Research reveals that pelvic pain caused by pelvic floor dysfunction affects one in three women at some point during their lives. While some of these symptoms may seem common, they are never normal and pelvic floor physical therapy can help!

Symptoms

• Pelvic pain generally refers to burning, itching, aching or other types of pain in the vulva, vagina, perineal, and/or anal area
• Pain with intercourse and/or tampon insertion, and/or GYN examinations
• Hypersensitivity when wearing pants and/or underwear, and may have pain with sitting
• Endometriosis
• Painful Bladder Syndrome (Persistent pelvic pain or discomfort, especially during bladder filling)
• Pudendal Neuralgia ( discomfort in the genitals, perineum, and rectum. Symptoms might include burning, aching, or sharp pain, and they can be aggravated by sitting or certain activities.)
• Rectal Pain
• Abdominal bloating, gastrointestinal distress, and/or constipation
• Symptoms can be intermittent or constant

Causes of Pelvic Pain

• Exercise may provoke or exacerbate symptoms
• The majority of women with pelvic pain have pelvic floor dysfunction
• Repetitive vaginal and/or bladder infections and/or gynecologic, urologic, dermatologic or gastrointestinal conditions
• Diseases such as Endometriosis and Polycystic Ovarian Syndrome (PCOS)
• Surgical trauma (childbirth, pelvic organ prolapse repair, hysterectomy)
• Orthopedic injuries or traumas
• Biomechanical or structural dysfunction (hip dysfunction, sacro-iliac joint dysfunction, piriformis syndrome, scoliosis, leg length discrepancy)
• Vaginal childbirth
• Menopause

Symptoms

• Stress incontinence (leaking urine when coughing, laughing, sneezing, and/or during exercise)
• Urge incontinence ( leaking on the way or before you get to the bathroom)
• Mixed Incontinence (both stress and urge incontinence)
• Pain or burning in the bladder and/or urethra before, during or after urinating
• Urinary urgency without a full bladder
• Urinary frequency without a full bladder
• Urinary hesitancy, slow or deviated urine stream
• Urinary urgency during sexual activity
• Urinary urgency/frequency after sexual activity or exercise
• Urethra or bladder pain
• Climacturia (leaking urine with orgasm)

Causes of Bladder Dysfunction

• Repetitive urinary tract and yeast infections
• Hormonal suppressive medications such as oral contraceptives, GnRH agonists (i.e. Lupron), acne medications
• Childbirth, breastfeeding, and menopause
• Surgical trauma
• Orthopedic injuries or traumas
• Biomechanical or structural dysfunction (hip dysfunction, sacro-iliac joint dysfunction, piriformis syndrome, scoliosis, leg length discrepancy)
• Pelvic floor dysfunction
• Pelvic organ prolapse
• Constipation and gastrointestinal distress/bloating

The pelvic floor and pelvic girdle muscles undergo significant changes during pregnancy and labor and delivery. Optimal pelvic health during pregnancy can help reduce musculoskeletal pain and dysfunction, ease labor and delivery, and help reduce postpartum complications. In 2018 the American College of Obstetrics and Gynecology issued a statement acknowledging that postpartum care in the United States needs to be improved, suggesting the term “4th Trimester” should be used for the immediate postpartum period and that postpartum women need more care than what is currently being offered. All pregnant and postpartum women can benefit from pelvic floor physical therapy given the crucial role these muscles play during delivery and how prevalent dysfunction is after birth. Pelvic floor physical therapy reduces the risk of pelvic organ prolapse, urinary, bowel, and sexual dysfunction and pelvic pain. Similar to other diagnoses we treat, many of our patients tell us they wish they knew about us sooner.

Pelvic Floor Physical Therapy During Pregnancy

Our bodies undergo significant changes as the pregnancy progresses. Many women experience symptoms that pelvic floor physical therapy can address.

• Constipation
• Urinary urgency, frequency, and leaking
• Pubic symphysis pain/separation
• Sacro-iliac joint, hip, and back pain
• Sciatic pain

Fortunately, some women tolerate pregnancy very well and experience no unwanted symptoms. For these women, pelvic floor physical therapy can help with the following:

• Optimize pelvic floor motor control to aid in labor and delivery
• Instruction in perineal massage to reduce perineal injuries
• Improve pelvic floor and pelvic girdle neuromuscular function to reduce pain and dysfunction in the postpartum period
• Education and support throughout the pregnancy and during the postpartum period

Postpartum pelvic floor physical therapy

All new moms should undergo an evaluation with a pelvic floor physical therapist. Ideally, this evaluation would take place in the first year following delivery; however, it is never too late to see a pelvic floor physical therapist. Postpartum pelvic floor physical therapy can help with:

• Urinary retention, urgency, frequency, hesitancy, pain and incontinence (leaking)
• Constipation, difficulty with bowel movement, fecal incontinence
• Painful sex, diminished or absent orgasm
• Diastasis Rectus Abdominis
• Restoring core function and strength: abdominals and pelvic floor
• Pelvic floor and pelvic girdle, low back, and hip pain
• Cesarean section and episiotomy scar tissue and pain
• Pelvic organ prolapse prevention and/or treatment
• Eliminate pain from perineal and/or levator ani trauma
• Reduce pain from pelvic neuralgias

Pelvic organ prolapse (POP) occurs when the uterus, bladder, urethra, gastrointestinal tract and/or rectum prolapse through the vaginal walls. Weakness in fascia and pelvic floor muscles are two of the primary contributors in the development of POP. Risk factors, such as obesity and vaginal delivery, can cause weakness and damage to the pelvic floor muscles and fascia, thereby resulting in herniation of the organs. Associated Diagnoses include:

• Urethrocele
• Cystocele
• Rectocele
• Enterocele
• Rectal prolapse

Symptoms of pelvic organ prolapse

• Feelings of heaviness or bulging in the vagina
• Urine and/or fecal leaking (incontinence)
• Abnormal bowel and bladder emptying
• Bladder and bowel urgency, frequency
• Nocturia (nighttime urination)
• Frequent bladder infections
• Pelvic pain
• Painful sex

Causes of pelvic organ prolapse

• Genetics
• Obesity
• Menopause
• Childbirth, with vaginal deliveries causing higher risk
• Age-related pelvic floor and girdle changes
• Previous Hysterectomy

When people undergo surgical interventions for orthopedic injuries, physical therapy is always prescribed afterwards, and sometimes before. The same should be true for pelvic surgeries given the complex and crucial functioning of the pelvic floor, but sadly, this is not always the case. Patients who are frustrated with persistent symptoms after surgery often find us on their own.

The term ‘prehab’ refers to optimizing pelvic health before a surgical procedure, such as a prostatectomy or pelvic floor reconstruction. Research shows that patients have better outcomes when undergoing pelvic floor physical therapy before and after these surgical procedures.

Pelvic Floor Physical Therapy and Pelvic Surgeries

Pelvic floor physical therapy is warranted before and after:

• Hysterectomy
• Pelvic Organ Prolapse Repair: cystocele, rectocele, entercocele, urethrocele, anal prolapse
• Mesh excision
• Hemorrhoidectomy, fissurectomy, sphincterotomy
• Prostatectomy
• Endometriosis excision and/or ablation
• Vestibulectomy
• Cesarean Section
• Pudendal Nerve Decompression
• Gender affirmation procedures
• Hernia repairs

Symptoms

• Pelvic pain
• Urinary urgency, frequency, hesitancy, weak stream, incontinence (leaking)
• Bowel urgency, frequency, hesitancy, incomplete and/or difficulty emptying
• Erectile dysfunction
• Painful intercourse
• Sexual dysfunction and painful or diminished/absent orgasm
• Abdominal, spine, hip, and leg pain

The pelvic floor muscles support the rectum and are voluntarily and involuntarily involved with bowel function. Under normal circumstances the pelvic floor muscles keep us from leaking gas and stool and we have the ability to relax the muscles voluntarily to evacuate stool. The anal sphincter is a sophisticated neuromuscular structure, as it has the ability to detect air, liquid, and stool and the pelvic floor muscles respond accordingly, involuntarily. Unfortunately, gastrointestinal distress is common in the United States. Ongoing gastrointestinal pain and dysfunction have somatic consequences on the pelvic floor muscles, which in turn exacerbate the gastrointestinal distress. When this system becomes dysfunctional people suffer, but pelvic floor physical therapy and a coordinated interdisciplinary treatment plan can help.

Symptoms of Bowel Dysfunction

• Straining to evacuate stool
• Constipation and/or incomplete emptying
• Need for excessive toilet paper
• Fecal urgency or gas leakage and incontinence
• Bloating and/ or gas
• Abdominal cramping
• Pain before, during or after bowel movements

Causes of Bowel Dysfunction

• Medication induced constipation (opiates, mood stabilizers, oral contraceptives, etc)
• Pelvic floor muscle dyssynergia, tightness, and/or weakness
• Peripheral nerve injuries from childbirth, chronic straining, or surgical trauma
• Consequences from gastrointestinal distress (IBS, SIBO, Crohn’s disease, ulcerative colitis, etc)

• Pelvic and Groin Pain
• Prostatitis
• Pre/Post Op Prostatectomies
• BPH