Women’s Pelvic Health

Women’s health physical therapy is an area of rehabilitation that specializes in the unique needs of woman throughout their lifecycle. Starting from the young female athlete, before, during and after pregnancy, through stages of menopause and elderly woman all can receive functional improvements from a women’s health physical therapist. The following is a list of some of the most common conditions a pelvic floor women’s health therapist may treat.

Pelvic Pain

Woman’s health physical therapists successfully treat women suffering from pelvic pain. Pelvic pain can originate from many areas in the body but still present itself as pelvic girdle, groin, vaginal, rectal or perineal pain. It can stem from many sources including the pelvic organs or from the joints in the spine, pelvic girdle or hips. All of these areas of dysfunction can present itself as similar symptoms of vaginal pain, pain with sexual intercourse or killer pain associated with menstrual periods. Other possible causes of pelvic pain are from scar adhesions from an episiotomy, cesarean or other previous abdominal surgical scars. Decreased abdominal organ mobility also known as visceral restrictions can also contribute to pelvic pain.

Pelvic pain can lead to muscle spasms in the pelvic floor muscles. The pelvic floor muscles are a group of muscles that span from the pubic bone to the tailbone. Hence, making up the floor of the pelvis. With dysfunction, these muscles can become hypertonic or result in a muscle spasm that does not relax or the opposite can occur, the pelvic floor muscles can become weak and atrophy. Both non-relaxing and weak pelvic floor muscles can be a major contributor of pelvic pain. A skilled pelvic floor physical therapist will identify and treat the root causes of your pelvic pain.

Various Diagnoses used for Pelvic Pain

  • *Dyspareunia
    Dyspareunia is pain associated with vaginal penetration during sexual intercourse. Dyspareunia often occurs after pregnancy at 3 months postpartum or it can be associated with endometriosis, menopause, pelvic congestion, interstitial cystitis (IC), levator ani syndrome, and uterine retroversion.
  • *Interstitial Cystitis
    Interstitial Cystitis aka Painful Bladder Syndrome is defined as chronic pelvic pain (lasting >6 months), pressure or discomfort perceived to be related to the urinary bladder and accompanied by at least one other urinary symptom such as increased urinary urge or frequency. (van de merwe et al 2008) Pain may occur in the urethra, vulva, vagina, rectum, low back and/or abdomen. It may worsen by eating specific foods.
  • *Levator Ani Syndrome
    The levator ani is a group of deep muscles in the pelvis. They extend from the pubic bone in the front to the coccyx in the back of the pelvis. These muscles support the bladder, rectum and uterus (in women). Symptoms occur when these deep muscles become too tight or don’t relax. Complaints of a constant or frequent pain in the rectum or anus is experienced. Patients often describe their symptoms as a feeling that they are sitting on a golf ball. Sitting frequently makes these symptom worse. Besides pain, patients may also experience sexual dysfunction as well as issues with the function of their bowel and bladder.
  • *Vulvodynia
    Vulvodynia is pain or discomfort at the vulva lasting >3 months that usually presents as burning pain.
    Check out the National Vulvodynia Association website for more information: https://www.nva.org/
  • *Pelvic Floor Dysfunction
    The pelvic floor is a group of muscles and connective tissue that sits at the floor of the pelvis. They span from the pubic bone to the tailbone. The function of these muscles are to support the pelvic organs: bladder, uterus and rectum, prevent incontinence, allow for ease of defecation and urination and they provide a sexual function. Dysfunction of the joints in the pelvic girdle, spine or emotional stress can cause these muscles to become weak and lax or develop tightness and muscle spasms. Normal muscle tone and coordination of these muscles are vital for pelvic function and to avoid pain. Pelvic floor dysfunction can cause symptoms of constipation, painful sexual intercourse, pelvic organ prolapse, urinary frequency, chronic pelvic pain and both urinary and fecal incontinence.
  • *Endometriosis
    Endometriosis, commonly referred to as “endo”, is a common condition that causes chronic pelvic and/or abdominal pain and painful periods. Endometriosis is a condition where the lining of the uterus (endometrial tissue) is deposited anywhere in the abdominal cavity including on the bladder, ovaries, bowel and other internal organs. Endo is a complex condition and may present differently for each woman. Symptoms can vary from mild to severe but are usually cyclical like their menstrual cycle.
    To learn more about endometriosis and how physical therapy can help, click here.
  • *Vaginismus
    Vaginismus is instantaneous and involuntary (psychosomatic) tightening of the pelvic floor muscles in anticipation of vaginal penetration causing the inability to participate in sexual intercourse.

Urinary Incontinence

Urinary incontinence is an involuntary leakage of urine. Over 13 million Americans suffer with this disorder, 25% of them are young women and 44-57% are middle-aged postmenopausal women. Although this is common problem, most people don’t talk about it, nor do they seek help for this condition until it gets severe. Delaying treatment occurs because most women are embarrassed to talk about incontinence and they falsely believe the only cure is invasive surgery. Well there is great news; physical therapy is an effective conservative treatment for four types of urinary incontinence.

  • *Stress Urinary Incontinence
    Stress urinary incontinence is the involuntary leakage of urine that occurs during coughing, sneezing, laughing, exercise and lifting. Leakage occurs when the intra abdominal pressure exceeds the urethral closure pressure. A combination of weak pelvic floor and abdominal muscles contribute to this disorder. A history of low back pain and pelvic pain can also add to inhibition and weakness of these muscles, which can exacerbate this condition.
  • *Urge Urinary Incontinence
    Urge urinary incontinence is the involuntary leakage of urine associated with a strong urge to urinate. Those suffering with this condition will frequently leak urine on the way to the bathroom or during the sound of running water.
  • *Mixed Urinary Incontinence
    Mixed urinary incontinence is a combination of both stress and urge urinary incontinence. Those suffering from mixed incontinence leak during coughing, sneezing laughing and while experiencing a strong urge to urinate.
  • *Functional Incontinence
    Functional incontinence occurs when you are functionally limited and can’t get to the bathroom in time. An example may be elderly woman who has severe arthritis or other medical condition contributing to slow ambulation, too slow to get to the toilet in time.

Organ Prolapse

The pelvic organs: bladder, uterus, intestines and rectum sit at the base of your pelvis and are supported by pelvic ligaments and 3 layers of pelvic floor muscles. Due to a variety of factors such as weakness of the pelvic floor muscles, ligamentous laxity, straining while lifting and during bowel movements and genetics can cause these pelvic organs to slip down into the vagina. Prolapse can cause symptoms of pelvic pain, pressure, heaviness, difficulty to initiate and maintain the normal stream of urine, difficulty having bowel movements and a sense that your organs or something is slipping out of your vagina.

There are different names for prolapse depending on what organ is falling downward. If the bladder is descending it is called a cystocele, if the rectum is falling it is called a rectocele, dropping of the intestines is called enterocoele and if the uterus is the problem, it is named a uterine prolapse.

Organ prolapse is graded regarding the amount of dropping of the organ. If the organ drops to the top half of the vagina it is grade 1 prolapse and if it drops to bottom half of the vagina it is a grade 2 prolapse. If the organ lies at the opening of the vagina it is a grade 3 prolapse and a grade 4 prolapse is when the organ drops outside of the vagina.

Physical therapists can help alleviate the symptoms associated with grades 1-3 prolapse. A complete pelvic floor muscle rehabilitation program is indicated. Therapy will include many methods of strengthening, relaxing and coordination of the pelvic floor muscles with the diaphragm and abdominal muscles. Resolving constipation and avoiding straining are other important aspects of treatment. Functional kegels will be addressed during treatment. Functional kegels are pelvic floor muscle exercises that are performed during activities that can strain the pelvic floor region such as: lifting, coughing, sneezing and during various fitness exercises.

Surgery or a pessary (prosthetic device) are needed for correction of a grade 4 prolapse. Physical therapy is crucial before and after surgical correction. Pelvic floor muscle rehabilitation as well as instruction on how to return to exercise and lifting in a safe manner after surgical correction is recommended . Research shows that post surgical recurrence rate of prolapse is 31-59%. Physical therapy can help reduce the recurrence rate of prolapse after surgery.

What to Expect During Therapy

A woman’s health physical therapist will provide a thorough subjective and objective evaluation and develop a treatment program specific to your problems and goals.

Treatments may include one or more of the following:

Manual Therapy

Manual therapy is used to reduce muscle guarding and spasms, joint mobilization or muscle energy techniques to correct a rotated pelvis, sacroiliac joint or misaligned cervical, thoracic or lumbar vertebrae.

Visceral Mobilization

Visceral mobilization treatments may also be needed to improve mobility of restricted abdominal organs.

Therapeutic Exercises

Therapeutic exercises will be prescribed to correct areas of muscle weakness, muscle imbalances or muscle tightness.

Neuro-Muscular Reeducation

Neuro-muscular reeducation is provided to instruct patients on proper posture alignment, spine stabilization and facilitation techniques for weak muscles such as those in the pelvic floor.

Specific Functional Training

Specific functional training will be provided geared toward your specific goals. Functional activities may include instructions on proper posture while nursing your infant. Correct body mechanics education to learn how to correctly lift or bath your toddler to eliminate undue stress to your joints. For a woman suffering from urine leakage, functional training may include education on bladder training or foods that may irritate their bladder and cause urgency and frequency. Constipation tips such as fiber, hydration and positioning tips will be provided for those suffering with any pelvic floor condition. Constipation tips such as fiber, hydration and positioning tips will be provided for those suffering with any pelvic floor condition.

EMG Biofeedback

A device that utilizes electrodes to pick up, measure and treat muscle weakness in pelvic and abdominal areas. The electrodes transmit this electrical signal to a computer screen so the patients can see when and how strong their muscles are contracting so they can learn to strengthen very weak muscles.

If pelvic muscles are very weak it may be difficult to find and exercise the correct muscles. Physical therapists may utilize EMG biofeedback or manual techniques to help women identify and strengthen the correct muscles.

Electric Stimulation

Another device that may be utilized is electrical stimulation. This device utilizes a vaginal electrode that stimulates the pelvic floor muscles to contract artificially. With this facilitation, the patient can identify the correct muscles and begin their rehabilitation process.

Women’s Health Specialists

For more information here are a list of reputable websites:

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