What Is Internal Pelvic Release Work (IPRW)? Your Questions Answered
Internal pelvic release work (IPRW) is a hands-on pelvic health technique that involves working internally with the muscles of the pelvic floor.
It can be used for a number of different reasons, from preparing the pelvic floor for birth, to helping with pelvic floor overactivity, pain, bladder or bowel concerns, postpartum birth tension, feelings of pelvic pressure and heaviness.
But what does internal pelvic release work actually involve? Does it hurt? Who might benefit from it? And is it something you need to specifically book?
Here are some of the most common questions we are asked.
What is internal pelvic release work?
Internal pelvic release work (IPRW) involves assessing and treating the pelvic floor muscles internally through the vagina.
The pelvic floor is a group of muscles and connective tissues that sit at the base of the pelvis. These muscles play an important role in bladder and bowel function, sexual function, pelvic support, pregnancy and birth.
During internal pelvic release work, a pelvic health practitioner can assess how these muscles are functioning, including their tension, tenderness, ability to contract and, importantly, their ability to relax and lengthen.
Treatment may then involve gentle hands-on techniques to specific areas of the pelvic floor where appropriate.
Why might someone have internal pelvic release work?
There isn't one single reason.
Internal pelvic release work may be incorporated into pelvic health treatment for people experiencing:
Pregnancy and preparation for vaginal birth
Postpartum recovery
Pelvic floor muscle overactivity or difficulty relaxing
Pain during or after intercourse
Chronic pelvic pain conditions
Ongoing hip or back pain that is pelvic floor related
Bladder symptoms that may be influenced by pelvic floor tension
Bowel symptoms or difficulty relaxing to empty your bowels
Pelvic pressure or heaviness
Having one of these symptoms doesn't automatically mean internal treatment is needed. Your practitioner will look at your symptoms, history and goals to determine what may be appropriate for you.
Can internal pelvic release work be used for birth preparation?
Yes. Internal pelvic release work can form part of pelvic floor birth preparation during pregnancy.
Preparing your pelvic floor for birth isn't simply about making it stronger.
During a vaginal birth, the pelvic floor needs to be able to relax, lengthen and accommodate your baby moving through the birth canal.
For some people, birth preparation may therefore involve working on pelvic floor awareness, relaxation and lengthening rather than strengthening alone.
Internal pelvic release work may be used to assess how well you can relax and lengthen your pelvic floor and to work with areas that may be holding increased tension.
This can also be combined with other birth preparation strategies, including breathing, pelvic and hip movement, positions for labour, pushing strategies and learning how to consciously relax the pelvic floor.
The goal isn't to simply make the pelvic floor “loose”. It is about helping you understand your pelvic floor and improving its ability to respond appropriately when you need it to relax and lengthen.
Is internal pelvic release work the same as perineal massage?
No.
Both may be used as part of preparation for vaginal birth, but they have slightly different focuses.
Perineal massage generally focuses more specifically on the tissues around the vaginal opening and perineum in preparation for the stretching that occurs during birth.
Internal pelvic release work can involve assessing and working with different muscles and areas throughout the pelvic floor.
Depending on where you are in your pregnancy, your individual pelvic floor and what is found during your assessment, your practitioner may discuss one or both approaches with you.
What actually happens during internal pelvic release work?
Internal pelvic release work is a hands-on technique performed vaginally using a gloved, lubricated finger.
Your practitioner will first assess the pelvic floor muscles, looking at things such as muscle tension, tenderness, how well the muscles contract and relax, and whether certain areas reproduce any of your familiar symptoms.
The hands-on treatment itself can involve gently holding pressure over an area of muscle tension or slowly moving over the muscle to encourage it to release and relax.
It doesn't always involve staying still either. Your practitioner may combine the hands-on technique with:
Breathwork, particularly using your breathing to encourage the pelvic floor to relax and lengthen
Movement of the leg or hip while gently holding a particular area, which can change the load through the muscle and help it release
Practising your own awareness of how to relax and lengthen the pelvic floor
Does internal pelvic release work hurt?
Internal pelvic release work should not hurt.
If there are areas of increased tension or a particular spot reproduces some of your familiar symptoms, there can be moments of mild discomfort or tenderness during treatment.
For example, someone who experiences pain with intercourse may notice that pressure over a particular pelvic floor muscle produces a familiar sensation. This can provide useful information about whether that area may be contributing to their symptoms.
However, the aim is not to cause pain or push through pain.
Your practitioner can alter their pressure at any time, move away from an area or stop completely. You are always in control of what feels comfortable, and treatment should be adjusted to suit you.
Can internal pelvic release work help an overactive pelvic floor?
It may form part of treatment for pelvic floor overactivity.
An overactive pelvic floor is a pelvic floor that has difficulty fully relaxing or lengthening when required.
Importantly, an overactive pelvic floor isn't necessarily a weak pelvic floor, and it doesn't necessarily need more strengthening.
For some people, treatment may instead focus on helping the muscles relax, improving coordination and reducing unnecessary tension.
Internal release work is one technique that may be used alongside breathing, movement, education, pelvic floor awareness and other treatment approaches.
Can pelvic floor tension contribute to pain during intercourse?
Yes. Pelvic floor muscle tension and overactivity can be one contributor to pain during penetration or intercourse.
If the pelvic floor muscles remain guarded, sensitive or have difficulty relaxing, penetration may feel uncomfortable or painful.
Internal pelvic release work may be used to identify areas of muscle tension or tenderness and help improve the ability of the pelvic floor to relax and lengthen.
However, pain with intercourse can have many different causes, so pelvic floor tension shouldn't automatically be assumed to be the reason.
Can pelvic floor tension cause bladder symptoms?
It can contribute to some bladder symptoms.
The pelvic floor doesn't just need to contract — it also needs to relax appropriately for normal bladder emptying.
When the pelvic floor has difficulty relaxing, some people may experience:
Difficulty starting their urine stream
Feeling like they haven't completely emptied their bladder
Feeling like they need to push or strain to urinate
Urinary urgency
Urinary frequency
Pelvic discomfort associated with bladder filling or emptying
Internal pelvic floor assessment can help determine whether muscle tension or coordination may be contributing to these symptoms.
Can pelvic floor tension affect bowel movements?
Yes, in some people.
The pelvic floor needs to relax and coordinate with the abdomen to allow you to empty your bowels.
If the pelvic floor remains tense or doesn't relax appropriately, this can sometimes contribute to difficulty emptying, straining or a feeling of incomplete bowel emptying.
Treatment may involve internal pelvic floor work where appropriate, alongside breathing, abdominal pressure management, toileting position and bowel habits.
Can internal pelvic release work be used for chronic hip or back pain?
Sometimes, yes.
The pelvic floor doesn't work separately from the rest of the body. It works alongside the muscles of your hips, abdomen, diaphragm, pelvis and lower back.
For some people with persistent hip, buttock, pelvic or lower back pain, there may be areas of pelvic floor tension or tenderness contributing to their symptoms.
Sometimes pressing on a particular pelvic floor muscle during an internal assessment may even reproduce a person's familiar hip, buttock or pelvic pain.
In these cases, internal pelvic release work may be incorporated into treatment to address the pelvic floor component of their presentation. This might involve gently holding or moving over the involved pelvic floor muscle, combining the technique with breathing, or moving the hip or leg to change the load through the muscle and encourage it to release.
This doesn't mean that all hip or back pain comes from the pelvic floor. Rather, the pelvic floor can sometimes be one part of the picture that hasn't previously been assessed or treated.
Can internal pelvic release work be helpful after having a baby?
Yes. Internal pelvic release work can also be used as part of postpartum pelvic floor care.
We often hear about the pelvic floor becoming “weak” after having a baby, but weakness isn't the only change that can occur. Some women can actually hold increased tension through their pelvic floor after pregnancy and birth.
And when you think about what the body has been through, this makes sense. The pelvic floor has spent around nine months supporting the increasing weight and pressure of a growing baby, followed by the physical demands and potential trauma of childbirth.
After birth, some areas of the pelvic floor may remain tight, tender or guarded, or the muscles may have difficulty fully relaxing and lengthening.
This can occur following a vaginal birth, particularly where there has been tearing, an episiotomy or other birth trauma, but pelvic floor tension can also be present after a caesarean birth.
When appropriate, internal pelvic release work may be used postpartum to gently work with areas of increased muscle tension or tenderness and help the pelvic floor relax and move more comfortably.
This is also why postpartum pelvic floor care isn't always simply about doing more Kegels. Sometimes, relaxation and reducing tension need to come before strengthening, and your pelvic health assessment helps us work out what your pelvic floor actually needs.
Can pelvic floor tension feel like a prolapse?
Pelvic heaviness or pressure doesn't always mean you have a pelvic organ prolapse.
True heaviness is a big indicator of a potential prolapse, however heaviness can feel different person to person.
In some cases, increased tension through the pelvic floor and surrounding tissues may be contributing to the sensation rather than a prolapse itself.
This is why assessment is important rather than assuming that pelvic heaviness automatically means prolapse.
A pelvic health assessment can help determine whether your symptoms may be related to prolapse, pelvic floor muscle function or another contributing factor.
Do I have to have internal pelvic floor treatment?
No. Internal assessment and treatment are always optional.
Your practitioner will explain what they are recommending, why they think it may be helpful and what the assessment or treatment involves before proceeding.
You can ask questions, decline internal treatment, change your mind or withdraw consent at any point during your appointment.
There are also many external treatment and management options that may be appropriate depending on your presentation.
Do all pelvic health appointments involve internal treatment?
No.
A pelvic health appointment looks at your individual symptoms, history and goals. Internal assessment or treatment is only one of the tools that may be used.
Depending on your presentation, treatment may also involve the abdomen, diaphragm and breathing, hips, lower back, pelvis, movement and strength, as well as bladder or bowel habits, education and home management strategies.
Is internal pelvic release work a separate service at Yarra Valley Women’s Health?
No. You won't see “Internal Pelvic Release Work” listed as a separate service on our website.
That's because internal pelvic release work is a treatment technique rather than a specific appointment type.
It may be incorporated into any of our pelvic health appointments when it is clinically appropriate, relevant to your goals and you are comfortable proceeding.
For example, someone attending for pregnancy and birth preparation may have internal pelvic release work incorporated into their appointment, while another person may attend because of painful intercourse, bladder or bowel symptoms, pelvic floor overactivity or pelvic heaviness.
Another person with exactly the same symptoms may not require internal treatment at all.
How do I know if internal pelvic release work is right for me?
You don't need to know before you book.
If you're looking for pelvic floor birth preparation during pregnancy, experiencing pain with intercourse, having bladder or bowel concerns, noticing pelvic heaviness or pressure, or wondering whether pelvic floor tension could be contributing to your symptoms, a pelvic health appointment is a good place to start.
At Yarra Valley Women’s Health in Healesville, your practitioner can assess your pelvic floor function and discuss whether internal pelvic release work may be useful as part of your individual treatment.
You don't need to book internal pelvic release work separately. Simply book an appropriate pelvic health appointment, and we can determine together what assessment and treatment options may be suitable for you.