What’s Up Down There? The role Physical Therapy in Pelvic Floor Dysfunction

Originally Posted on January 15, 2018

Incontinence…Pelvic Pain…Pain with Intercourse? All taboo topics for much of our society but actually not uncommon to be treated in Physical Therapy.  Many people who experience any of the above are too afraid/ashamed/(fill in the blank) to bring it up with their medical providers until it has often progressed to a point that it interferes with everyday life.  Most patients with these issues have then mentioned it to several providers before they are even seriously addressed and for most, that usually means medications.  Medications to treat incontinence.  Medications to treat the pain.  They are often not provided with the information that they might be able to address the causes of these issues through non-medicinal means with a physical therapist.

Pelvic floor physical therapy is a specialization within the physical therapy scope that addresses dysfunction involving the urinary, bowel, and sexual systems, as well as pain in or around the pelvis, pelvic organ prolapse, and peri/postpartum concerns. The pelvic floor is a network of muscles that function as an important part of your core muscles, while also supporting the abdominal contents and maintaining the integrity of the sphincters (think bowel/bladder). When functioning properly, the pelvic floor muscles should independently to maintain continence and allowing for voiding when appropriate.

Here is a quick screen to determine whether or not it may be appropriate to reach out to a pelvic floor physical therapist (PT):

• During the daytime do you urinate more than once every 2 hours?
• Does the urge to urinate wake you more than once per night?
• Do you experience urine/stool leakage with sneezing, coughing, laughing, running, jumping?
• Do you ever experience such a strong urinary urge that you leak or worry that you will leak if you do not make it to the bathroom in time?
• Does it take more than 1 second to initiate urination?
• Do you feel chronically constipated, despite trying to address dietary/lifestyle changes?
• Do you often need to strain to initiate or pass a bowel movement?
• Do you ever need to brace in order to fully evacuate a bowel movement?
• Do you experience a feeling of heaviness, pressure, or falling out in the vagina?
• Do you experience pain or discomfort with sitting, standing, urination, bowel movements, sex, or in the tailbone?
• Do you feel like you may be experiencing a urinary tract or yeast infection, but cultures are negative?

If you answered yes to any of the above questions, you may want to discuss treatment options with a PT specializing in pelvic floor dysfunction.

Not all physical therapists handle this sensitive area so it is important to ask the right questions and to get to the practitioner who can help you most.  There are PTs who work primarily externally on the body assessing movement patterns and strategies, areas of muscle weakness in the pelvic floor and surrounding areas and assessments of the spine and hips as to how they relate and may be contributing to one’s presentation.  The PT then performs manual therapy including soft tissue and joint mobilization externally as well as re-trains poor movement strategies to ensure the most efficient strategies to help decrease symptoms.  There are also Internal Pelvic Health therapists who will palpate the areas of the vagina, penis or rectum as needed.  This gives them a greater ability to assess the muscle tone of the pelvic floor and allows them to perform increased manual skills directly to some of the deeper tissues.

Oftentimes we hear…..“Oh I have leaked a bit since my last child, but it’s fine” or “I do CrossFit, we all leak!”  Although these may be COMMON reports, it does NOT make them normal.  Stress incontinence or vaginal prolapse are diagnoses which may be helped with the external techniques mentioned above.  Pain with intercourse or after childbirth or hysterectomies/prostatectomies may be best suited to be first evaluated by an internal pelvic therapist.  Oftentimes these two practitioners can work closely together and may have overlapping training, but it is important to find the one who best suits your needs and symptoms.  There is nothing wrong with first meeting with an external pelvic health therapist if you are hesitant about internal therapy.  They may be able to give you some good information and activity modification to start you on the path to recovery and then if needed, will recommend you to a trustworthy internal pelvic health colleague.

There are so many treatment options to address any pelvic floor muscle issues! Strengthening, lengthening, and re-educating are all non-invasive ways to improve the function of these muscles and there is no time like the present to take control of your body and your health.

Created by Lauren Masi PT, DPT, OCS, ATC Co-Owner and Clinical Services Director, LPT and Allison Romero PT, DPT Owner Reclaim Pelvic Therapy

Facts:

• 79% of patients with urinary stress incontinence (SUI) improved sufficiently to avoid surgery with pelvic floor physical therapy (Bond E., et al. The role of pelvic floor muscle exercise in reducing surgical management of women with stress incontinence: a clinical audit. Association of Chartered Physiotherapists in Women’s Health Journal, 95. pp. 66-70.)
• Prostatitis is 3rd most common diagnosis of men under 50, 90-95% of “prostatitis” diagnoses are actually male pelvic pain (Bergman, 2007)
• About 60% of sexually active women will experience pain with sex at some point in their lives (Gyang, 2013).
• 24% women have pain with sex 18 months after giving birth (McDonald, 2015).
• 9% of nulliparous (Women who haven’t given birth) women experienced stress incontinence. After the first pregnancy, the female prevalence rate rose to 37.4% (Alastair, 2000).

Stress Urinary Incontinence in women in the United States estimated: 25% to 50%, more than $12 billion is spent annually to manage incontinence (surgical and conservative treatments) (Chong, 2011).

We are here to help. If you feel you need professional help to improve your alignment, posture and help prevent further or future injury please don’t hesitate to contact us (925) 284-6150.

Written by Lauren Masi, PT, DPT, OCS, ATC, Clinical Services Director and Co-Owner at Lafayette Physical Therapy, Inc. & Allison Romero, PT, DPT, Pelvic Health Specialist and Owner of Reclaim Pelvic Therapy.

Arranged and Edited by Zack Krumland, BSBA, PR & Marketing Coordinator

References: 

• Bond E., et al. The role of pelvic floor muscle exercise in reducing surgical management of women with stress incontinence: a clinical audit. Association of Chartered Physiotherapists in Women’s Health Journal, 95. pp. 66-70.

Disclaimer
This article is intended as general health information and is not intended to provide individual specific medical advice, professional diagnosis, opinion, treatment or services to you or any other individual. Please consult your doctor or a medical professional before starting or changing a health, fitness, or nutrition program.