PELVIC FLOOR DISORDERS

Did you know . . . Pelvic Health is more than just treating urinary incontinence and pelvic pain. The health of your pelvic floor muscles can affect sexual health, musculoskeletal issues, mobility and digestive disorders. 

Thankfully, there are many effective treatment options.

We offer multiple health solutions and treatments for women.

The following outlines some of the diagnoses we can treat at our practice:

Urinary Incontinence (Stress, Urge and Mixed) : loss of bladder control is a common and very treatable issue. The severity ranges from occasionally leaking urine when you cough or sneeze to having an urge to urinate that's so sudden and strong you don't get to a toilet in time.  Treatments recommended include pelvic floor muscle training and education and electrical stimulation.

Fecal Incontinence: is the inability to control bowel movements, causing stool (feces) to leak unexpectedly from the rectum. Patients with chronically dysfunctional lower gastrointestinal tracts tend to show uncoordinated relaxation of one or both of these muscles, or no relaxation at all. Physical therapy is an effective treatment for this pelvic floor diagnosis.

Chronic Pelvic Pain Syndrome ("CPPS"): is most likely to affect males 35-45 years old. Studies have shown that patients with CPPS have increased pelvic muscle tenderness and pelvic floor dysfunction. Biofeedback combined with education and pelvic floor muscle exercise has been shown to decrease pain and increase quality of life.

Pelvic Neuralgia – including Pudendal Neuralgia: is a cause of chronic pelvic pain. It typically presents in the penis, scrotum, perineum, or anorectal area for men, and can be aggravated by prolonged sitting. Conservative treatment including electrical stimulation has been shown to decrease pain and increase quality of life for these patients.

Endometriosis: is a painful disorder in which tissue that normally lines the inside of your uterus — the endometrium — grows outside your uterus. This disorder may also cause pelvic pain, pain with intercourse and pain with bowel movements and urination. Pelvic floor physical therapy can help to alleviate and manage the pain associated with this disorder.

Bowel Disorders: Physical therapy can treat and help you manage a variety of bowel disorders such as constipation, abdominal pain and small bowel obstruction. Treatment includes manual therapy, localized soft tissue massage, behavioral modification and body mechanics re-training. 

Vulvar Pain (Vestibulodynia): is hypersensitivity on light touch to the vestibule, such as during intercourse and on insertion of tampons. The degree of pain is variable. Some women have pain but are able to tolerate penetrative sex. For others any pressure to the vestibule area causes symptoms of soreness and tenderness, including tight clothes and even light touch to the area. Treatment may include manual therapy, dilator regimen and pelvic floor muscle re-training. 

Painful Intercourse Dyspareunia:  is painful sexual intercourse due to medical or psychological causes. The pain can primarily be on the external surface of the genitalia, or deeper in the pelvis upon deep pressure against the cervix. It can affect a small portion of the vulva or vagina or be felt all over the surface. Treatment may include manual therapy, dilator regimen, biofeedback and pelvic floor muscle re-training. 

PGAD: Persistent genital arousal disorder (PGAD) is characterized by unrelenting, spontaneous, and uncontainable genital arousal, mostly in females. PGAD can lead to ongoing physical pain, stress, and psychological difficulties due to an inability to carry out everyday tasks. Symptoms can be managed on an ongoing basis to improve the quality of life of people with this condition. 

 

Our Program

After a comprehensive individualized evaluation, the physical therapist will select modalities and procedures that will help you reduce your pain, improve your function, and assist you in achieving your goals. Plan of care is typically twice per week, lasting six to eight weeks. 

Typical modalities and procedures include: 

  • Electromyography (biofeedback) evaluation of the pelvic floor and abdominal muscles
  • internal muscle assessment - vaginal or rectal
  • bladder or bowel diary
  • pelvic floor education
  • instruction/training of the pelvic floor muscles during lifting and exertion coupled with proper breathing
  • pelvic floor muscle re-education/strengthening/down training/endurance/timing using biofeedback
  • instruction in proper posture for fecal elimination
  • internal therapeutic ultrasound 
  • real-time ultrasonography: used for neuromuscular reeducation, back extensors of the pelvic floor and transverse abdominis 
  • internal connective tissue manual techniques for scar tissue and hypertonic pelvic floor muscles
  • manual therapy
  • Electrical stimulation for pelvic floor re-education and strengthening (as needed)
  • Abdominal stabilization/Core 4 exercises/
  • deep intrinsic trunk muscle synergy, coupled with coordinated breathing 

Our specially trained therapists design a individualized program, which includes a detailed home exercise program with on-going patient education.


A more in-depth look at:

Urinary Incontinence

"What is Urinary Incontinence?"

Urinary incontinence refers to any time that you lose urine when you don’t want to.  Along with leaking, there may be other symptoms:

Urgency:  A strong desire to urinate, even when the bladder is not full.  Pelvic discomfort or pressure sometimes accompanies this.

Frequency:  Urinating more than six to eight times a day or more than once every two hours (with normal fluid intake).

Nocturia:  Awakening from sleep because of the urge to urinate.  This varies with age and is not necessarily abnormal until it occurs regularly more than two or three times a night.

 

Basic Bladder Control

The bladder’s job is to store and empty urine.  When the bladder becomes full, your brain tells your bladder to relax.  You then feel the urge to urinate.

You then urinate by relaxing your sphincter and contracting the bladder’s detrusor muscle.  This pushes the urine out of your body through a tube called the urethra.  Strong sphincter and pelvic floor muscles help keep the urethra closed until you’re ready to urinate.

 

Treating Incontinence

The first step is making an appointment to discuss your problem with your physician, so that any medical conditions that may result in a loss of bladder control may be ruled out.  However, physical therapy can help treat incontinence.

There are two major types of urinary incontinence that benefit form physical therapy treatment: stress and urge.

Stress incontinence involves the sudden involuntary loss of urine when you impose a force on the muscles, such as done by laughing, jumping, or sneezing.  Urine leakage occurs as a result of weak pelvic floor muscles and poor ligament.

Urge Incontinence happens when as soon as you get the urge to urinate, leakage occurs.  The sensation is over whelming, your bladder contracts at the wrong time, and your can’t control it.

 

Physical therapists use a variety of methods to help their patients correct pelvic floor dysfunction.  Physical therapy exercises and modalities can strengthen and coordinate pelvic floor muscles.  Bladder retraining can assist by regaining regular urinary cycles.  Additionally, lifestyle choices, such different food and drink options,  may be discussed so that the bladder will be less irritable.  Together, you and your therapist can help you regain proper functioning of your bladder and life activities.

Fecal Incontinence

"What is Fecal Incontinence?"

Fecal incontinence is having an uncontrolled bowel movement.   Frank fecal incontinence is loss of solid or liquid stool.  Precursor symptoms include soiling, fecal urgency, and flatulence (gas loss).  Although a person may feel as though a bowel movement occurs when it is not intended, fecal incontinence refers to the repeated occurrence of unwanted bowel movements. 

Causes of fecal incontinence:

1) Muscle damage– Common in childbirth with forceps and episiotomy deliveries.  This may also result from rectal surgery, inflammatory bowel disease, or an abscess in the perirectal area.

2) Nerve damage - Childbirth, severe constipation, diabetes, spinal cord tumors, and multiple sclerosis can all have damaging effects on the nerves, especially the puedendal nerve, in the rectal sphincter that control bowel movements.

3) Decreased elasticity - Surgery, radiation, and childbirth can shock and scar the rectum, causing it to stiffen.

4) Anal sphincter mechanical dysfunction - Muscle and fascia strain sometimes occurs post delivery due to straining when voiding.

Physical Therapy Fecal Incontinence Treatment Options 

  - Pelvic floor rehabilitation—normalize pelvic floor function at rest and upon contraction

 - Electrical stimulation—vaginal, rectal (internal or external)

 - Neuromuscular re-education —vaginal, rectal, internal

 - Facilitation– 63-74% Myofascial success with techniques to increase or decrease muscle tension

 - Weights, rectal or vaginal air pressure measurements, EMG muscle recording during exercise

 - Home exercise program for pelvic floor muscle exercises and core stabilization - including back and abdominal muscle      strengthening for spine support

 - Bowel retraining

 - Perineal support during eliminating and orthotic usage during activities of daily living

 - Integration of pelvic floor contractions during activities of daily living

 - Diet education to firm feces