Pelvic floor dysfunction is seldom discussed in private, much less public forum. This is unfortunate as it is both prevalent and managabe. The pelvic floor consists of 2 layers of skeletal muscles, sphincters, a mesh of connective tissue, and a plexus of nerves and blood supply. It rests in the base of the bony pelvic girdle and helps give support to the abdominal viscera and the pelvic girdle and is intimately related to low back and hip function. Dysfunctions of the pelvic floor include but are not limited to incontinence of bowel or bladder, pelvic pain at rest or with penetration, pelvic organ prolapsed, and chronic constipation. We will discuss urinary incontinence and pelvic pain focusing on research proven physical therapy interventions for each.
Physical Therapy treats pelvic floor dysfunction form a musculoskeletal and neuromuscular approach beginning with a thorough musculoskeletal exam. If incontinence is the primary complaint, the client will fill out a three day voiding diary to help quantify symptoms, identify bladder or bowel irritants, recognize inappropriate habitual management techniques, and determine the amount of time the bladder can hold urine. If the client gives informed consent an external and internal pelvic floor exam will follow. This allows the clinician to assess resting tone, neural control, and strength of the pelvic floor muscles, as well as pelvic organ prolapse. In pelvic pain clients it allows assessment of scar tissue mobility and trigger points.
Stress incontinence is the leakage of small amounts of urine with exertion of force like sneezing or lifting. Urge incontinence is the inability to control a powerful urge resulting in a large loss of urine. Often those with stress incontinence will dehydrate themselves for fear of leakage and begin bad habits including “just in case voiding” and these lead to urge incontinence. Therefore, these often occur in concert. Over 22.5 million women in the U.S. experience urinary incontinence and an estimated 16 billion dollars is spent yearly in management. Why then is it not discussed more openly? Women use feminine hygiene products from an early age and many have accepted the misconception that urinary incontinence is a natural part of the aging process. It is never normal to leak urine! Women at risk are those who participate in high impact sports, who have had a child via vaginal delivery or who labored for over an hour before c-section, who have experienced an abdominal or pelvic surgery, and who are postmenopausal due to changes in pelvic blood supply. Physical Therapy treatment is aimed at strengthening the pelvic floor and educating the patient to promote healthy bladder habits.
Pelvic pain can occur for many reasons and is often linked to a hyperactive, high tone pelvic floor. This abnormal resting tone may be due to trauma, scar tissue, neural dysfunction, or muscle imbalance. Trigger points often develop in the larger, deeper of the 2 layers of pelvic floor muscles. Scar tissue formed by trauma or surgery can be hypersensitive causing burning with touch or stretch. It can also interfere with normal mobility of adjacent tissue to include nerve mobility. Physical Therapy focuses on down training overactive muscles, quieting trigger points, and restoring normalmobility to scar tissue.
Upon completion of the evaluation, I personalize a plan of care focused on the client’s complaints, impairments, and lifestyle. This is the strength of the Physical Therapy approach, and the key to successful outcomes for my clients. Physical Therapists have several modalities available to promote maximum medical improvement: electrical stimulation and biofeedback for strengthening, bladder re-education, and pain management; vaginal dilators for tissue re-education; and vaginal weights for strengthening. Clients can rent and purchase home units if needed to allow for ease of compliance and continuation with the program after being discharged from care.Stress incontinence is often resolved in only four to six treatment visits. Don’t continue to suffer pelvic floor dysfunction in silence. The American Physical Therapy Association can help you find a qualified therapist.
If you suspect you or someone you know is suffering from pelvic floor dysfunction, please contact us immediately! Call us at (904) 217-0520 or email us at firstname.lastname@example.org or go to our website www.longevityptcenter.com. At Longevity Physical Therapy St. Augustine we can help you get back to your better self!