Advanced Physical Therapy

Pelvic Floor Dysfunction

Where is my pelvic Floor, or what is it?

The pelvic floor includes the muscles, ligaments and connective tissue in the lowest part of the pelvis. It supports your organs, including the bowel, bladder, uterus, vagina, and rectum. The pelvic floor prevents these organs from falling down or out of your body. It also helps the organs function properly.

What is pelvic floor dysfunction?

Pelvic floor dysfunction refers to a wide range of issues that occur when muscles of the pelvic floor are weak, tight, or there is an impairment of the sacroiliac joint, lower back, coccyx, or hip joints. Tissues surrounding the pelvic organs may have increased or decreased sensitivity or irritation resulting in pelvic pain. Many times, the underlying cause of pelvic pain is difficult to determine.

Pelvic floor dysfunction may include any of a group of clinical conditions:

  • Urinary Incontinence

  • Fecal Incontinence

  • Pelvic Organ Prolapse

  • Sensory and emptying issues of the lower urinary tract

  • Defacatory Dysfunction

  • Sexual Dysfunction

  • Chronic Pain Syndromes

The major known causes include obesity, diet, smoking history, menopause, pregnancy and childbirth. Some women may be more likely to developing pelvic floor dysfunction because of an inherited deficiency in their collagen type. Studies suggest some women may have congenitally weak connective tissue and fascia and are therefore at risk of stress urinary incontinence and pelvic organ prolapse.

Bladder Disorders: 

  • Prostatitis /Prostatodynia (inflammation of the prostate gland)
  • Interstitial Cystitis (also called painful bladder syndrome — is a chronic condition causing bladder pressure, bladder pain and sometimes pelvic pain. The pain ranges from mild discomfort to severe.)
  • Cystocele (also called anterior prolapse -- occurs when the supportive tissue between a woman's bladder and vaginal wall weakens and stretches, allowing the bladder to bulge into the vagina. Anterior prolapse is also called a prolapsed bladder.)
  • Urinary Incontinence
    • Stress Incontinence (happens when physical movement or activity — such as coughing, sneezing, running or heavy lifting — puts pressure (stress) on your bladder.)
    • Urge Incontinence (a sudden, intense urge to urinate followed by an involuntary loss of urine)
    • Mixed Incontinence (shares the causes of both stress incontinence and urge incontinence)

Bowel Disorders:

  • Irritable Bowel Syndrome (IBS) (a common disorder that affects the large intestine (colon). IBS commonly causes cramping, abdominal pain, bloating, gas, diarrhea and constipation. IBS is a chronic condition that you will need to manage long term.)
  • Constipation (infrequent bowel movements or difficult passage of stools that persists for several weeks or longer)
  • Dyssynergia with bowel movements (a condition in which there is a problem with the way certain nerves and muscles function in the pelvic floor)
  • Fecal Incontinence (uncontrollable loss of rectal contents)

Pelvic Pain Conditions and Other Dysfunctions:

  • Levator Ani Syndrome (People who have levator ani syndrome report tenderness in the levator muscle of the pelvis when it is touched during a rectal examination.)
  • Pudendal Neuralgia (is a chronic and painful condition that occurs in both men and women, although studies reveal that about two-thirds of those with the disease are women. The primary symptom is pain in the genitals or the anal-rectal area and the immense discomfort is usually worse when sitting.)
  • Dyspareunia (difficult or painful sexual intercourse)

  • Vaginismus (vagina muscles squeeze or spasm when something is entering it, like a tampon or a penis. It can be mildly uncomfortable, or it can be painful.)

  • Vulvodynia (chronic vulvar pain with no known cause)

  • Vulvar Vestibulitis (a condition that causes redness and pain of the vulvar vestibule.  Vestibulitis is an inflammation of this skin and the mucous secreting glands found in the skin. The mucous secreting glands are called the lesser vestibular glands. Vestibulitis may include all the area around the opening of the vagina but is most commonly seen in the lower part.) 
  • Pelvic Inflammatory Disease (PID) (is an infection of the upper part of the female reproductive system namely the uterus, Fallopian tubes, ovaries, and inside of the pelvis)

  • Pelvic Congestion (a chronic medical condition in women caused by varicose veins in the lower abdomen. The condition causes chronic pain, often manifesting as a constant dull ache, which can be aggravated by standing.)

  • Erectile Dysfunction

  • Prostatodynia (chronic male pelvic pain where the patient might display symptoms (including chills, fever, pain in the lower back and genital area, body aches, burning or painful urination, and the frequent and urgent need to urinate)
  • Prostatitis (a condition where the prostate becomes becomes swollen, tender, and inflamed)

  • Proctalgia Fugax (a severe, episodic pain in the regions of the rectum and anus. It can be caused by cramp of the levator ani muscle, particularly in the pubococcygeal part)
  • Lichens Sclerosus (an uncommon condition that creates patchy, white skin that's thinner than normal. Lichen sclerosus can affect skin anywhere on your body. But it most often involves skin of the vulva, foreskin of the penis or skin around the anus.)

  • Lichens Planus (is an inflammatory condition that can affect the skin of the mucous membranes of the vagina. Lichens Planus forms lacy white patches, sometimes with painful sores.)

  • Coccydynia (tailbone pain)

  • Endometriosis (is an often painful disorder in which tissue that normally lines the inside of your uterus — the endometrium — grows outside your uterus)

Can physical therapy help?

At Advanced Physical Therapy Center, we have specially trained physical therapists who have continuing education or a certification in the treatment of disorders of the pelvic floor. They have hundreds to thousands of hours of experience and have extensive training in the diagnosis, evaluation and treatment of these disorders.  

Physical Therapy Treatment Plan:

The first step in treating these conditions depends on the diagnosis and a careful evaluation by the physical therapist. Part of the evaluation process includes a postural analysis (including assessment of pelvis/ sacrum alignment); gait analysis; orthopedic screen; neurological screen (reflexes, nerve tension, and/ or sensation testing); observation of the pelvic floor (skin integrity, signs of lack of estrogen/ thinning of tissues, skin color, presence of caruncle?); visually assess bearing down vs. resting of the pelvic floor; and external (around the pelvic clock) and internal (vagina &/or rectum) palpitation.  The practitioner might also use biofeedback to assess tone, pressure generation and the ability to transition from contraction to rest.

Depending on what the therapist finds, we may use the following to correct these conditions and improve symptoms and function: electrical stimulation, manual therapy techniques, biofeedback, pelvic floor muscle training and core strengthening. The physical therapist will also educate the patient on methods that will relieve symptoms in daily routines and provide helpful suggestions to avoid these issues in the future.

After your initial prescription for physical therapy is completed, your physician and physical therapist will decide if you need to continue physical therapy or if you will be discharged to a home exercise program.

This information is provided as a learning resource for the benefit of our patients. It is NOT INTENDED to replace personal consultation with your medical professionals.

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