Pelvic floor disorders are very common and are estimated to affect at least a third of all women. Pelvic pain can include a variety of symptoms and diagnoses. Musculoskeletal aches and pain can originate from tight or weak muscles, nerve irritation from the lumbar spine or locally around the pelvic area, misalignment of the spine or pelvis, a result of pregnancy/delivery or from other trauma. This pain can be felt in your lower back, thighs, abdomen, genital region, pubic area, groin, tail bone or butt. The pain can be local or radiate to other parts of the body.
What may start out as a musculoskeletal pain in origin can in time affect other body parts in the area. Pelvic floor dysfunction is characterized by pain that starts in one area of the body from one single cause and then spreads into the surrounding muscles, nerves and organs of the body and pelvis. A disruption anywhere in the pelvic floor or vaginal muscles can affect any of the pelvic floor muscle’s other functions.
The three main functions of the pelvic floor muscles are:
- Supports the organs in the pelvis including the bladder, uterus and rectum by acting as a “hammock” and keeping these organs in place. They help maintain their normal function by keeping them in their anatomical position
- Works with the bladder during urination by decreasing the urethral pressure to allow voiding. The pelvic floor muscles must relax while urinating to let the bladder empty. The normal resting tone of the pelvic floor muscles are what keep the urethra closed when not attempting to urinate
- Sexual functioning-the stronger the pelvic floor muscles are the more muscle fibers are created, which in turn can make for stronger sexual response or orgasm
An irritation or pain involving the muscles or nerves in the pelvis can in turn cause a dysfunction involving the bladder, bowel or sexual disorder, and vice versa. For example pain in the pelvic floor can lead to dyspareunia, which is difficult or painful intercourse. Interstitial cystitis is pain that is produced by inflammatory changes in the bladder, which in turn can cause pain in the lower abdomen or vagina. These are just a couple of examples of how one dysfunction can effect something else.
Common symptoms or diagnoses include:
- Low Back/Sacroiliac dysfunction
- Piriformis syndrome
- Iliopsoas syndrome or spasm of the hip flexor muscle
- Pudendal Neuralgia-Pain with sitting/pain during intercourse
- Groin or Pubic Pain
- Levator Ani Syndrome-Pain or pressure in the sacrum, coccyx or tailbone, vagina or rectum. Pain can increase with intercourse, sitting, having a bowel movement and constipation
- Vaginismus-This is difficulty to have intercourse or use a tampon due to muscle spasms of the pelvic floor muscles preventing entry of the vaginal opening
- Dyspareunia-Painful intercourse
- Vulvar vestibulitis-Severe pain and redness along the vaginal opening
- Interstitial Cystitis also known as painful bladder syndrome
- Irritable Bowel Syndrome
- Urinary hesitancy or painful urination
- Lower Abdominal Pain
- Painful or adherent scar
- Proctalgia Fugax-Episodes of severe rectal pain
- Tailbone pain or coccydynia
During the first appointment at Indy Women PT a complete medical history will be taken along with a review of current symptoms. After taking the history, the physical therapist will then perform a thorough external and internal musculoskeletal examination. You are welcome to bring a second person with you into the examination room during the examination and subsequent treatments. We will discuss the physical findings and together will set up a plan of care with your personal goals in mind.
Treatment may include:
- Manual therapy both internal and external to address any tight muscles or spasms. Scar tissue massage may be helpful with recent or past surgeries such as c-section scars or episiotomies
- An internal exam will include a gloved finger with lubricant inserted either vaginally or rectally to assess for muscle tone, strength and any pain
- Biofeedback to help cue isolation of the pelvic floor muscles or as a tool to help the muscles learn to relax again
- Electrical stimulation for pain control, deferring urgency or to facilitate pelvic floor muscle strength
- Exercises to strengthen stretched or weakened muscles/stretches to help increase flexibility
- Home education program including both exercise and the education to help manage your symptoms at home as needed
Our goal is to make you feel as comfortable as possible during the evaluation and treatment sessions. We understand the sensitivity to the issues we are treating and want you to know that you always have a voice in our treatment plan. We hope that when you are discharged from therapy that not only will you leave with less pain, but also feel more empowered over your diagnosis along with the ability to help manage it.