Pelvic Health & Incontinence

Pelvic Pain

Pelvic pain is an “umbrella term” that may include conditions such as:

  • Vulvodynia (pain in the vulvar area, which refers to the female external genital organs including the labia, clitoris, and entrance to the vagina; and pain that also may extend to the area between the vagina and anus, thigh or buttock and is often associated with discomfort in the urethra and rectum)
  • Vagismus (vaginal tightness that causes pain with penetration and makes intercourse painful, difficult and sometimes impossible)
  • Vulvar Vestibulitis (inflammation, redness and pain at the opening of the vagina)
  • Pelvic Muscle Tension Syndromes (pain, tightness or spasm in the pelvic muscles)
  • Coccydynia (pain in the tailbone/coccyx)
  • Endometriosis (tissue similar to the lining of the uterus, also found elsewhere in the body, mainly in the abdominal cavity, with associated pain, especially during menstruation)
  • Dysmenorrheal (pain with menstruation)
  • Dyspareunia (pain with intercourse)
  • Interstitial Cystitis (recurring discomfort or pain in the bladder and the surrounding pelvic region)

Pelvic pain is a condition that affects a number of men and women, but, unfortunately, it also is poorly understood and rarely discussed.

What Causes Pelvic Pain?

A number of body systems may be involved in pelvic pain. These include the reproductive, urinary, gastrointestinal, neurological, psychological, and musculoskeletal systems.

The musculoskeletal system includes the muscles, connective tissues and joints of the pelvis, which are affected by the nerves and blood supply.

The structures of the pelvis are subject to the same causes of pain that affect the low back, knee, or other areas. For example, muscles, ligaments, and tendons can get overstretched, partially torn, or cut during childbirth or surgery, or because of a trauma such as a car accident or sexual abuse.  Or, muscles can become weak from disuse or tight and immobile from injury. Joints may be hypomobile (unable to move as much as it should) or hypermobile (allowing too much motion). Habitual postures, positions, or movements can also slowly stretch or tighten structures around the pelvis and lead to dysfunction and pain.

The abdominal, low back, and hip muscles all attach to the pelvis and affect its position and function. If they are tight or weak the pelvis will be stiff and tight or unstable, or both. Any of these can lead to pain. The pelvic muscles or joints may be the sole cause of pain or they may be just part of the overall problem.

What is Pelvic Floor Dyssynergia?

In most people, the process of contracting and relaxing pelvic muscles comes naturally, and we do not have to think twice about it. When you have pelvic dyssynergia, the muscles in your pelvic floor become uncoordinated. There are 4 types of pelvic dyssynergia, however most patient’s that come to physical therapy face type I or III dyssynergia, in which case they have adequate propulsive pressure or rectal pressure, however either have an inadequate anal relaxation or paradoxical increase in anal pressure. Ultimately these patients are “Fighting against a closed door” when they are straining to have a bowel movement. To sum it up: When you have pelvic floor dyssynergia, the muscles do not relax, resulting in constipation.

This condition can affect men and women and your signs may include:

  • Difficulty passing stool through your rectum
  • Difficulty knowing when you are ready to have a bowel movement
  • Feelings of incomplete bowel movements

We are able to provide educational treatment, including biofeedback training to improve your awareness and coordination of your pelvic muscles, as well as gastrointestinal pain management techniques to help you return to pain free bowl movements.

What is the Pelvic Floor?

Your pelvic floor is made up of a group of muscles and some connective tissue that line the bottom of your pelvis and support your bladder, rectum, and other organs. The pelvic floor muscles are essential for bowel and bladder function. When they contract they help prevent leakage (incontinence) and allow you to “hold it”. However it is equally important to be able to relax them to allow for bowel movements and urination.

How a Physical Therapist Can Help

When the cause of the pain lies in the musculoskeletal system, a person should seek the expertise of a physical therapist, whose knowledge of movement and function is a key to restoring the proper function of the pelvis.

The pelvis serves several important functions in the body. It supports the weight of the body from the vertebral column, and it also protects and supports the lower organs, including the urinary bladder, the reproductive organs, and the developing fetus in a pregnant woman. In addition, nearly every movement and position of the human body relies on the pelvis.

Like the rest of the body, proper activity and balance between all of the muscles, joints, and tissues of the pelvis are essential for pain-free functioning. Your physical therapist will conduct a thorough evaluation of your musculoskeletal system to determine the cause of the problems and will design a program to address those problems.

Physical therapy techniques for joint and soft tissue dysfunction may include exercises, education, soft tissue and joint mobilization; modalities including ultrasound, electrical stimulation, biofeedback, and heat and cold. These techniques are part of a physical therapist program designed to reduce tightness, dysfunction, weakness, and pain in the pelvis.

What musculoskeletal issues are associated with the prenatal and postpartum periods?

The prenatal period is a time of great change for a woman, physically, emotionally, and hormonally. As the fetus grows, the overall musculoskeletal system is challenged by altered posture, shortened muscles, potential muscle imbalances, and changes in spinal mobility. These changes may cause pain and dysfunction. In the postpartum phase, fluctuating hormone levels combined with additional physical changes as a result of delivery may also result in musculoskeletal problems such as excessive joint mobility, weakness of the core stabilizers, and altered spinal mobility and function.

What causes dysfunction in the prenatal and postpartum periods?

Fluctuating hormone levels in both the prenatal and postpartum phases may cause excessive joint mobility which can cause pain and dysfunction. Because of the postural changes associated with pregnancy, some muscles become tight to support the changing posture, while others are stretched and become weak. This results in muscle imbalance and a potential for decreased stabilization. Mobility of the spine can be affected in both the prenatal and the postpartum periods as the spine adjusts to the changing posture as the fetus grows.

What are symptoms of musculoskeletal dysfunction during the prenatal and postpartum periods?

Symptoms of dysfunction may include pain in the joints of the pelvis or spine, muscular pain in the hips and L/E’s, or numbness into the extremities. Weakness may be present in the abdominals, resulting in pain with transitional movements or lifting. Weakness may also be manifested as urinary incontinence in the postpartum period. Muscle imbalance may also cause pain or contribute to urinary issues in the postpartum phase.

How can physical therapy help?

Physical therapists are skilled in evaluating and providing patient centered treatment of musculoskeletal problems. Physical therapists trained in the area of women’s health have further knowledge about issues directly related to women as they move through different stages of life, from childbearing years to the post menopausal period. Physical therapists can provide hands on treatment to address spinal and pelvic joint dysfunction, instruct in exercises to address muscle weakness and imbalance, and provide guidance and instruction related to modifications of activities of daily living that may be difficult during the prenatal and postpartum phases.

Who should be referred to a Pelvic Health Physical Therapist?

Those with:

  • Back, sacral, hip, pelvic, rib pain
  • Decreased ability to do normal daily activities
  • Weak or tight muscles
  • Pelvic pain with sexual intercourse
  • Pain with use of tampons or gynecologic exam
  • Desire to start or continue an exercise program
  • Outlet Dysfunction Constipation
  • Urinary Dysfunction
  • Pressure or pain in pelvis

We examine each individual and develop a plan of care using treatment techniques to promote mobility & flexibility, reduce pain & swelling, restore function, and prevent disability.