Pelvic floor physical therapy is a potential additional treatment for pelvic pain conditions. it has proven benefits for a wide range of systems including gastrointestinal, sexual and reproductive, orthopedic, neurological, and dermatologic. For women, in particular, the vagina, urethra, and bowels are such close neighbors that an adverse effect to one can disrupt the function of all three. The muscles surrounding these organs play a major role in their ability to function smoothly, so if the pelvic floor muscles go into spasm or involuntarily contract, this causes pain and other problems for the pelvis in general. Pain in this area can transfer to surrounding regions to include the lower back, spine, hips, and buttocks. This is where pelvic floor physical therapy comes into play.
Pelvic floor physical therapy treats a wide range of problems including pelvic and bladder pain, painful intercourse, pain when using tampons, Vaginismus (painful spasmodic contraction of the vagina from physical contact or pressure), urinary leakage, frequency or urgency, post-pregnancy problems (separation of the abdominal muscles or diastasis recti, bad back pain, SI joint pain), infertility, endometriosis, abdominal pain from surgery or scar tissue, and healing for sexual abuse, rape, or trauma, as well as provide potential treatment for the often enigmatic interstitial cystitis.
Pelvic physical therapists treat the pelvic floor musculoskeletal system both internally and externally. An initial assessment will un-intrusively give the therapist an idea of where the patient’s problem areas are before taking direct action; this also includes observing how the patient sits, stands, and walks.
For internal techniques, the physical therapist can manually massage out kinks or “trigger points” which are tight muscles or spasms found on the pelvic floor (these symptoms are often related to interstitial cystitis). If this simple fix does not alleviate pain, the therapist also assesses the interrelated functioning of the colorectal regions (vulvar, vaginal, and rectal) to find underlying causes. Because pelvic floor PT can look at and treat several problem areas at once, patients have a better chance of tackling their issue in one sitting by eliminating the need to see multiple doctors specializing in one specific area within the colorectal region.
External therapy may include deep tissue massages, skin rolling, outer “trigger point” therapy, nerve release, and joint mobilization. These techniques will generally be administered prior to internal therapy in order to get the patient comfortable with the processes.
There are also helpful exercises and techniques that patients can use tangentially while at home. These include general relaxation techniques which include visualizing the relaxation of the pelvic floor muscles, as well as back and leg stretches, and practicing good posture.
Due to the pelvic physical therapist’s ability to see the big picture within the region, they have an advantage in both diagnosing and treating problems that arise in this and other areas within the musculoskeletal system, as well as other conditions that are often overlooked or misdiagnosed by general practitioners. After getting past any initial discomfort with the hands-on process, it can potentially have lasting and far-reaching effects in eradicating pelvic pain and like conditions.
Questions:
What is a sphincterotomy and how does it work? Will it stop the pain I’m experiencing from IC?
A sphincterotomy or bladder outlet surgery involves a small scope being inserted into the urethra to reveal the bottom of the bladder.
A urologist then makes cuts on the muscular valve surrounding the urethra in order to relax the passageway so that urine can flow through without obstruction when the bladder contracts. An unobstructed bladder could help alleviate pain or pressure experienced from a full bladder, but it is not directly connected to interstitial cystitis nor will it treat IC unless there is some element of bladder outlet blockage. There is no single universal treatment for IC and also seeing as how a sphincterotomy is one of the last lines of defense for obstructed bladder sufferers, the two aren’t closely related.
What is interstitial cystitis and how does it cause or relate to incontinence?
Interstitial cystitis or IC is a painful bladder syndrome that is difficult to diagnose due to its various and often indeterminate causes. It caused by inflammation of the bladder wall that is characterized by mild to severe pain and pressure when the bladder is full. This results in the symptoms of frequent and painful trips to the bathroom. The bladder inflammation in IC can result from any one of several causes such as chemicals released from inflammation following an infection, nerve problems, a component in urine damaging the bladder, bladder tissue irritation, or from the immune system attacking the bladder. This disease is not related to or cause incontinence which instead involves the involuntary release or leakage of urine.
My doctor has ordered a video-cystometric dynamic test. What is it and what should I expect?
Urodynamic testing measures how well the bladder fills and empties, the sensation in the bladder, and the coordination of the sphincter to relax when the bladder contracts. The video-cystometric test uses a catheter and contrast day as well as fluoroscopy, which is a form of x ray, to visually monitor the filling and emptying of the bladder. A technician will insert a catheter and fill the bladder with saline first for the urodynamic testing and then contrast dye. The pictures and videos that result from the test provide the doctor with precise measurements of the size of the bladder when it is full and empty as well as the angle of the bladder when it leaks. This is a non-invasive procedure that only requires a local anesthesia for when the catheter is inserted.
My doctor says that Foley catheters cause cancer. Is that true?
Chronic use of a Foley catheter or any catheter can often lead to urinary tract infections or other infections within the bladder as well as bladder stones. The catheter can work as an outlet for bacteria to enter the bladder and cause damage. When an infection or stones occur, this leads to inflammation and irritation. If this persists over time, inflammatory changes can lead to pre cancerous changes and the potential for cancer. For this reason, it is imperative to follow the correct timeline for catheter use as well as administer to its proper cleaning.
I think I have prostate stones, though my doctor doesn’t agree. What are they and can they cause bladder leaks?
Prostate stones are tiny and due to prostate secretions that calcify and do not exit the gland. This can occur due to blockage of the ducts from benign prostatic hypertrophy. This increase in growth of the prostate occurs in most aging men. Because the stones are so small (often the size of a tiny bead) they can be overlooked by the doctor when running tests. Prostate stones are most common in
men ages 50 to 65, although they start to become common after age 40. They have similar symptoms to an enlarged prostate which include difficulties with emptying the bladder, an increase in urination frequency, as well as urinary tract infections.
Sexual Function In Women with Pelvic Floor Disorders
Urinary incontinence and/or pelvic organ prolapse affects nearly a third of premenopausal women and as many as 45% of postmenopausal women. The problems associated with incontinence and prolapse impacts the social, psychological, occupational, domestic, physical and sexual well-being of women. Studies of sexual function in women with incontinence and/or pelvic organ prolapse fall into two groups: those that concentrate on vaginal anatomy and those that evaluate sexual function.
Pelvic Trauma and Your Sex Life: Understanding How One Affects The Other
Pelvic trauma, whether through surgery or injury, can do major damage to any happy healthy sex life. How? Any kind of major pelvic surgery or injury can damage the nerves and blood vessels leading to the vagina and clitoris. If this happens, the blood flow through the arteries may be diminished or cut off entirely, leading to a loss of sexual sensation and a reduced ability to become sexually aroused. Some common causes of pelvic trauma include Hysterectomy, Uterine Embolization, childbirth, or straddle injuries.
