Did you know that in the first trimester of pregnancy the body changes so rapidly that some have calculated it accounts for 80% of the overall preparations for the entire pregnancy! Pelvic floor PT is a “given” in some countries like France, each expectant mom is seen by a therapist for exercise instruction and basic exam for pelvic health. Lots of things can happen over the course of a pregnancy—back or neck pain, pelvic girdle pain, incontinence, diastasis recti, swollen ankles, nerve pain in the arms or legs, hemorrhoids…a pelvic PT can help sort through just about anything.
Much like during pregnancy, post-childbirth bodily changes might warrant a series of sessions with a pelvic floor PT. Common musculoskeletal problems include back or spine pain, rib dysfunction, elbow or wrist pain, nerve pain just about anywhere, pelvic girdle problems such as tailbone, sacral, or pubic pain. Sometimes birthing trauma can cause either laxity of the pelvic muscles, or in some cases, excessive tightness, making vaginal penetration difficult. Childbirth is a major life event and a whole body experience, so a new mom might have pain or dysfunction anywhere head to toe. Pelvic floor PT’s are specially trained to understand the specific needs of this most under-served patient population.
“Diastasis Recti” (DR) commonly occurs during pregnancy or during the childbirth process. It can also occur to individuals of any gender with poor core strength and poor movement strategies especially if they have a job or hobby that increases pressure in the abdomen (think heavy lifting or playing the trumpet.) It is a splitting, widening, or gaping of the abdominal muscles and fascia in the midline of the belly (linea alba,) usually occurring at the bellybutton, but also seen above and below it. We check the actual width and depth of this gaping; in severe cases, we may find a bulge or herniation of abdominal viscera. Special care is taken to rehab this condition.
Surgery can be lifesaving, pain-reducing, and necessary, but it can also lead to other problems such as mobility challenges, pain in the surgical site, muscle tightness around the surgical site, etc. Over time we can even see or feel evidence of deep tightness from possible adhesions or just plain muscle shortening. Depending where the surgery was, we might even experience problems with bowel or bladder functioning, or sexual pain. This is when a pelvic floor PT, with her deep knowledge of abdomino-pelvic anatomy becomes useful.
Urinary incontinence after prostate surgeries or prostatectomy is a common occurrence. Some bladder cancers, and even benign prostate hypertrophy (BPH), can cause the prostate, which has enlarged, to act to stunt the urine flow, so it’s harder to void. In some cases, the pelvic floor muscles have simply become lazy and weak, causing the bladder to leak. Some men try so hard to not leak that they squeeze and overuse their pelvic floor muscles, making them tight and painful. Skilled assessment is always a must, and either manual therapy and biofeedback, or both are used to help recover.
Tailbone or “coccyx” pain often occurs after a fall on the bum, or even just too much sitting, especially if on a hard surface—the coccyx flexes inward, causing possible laxity at the joint where it connects to the sacrum, and pelvic muscle tension. But it can also occur after childbirth, when the coccyx extends backwards, ouch. There is always pelvic muscle involvement, and often other structural issues along the kinetic chain from the feet on up.
There are actually “many” types of Urinary Incontinence or “UI.” Stress UI or “SUIC” or “SUI” occurs when we leak urine due to a physical or mechanical stressor like a hearty laugh, sneeze, or cough. Exercise like lifting a weight (or your baby,) running, squatting, swinging a racket, even laughing can also cause leaking.
Urge UI is exactly what it sounds like: urine loss related to urge. Losing urine on the way to the bathroom, or just as you are sitting down to pee. This urge can also occur with social or environmental triggers, like running water, opening your front door, or driving into your driveway. Your bladder knows when you are close to home and it overreacts, contracting before you are ready! OAB, or “overactive bladder” is related to Urge UI. There are many things to do to treat this such as urge suppression techniques, appropriate PFM exercise, and cognitive behavioral tricks.
In addition to Urge, Stress, and Mixed (both urge and stress) UI, there can be urine loss due to overflow or loss of bladder sensation, UI due to diabetes (too much urine), UI from neurological causes, even functional UI—and inability to get the bathroom quickly enough due to a physical limitation.
Fecal incontinence or “FI” can occur to anyone. It can be very mild with just a rare pebble or smear sans awareness, to a full-blown episode that occurs repeatedly. It can occur with either hard or soft stool. Imperative is finding out the cause. Is there a problem simply with weak PFM or your anal sphincter or is your diet an issue? Constipation can actually cause stool loss too. Pelvic organ prolapse or rectal prolapse can cause FI, along with poor rectal sensation from past trauma or scar tissue. There may be muscle “dyssnergia” or confusion and myriad other possibilities that impact normal stool evacuation. Proper assessment is a must.
A “functional” problem means that it is caused by abnormal “function” rather than something structural like a tumor or fracture. For example, some of these functional GI disorders are caused by an improper breathing pattern that, if identified, can be retrained. There are about 20 different GI disorders that are identified as “functional!” Often these disorders are chronic and hard to diagnose with standard medical testing. To use our example of an altered or inefficient breathing pattern, it’s easy to understand how that wouldn’t show up on an X-ray! Pelvic floor PT can often help with some of these disorders, like IBS and abdomino-phrenic dyssynergia (APD), both of which can cause bloating and abdominal pain.
Constipation has many causes. One cause is at the “outlet” or end of the system, meaning it is the muscles that are not allowing the stool to pass. This is a “functional” problem, as is described above. It could be that the muscles are too tight to allow for normal, easy evacuation, or that there is a biomechanical issue around the outlet. This may even involve your hips. Abnormal relationship between the pelvic outlet and respiratory diaphragm can cause confusion in the system as well.
Pelvic organ prolapse or “POP,” is when one or more of our pelvic organs (bladder, uterus, rectum and in some cases, small bowel or sigmoid) drop into the vagina, or even out of the vagina. While not life threatening, people with vaginas often find this condition extremely worrisome and troubling, even if presenting with little or no actual “symptoms.” The altered body image alone is distressing to many. And patients frequently lament that their health provider minimizes their experience. But the feelings of pressure, heaviness, bulging, and often feeling these symptoms during normal activity can lead to feeling unsafe, unstable, and that even simple activity “makes it worse.” People will limit their activity, exercise, even sex. PT is essential to 1. Understand your POP and what your symptoms and “bother scale” really are so you don’t live your life in fear; 2. Learn creative new ways to move and manage your sx; 3. Get help making decisions about more treatment “if” indicated.
Pain before, during or after vaginal penetration is the “simple” definition for a disorder that is anything but simple. Dyspareunia can be chronic or acute, it can occur superficially “shallow dyspareunia” or with deep penetration “deep dyspareunia,” and there are myriad possible causes including inadequate estrogen/testosterone levels, yeast, dermatological disorders, pelvic muscle imbalance/spasm, vaginitis, vestibulodynia, and more.
Vaginismus implies actual spasming or contraction of the pelvic floor muscles rendering penetration very difficult or impossible. There may be an emotional or psychological component to this. The literature discusses “primary vaginismus,” in which the person has “always” had it, and “secondary vaginismus,” which arose after an incident, like a surgery, accident, or any kind of trauma. Both dyspareunia and vaginismus can prevent vaginal penetration altogether, but with vaginismus there is involuntary muscle spasm. Overcoming vaginismus is hard to do alone. Seek out a skilled and compassionate pelvic floor PT for help.
We know so much more about vulvar vestibulitis now than we did even a few years ago. We know that there are 3 main drivers for it: muscle, hormones, or a neuro-proliferative etiology. A savvy PF PT can perform some tests to help determine the root and then build a treatment program for you that will often include a combination of manual therapy including orthopedic techniques to balance your pelvic girdle and spine/hips, external and internal PF techniques, along with special ex’s to soothe and quiet the nervous system, correct muscle imbalances, and lots of self-care instruction. It also may be appropriate to seek help with diet/nutrition, hormone balancing, or a pain specialist if there is a neuro-proliferative component.
Just like we can hold tension in our shoulders, jaws, neck, and tummy, we can hold tension in the deep muscles of the pelvic floor (PFM.) Normally, our PFM tense and relax throughout the day depending what kind of activity we are doing. Our PFM should automatically tighten if we are lifting a heavy load, then they relax when the task is complete. We might tighten them from a cue from a yoga or Pilates instructor, but after class, they should let go. For some, the letting go doesn’t happen, or it happens, but not well enough. Over time, PFM tension causes pain and other problems like inability to have vaginal penetration, voiding trouble, even problems evacuating bowel.
“IC” or interstitial cystitis is now called “PBS” or painful bladder syndrome, because we don’t always find actual pathology inside the bladder to have symptoms like painful bladder filling, difficulty emptying the bladder, delay of urine stream, urinary urgency & frequency, excessive nighttime voiding, urinary incontinence. Most urologists will perform a cystoscopy to look for bladder lining “ulcers” or inflammation, but sometimes they will refer you immediately to a pelvic floor PT to learn good bladder habits and assess for other problems in the muscles and other regions around the pelvis.
Pundedal neuralgia, or “PN” can be a scary diagnosis to receive. Like the sciatic nerve, which most people have heard of, if not had flare ups with, the pudendal nerve is a major paired nerve of the pelvis, which innervates many of our pelvic muscles, our bowel and bladder, along with skin and tissue. PN can occur after injury or more insidiously after a prolonged sitting situation or some other event that either stretches or compresses the nerve. Neuralgia is hard to treat and you need to see a specialist who truly understands nerve dysfunction to properly treat this condition, as it requires a whole-person approach. It is easily re-injured or exacerbated by certain movements and even other well-meaning therapists because they missed the pudendal symptoms. Common symptoms are pain with sitting, burning/itching/lacerating/dull or achey pain that can occur in the rectum, perineum, inside the sitting bones, or clitoris/penis. Other sx may include bowel and bladder dysfunction of all sorts.
Yes, men can also have chronic pelvic pain. Sadly, the common history we hear from them is that they have visited numerous doctors and been misdiagnosed, given ineffective antibiotic treatment, unnecessary catheterizations or other tests, when the pain generator was simply muscle. While confusing, the diagnosis of “prostatitis” or “prostadynia” are used but a special subset of “non-bacterial, non-inflammatory prostatitis” due to the fact that many of the symptoms mimic that of actual prostatitis: pain, urinary dysfunction, sexual concerns.
Endometriosis is an insidious and challenging diagnosis to receive, and sadly quite prevalent with anywhere from 6.5 to 16% of American women affected. These patients can have a range of symptoms from pelvic pain, abdominal bloating, constipation or urinary problems, to full-blown nerve pain globally. Finding an experienced pelvic floor PT is a must, and most doctors recommend physical therapy for their patients. We can help in so many ways, from balancing the hips and pelvis; softening and retraining tight and painful abdominal and pelvic muscles; to establishing a self-care program and prescribing safe exercises to help you stay strong and ease pain.
Sexual affirmation surgery is an exciting and important step in an individual’s life. Post-surgery complications might include pelvic floor or pelvic girdle pain, incontinence, bowel or bladder difficulty, pain with penetration, difficulty in dilator progression, sexual concerns, upper body pain/fascial restrictions, even learning how to walk or move differently!
Pelvic floor PT can help with a wide range of things, through treatments such as postural corrections, manual therapy, toileting training, and more, and it will be an important part of your healing journey.
It’s just too difficult to describe every single thing that a pelvic floor PT might see. Our patients are typically challenging and some present with conditions that stem from a disease or injury or condition that other PT’s have never heard of. Epididymitis, genito-femoral nerve entrapment, proctalgia fugax, pelvic muscle dyssynergia might all fall into that “unusual” category of diagnoses. If you have pain or problems of a musculo-skeletal-fascial-neural nature in the region of the abdomen, back, pelvis, genitals, or hips, chances are a pelvic floor PT has seen it.