June 20, 2024
Pelvic health focuses on a group of conditions in both men and women that may interfere with bowel or bladder control, sexual health, and chronic pelvic pain. The unique anatomy and function of the pelvic floor and surrounding joints and muscles is the primary focus of this type of physical therapy. Pelvic Floor Dysfunction is when your pelvic floor and surrounding muscles are not working efficiently. We often get stuck in patterns and stop moving in multiple planes of movement, which can contribute to this dysfunction. In some cases, our pelvic floor muscles can be weak or underactive, and in other cases, the pelvic floor can be tight or overactive. The treatment can vary depending on which condition you may have, but in both situations, moving more and in multiple planes of movement often has the most impact.
Pelvic floor dysfunction can present itself with many symptoms and in many ways. – Incontinence of urine (whether full loss of urine or just little dribbles) is the most talked about but not the only issue that we can help with. – Leakage of stool as well as lack of control passing gas. – Urinary urgency and frequency – Voiding dysfunctions such as hesitancy starting stream, straining to void, or a sense of incomplete emptying – Pelvic Organ Prolapse – Painful intercourse, pain with using tampons or menstrual cups, pain with gynecological examinations – Lower abdominal pain (especially prevalent if you have any old abdominal incision/scar) – Low back pain, SIJ pain, hip pain – Constipation, straining to defecate, and pain with bowel movements.
The answer is “it depends.” If muscle tone is too high – from trauma, stress, abnormal posture or other reasons – the exercise focus is to relax and “down train” the pelvic floor. If the pelvic floor is weak or tone is low, exercises focus on strengthening the pelvic floor. But again, in both situations, moving more and in multiple planes of movement often makes the most impact. Addressing other limitations in strength and mobility of surrounding joints/muscles is essential. All therapeutic exercise is unique and specific to the individual’s need.
Depending on the exact diagnosis and condition, pelvic health physical therapy includes specific patient education, manual therapy techniques as needed (possibly both internal and external work if you are comfortable with this), therapeutic exercise and home program guidance. Occasionally we may recommend use of supplemental modalities such as biofeedback, dilators, or pelvic wand work. Traditional orthopedic physical therapy will be used to address thoracic and lumbar spine, SIJ, and hip dysfunctions that all likely contribute to how your pelvic floor is working. Education may focus on hydration and nutrition recommendations, teaching how to suppress urges and retrain your bladder, breathing strategies to help calm your autonomic nervous system as well as decrease pressure, and methods to improve control. All treatments are discussed with the patient first so the best pelvic floor rehabilitation plan can be implemented, and only with our patient’s consent.