Jennie Murray, DPT - Pelvic floor physical therapy

WHAT IS PELVIC FLOOR PHYSICAL THERAPY?

A non-surgical approach to rehabilitation of dysfunctions in the pelvis that contribute to bowel, bladder, sexual health, and pain complaints. Pelvic PT’s are neuromusculoskeletal experts who aim to treat patients with pelvic dysfunction who are limited in daily function. Not every PT can treat pelvic floor, additional training is required! When looking for a pelvic floor PT it is important to inquire if they perform internal as well as external pelvic exams. If they do not perform internal exams, they are not specifically trained in pelvic floor rehab and your treatment and success in resolving your complaints will be limited.

ISN’T IT ENOUGH TO DO KEGELS?

Kegel exercises strengthen the pelvic floor muscles. Many people associate treatment of their pelvic floor with doing Kegels. It’s what doctors have always told patients to do, so it became common knowledge. This is one of the greatest myths. Studies have shown that up to 40% of women when asked to perform a pelvic floor muscle contraction, do so incorrectly. In fact, many times it’s a completely inappropriate exercise to prescribe to someone, and could be making their condition worse. The reason for this is that the underlying cause of the symptoms could be attributed to muscle stiffness or spasm, not just weakness. A muscle in spasm is shortened and contracting it systematically many times a day can be making it more spasmed and more painful. The correct treatment most often is to first lengthen and release the muscle before proceeding with the strengthening. Your pelvic floor physical therapist will be able to evaluate your muscles and determine the appropriate plan of care based on their findings.

PELVIC FLOOR CONDITIONS TREATED INCLUDE:

STRESS and URGE INCONTINENCE - Stress incontinence is involuntary loss of bladder control with physical exertion such as sneezing, coughing, laughing, jumping or lifting. Urge incontinence is involuntary loss of of bladder control due to an overactive bladder muscle. Incontinence is so common, many women think it’s normal after having babies and leave it untreated. Just because it’s common does not mean it’s normal! Pelvic floor PT has a great success rate of treating this condition and you no longer have to “live with it”.

DIASTASIS RECTUS ABDOMINIS - A condition in which the large abdominal muscles separate. Most common after giving birth. There may be a bulge in the middle of the belly, or coning/doming with abdominal contraction. Treatment with physical therapy for correct progression of abdominal exercises to increase strength and stability. Avoid doing sit-ups initially!

PELVIC ORGAN PROLAPSE - A condition in which one or more of the organs in the pelvis slip down from their normal position and bulge into the vagina. It can be a bladder prolapse (cystocele), a rectum prolapse (rectocele) or uterus prolapse (uterocervical). Symptoms include a feeling of pressure or heaviness, pain, difficulty voiding or emptying completely. Treatment includes patient education to avoid bearing down, constipation management, treatment of the pelvic floor muscles, exercises to strengthen, including those that are in gravity eliminated positions to encourage the prolapse to return to its normal position.

VULVODYNIA -Chronic pain of your vulva (the area on the outside of your genitals). This can be due to stiffness in your pelvic floor muscles and physical therapy is very effective in treating it. Stress management and breathing techniques are also very important.

DYSPAREUNIA- Genital pain that occurs just before, during or after intercourse. This is not normal, intercourse should be enjoyable. Any of the conditions listed above could cause pain with sex. Pelvic floor physical therapy is very effective in treating the underlying causes of this condition. Sometimes the patient has a history of some kind of sexual abuse and needs to seek counseling to treat the stress response/PTSD side of this issue. Treating the mind and the body as a whole provides the best results.

ENDOMETRIOSIS- A condition in which tissue that normally lines the uterus grows outside the uterus. Symptoms include long or heavy periods, severe cramps, fatigue, nausea, sometimes can contribute to infertility. Pelvic Floor Physical therapy can help to improve the function, flexibility and strength of the pelvic floor muscles which can help ease symptoms of Endometriosis. Often a comprehensive approach is needed including dietary changes, exercise program and stress relief strategies.

INTERSTITIAL CYSTITIS (IC) or PAINFUL BLADDER SYNDROME (PBS)- A chronic, painful bladder condition. It’s often mistaken for a urinary tract infection (UTI), but there is no infection. Pelvic Floor Physical therapy and lifestyle modification is effective in treating the underlying causes of this condition.

POLYCYSTIC OVARIAN SYNDROME (PCOS)- A hormonal disorder causing enlarged ovaries with small cysts on the outer edges. PCOS can cause missed or irregular menstrual periods, excess hair growth, acne, infertility and weight gain . Pelvic Floor Physical Therapy can help improve flexibility, strength and function of pelvic floor muscles which can help alleviate PCOS symptoms.