Pain can emerge because of lifestyle factors and underlying medical problems. Sitting all day can affect the nerves in your saddle, which may translate into a burning pain in your vulva, explains Rhonda K. Kotarinos, DPT, a specialist in pelvic floor dysfunction in the Chicago area. The discomfort of chronic vaginal infections or holding urine all day long can also lead someone to “walk around with their pelvic floor clinched to their ears. It can make your pelvic floor very angry,” she says.
“I would recommend that people call the facility and maybe schedule the first appointment and see how you feel about it. I also think patient support groups tend to have closed Facebook groups and they can recommend people in certain geographical areas. I know people call [our practice] a lot and we try and get them paired up with somebody we trust in their area,” Prendergast says.
If you think of the pelvis as being the home to organs like the bladder, uterus (or prostate in men) and rectum, the pelvic floor muscles are the home’s foundation. These muscles act as the support structure keeping everything in place within your body. Your pelvic floor muscles add support to several of your organs by wrapping around your pelvic bone. Some of these muscles add more stability by forming a sling around the rectum.

Some pelvic floor physical therapists may have the opportunity of getting a lot of time to speak one-on-one with a patient to determine possible causes of his or her symptoms, educate the patient and to guide them to other practitioners who may optimize their physical therapy results if necessary. We truly can find out so much by just listening to what our patients have to say. A fall, or infection can be significant as well as a patient’s feelings and knowledge about their current condition.
Pelvic floor dysfunction can be diagnosed by history and physical exam, though it is more accurately graded by imaging. Historically, fluoroscopy with defecography and cystography were used, though modern imaging allows the usage of MRI to complement and sometimes replace fluoroscopic assessment of the disorder, allowing for less radiation exposure and increased patient comfort, though an enema is required the evening before the procedure. Instead of contrast, ultrasound gel is used during the procedure with MRI. Both methods assess the pelvic floor at rest and maximum strain using coronal and sagittal views. When grading individual organ prolapse, the rectum, bladder and uterus are individually assessed, with prolapse of the rectum referred to as a rectocele, bladder prolapse through the anterior vaginal wall a cystocele, and small bowel an enterocele.[10]
Pelvic floor dysfunction is common for many women and includes symptoms that can affect all aspects of everyday life and activities. Pelvic floor muscle (PFM) training is vital for treating different types of pelvic floor dysfunction. Two common problems are uterine prolapse and urinary incontinence both of which stem from muscle weakness. Without the ability to control PFM, pelvic floor training cannot be done successfully. Being able to control PFM is vital for a well functioning pelvic floor. Through vaginal palpation exams and the use of biofeedback the tightening, lifting, and squeezing actions of these muscles can be determined. In addition, abdominal muscle training has been shown to improve pelvic floor muscle function.[11] By increasing abdominal muscle strength and control, a person may have an easier time activating the pelvic floor muscles in sync with the abdominal muscles. Many physiotherapists are specially trained to address the muscles weaknesses associated with pelvic floor dysfunction and through intervention can effectively treat this.[12]
Pelvic floor dysfunction is an umbrella term for a variety of disorders that occur when pelvic floor muscles and ligaments are impaired. Although this condition predominantly affects females, up to 16% of males suffer as well.[1] Symptoms include pelvic pain, pressure, pain during sex, incontinence, incomplete emptying of feces, and visible organ protrusion.[2] Tissues surrounding the pelvic organs may have increased or decreased sensitivity or irritation resulting in pelvic pain. Underlying causes of pelvic pain are often difficult to determine.[3] The condition affects up to 50% of women who have given birth.[4]
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.
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]
^ Bernard, Stéphanie; Ouellet, Marie-Pier; Moffet, Hélène; Roy, Jean-Sébastien; Dumoulin, Chantale (April 2016). "Effects of radiation therapy on the structure and function of the pelvic floor muscles of patients with cancer in the pelvic area: a systematic review". Journal of Cancer Survivorship. 10 (2): 351–362. doi:10.1007/s11764-015-0481-8. hdl:1866/16374. ISSN 1932-2259. PMID 26314412. S2CID 13563337.
People with trigger points in their pelvic floor and surrounding areas can experience pain in the rectum, anus, coccyx, sacrum, abdomen, groin and back and can cause bladder, bowel, and sexual dysfunction. When physical therapists find a trigger point they work to eliminate it and lengthen it through a myriad of techniques. Recent literature has found that trigger point release alone can achieve an 83% reduction in symptoms.
Neural mobilization as the name implies, involves the restoration of neural structures back to their normal mobility: to glide and slide. Neural structures that cannot move properly can cause pain that can radiate down an extremity or into the trunk and can give the sensation of burning, zinging, and stabbing. Some orthopedic therapists practice this type of mobilization; common examples include the sciatic nerve in the leg and the ulnar nerve in the arm. Pelvic floor PTs focus on these nerves when they cause issues, but they also pay attention to nerves that innervate the perineum and genital region (bicycle seat area), such as the pudendal, iliohypogastric, obturator, ilioinguinal, genitofemoral and the femoral cutaneous nerves. By allowing these nerves to move freely, symptoms such as vulvovaginal, penile, rectal, clitoral and testicular pain, itching and burning can be greatly improved.
If you’re dealing with pelvic pain, Kotarinos recommends researching the International Pelvic Pain Society or the American Physical Therapy Association to find a qualified pelvic floor physical therapist. (You can also see your PCP for a referral.) Dr. Huang also suggests focusing on your health holistically, with things like stress management, regular exercise, and a well-balanced diet. “We want to educate and empower women to be in control,” she says.

Electrical stimulation uses a small probe inserted into the vagina or rectum to stimulate your pelvic floor muscles, helping desensitize nerves and causing muscles to contract and relax. Stimulation through electrodes placed on your body may calm pain and spasms. Different kinds of electrical stimulation devices are available for home use, both for internal stimulation with a probe or for external stimulation, such as a transcutaneous electrical nerve stimulation (TENS) or similar unit, to ease pain.

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?

OMG I have it so bad can you help me, having rectocele repaired for 2nd time along with bladder lift oct 24 dr. Acher-Welch Ehlers Danlos Syndrom is also one of the diagnosis I have causing lots of elasticity to my skin. Saw you on IIN Talk love your style and information, our whole class is talking about how they love you. Just wanted to let you know, I’m still finishing the video but loving every bit of it as did my classmates. You are spot on in everything I know or am learning. Go Dr. N
Issues with the pelvic floor can arise from a multitude of reasons. Infections, previous surgeries, childbirth, postural and lifting problems, and trips and falls can all bring on pelvic floor dysfunction. Pelvic floor pain can persist well after the cause of it has been removed. So it is entirely possible to feel the effects of an old infection, surgery or injury, days to years after they occur. Anyone who has had long standing abdomino-pelvic pain, or pain that they can’t seem to get rid of after seeking the help of medical doctors or other healthcare providers is a good candidate for a pelvic floor physical therapy evaluation and possible curative treatment.
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