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.
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.
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.
During the internal exam, your physical therapist will place a gloved finger into your vagina or rectum to assess the tone, strength, and irritability of your pelvic floor muscles and tissues. Internal exams and internal treatment are invaluable tools that are taught to pelvic floor physical therapists. It can tell us if there are trigger points (painful spots, with a referral pattern or local); muscle/tissue shortening; nerve irritation and/or bony malalignment that could be causing your pain directly or inhibiting the full function of your pelvic floor muscles. We can also determine if your pelvic floor has good coordination during the exam. A pelvic floor without good coordination, may not open and close appropriately for activities such as going to the bathroom, supporting our pelvis and trunk, sexual activity, and keeping us continent.
I’m not sure this diagnosis is correct; how is it confirmed? I’ve been recommended by my new GYN to go to this therapy with this new diagnosis. I have pain during sex. I HATE the muscle feelings of doing Keegles- absolutely hate those feelings. Doc says I won’t be doing Keegles. Have been athletic entire life, and continue to play tennis, do Zumba, garden, snorkle, kayack, still, as I’m a very healthy 57 year old, with left side internal pain during sex, sometimes what feels like a broken pelvic BONE pain. How is this diagnosis confirmed?
My pelvic floor dysfunction has the opposite effect in terms of peeing. My bladder will not fully empty when I pee although I’ll wait and wait until a little more will come out, then I’ll go lie down because I have some burning sensation and discomfort. At that time, lying down, I will experience of flood of urine. my urologist wants to test me by filling my bladder up but that is counterintuitive to me so I’m not sure if I should have that test?
A defecating proctogram is a test where you’re given an enema of a thick liquid that can be seen with an X-ray. Your provider will use a special video X-ray to record the movement of your muscles as you attempt to push the liquid out of the rectum. This will help to show how well you are able to pass a bowel movement or any other causes for pelvic floor dysfunction. This test is not painful.
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.
Practice yoga or Pilates. My Pilates teacher has had countless clients over the years who have healed their urinary incontinence in a few months after starting classical Pilates. And, many pelvic floor physical therapists use Pilates reformers as part of their practices. Both Pilates and yoga can help strengthen your core, which helps improve pelvic floor strength. Pilates targets the deep core and helps you develop both strength and flexibility. You can try a Pilates mat class or seek out an instructor who is well-versed in using the equipment. In yoga class you can practice your root lock, or mula bandha, to target your pelvic floor.
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 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.