Real-time ultrasound (RTUS) is a valuable tool used by physiotherapists to assess how your pelvic floor and abdominal muscles are working. It provides a safe, painless and non-invasive way to see inside the body, helping both clinicians and patients better understand pelvic health concerns.

RTUS is an ultrasound machine that produces sound waves above the range of human hearing.

These sound waves travel through the tissues and bounce back to the probe, allowing the machine’s computer to create an image on the screen.

In pelvic health, the probe is placed on the lower abdomen to view the bladder and pelvic floor muscles. RTUS is completely safe, non-invasive and comfortable for patients.

Physiotherapists use RTUS to assess muscles and soft tissues as they move and function. In pelvic health specifically, we use it to observe the bladder and the surrounding pelvic floor muscles. We get to see how they move, how they coordinate, and how effectively they activate.
This visual feedback helps patients perform exercises correctly and confidently.

RTUS is especially helpful for people who need support finding or activating their pelvic floor muscles, including:

• Women after childbirth when the pelvic floor may be stretched or weakened
• Women during or after menopause as hormonal changes can impact muscle strength
• Men after prostate surgery where bladder control may be affected
• Anyone with pelvic floor weakness or incontinence who needs help seeing and understanding how their muscles function

During the assessment, the patient lies comfortably on a treatment bed.
Gel is applied to the ultrasound probe, which is then placed on the lower abdomen.
The physiotherapist moves the probe gently to obtain images of the bladder, pelvic floor, and abdominal muscles as they work.

RTUS provides valuable information about:

• Pelvic floor muscle lift and contraction
• Pelvic floor muscle relaxation—essential for healthy bladder and bowel function
• Pelvic floor strength and endurance
• Bladder volume before and after voiding, helpful for conditions like overactive bladder or incomplete emptying
• Abdominal muscle activation, including how well they contract and relax

By reviewing this information together, we form a clear picture of how your muscles coordinate and function as a whole.

Pelvic floor muscles can be hard to connect with because they’re inside the body and difficult to feel or visualise.
RTUS gives patients live visual feedback, showing whether they are contracting correctly and helping them learn proper technique.
Seeing the muscles move can make exercises easier to understand and more effective.
Before and after images can also boost confidence and motivation.

RTUS provides a safe, non-invasive and empowering way to better understand your pelvic floor health.