Roughly about 15% of women of childbearing age in the United States, report having pelvic pain that has lasted at least six months. Up to 30% of these women have severe pain causing them to miss work. Pelvic floor dysfunction is more common than you think as age and childbirth take their toll on a woman’s body. Pelvic dysfunction isn’t just a “women’s disorder” though; men can have pelvic floor dysfunction, known as chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). It affects men of all ages worldwide and is the most common urologic disease in men under 50 years old.
The pelvic floor is a group of muscles found in the pelvis’s floor (the base/bottom of the torso). Pelvic pain is primarily located in the lowest part of the abdomen and pelvis. Pelvic pain can be dull or sharp, constant or off and on, and mild, moderate, or severe. The pain can sometimes radiate to your lower back, buttocks, thighs, or knees. Occasionally, you may notice pelvic pain only at certain times, such as when you urinate or during sexual activity.
What Causes Pelvic Floor Dysfunction?
- Irritation of the nerves in the pelvis
- Traumatic injuries to the pelvic area
- Pregnancy/Miscarriage (tissues can become strained)
- Overuse of the pelvic muscles (going to the bathroom too often or constipation)
- Pelvic surgery
Signs and Symptoms of Pelvic Floor Dysfunction
- Difficulty walking, sleeping, or performing daily activities
- Inability to sit for regular periods
- Reduced mobility in the hips or lower back
- Pain or numbness in the pelvic region during exercise or activities
- Pain during sexual activity
- Pain during urination or bowel movements
- Difficulty using tampons
Why Pelvic Floor Physical Therapy?
Pelvic floor physical therapy is simply a branch of physical therapy built upon the same principles. The goal is to restore function, reduce pain, and improve muscle coordination and strength through various techniques. Physical therapists who specialize in the pelvic floor, are experts at treating pelvic floor dysfunction or underlying hip/low back dysfunctions.
Pelvic floor dysfunction occurs when the muscles, nerves, connective tissue, skeletal structures in the pelvis are not functioning properly to keep us continent, aid in sexual performance, and assist in core stability. Pain from the low back, abdomen, hips, and legs can contribute to pelvic pain and most likely result in pelvic floor impairments.
Those who experience long-standing abdominal, and lower back pain along with pelvic pain are excellent candidates to see a pelvic floor physical therapist.
What to Expect from Pelvic Floor Physical Therapy?
Physical therapists are experts in movement and function, addressing the neuromusculoskeletal system, including muscles, joints, connective tissue, and nerves. After graduating from Physical Therapy School, physical therapists can find their niche and specialize. It varies from working with high-level athletes, pediatrics, people recovering from injuries or surgery, and people with neurological conditions to name a few.
Pelvic floor physical therapists specialize in the muscles, nerve, and connective tissues that live in between your legs, known as the pelvic floor. They take post-graduate continuing education classes, training, and certification to gain expertise in the field. This allows the physical therapists to perform internal and external pelvic exams to treat conditions that affect the pelvic floor. These exams are delivered in a one-on-one session in a private room.
Most patients have questions concerning what to expect during the first visit when addressing pelvic dysfunctions. Typically, the first visit is about an hour with 45 minutes of one-on-one time. The physical therapist spends time reviewing medical history, understanding the patient’s concerns, and collecting information to guide treatment. The rest of the evaluation involves a postural or low back screening, pelvic examinations, and an education related to pelvic health.
To properly assess the pelvic floor muscles, an internal examination is encouraged. It may seem daunting, especially if you have pelvic floor pain, but pelvic floor therapists are trained to be a thorough as possible while minimizing discomfort. During the internal examination, your physical therapist will place a gloved finger into the vagina or rectum to assess the tone, strength, and irritability of your pelvic floor muscles and tissues.
This is extremely helpful in determining if there are trigger points, muscle tightening/shortening, nerve irritation, or bony malalignment that could be causing your pain or inhibiting the full function of your pelvic floor muscles. In addition, we can determine if there is appropriate coordination required for activities such as going to the bathroom, supporting our trunk, and sexual activity.
It is also essential to include other assessments to determine if there is an underlying condition somewhere else in your body that could affect your pelvic floor. This is often done externally. As your physical therapist, once we determine the root of the dysfunction, we will plan to get you back to your prior level of function.
What Treatments are Available for Pelvic Floor Dysfunction?
Therapeutic strategies for pelvic floor dysfunction have evolved beyond the traditional Kegel exercises for incontinence. Physical therapists customize treatment plans and select treatments based on the examination and evaluation. Pelvic floor muscle rehabilitation employs various strategies to improve the capacity of the muscles through neuromuscular re-education. This rehabilitation includes but is not limited to:
- Trigger point release
- Electrical stimulation for pain relief/control
- Myofascial release
- Soft tissue lengthening
- Dry needling
- Soft tissue manipulation
- Deep tissue manipulation
- Joint mobilizations
If you’re experiencing pelvic floor dysfunction, schedule an appointment at one of our many physical therapy clinics throughout the Valley and let our experts help you achieve your health goals.
Clinic Director Lindsey Fonacier, PT, DPT from our North Mesa Clinic utilizes her post-graduate education specialization in pelvic floor and orthopedics to provide her patients with a well-rounded approach to treating the entire body as a whole. Lindsey specializes in orthopedic physical therapy and women’s health. She’s received specialty training via Herman and Wallace to advance her expertise in women’s health, treating urinary incontinence, chronic pelvic pain, diastasis recti, coccyx pain, fecal incontinence, and constipation.