Your pelvic floor is the group of muscles and ligaments in your pelvic region. The pelvic floor acts like a sling to support the organs in your pelvis — including the bladder, rectum, and uterus or prostate. Contracting and relaxing these muscles allows you to control your bowel movements, urination, and, for women particularly, sexual intercourse.
As many as 50 percent of people with chronic constipation have pelvic floor dysfunction (PFD) — impaired relaxation and coordination of pelvic floor and abdominal muscles during evacuation. Straining, hard or thin stools, and a feeling of incomplete elimination are common signs and symptoms. But because slow transit constipation and functional constipation can overlap with PFD, some patients may also present with other signs and symptoms, such as a long time between bowel movements and abdominal pain.
Pelvic floor dysfunction is a common condition where you’re unable to correctly relax and coordinate the muscles in your pelvic floor to urinate or to have a bowel movement. If you’re a woman, you may also feel pain during sex, and if you’re a man you may have problems having or keeping an erection (erectile dysfunction or ED). Your pelvic floor is a group of muscles found in the floor (the base) of your pelvis (the bottom of your torso).
For internal massage, your PT may insert a finger into the vagina or rectum and massage the muscles and connective tissue directly. A frequently used technique is “Thiele stripping,” in which your therapist finds a trigger point by feeling a twitch in the muscle underneath, exercising it using a circular motion, and then putting pressure on it to help relax it, repeating the process until the muscle starts to release. Internal massage can also help release nerves. Sometimes, anesthetics can be injected into these trigger points. PTs may do this in a few states, but in most states, a doctor or nurse must administer injections.
As you can now see, there is so much out there that can be done for people suffering with pelvic floor dysfunction. This blog is by no means extensive, and there are even more options you and your physical therapist can explore to help manage your pain or other pelvic issues. Pelvic floor dysfunction requires a multidisciplinary approach for most of our patients. Hopefully, this blog helped to paint a picture of what you will experience with a pelvic floor physical therapist. We advise that you seek out an expert and experienced pelvic floor physical therapist in order to help better your life and improve your function.
Joint mobilization is a common and favorite tool of most orthopedic physical therapists. We love it so much because it can have so many different benefits depending on the type of technique used. Maitland describes types of joint mobilization on a scale between 1 and 5. Grade 1 and 2 mobilizations are applied to a joint to help to lessen pain and spasm. These types of mobilizations are typically used when a patient is in a lot of pain and to help break the pain cycle. On a non-painful joint, grade 3, 4, and 5 (grade 5 requires post graduate training) mobilizations can be used to help restore full range of motion. By restoring full range of motion within a restricted joint, it is possible to lessen the burden on that and surrounding joints, thereby alleviating pain and improving function.
Once patients with pelvic floor constipation have these basic tools, they can begin retraining the pelvic floor muscles with biofeedback. Based on the principle of operant conditioning, biofeedback provides auditory and visual feedback to help retrain the pelvic floor and relax the anal sphincter. Biofeedback training is the treatment of choice for medically refractory pelvic floor constipation, with some studies showing improvement in more than 70 percent of patients. Patients also learn to identify internal sensations associated with relaxation and long-term skills and exercises for use at home.
The pelvic floor muscles support various pelvic organs, including the bladder, prostate, rectum, and female reproductive organs. The muscles themselves are also involved in the functioning of the urinary and anal sphincters. When they are functioning normally, you are able to control your bowel and bladder movements by contracting and relaxing these muscles.
Nerves, organs, and joints can lose their natural mobility over time and cause a whole host of symptoms from pain, to loss of range of motion, and poor functioning of the bodily symptoms. Skilled and specialized therapists can use a variety of active techniques (patient assisted) and passive techniques to free up restrictions in these tissues and organs and improve overall function.
I’ve had problems with my lumbar spine all of my adult life, including spina bifida occulta. I underwent a lumbar fusion about 6 years ago. I was diagnosed with PFD about a year ago with extremely tight pelvic floor muscles. Three months after my diagnosis I underwent more back surgery including removing the original hardware and another fusion, including fusion of my pelvis. Since the second surgery I’ve experienced increased pain in my pelvis, hips and lower back, and a lack of mobility that I can only attribute to the surgery. How does having a fused pelvis affect therapeutic solutions for PFD?
Breathe from your diaphragm. Your inner core is made up of your pelvic floor, your transversus abdominus and multifidus, and your diaphragm. When everything is working optimally, your diaphragm and pelvic floor move in sync. However, when you suck in your gut, slouch over your computer, or experience chronic tension, this pattern gets disrupted. To practice diaphragmatic breathing, lie down on your back. You can put a pillow under your knees, but you want a neutral spine. Place one hand just above your belly button. Breathe in slowly through your nose, allowing your inhale to expand your belly. Feel your upper belly rise under your hand. Keep your upper chest, shoulders, and neck muscles relaxed as you inhale. Then release your breath without forcing it out. Feel your chest and belly drop. Do this for 1-2 minutes and work up to doing this for 5 minutes and several times per day.
If that’s part of your treatment protocol as determined by your therapist, she may use one finger to stretch and mobilize the pelvic floor muscles, explains Tadros. While it may seem like some patients would balk at this, “I find that patients are so desperate for help, they’re more than okay with having it done. We don’t use a speculum or stirrups. This isn’t invasive, it’s designed to keep someone as comfortable as possible,” she adds.
My problem seems to be neurological as I have a burning pain, numbness radiating from an area near my vagina (sometimes numbness extends up my right buttock) that is bothering me 24 hrs, 7 days a week. This has gone on 4 years or more with varying intensity. I had seen a pelvic floor therapist while i was i Arizona and a anesthesiologist for pudendal nerve blocks. I am going back to the therapist. The nerve blocks have not helped. Is there blocks for other nerves around there?
I am 61 and was diagnosed last year with pelvic floor tension after months of pain. Let me first recommend an article from prevention magazine 2014 titled “why it hurts down there”. I am healthy, thin, on no medications, I walk 2miles and do lots of gardening. I went to my gynecologist (male) and he prescribed an antibiotic for a urinary tract infection, which upon culture I did not have, but he never told me that. The pain never went away. He prescribed a 2nd round of antibiotic, the pain never went away. He sent me to a urologist( a female) who Did a pelvic exam and diagnosed PFT. She sent me to specialty physical therapy and 4 sessions later I was pain free.
Joint mobilization is a common and favorite tool of most orthopedic physical therapists. We love it so much because it can have so many different benefits depending on the type of technique used. Maitland describes types of joint mobilization on a scale between 1 and 5. Grade 1 and 2 mobilizations are applied to a joint to help to lessen pain and spasm. These types of mobilizations are typically used when a patient is in a lot of pain and to help break the pain cycle. On a non-painful joint, grade 3, 4, and 5 (grade 5 requires post graduate training) mobilizations can be used to help restore full range of motion. By restoring full range of motion within a restricted joint, it is possible to lessen the burden on that and surrounding joints, thereby alleviating pain and improving function.
To assess the degree of dysfunction, three measurements must be taken into account. First, an anatomic landmark known as the pubococcygeal line must be determined, which is a straight line connecting the inferior margin of the pubic symphysis at the midline with the junction of the first and second coccygeal elements on a sagittal image. After this, the location of the puborectalis muscle sling is assessed, and a perpendicular line between the pubococcygeal line and muscle sling is drawn. This provides a measurement of pelvic floor descent, with descent greater than 2 cm being considered mild, and 6 cm being considered severe. Lastly, a line from the pubic symphysis to the puborectalis muscle sling is drawn, which is a measurement of the pelvic floor hiatus. Measurements of greater than 6 cm are considered mild, and greater than 10 cm severe. The degree of organ prolapse is assessed relative to the hiatus. The grading of organ prolapse relative to the hiatus is more strict, with any descent being considered abnormal, and greater than 4 cm being considered severe.[2]
Ultrasound uses high-frequency sound waves applied through a wand or probe on your skin to produce an internal image or to help treat pain. Real-time ultrasound can let you see your pelvic floor muscles functioning and help you learn to relax them. Therapeutic ultrasound uses sound waves to produce deep warmth that may help reduce spasm and increase blood flow or, on a nonthermal setting, may promote healing and reduce inflammation.
Pelvic Floor Dysfunction usually does not occur due to one-time events such as childbirth. However, childbirth, repeated heavy lifting, and hip or back injuries can cause your pelvic floor to weaken, increasing the likelihood of PFD. In short, whenever the muscles, tendons, ligaments, or nerves of the pelvic floor are affected, you are at risk for PFD.
I’ve had problems with my lumbar spine all of my adult life, including spina bifida occulta. I underwent a lumbar fusion about 6 years ago. I was diagnosed with PFD about a year ago with extremely tight pelvic floor muscles. Three months after my diagnosis I underwent more back surgery including removing the original hardware and another fusion, including fusion of my pelvis. Since the second surgery I’ve experienced increased pain in my pelvis, hips and lower back, and a lack of mobility that I can only attribute to the surgery. How does having a fused pelvis affect therapeutic solutions for PFD?
Help….I had a preventive hysterectomy seven months ago because of a horrible maternal family history of ovarian and uterine cancer. At 53, I had just started into menopause with skipping periods, but hadn’t gone a year. Now, I have had constant pelvic pain….it’s hard to walk sometimes, hard to stand for more than 30-40 minutes and a cystocopy showed that my bladder was inflamed. All these practitioners are telling me I have IC, but I have no frequency, no urgency or burning. When I finally went to a uro/gyn, during the exam she told me several of my pelvic muscles were tight and I the only pain I had was when touched near my bladder. I think this may be a pelvic floor dysfunction along with a hormonal imbalance, but no one listens and just keeps prescribing Uribel and other bladder drugs and now they want to do instillations. Am I completely off base that this is a wrong diagnosis? Any insights would be helpful.
Pelvic floor dysfunction may include any of a group of clinical conditions that includes urinary incontinence, fecal incontinence, pelvic organ prolapse, sensory and emptying abnormalities of the lower urinary tract, defecatory dysfunction, sexual dysfunction and several chronic pain syndromes, including vulvodynia in women and chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) in men. The three most common and definable conditions encountered clinically are urinary incontinence, anal incontinence and pelvic organ prolapse.
Patients may meet individually with a dedicated nurse educator who provides a focused session on bowel management techniques. Central to the process is a daily regimen that combines an evening dose of fiber supplement with a morning routine of mild physical activity; a hot, preferably caffeinated beverage; and, possibly, a fiber cereal followed by another cup of a hot beverage — all within 45 minutes of waking. This routine augments early morning high-amplitude peristaltic contractions by incorporating multiple colon stimulators.
Breathe from your diaphragm. Your inner core is made up of your pelvic floor, your transversus abdominus and multifidus, and your diaphragm. When everything is working optimally, your diaphragm and pelvic floor move in sync. However, when you suck in your gut, slouch over your computer, or experience chronic tension, this pattern gets disrupted. To practice diaphragmatic breathing, lie down on your back. You can put a pillow under your knees, but you want a neutral spine. Place one hand just above your belly button. Breathe in slowly through your nose, allowing your inhale to expand your belly. Feel your upper belly rise under your hand. Keep your upper chest, shoulders, and neck muscles relaxed as you inhale. Then release your breath without forcing it out. Feel your chest and belly drop. Do this for 1-2 minutes and work up to doing this for 5 minutes and several times per day.
Although many centers are familiar with retraining techniques to improve pelvic floor dysfunction, few have the multidisciplinary expertise to teach patients with constipation how to appropriately coordinate abdominal and pelvic floor muscles during defecation, and how to use bowel management techniques, along with behavior modification, to relieve symptoms. Because pelvic floor dysfunction can be associated with psychological, sexual or physical abuse and other life stressors, psychological counseling is often included in the evaluation process.
As you can now see, there is so much out there that can be done for people suffering with pelvic floor dysfunction. This blog is by no means extensive, and there are even more options you and your physical therapist can explore to help manage your pain or other pelvic issues. Pelvic floor dysfunction requires a multidisciplinary approach for most of our patients. Hopefully, this blog helped to paint a picture of what you will experience with a pelvic floor physical therapist. We advise that you seek out an expert and experienced pelvic floor physical therapist in order to help better your life and improve your function.
