Pelvic Floor Dysfunction and Pain

Definitions:
Pelvic Floor describes a group of muscles that attach to the inside of the pelvic bone and serve as “hammock” support for the bladder, uterus, rectum, prostate, and anus in men and women. These muscles must relax and contract to provide continence, voiding, bowel movements and in women for sexual intercourse.

Dysfunction:
The state of high-tone or spasm or low-tone or weakness in the pelvic floor resulting in pain voiding dysfunction, retention urinary or fecal incontinence.

Pelvic Floor Symptoms:

  • Frequency, urgency, urge incontinence, hesitancy and urinary retention
  • Constipation,  rectal pain after bowel movement, with intercourse or with prolonged sitting, traveling and etc.
  • Chronic pain in perineum, rectum, vagina or back
  • Uncoordinated  muscle contractions resulting in pelvic floor spasms

Diagnosis:
A doctor or physical therapist trained in pelvic floor dysfunction will do an external and internal exam of the pelvis. A manual “hands-on” exam will identify muscle spasm, the effectiveness of pelvic floor, muscle strength and relaxation as well as lumbar/pelvic support. If a pelvic exam is too tender electrodes or vaginal/rectal probe may be used to obtain information (pudendal EMG and pelvinometer).

Treatment:

  • Self-care:  The goal of therapy is relaxation of the pelvic floor muscles with avoidance of straining to pass urine or bowels.  Application of local ice and warm baths may be helpful. Good posture to relieve pelvic pressure and muscle stretching therapy with yoga relieves pain.
  • Medications: Anti-inflammatory and/or low dose muscle relaxers may help with spasm or pain i.e. Valium by oral route or suppositories in servere cases of pelvic floor spasm/pain.
  • Physical Therapy:  A variety of methods are used successfully.
  • Internal and External manual manipulation/massage (Theile teclmique, relaxation of muscle  (myofascial release by skin rolling, deep muscle massage, nerve release or joint mobilization.
  • Trigger point injections
  • Biofeedback
  • Interferential therapy with electrical stimulation  by skin electrodes which interfere or cancel out contractions/spasm  to relieve pain
  • Thermal ultrasound or cold laser therapy to increase blood flow to the pelvic floor to induce muscle relaxation.
  • Home exercise is the mainstay of therapy. Practicing daily with strengthening and stretching of the back muscles, relaxation of the pelvic floor muscles, visualization and good posture with an overall improvement in sensation and awareness of the pelvic floor leads to the best therapeutic result.
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