When faced with a diagnosis such as endometriosis or chronic prostatitis, a majority of men and women are unaware that treatment options exist outside of medication and surgery. Unfortunately, many healthcare providers are also unaware that conservative treatments, such as physical therapy, can reverse the pain associated with these health conditions.
As physical therapists who specialize in pelvic floor dysfunction, we are passionate about increasing the awareness surrounding pelvic health. While many practitioners emphasize disease as a source of pain, physical therapists educate their patients on the role that muscles, fascia and organ mobility may play in their symptoms.
One may ask: What is the “pelvic floor?” The pelvic floor refers to the numerous muscles that attach around the pelvic and thigh bones. These muscles serve to provide support for our pelvic organs, maintain control of our bladder and bowel function and are responsible for healthy sexual activity. These muscles form the lower part of “the core” and are important for stability and balance.
There are many different types of pelvic floor dysfunctions that can occur when these tissues are imbalanced, either weak and elongated or overactive and shortened. The treatment usually involves neuromuscular re-education and manual release of associated restricted tissues either externally or internally, depending on the individual’s needs and comforts. Below are three of the most common reasons you or someone you know of may want to see a physical therapist who specializes in pelvic floor health.
1. Pre and Post Partum Health
During pregnancy, the body releases relaxin, a hormone that increases joint laxity. This increase in joint laxity can lead to injury to the low back, sacroiliac joint and pelvic floor. A pelvic floor physical therapist can help pregnant women prevent or recover from pregnancy-related pain or dysfunction. A physical therapist can also teach women how to coordinate their abdominal and pelvic floor muscles in order to facilitate vaginal birth.
In France, it is the standard of care to complete a full course of pelvic floor physical therapy in the post-partum period. It is important to re-learn pelvic floor muscle coordination during this time in order to prevent incontinence and pelvic organ prolapse. An unknown number of pelvic surgeries could be prevented later in life if more women were made aware of the importance of post-partum physical therapy.
One in three women experience incontinence at some point in their lives. There are different types of incontinence that people may suffer from, all of which have been shown to improve with physical therapy. Most commonly, the incontinence is due to pelvic floor weakness. Many women believe incontinence is part of the normal aging process. However, at no point in the life span of an adult is incontinence ever “normal.” Studies have shown that when people are instructed to perform a “Kegel” (pelvic floor contraction), most people actually bear down or perform the contraction incorrectly. Men and women experiencing bladder dysfunction benefit the most when they are guided by physical therapists who can help re-train their bladder habits and properly strengthen the correct muscles.
3. Pelvic Pain
One in three men and women will experience pelvic pain in their lifetime. Men may experience pain in their testicles or penis, while women may experience vulvar or clitoral pain. Both men and women may experience bladder pain, tailbone pain or pressure in the rectum. After physicians rule out specific diseases, they are often stumped as to the cause of the pelvic pain. Even worse, providers may tell the patient that the pain is in their head or solely psychological in origin.
To the relief of their patients, pelvic floor physical therapists can usually find soft tissue dysfunctions that contribute to the patient’s pain. Often times, an injury to the lower body, a bout of repeat infections or general stress causes a reflexive muscle guarding of the pelvic floor muscles. Sometimes this muscle guarding will resolve on its own and a person will recover quickly from their injury or infection. Other times, these tissues retain the memory of the injury and stay contracted, leading to trigger points and subsequent referred pain.
For example, women often continue to experience the symptoms of a urinary tract infection (UTI), even after their lab tests return negative for bacteria. In this case, the tissues around the urethera have remained contracted and congested, recreating the sensation of bladder pain and urinary urgency. In addition to UTI’s, physical therapists often find that muscular trigger points inside the pelvic floor contribute to the pain associated with endometriosis, interstitial cystitis, constipation, hemorrhoids, itching and burning that tests negative for yeast, pain with sexual activity, testicular pain and chronic prostatitis.
Pelvic floor physical therapy is slowly gaining recognition as a successful treatment option, as numerous research studies have demonstrated good efficacy. We hope that with increased awareness, more men and women will be able to address the intimate issues that significantly impact quality of life.
This is a guest blog post written by our Pelvic Floor Specialists Rachel Parrotta and Vanessa Diamond for Parsley Health.