Technologies in Pelvic Health

Published January 1, 2026

What You Need to Know 

Technology is central to pelvic health physical therapy — both for assessment and treatment. Access, training, and clear documentation remain key to safe and effective use.

• Many tools serve dual roles in assessment and treatment, such as EMG or ultrasound used for biofeedback.

• Investigative tools can include electromyography, manometry, dynamometry, real-time ultrasound, and MRI.

• Clear documentation and terminology is essential to distinguish investigative versus therapeutic use.

Pelvic health physical therapy specialty training and practice require high utilization of technology, both as investigative tools during assessment and as intervention tools (Frawley et al., 2021). Investigative tools use technology or mechanics to objectively measure the function or morphometry of the pelvic floor muscles (PFM) and include dynamometry, electromyography, manometry (including rectal balloon assessment), myotonometry, and real-time ultrasound imaging (Frawley et al., 2021; Worman et al., 2023-a; Aljuraifani et al., 2025; Worman et al., 2023-b; Stafford et al., 2020). In pelvic health research, the use of investigative tools such as algometry, magnetic resonance imaging (MRI) and shear wave or strain elastography to measure the PFMs and other pelvic structures is advancing (Worman et al., 2024; Morin M. 2016; Morin M. 2022). From these tools, there are numerous outcome measures that have been developed and can be used to investigate a variety of pelvic health conditions (Worman et al., 2023-b). It is beyond the scope of this commentary to discuss all the outcome measures that have been studied for each tool in every pelvic health condition. However, to provide some understanding of the importance and use of technology in pelvic health practice we can look to the study of greater tone of the PFMs. 

According to a recent systematic review, greater tone of the PFMs is implicated in 33 different pelvic health conditions, across gender and lifespan, in 5  condition categories (pain, sexual dysfunction/reproductive health, bowel, urogenital, other) and has been studied using 103 outcome measures derived from 8 different tools( Worman et al., 2023-b).​​ Seven out of eight tools were investigative, applying technologies( Worman et al., 2023-b)​.The remaining tool, digital palpation, is classified as a sign, rather than an investigation, per the International Continence Society (Frawley et al., 2021) and is considered less objective indicating the importance and value of technologic tools in clinical practice and research(Frawley et al., 2021;Worman et al., 2023-a)​. Only 3 of the tools were considered to provide convincing evidence for the study of greater tone of the PFMs (electromyography, dynamometry and manometry) because they are direct measures of the PFMs with evidence of validity(Worman et al., 2023-b). However, it is important to note that each of the eight investigative tools provides different valuable measures to inform clinical decision-making and therefore access to multiple tools is important in pelvic health physical therapy practice and research (Frawley et al., 2021; Worman et al., 2023-b). Many of the same investigative tools are also used to study conditions considered to be related to lesser tone of the PFMs, such as urinary incontinence (Kari B. 2024). It remains unclear if there is consistent access, adequate training and clinical utility for all of the available investigative tools across practice settings around the globe.  

Practically, some of the investigative tools have dual utility and may also be used as intervention tools, primarily in the form of biofeedback (Rao et al., 2007; Wu et al., 2021). For instance, real-time electromyography activity or manometry pressures can be viewed by a participant or patient on a screen during a treatment or testing session ​(Rao et al., 2007; Wu et al., 2021).​ Target lines may be set and/or cues given to provide feedback of accuracy of muscle contraction and/or relaxation. Real-time ultrasound imaging is another technology that can provide biofeedback to participants or patients as they visualize the change in muscle or organ position during a muscle contraction or relaxation attempt (LaCross et al., 2021). Evidence supports electrical stimulation of the PFMs, pelvic and abdominal structures for both pain reduction and muscle stimulation (Hon et al., 2024)​. Other promising treatment technologies increasingly used in pelvic health PT practice are low level laser therapy and shockwave therapies, although evidence remains limited at this time and it is unclear if these tools treat the cause of the condition or contribute to symptom relief (El-shafei et al., 2024; Yuan, 2019).​ Because investigations and treatments may be derived from the same tools, it is important that terminology and documentation is clear when using a tool for investigations (assessment using biofeedback) and/or intervention (biofeedback training) to avoid confusion in use of investigative tools/technologies (Frawley et al., 2021).

References