The Pelvic Health and Wellness Program helps people with pelvic floor disorders Love Your Life! Pelvic floor disorders cause uncomfortable symptoms, such as urine leakage and constipation, and lead to embarrassing limitations in daily life. Many people are so embarrassed by these issues that they don’t seek help. They also don’t know that pelvic physical therapy treatment is supported by very strong research (evidence-based) and is highly effective. It involves no medication or surgery. Enjoying a life with good bladder and bowel control, physical activity, laughter, and sexual health requires healthy pelvic floor muscles. At FYZICAL Therapy and Balance Centers, we believe that having a healthy pelvic floor will help you to Love Your Life!
Pelvic floor disorders are a group of conditions, listed below, that affect the pelvic floor. The pelvic floor is made up of skin, muscles, ligaments, connective tissue, nerves, blood vessels, and organs in the pelvis. The pelvic floor supports the body, stabilizes the pelvic girdle and spine, and supports the bladder and pelvic organs. Pelvic floor disorders are common and affect both men and women of all ages. Physical therapy treatment of pelvic floor disorders is highly specialized and is provided only by physical therapists that have completed advanced post-graduate education and training.
Pelvic Floor Disorders - 4 categories. Many people have more than one disorder
Bladder Control Problems – Affects 35% of all women, 50% of women over the age of 65, & 25% of all men
Urinary incontinence- unintentional urine leakage of any amount, at any time
Urinary urgency – experiencing a sudden strong urge to urinate that is difficult to defer
Urinary frequency- urinating more than 8 times in 24 hours
Nocturia- waking more than one time per night to urinate
Difficulty emptying the bladder – incomplete bladder emptying
Pelvic organ prolapse- “dropped bladder” or cystocele
Bowel Control Problems
Constipation / obstructed defecation- difficulty emptying the bowels, incomplete bowel emptying
Fecal incontinence- unintentional leakage of any amount of stool at any time
Fecal urgency- difficulty or inability to defer the urge to have a bowel movement
Pelvic organ prolapse- rectocele
Pelvic Pain Problems
Bladder pain- painful urination, pain after urinating, interstitial cystitis
Pain with bowel movements
Painful abdominal scars- abdominal nerve entrapments, trigger points
Painful/limited vaginal penetration in women – dyspareunia, difficulty with gynecological exams, post radiation narrowing of the vaginal canal
Sexual Pain – pain during arousal, during or after intercourse, or after climax
Postpartum perineal pain- pain from perineal injury or episiotomy sustained during vaginal delivery
Coccydynia- tailbone pain
Vulvar pain conditions – vulvodynia, vestibulodynia
Post-surgical rehabilitation after hysterectomy or reconstruction
Pelvic Girdle Pain Problems – affect 50-70% of women in pregnancy
Pelvic girdle and back pain during pregnancy and postpartum
Sacroiliac joint pain
Pubic symphysis dysfunction
Cesarean section recovery – complications from C-section
Components of Pelvic Floor Physical Therapy Rehabilitation: (downloadable pdf? )
At FYZICAL, our pelvic health physical therapists provide discreet personal evaluation and treatment sessions in a private room.
- Examination: Comprehensive physical examination of the pelvic girdle, abdominal wall, and pelvic floor muscles including an internal vaginal and/or rectal muscle examination of the pelvic floor muscles.
- Patient Centered Plan of Care: Physical therapist partners with a patient to agree on a plan of care and treatment goals including a timeline for achievement of goals. The plan is shared with referring medical provider for a collaborative approach to care.
- Pelvic Floor Muscle Training: Specific progressive exercises of pelvic floor muscles focusing on correct contraction, motor control, timing, coordination, isolation, endurance, and strength.
- Manual Therapy: Manual techniques to restore musculoskeletal function including myofascial and trigger point release, joint mobilization, and more.
- Behavioral and Cognitive Strategies and Interventions: Analysis of the patient’s fluid and food intake related to voiding and bowel patterns and habits. Options include: fluid management strategies, bladder training, timed voiding, habit training, and urgency inhibition strategies. Cognitive strategies related to pain.
- Biofeedback: Surface perineal EMG biofeedback to the pelvic floor muscles and abdominal muscles allow the patient to improve awareness, proprioception, and control of the muscles in order to perform muscle contraction and relaxation correctly and effectively. Sensors are either internal vaginal or rectal, or external.
- Electrical stimulation: First line of treatment for mixed and urge incontinence and nocturia. Options include internal vaginal or rectal or external neuromuscular electrical stimulation (NMES). NMES inhibit or calm the overactive bladder, and may improve contraction of weak pelvic floor muscles. Transcutaneous electrical stimulation (TENS) may be prescribed for the treatment of pain. Patients may benefit from the use of a stimulation unit to use at home.
- Cold Laser: Stimulates tissue healing and repair, and reduces pain
- Core Muscle Strengthening: Exercises to optimize core muscle strength and function
- Functional training: Training for correct positions for urination and defecation. Incorporation of active pelvic floor muscle contraction into daily activities to optimize the success of long-term efficacy of pelvic floor muscle training. May include progressive vaginal dilation for painful intercourse.
Pelvic Floor Rehabilitation is strongly supported by the American College of Physicians, the American Medical Society, and the International Continence Society and overwhelmingly in the literature as the first line of treatment for stress, urge, and mixed urinary incontinence.
Qaseem A, et al. Nonsurgical Management of Urinary Incontinence in Women: A Clinical Practice Guideline From the American College of Physicians Ann Intern Med. 2014; 161:429-440.