Millions of Americans are suffering from pelvic floor dysfunction, yet for most, the disease goes unidentified and untreated. Pelvic floor dysfunction refers to a wide range of problems that occur when the muscles of the pelvic floor are weak, tight, or there is an impairment of the sacroiliac joint, low back, coccyx and/or hip joint. The tissues surrounding the pelvic organs may have increased or decreased sensitivity and/or irritation resulting in pelvic pain.
Physical therapy involves the therapeutic manipulation of tissues, muscles, ligaments, and joints to increase strength, improve range of motion, release tension, and relieve pain. Pelvic floor physical therapy focuses on the muscles of the pelvic floor. This specialized technique utilizes both internal (transvaginal and/or transrectal) and external stretching and massage techniques to improve muscle and tissue function along the floor of the pelvis. It is performed by specialized physical therapists in an outpatient office. In many cases patients and their partners may be taught these techniques so that they be performed more frequently and at home.
Physical therapists can be specially trained in the treatment of disorders related to the pelvic floor. Pelvic floor disorders include urinary dysfunction and organ prolapse with sexual dysfunction closely related. Low libido, vaginal dryness, painful intercourse, decreased orgasm rates and intensity, and decreased overall sexual satisfaction have been reported in women with urinary incontinence. The relationship between urological and sexual problems has prompted the suggestion that women with urinary problems be questioned about their sexual function.
As specialists in pelvic floor and core disorders, we understand the need for modesty and privacy. When arriving at our office, you will meet your therapist and receive a thorough physical therapy evaluation in a private treatment room. You may be given a surface EMG evaluation, which is a painless test that indicates how your pelvic floor muscles are functioning. The physical therapist will explain in detail the results of the evaluation and how they relate to your problems and what specific steps are needed to correct them.
Pelvic Floor and Core Exercise is an important part of pelvic floor physical therapy. Muscle weakness, tightness, spasm and /or imbalances can make it difficult for you to control your bladder or bowel. Or it may be a cause of your pelvic pain. Your physical therapist will identify your specific problem areas and design an individualized home exercise program to correct them. You will be expected to perform the exercise daily at home and will be progressed each time you see the therapist, if you are compliant with the home program.
Anatomy of the Pelvic Floor
Pelvic floor (PF) muscles function to support pelvic floor organs, assist in urinary and fecal continence, aid in sexual performance (orgasm), stabilize connecting joints, and act as a venous and lymphatic pump for the pelvis.
Female Pelvic Floor
Male Pelvic Floor
Female Urogenital System
Male Urogenital System
Coccygeus, Piriformis and Obturator Internus
How Can Physical Therapy Help Incontinence?
Incontinence Refers to an Involuntary Loss of Urine. Incontinence can be both a socially embarrassing and a hygeine problem. There are several forms of incontinence.
A physical therapist trained in incontinence will complete a thorough history and medical screening, which will include medical, surgical, gynecological, childbearing, diet, hobbies, exercise, and bladder symptom information. Treatment will depend on the type of incontinence you may have, which will be evaluated by your therapist. Treatment possibilities include behavioral modification, dietary counseling, urge-suppression techniques, timed voiding, habit training, biofeedback, neuromuscular electrical stimulation, connective tissue realignment, and of course pelvic floor strengthening during non-functional activities progressing to functional activities.
Biofeedback is a device that will help you isolate the pelvic floor muscles, increase awareness of contraction and relaxation, relax the nearby muscles, and retrain breathing patterns during pelvic floor strengthening. Urge incontinence also benefits from an NMES, an electrical stimulation device that either can be inserted into your vagina or its electrodes can be placed around your anus or on your sacrum.
How Can Physical Therapy Help Pelvic Organ Prolapse?
Pelvic prolapse refers to a weakness in the tissues of the pelvis that allow internal organs to drop. The symptoms of a pelvic organ prolapse include can include: a bulging feeling in the vagina that worsens as the day progresses, urinary incontinence, or constipation.
Although surgery may be required in some cases, a physical therapist trained in women’s health can can assist you in supporting the prolapse with a strong pelvic floor, which will alleviate the symptoms of a pelvic organ prolapse.
How Can Physical Therapy Help Pelvic Pain?
The effectiveness of physical therapy in reducing pelvic pain depends largely on the cause.
• Non-relaxing pelvic floor/tension syndrome – The pelvic floor muscle holds tension, which sets off a pain syndrome, and can be caused by trauma, surgery, or sexual abuse. The condition may result in bowel and bladder incontinence and uncomfortable intercourse. Physical therapy would proceed with manual therapy, vaginal dilators, modalities, biofeedback, exercise, posture training, and reeducation in activities of daily living.
• Interstitial cystitis – Symptoms include pain above the pubic bone that is relieved by urinating. There is pain on the bladder as it fills, and relief is achieved when it empties. Patients may urinate 30 times a day and most report painful intercourse. Physical therapy may include biofeedback, neuromuscular electrical stimulation, manual therapy, and diet. Biofeedback will improve the strength, endurance, and relaxation of the pelvic floor muscles. A person will need to learn to relax the pelvic floor muscles before urinating. Electrical stimulation will decrease the urgency felt to urinate and provide pain relief. Manual therapy will realign the connective tissue, which consists of muscles, fascia, bone, viscera, and vessels. Dietary suggestions will address the foods and beverages that are irritants to the bladder.
• Vulvodynia– Is characterized by burning, stinging, and irritation or rawness on the female genitals. A physical therapist may use biofeedback to improve relaxation, strength, and endurance.
• Coccydynia – Pain is felt in the tailbone, especially when sitting, and is caused by an injury to the coccyx. Treatment consists of a joint mobilization to the coccyx, most often done through the rectum. The therapist must test the body’s response system to determine the direction to mobilize the coccyx. A gentle touch in the correct direction will mobilize the coccyx and reduce the pain.
• Pain with Intercourse – Can be caused by childbirth and episiotomy, or tearing from a vaginal delivery can trigger vaginal pain or painful sexual intercourse which may persist after delivery. Other causes can be past physical or emotional trauma such as an impact injury or sexual abuse. A physical therapist can help by using biofeedback to improve relaxation of the pelvic floor, manual therapy to relax and align the muscles and fascia, scar tissue mobilization, and electrical stimulation.