Pelvic Floor Evaluation — Understanding What Is Driving Your Symptoms
The pelvic floor is a group of muscles, ligaments, and connective tissues that support the bladder, uterus, rectum, and vaginal walls. When these structures weaken, overwork, or sustain injury — from childbirth, aging, chronic strain, or surgery — the result is a range of symptoms that significantly affect quality of life: leaking urine with activity, a sensation of pelvic heaviness or bulge, painful intercourse, pelvic pain, or incomplete bladder and bowel emptying.
At Lapeer Women’s Health, Dr. Andrei performs a structured in-office pelvic floor evaluation to assess what is contributing to your symptoms and determine the most appropriate management pathway. The evaluation characterizes prolapse type and stage, assesses pelvic floor muscle tone and coordination, evaluates bladder function, and identifies pain triggers — all of which direct whether the treatment plan involves physical therapy, a pessary, hormonal support, or surgical repair.
Pelvic floor symptoms are common and under-reported. Many women assume leaking with coughing, a sense of vaginal fullness, or pain with intercourse are simply part of aging or the aftermath of childbirth. They are not conditions you have to accept — and effective treatment options exist at every stage.
Components of the Pelvic Floor Evaluation
The evaluation is tailored to your specific symptoms. These are the areas Dr. Andrei assesses to characterize pelvic floor dysfunction and determine the right treatment path.
Prolapse assessment and staging
Pelvic organ prolapse — cystocele, rectocele, uterine prolapse, or vault prolapse after hysterectomy — is staged using the POP-Q system during a clinical examination with Valsalva maneuver. Staging determines whether conservative, pessary, or surgical management is most appropriate.
Pelvic floor muscle tone evaluation
Dr. Andrei assesses whether the pelvic floor muscles are hypotonic (weak, unable to generate adequate support), hypertonic (overactive, generating pain and tension), or dyssynergic (uncoordinated). The treatment for each is fundamentally different — identifying which pattern is present is essential.
Stress and urge incontinence assessment
Urine leakage with coughing, sneezing, laughing, or exercise (stress incontinence) is evaluated separately from urgency-driven leakage (urge incontinence). Mixed presentations are common. Clinical assessment guides whether conservative management, pessary, medication, or surgical referral is the right next step.
Pelvic pain and dyspareunia evaluation
When pelvic pain or pain with intercourse is the primary complaint, Dr. Andrei evaluates for pelvic floor muscle tenderness, trigger points, vulvodynia, and vestibulodynia in addition to structural causes. Pelvic floor physical therapy referral is coordinated when musculoskeletal contribution is identified.
Vaginal tissue assessment
Postmenopausal genitourinary syndrome (GSM) — vaginal atrophy, dryness, and tissue thinning due to estrogen decline — significantly worsens pelvic floor symptoms. Dr. Andrei assesses tissue quality and discusses local or systemic estrogen options when indicated.
Bladder diary and symptom questionnaire
For patients with significant urinary symptoms, a bladder diary tracking fluid intake, voiding frequency, urgency episodes, and leakage events provides objective data that guides management. Dr. Andrei reviews the diary at your evaluation visit.
What Comes After the Evaluation
The evaluation determines which treatment pathway is most appropriate for your specific presentation. Most pelvic floor conditions have effective nonsurgical options — surgery is discussed only when conservative measures are inadequate or a patient’s goals make it the preferred path.
- Pelvic floor physical therapy referral — the first-line treatment for hypertonic pelvic floor, stress incontinence, and dyspareunia
- Pessary fitting — in-office nonsurgical support for prolapse and stress incontinence, fitted and managed at LWH
- Local vaginal estrogen — for postmenopausal tissue atrophy contributing to prolapse symptoms and pain
- Bladder training and behavioral modification — for urge incontinence and overactive bladder
- Surgical repair discussion — when prolapse is advanced or conservative treatment has not provided adequate relief
- Urogynecology referral — coordinated by Dr. Andrei when complex reconstruction is indicated
“Pelvic floor symptoms are among the most commonly under-treated problems in gynecology — because patients don’t bring them up, and providers don’t always ask. I ask. And once we know what’s actually happening with the pelvic floor, we have a clear set of options to address it.”
- Prolapse repair surgery performed at McLaren Lapeer, McLaren Flint, and Henry Ford Rochester
- Pessary fitting and management available at both Lapeer and Rochester Hills offices
- Pelvic floor physical therapy referrals coordinated locally in Lapeer County and Oakland County
- Most pelvic floor conditions improve significantly with appropriate nonsurgical management
- Surgical options discussed in full — risks, recovery, expected outcomes — before any operative recommendation
Questions About the Pelvic Floor Evaluation
Pelvic Floor Symptoms
Have Solutions.
In-office pelvic floor evaluation with Dr. Andrei at Lapeer and Rochester Hills — prolapse staging, muscle assessment, incontinence evaluation, and a clear treatment plan. You do not have to manage these symptoms without answers.
The information on this page is intended for educational purposes only and does not constitute medical advice. Individual symptoms, diagnoses, and treatment options vary significantly. Reading this content does not establish a physician-patient relationship with Dr. Ramona D. Andrei or Lapeer Women’s Health. If you are experiencing a medical emergency, call 911 or go to the nearest emergency room immediately. Please consult a qualified healthcare provider for advice specific to your situation. Content reviewed by Dr. Ramona D. Andrei, MD PhD FACOG.
Gynecologic care for women of every age
Lapeer Women’s Health — Rochester Hills
2710 S Rochester Rd, Suite 2
Rochester Hills, MI 48307
Serving patients in Lapeer, Rochester Hills, and surrounding communities throughout Southeast Michigan.