Injuries & Conditions
The pelvic floor is a group of muscles found in the pelvis’ floor (the base) (the 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. Pelvic pain can sometimes radiate to your lower back, buttocks, or thighs. Occasionally, you might notice pelvic pain only at certain times, such as when you urinate or during sexual activity.
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.
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
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
Treatments 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:
- Biofeedback – a technique that can help patients learn how the pelvic floor muscles are working.
- Trigger point release – Seeks to address the musculoskeletal pain and to release the “knots” of pain, tightness, tension, and stiffness within the taut bands of the muscle fibers. Treatment of the trigger point “unlocks” the contraction in the muscle by applying an increasing pressure on the trigger point to release or loosen it.
- Electrical stimulation for pain relief/control – A low voltage electrical current may be used to teach patients how to coordinate muscle contractions.
- Myofascial release – The therapist will hold gentle pressure at the barrier of the tissue (the point where resistance is felt) for a short period of time, usually less than 2 minutes until the therapist feels the tissue release on its own.
- Soft tissue lengthening – Soft tissue therapy is an effective way to eliminate knots, adhesions and scar tissue in order to restore biomechanics, optimize movement and improve performance.
- Dry needling – is a specialized technique that uses a thin filiform needle to penetrate the skin and release underlying myofascial trigger points (muscular and connective tissues) for the management of neuro musculoskeletal pain.
- Soft tissue manipulation
- Deep tissue manipulation
- Joint mobilizations – Skilled and specialized therapists can use a variety of active techniques (patient assisted) and passive techniques to free up restrictions in these tissues and organs and improve overall function.
What to Expect from Pelvic Floor Physical Therapy
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.
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.
Pelvic Floor Dysfunction: Symptoms, Causes and Physical Therapy for Pelvic Floor Pain
Pelvic dysfunction isn’t just a “women’s disorder” though; men can have pelvic floor dysfunction, known as chronic prostatitis or chronic pelvic pain syndrome (CP/CPPS).