Physical therapy for pelvic floor pain and urinary problems such as incontinence, urge and frequency may be advised by your doctor. The application of therapy for these disorders is not so different than it is for other parts of the body, such as the back or shoulder, but since very few PTs are trained in this specialized treatment, you may not have realized that PT could be an option for you.
Physical therapy can be an excellent tool to aid in your recovery from pelvic pain and many bladder dysfunctions such as urgency, frequency and incontinence since in many cases it can get to the direct cause of your problems. What causes these problems that sometimes seem to start so suddenly? Some of the mechanical changes in the joints of the spine and pelvis come from surgeries in and around the abdomen, back and pelvis. Trauma to this area as well as diseases such as endometrosis can contribute by causing scar tissues that can pull on the internal structures. As we lose normal mobility,our bodies try and make up for this loss in other locations, further adding to dysfunction of the bladder and causing pelvic pain. Complicated pregnancies and births can put the pelvic floor under tremendous stress.
Muscles weakness of the pelvic floor can result and without the proper support, the internal organs can prolapse, or drop down from their normal position. This can add to weakness of the urinary and rectal sphincters and can lead to incontinence. These muscles support the base of the pelvis and it is vital that they have normal strength to function properly and not cause pain or urinary problems. Often there is no one factor that stands out but it can be that it is a compilation of many stressors that lead to your problems. These imbalances can then cause pain and dysfunction in the pelvis and bladder. Sometimes the imbalance will first show up as back or hip pain since these muscles can refer pain to areas in the abdomen, back, hip and even the legs. What seems like two or more different problems can actually come from the same source. It is important to have these muscles assessed to see if they are the source of your pain.
Physical therapy is done by F.E. Boswell, MSPT, who has been practicing PT since 1985 and specializing in pelvic floor disorders since 1998. This is a “hands on” style of therapy called myofascial release that utilizes direct, sustained pressure to release and stretch the areas that have lost their normal range of motion. If the problems are especially complicated, the physical therapist may suggest an internal evaluation.
Only specialized therapists perform these types of evaluations and treatments. This is done through the vagina for women and the rectum for men. The internal assessment is done to identify any internal muscle tightness, weakness and/or joint restriction of the pelvis, sacrum and coccyx (tail bone). This direct treatment can offer relief that often the external treatment cannot fully resolve. The internal evaluation is only performed with your permission and only in cases where it is vital to assessment and treatment of your problem.
Some different types of disorders that can be treated include:
Stress incontinence- This is usually due to weakness of the pelvic floor muscles. You may have been advised to do Kegels but the proper performance is more difficult than we are lead to believe. Often people actually are pushing out and stressing the bladder instead of squeezing and lifting up due to the amount of muscle weakness they have in this area. A direct assessment in your ability to perform a Kegel is very important. It is also important to assess your ability to maintain the contraction of the pelvic floor muscles when you are doing any type of abdominal exercises. Again, you may be relaxing these muscles when you do abdominal training, another stress to the bladder and sphincter. You can learn the proper way to exercise this area in therapy and then apply this information to your home exercise program.
Urge incontinence, urgency and frequency- We have see many of our patients with these type of problems actually have a lot to tightness and trigger points in the muscles of the abdomen, hip, back and pelvic floor. This abnormality of high tone can compress the bladder and give these sensation of a full bladder. Myofascial release to the areas of tightness along with bladder retraining can do much to alleviate your problems.
Interstitial Cystitis-The chronic inflammatory condition of the bladder has no known cause. Some common treatments are medications, bladder instillations and eliminating certain foods, but PT to help relax the pelvic floor muscles may be beneficial as well. Due to the pain and stress involved with IC, these muscles often develop trigger points. After you become familiar with the location of the tense muscle, you can do the trigger point releases on your own.
Dyspareunia- Pain with sexual intercourse can be so intense that many women elect not to have sex rather than subject themselves to the pain. Gentle stretching and trigger point release along with relaxation techniques can often help.
Endometrosis and chronic pelvic pain-Chronic pelvic pain can occur with endometrosis although the pain is not related to the extent or stage of this disease. It leads to adhesions which may spread to various sites such as surgical abdominal incision. Less commonly it can even spread as far away as the respiratory diaphragm and rarely, even the lungs or central nervous system. A common physical therapy treatment for the pain is the soft tissue release of the adhesions in the restricted area, such as the abdomen. A regular home program of stretching on a small inflatable ball can help you maintain the mobility you gain with the therapy. Internal treatment can be performed as well to the adhesions of the pelvic floor and deep hip rotator muscles. Talk with your doctor if you feel you may be helped with physical therapy. Our staff can check on your insurance coverage and set up an appointment for an evaluation and your first treatment. Thank you and we look forward to helping you find the solutions for your problems.
