What is the Pelvic Floor?
The Pelvic floor is a 3-dimensional myofascial system that connects between the tailbone and the pubic bone. It's composed of muscles, ligaments, and fascia that work together to help maintain continence, optimize reproductive health, and maintain stability of the spine and trunk. It also acts to help pressurize the trunk appropriately during lifting and straining. Pelvic floor muscles support bowel, bladder and uterine function.
What is Pelvic Floor Dysfunction?
Pelvic floor dysfunction occurs when the pelvic floor system is not working properly, either because of weakness, tightness, or abnormal muscle tone. This can occur for a multitude of reasons, including:
- trauma due to childbirth complications, sexual abuse, cancer, post-surgical scarring, among many other reasons
- chronic low back pain causing core inhibition
- stress, anxiety
- repetitive motions
What symptoms indicate Pelvic Floor Dysfunction?
Symptoms of pelvic floor dysfunction can manifest in many ways:
- Urinary incontinence, frequency and urgency, especially during strenuous activity
- Painful urination
- Fecal incontinence
- Painful sex or pain in the genital area
- Constipation
- Vaginismus
- Pain in the pelvis, hip, abdomen, thigh, or low back
- Rectal pain
- Endometriosis
- Pregnancy-related pain
- Testicular pain
- Pelvic organ prolapse
How can HMPT help?
Pelvic floor therapy begins with history taking, which includes past surgical and medical history, medications, and sexual, gynecologic or obstetric history. A thorough orthopedic examination is performed, with close attention to the lumbopelvic region and hips spine and hips during functional movements. The assessment usually includes evaluation of both internal and external muscles, with patients often asked to stand, walk and sit to enable the therapist to detect any existing posture or joint issues affecting the pelvic floor muscles.
The evaluation helps to determine whether the therapy is appropriate and guides the creation of an appropriate care plan. And usually, the type of therapy recommended depends on the symptoms experienced. For example, relaxing and lengthening muscle exercises may be necessary to relieve some symptoms while in other cases strengthening exercises are appropriate.
The eventual treatment plan may include:
Through a tailored treatment plan, the physical therapist manipulates pelvic floor muscles to restore strength and function. For example, shortened and contracted muscles are stretched to relax in order to relieve pelvic floor pain associated with excessive tightening and cramping. Likewise, appropriate techniques are used to strengthen muscles, alleviate contractions associated with overactive bladder, and keep the bladder, rectum and uterus in their positions. Ultimately, the therapy helps to ease pain and associated symptoms, and restore normal functioning.
Most pelvic floor therapy techniques are hands on and include both internal and external treatment. External therapy techniques include nerve release, trigger point therapy, deep tissue massage (myofascial release), skin rolling and joint mobilization. Internal techniques may involve using specialized instruments or passing a finger through the rectum or vagina to manipulate soft tissue and joints.
The evaluation helps to determine whether the therapy is appropriate and guides the creation of an appropriate care plan. And usually, the type of therapy recommended depends on the symptoms experienced. For example, relaxing and lengthening muscle exercises may be necessary to relieve some symptoms while in other cases strengthening exercises are appropriate.
The eventual treatment plan may include:
- Stretching or strengthening exercises of the legs, trunk or pelvic muscles.
- Relaxation exercises for shortened pelvic muscles.
- Education in self-management and prevention.
- Coordination exercises.
- Modalities such as ice, heat or electrical stimulation.
Through a tailored treatment plan, the physical therapist manipulates pelvic floor muscles to restore strength and function. For example, shortened and contracted muscles are stretched to relax in order to relieve pelvic floor pain associated with excessive tightening and cramping. Likewise, appropriate techniques are used to strengthen muscles, alleviate contractions associated with overactive bladder, and keep the bladder, rectum and uterus in their positions. Ultimately, the therapy helps to ease pain and associated symptoms, and restore normal functioning.
Most pelvic floor therapy techniques are hands on and include both internal and external treatment. External therapy techniques include nerve release, trigger point therapy, deep tissue massage (myofascial release), skin rolling and joint mobilization. Internal techniques may involve using specialized instruments or passing a finger through the rectum or vagina to manipulate soft tissue and joints.
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