Pelvic Health Physical Therapy and How it Can Help You.

Abigail Taylor, BS, PTA, Women’s Health specialist, employee of CPR

Physical Therapy is a well known practice that is often utilized as the first defense for non-invasive rehabilitation. Often, traditional physical therapy focuses on the loss of function or pain of the larger extremities such as the shoulder or knee. What is commonly missed when seeking physical therapy is dysfunction related to the pelvis as it can either feel uncomfortable for patients to speak about or not considered as something that can be addressed at physical therapy.

This is where pelvic physical therapy comes into the conversation. Pelvic Health Physical Therapy is the rehabilitation of the pelvic muscles and nearby structures to address a variety of pelvic dysfunction such as urinary incontinence, pelvic pain, and constipation to name a few.(Bergmahns,2006) This specialty utilizes a variety of treatment options to improve patients' understanding of their pelvic anatomy and function as well as address symptoms.

What can be treated by pelvic rehab?

Listed below you will find the most commonly treated pelvic conditions and symptoms that pelvic physical therapy can address.

Conditions may include:

Pregnancy and post-partum

This population has the highest need for pelvic physical therapy as the structures of the pelvis, abdomen and low back change as the mother progresses through her pregnancy and after delivery.

• Pubic symphysis and sacroiliac joint pain
• Diastasis Recti: During pregnancy the tissue between the rectus abdominus muscle can become stretched and lose its tensile strength causing abdominal doming or “gapping” between the abdominal muscles.
• Pelvic organ prolapse: The three pelvic organs including the bladder, rectum, and uterus may lose their structural support and begin dropping down through the vaginal or rectal area causing discomfort and dysfunction.
• C-section scar mobility
• General physical conditioning

Stress, Urge and Fecal Incontinence

Bowel and bladder dysfunction are the number one most referred conditions for pelvic physical therapy as they have the largest impact in both male and female quality of life. (Bergmahns,2006)

• Stress incontinence: This occurs when intra-abdominal pressure inside the abdomen increases when coughing, sneezing, laughing or jumping, therefore placing stress on the bladder. If the pelvic floor muscles do not have proper coordination to manage this pressure leakage may occur.
• Urge incontinence: This occurs when there is a strong urge to urinate followed by urinary incontinence. The bladder should send 3 urge signals to let you know when it is time to urinate. Because the bladder is very trainable, bad habits such as “just in case” bathroom trips can mix up these signals and train the bladder to be very sensitive to urinary filling.
• Urinary and fecal incontinence: Both include the inability to control the bowels and bladder leading to fecal or urinary loss. There are many conditions that can contribute to this such as surgery to the pelvic region or poor pelvic muscle coordination and strength.

Pelvic Pain, Including Hip & Low Back Pain

Pelvic, low back, and hip pain can be described by a variety of conditions some which may include:

• Vaginismus: Involuntary contraction of the pelvic floor muscles.
• Dyspareunia: Pain with intercourse.
• Pelvic hypertonicity: Tension of the pelvic muscles that prevent the ability to relax the muscles. This can lead to difficulty urinating or passing stool.
• Pelvic muscle weakness.
• Poor core, hip and low back mobility and stability.

Constipation and abdominal pain

Constipation is the inability to have a daily bowel movement which may lead to difficulty passing stool or emptying bowels. Constipation may be affected by poor fiber and water intake as well as abdominal and pelvic muscle tension.

What Treatment to Expect at Pelvic Rehab?

Treatments that may be performed in pelvic rehab may include but are not limited to:

• Education

In pelvic rehab the goal is to help patients gain awareness of their own pelvic anatomy and the normal functioning of the body. This education is provided in a variety of ways such as use of a pelvic model to show muscular anatomy or written education on their condition.

•  Internal Pelvic Muscle Assessment

With consent from the patient, the highly trained therapist may perform a vaginal or rectal assessment to better aid in diagnosing and treating the internal pelvic muscles and bony structures.  

•  External Biofeedback

External biofeedback requires placing two sensors outside of the anal space. Because muscles can produce electrical impulses when they contract, the machine can pick up on this and provide a visual aid to determine whether or not the pelvic muscles are able to contract or relax. (Hite et al.,2021)

•  Transabdominal Ultrasound

Ultrasound is utilized to provide a visual aid in improving the patient’s awareness of their pelvic and abdominal muscles ability to contract and relax. Ultrasound may also be used to assess the bladder as it can detect whether or not a bladder can fully empty after urination. (Whittaker et al.,2007)

• Exercise and Mobility Training for the Pelvic Muscles

The weak pelvic floor muscles: The patient may be trained to perform “Kegels”. This is a voluntary contraction of the muscles to promote strength and endurance. (Wallace et al.,2019)

The hypertonic pelvic floor muscles: When unnecessary tension is present in the pelvic muscles techniques such as diaphragmatic breathing and pelvic floor muscle lengthening stretches may be utilized. (Wallace et al.,2019)

• Bladder and bowel retraining

In pelvic rehab the patient can expect utilizing a daily voiding log to track their bowel and bladder habits which include: fluid/food intake, urinary and bowel frequency/amount, leakage, and urgency. This tool better helps the therapist prescribe specific training and techniques to the patients particular habits and dysfunction.

When to seek help?

Pelvic dysfunction can feel scary and lonely as it is not often openly discussed at regular doctor’s visits or amongst peer groups, but it shouldn’t be. The pelvic floor is just another muscle group that can benefit from training, just like the other muscles throughout the body. Lack of knowledge about pelvic function can lead people to dismissing their symptoms stating it’s the “normal part of aging” or “the curse of being a woman” which couldn’t be farther from the truth. If you are suffering from any symptoms or conditions of the pelvis, abdomen, low back or hips you may benefit from pelvic rehabilitation.

At CPR Physical Therapy and Performance, there are highly trained pelvic health practitioners that are here to help. Although some treatment options may be daunting, our trained therapists will work with you to create an appropriate and effective treatment plan that brings you comfort and results. Don’t wait to get help! Please reach out to https://www.cprtherapy.org/ to start your journey to a better quality of life and improved pelvic health.

References:

Berghmans, B. (2006). The role of the pelvic physical therapist. Actas Urológicas Españolas, 30(2), 110-122.

Wallace, S. L., Miller, L. D., & Mishra, K. (2019). Pelvic floor physical therapy in the treatment of pelvic floor dysfunction in women. Current Opinion in Obstetrics and Gynecology, 31(6), 485-493.

Hite, M., & Curran, T. (2021). Biofeedback for pelvic floor disorders. Clinics in colon and rectal surgery, 34(01), 056-061.

Whittaker, J. L., Thompson, J. A., Teyhen, D. S., & Hodges, P. (2007). Rehabilitative ultrasound imaging of pelvic floor muscle function. journal of orthopaedic & sports physical therapy, 37(8), 487-498.