doreen McClurg, Jane Meijlink, Elizabeth Shelly, Emanuel Trabuco, Caroline Walker, Amanda Wells. An international urogynecological association (IUGA) / international continence society (ICS) joint report on the terminology for the conservative and non-pharmacological management of female pelvic floor dysfunction

  3. Kegel AH. Progressive resistance exercise in the functional restoration of the perineal muscles. Am J Obstet Gynecol. 1948;56:238 –249

  4. Carrier. The pelvic floor. 2006;384-386

  5. Slieker‐ten Hove, M. C. P., Pool‐Goudzwaard, A. L., Eijkemans, M. J. C., Steegers‐Theunissen, R. P. M., Burger, C. W., & Vierhout, M. E. (2009). Face validity and reliability of the first digital assessment scheme of pelvic floor muscle function conform the new standardized terminology of the International Continence Society.Neurourology and urodynamics, 28(4), 295-300.

  6. Van Kampen M, De Weerdt W, Fey SH, Honing S. Reliability and validity of a digital test for pelvic muscle strength in women. Neurourol and Urodynam 1996;15:338-339.

Keep me updated