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How can I be Treated for Pelvic Pain?

May is one of my favorite times of the year. The flowers are blooming, the air is warming, people are getting outside and being active. Although this is a beautiful time of the year to some and with all the buzz in the air, some people may feel more crippled during this time and limited in their activity level due to pain. The idea of going on a hike or riding a bike may be unfathomable to those suffering from pelvic pain. Infact worldwide prevalence of chronic pelvic pain (CPP) is 16%. It is the most common urologic condition in men under the age of 50, CPP accounts for 15 % of all gynecological visits and 1 in 10 women are affected by endometriosis. Chronic pelvic pain can also cause symptoms such as urinary frequency, urge incontinence, low back and hip pain as well as lower abdominal pain.


Today I want to talk to you about the benefits of pelvic floor physical therapy in management of CPP and what to expect in your first visit and treatment but let’s first address the anatomy.


Anatomy


The pelvic floor, also known as the levator ani muscles, is a group of muscles that make up a sling within the bowl of the pelvis. They are found in both females and males. They are responsible for 5 main functions: support, sphincter control, sexual function, stability and blood flow. To put it simply, these muscles are important in the functions of pooping, peeing, sexual function and birthing a baby. They are innervated by the pudendal nerve (which can become entrapped in certain areas within the pelvis, aka pudendal neuralgia). The bladder, uterus, and rectum sit inside this “pelvic bowl” and have fascial/connective tissue that attaches the muscles to these structures as well as bones. These muscles are clearly important for every day functions we don’t even think about! So, for example, when dealing with a diagnosis such as endometriosis that causes adhesions/scar tissue and inflammation inside the pelvic floor it makes sense that the pelvic floor muscles react by tightening - and therefore causing more pain.


Pelvic pain conditions we commonly treat

  • Endometriosis

  • Pudendal neuralgia

  • Vulvodynia

  • Dyspareunia (pain with intercourse) and Vaginismus (pain with penetration)

  • Interstitial Cystitis / Painful bladder syndrome

  • Post surgical pains due to scar adhesions, like cesarean section

  • Pain with erections, ejaculation, prostate pain

  • Persistent abdominal pain and bowel conditions


What to expect for your first treatment

First, your therapist will assess your body movements, mobility and strength. As pelvic floor physical therapists we look commonly at the low back, hips and abdomen. We will be assessing your posture, alignment, diastasis recti, trigger points throughout the abdominal wall, scars, low back and hip mobility. We will also address your pelvic floor movement, tightness or weakness and this can be done several ways. One way is by using external biofeedback such as real time ultrasound where we can see how well your pelvic floor moves and give you cues for helping you relax any tension in your pelvic floor as well as a proper contraction.

Another way is an internal pelvic floor muscle assessment. As pelvic floor physical therapists, we are trained and certified in the assessment of the pelvic floor muscles and are the best musculoskeletal professionals when it comes to piecing together the cause for your pelvic pain. An internal assessment allows us to feel the muscle tone, release trigger points, give you feedback on a proper contract vs relax and so much more! We only assess the pelvic floor internally with your consent. And yes, it can be done on both men and women. Our treatment is much different than your appointment at the gynecologist or urologist. For the assessment you are always in a private treatment room one on one with your therapist, typically lying on your back (or side or stomach in men) with your legs in a relaxed position (not in stirrups like at your GYN’s office) and pillows to make you more comfortable. Patients are always amazed that first of all, their pain does decrease relatively quickly with internal release work as we are listening to the tissues - internal release work is not a deep tissue massage and secondly, no pain no gain doesn’t exist in pelvic PT. It is not our goal to cause pain to get over pain.

We then will go over gentle exercises addressing our findings in the initial examination to have you work on at home. Whether it’s addressing that tight hip muscle, stress management, or stretches for your pelvic floor. Usually when dealing with pelvic pain we end treatments focusing on addressing the central nervous system by creating a calm environment for stress management. A comment we often hear from patients is they wish they would have done pelvic floor physical therapy sooner. You do not have to live with your pelvic pain, let your pelvic specialists at Wasatch Physical Therapy help you get back to life.

-Danielle Khoury, DPT


References:

1. Prevalence of Chronic Pelvic Pain Among Women: An Updated Review. Alebtekin Ahangari, BSc. PT.ww.painphysicianjournal.com. Pain Physician 2014; 17:E141-E147 • ISSN 2150-1149

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