Pelvic Health

In both men and women, when the muscles, ligaments and tissues that surround the pelvic area are tight and irritated, the results can be pain, incontinence and many other dysfunctions in the body. The good news is that specialized pelvic floor physical therapy has a very high success rate with no medication.

Our therapists will determine your condition and plan a treatment program based on your specific results. Some of the more common conditions below are underlined. Please click on these conditions for a more detailed explanation of treatment. If you have any questions about your specific diagnosis or our treatments, please don't hesitate to contact us.

Constipation

Constipation is defined as infrequent bowel movements or hard to pass stool. As many as 50% of people with chronic constipation have dysfunction with the pelvic floor. The dysfunction can include difficulty relaxing the pelvic muscles in order for stool to pass and/or difficulty coordinating the relaxation of the pelvic muscles with the use of the abdominal muscles to help evacuate stool. It is not uncommon that coordinating evacuation of stool is difficult for people if they have used laxatives or have suffered from constipation for an extended period of time.

Other signs and symptoms that can fall under the constipation diagnosis are:

  • Hard or thin stools
  • Straining to empty bowels
  • Feelings of incomplete emptying of bowel
  • Abdominal pain
  • Increased time between bowel movements

When mechanical, anatomic and disease related causes of constipation have been ruled out, evaluation by a pelvic health physical therapist can be performed to see if pelvic floor dysfunction is contributing to constipation.

If pelvic muscle dysfunction is found to be contributing, physical therapy may include but is not limited to:

  • Education on how to coordinate abdominal and pelvic muscles during defication
  • Bowel massage techniques
  • Digital examination of the pelvic floor muscles
  • Biofeedback to retrain pelvic floor muscles
  • Diet instruction
  • Stretches and breathing techniques to help relax muscles of the pelvic floor and pelvic girdle

Prolapse

Pelvic organ prolapse is the descent (falling) of one or more of the pelvic organs from its original position in the body in the pelvic cavity. Three types of prolapse can occur: bladder (anterior vaginal wall), the rectum (posterior vaginal wall), the uterus (cervix), or the top of the vagina (vaginal vault) after hysterectomy. Along with vaginal delivery, the probability of prolapse increases with age due to the hormone loss of estrogen, which weakens vaginal support tissue.

The cause of prolapse can be from a lot of factors but is primarily associated with:

  • Pregnancy and vaginal delivery, which leads to direct pelvic floor muscle and connective tissue injury.
  • Hysterectomy
  • Pelvic surgery
  • Conditions associated with sustained episodes of increased intra-abdominal pressure including obesity, chronic cough, constipation, and repeated heavy lifting.

Most patients with pelvic organ prolapse are asymptomatic. Symptoms become more bothersome as the bulge of the organ protrudes to or past the vaginal opening. In these instances it is not uncommon that a woman experiences aching in the pelvis, particularly at the end of the day, or a feeling that you are sitting on something in between your legs.

Urinary incontinence (loss of urine), particularly stress urinary incontinence, can be common in women with prolapse. Stress incontinence is the leaking of urine which occurs when any kind of pressure is put on the bladder such as coughing, exercising, walking or rising from a chair.

Pelvic floor physical therapy is a common conservative approach to help with prolapse symptoms and can include the following:

  • Lifestyle modification education
  • Core exercises and breathing techniques incorporating the pelvic muscles
  • Treatment of chronic constipation
  • Biofeedback for pelvic muscle retraining

Dyspareunia

Dyspareunia is defined as persistent or recurrent genital pain that occurs just before, during or after intercourse, which can affect your sex life, emotional intimacy and your self image.

Specifically, symptoms can include:

  • Pain only at sexual entry
  • Pain with every penetration including putting in a tampon
  • Deep pain with intercourse
  • Burning or aching pain
  • Pain lasting hours after intercourse

Emotions are deeply entwined with sexual activity, so they may play a role in sexual pain. Initial pain can lead to fear of recurring pain, making it difficult to relax, which can lead to more pain.

Pelvic floor physical therapy will include an examination of the pelvic muscles as well as flexibility and strength of the pelvic girdle. Treatment techniques can include:

  • Relaxation strategies including deep breathing and visualization
  • Biofeedback for pelvic muscle retraining
  • Flexibility exercises for the pelvic girdle
  • Instruction on self stretch techniques for the pelvic floor muscles with the use of vaginal dilators

Post Prostate Surgery

There are different treatment options for prostate cancer depending on the severity. Radical prostatectomy, laser surgery, radiation, TURP (transurethral resection of the prostate) and laproscopic surgery are all common options.

Common side effects post surgery include:

  • Pain in the pelvic area (penis, testicles, perineum and lower abdomen)
  • Frequent urination
  • Strong sense of urinary urgency or decreased urge to urinate
  • Urinary leaking or dribbling
  • Difficulty starting or completing urination
  • Pain with orgasm
  • Difficulty getting or maintaining an erection

Pelvic floor physical therapy can often help these symptoms, as they are often the result of pelvic muscle dysfunction. Treatment will include:

  • Biofeedback for pelvic muscle retraining
  • Soft tissue massage to pelvic girdle muscles
  • Education on core and hip strengthening to support the pelvic floor
  • Detailed instruction on home exercise to program for long term management

Urinary & Fecal Incontinence

Urinary incontinence, the loss of bladder control, is a common and often embarrassing problem that can affect your quality of life. The severity of the incontinence can range from leaking urine when you cough or sneeze to having the urge to urinate so strong that you don’t get to the bathroom in time. Many people experience occasional, minor leaks of urine while others may lose moderate amounts of urine more frequently.

Types of urinary incontinence include:

  • Stress incontinence. Urine leaks when you exert pressure on your bladder, which can occur with coughing, sneezing, jumping or lifting something heavy.
  • Urge incontinence. Commonly a sudden, intense urge to urinate followed by an involuntary loss of urine. Urinating frequently can also accompany the strong urge to urinate.
  • Mixed incontinence. The experience of more than one type of urinary incontinence.

Pelvic floor physical therapy is a great conservative approach to treat urinary incontinence. Many people think contractions of the pelvic floor muscles (a.k.a “Kegels”) are all you need to do to fix incontinence, which may or may not be the full answer to the problem.

The pelvic floor muscles are like any other muscle in the body, meaning they need to move through the whole range of motion in order to achieve full strength and work maximally for you. A thorough evaluation by a pelvic specialist will determine if the pelvic muscles are working in their full motion. If they are not, treatment will be focused on achieving the full range of motion before pelvic strengthening will be instructed.

Along with addressing the pelvic floor muscles, treatment may also include the following:

  • Soft tissue massage to the muscles around the pelvis and back
  • Focused strengthening for the core and pelvic girdle
  • Biofeedback for pelvic muscle retraining
  • Education on behavioral techniques to maximize bladder & bowel health