Frequently Asked Questions
What is pelvic floor dysfunction?
Pelvic floor dysfunction is a disorder in the muscles and/or nerves of the pelvic floor, or in the surrounding skeletal structure. It is extremely common to have a dysfunction in the pelvic floor: The pelvic floor muscles surround the urethra, rectum, vagina and prostate; therefore, if there is a dysfunction in these muscles it can result in urinary, bowel or sexual dysfunction in men, women and children.
How does one get pelvic floor dysfunction?
The occurrence of pelvic floor dysfunction is typically multi-factorial and difficult to identify. It can be the result of a traumatic fall,childbirth, insidious onset, or from abdominal or pelvic surgery. It can occur due to poor posture, muscle incoordination, disuse atrophy, a chronic holding pattern in the pelvic floor, from a urinary tract or yeast infection or from a skeletal malalignment.
Whom should one see to get a proper diagnosis?
It is essential to get a proper diagnosis and that would come from a healthcare practitioner that specializes in pelvic floor dysfunction/pelvic pain. Too often I have had patients come to my office and say they have been to 10 different doctors and healthcare providers and their symptoms have not improved, or have worsened. Also, many healthcare providers will state that "it is in your head". They do not assess (or they do not know how to assess) the pelvic floor muscles and nerves. If you do not have this type of healthcare provider please email us at firstname.lastname@example.org or call us.
Why might pelvic floor dysfunction be difficult to diagnose?
Part of this is due to the fact that there has been little research on the subject. However, in the past 15 years an abundant amount of research has been published and many more schools are starting to teach the medical students and healthcare students what pelvic floor dysfunction is and how to diagnose it.
Explain the exercises that you prescribe and whom they will help.
There are 2 different Programs:
- Downtraining Program (to decrease tone and decrease pain)
refers to those that experience pelvic, abdominal, hip and/or back pain and any disorder that has an increase in the pelvic floor muscle tone. Both of these can result in tight or spasmed muscles which commonly results in an inability to relax the pelvic floor muscles. In turn this can affect bladder, bowel, and/or sexual function. The exercises to help with this diagnosis are described in Chapter 3-End the Pain and Chapter 5-Massage of Heal Pelvic Pain.
- Uptraining Program (increase tone and increase strength)
refers to pelvic floor and possibly core muscle and tissue weakness resulting in incontinence, pelvic organ prolapse (organs dropping) and/or decreased sexual response. Women may experience these symptoms after labor and delivery and men may experience symptoms after prostatectomy or surgery. Chapter 4 of Heal Pelvic Pain will help, and/ or completely eliminate these problems through strengthening the pelvic floor and core muscles.
- Downtraining Program (to decrease tone and decrease pain)
How does one know if they are improving?
In Chapter 2 of Heal Pelvic Pain, there is a "symptoms" monitor which allows you to track your symptoms through the programs. There are also recommendations of how and when to advance each program according to how you are progressing.
How is sexual activity affected?
Sexual activity can be affected in 2 different ways, similar to what is described above:
- pain or discomfort with sexual activity may be the result of tight pelvic floor muscles, irritated vaginal tissue, and more.
- weakness resulting in decreased libido and sexual response.
At what age does this occur?
Pelvic floor dysfunction can occur as early as 4 years old and into the elder years. For children, it is common to suffer from pelvic floor muscle incoordination whereas the elderly tend to suffer from weakness due from disuse; although, all ages can be diagnosed with any of the diagnoses.
What is in a typical Physical Therapy session?
The therapists at Beyond Basics Physical Therapy are trained to evaluate, assess, and treat a variety of musculoskeletal, neurological, geriatric, women's health, pelvic floor (men and women), and pediatric dysfunctions. Therapists are also encouraged to participate in continuing education courses, thereby being informed about current developments and changes in the medical and physical therapy fields.
- Initial visit:
- Evaluation: 60 – 90 minutes
- Treatment plan development:- one on one and individualized
- Home exercise program
- Subsequent Visits:
- One on one
- 45 minutes (minimum) to 90 minutes
- Addition to home exercise program
We encourage patients to take part in their road to recovery and ask questions about any concern they may have throughout the treatment course.
Treatment consists of:
- Muscle relaxation and/or re-education
- Exercises to enhance function
- Postural re-education and relaxation techniques which are key in breaking the pain cycle caused by these problems
- Patient education for functional activities of daily living
We primarily use manual skills and augment them with electrical modalities.
Instantaneous performance-dependant feedback regarding the function of muscles to increase self regulation, awareness, and control.
- Connective Tissue Manipulation
It is the movement of one layer of skin over the other to release tension in the tissue and to increase range of motion in the joint or the limb. The manipulation creates a sensation of a sharp scratch, or a "nails" sensation; and the tighter the tissue, the sharper the sensation. When the tension is released, the blood flow to the area increases, thereby removing toxins from that region, decreasing pain, and ultimately allowing more movement to occur. With each treatment, there is further reduction in connective tissue tension, and this reduction can be maintained.
- Craniosacral Therapy
The membranes and the cerebrospinal fluid of the brain and spinal cord form the craniosacral system. It extends from the skull, face, and mouth to the tailbone area. An imbalance in this system may affect sensation and motor skills. CranioSacral therapy is the use of light touch which detects imbalances and encourages correction through an individual's own healing process.
It can be used to treat migraines, headaches, chronic neck and back pain, stress and emotion-related problems, chronic fatigue, TMJ syndrome, scoliosis, PTSD, and other orthopedic conditions.
- Electrical Stimulation
Used to treat stress incontinence, urge incontinence, pain, urinary and/or bowel retention.
- Lymphatic massage/manual lymphatic drainage
Technique that uses very light pressure with soft pumping movements in the direction of lymph nodes to help increase lymph flow, removing harmful substances from tissues and improving metabolism, which will increase immune function.
- Myofascial Release
Fascia is a sheet of connective tissue that surrounds, separates, or connects muscles, organs, and other soft structures of the body.
Myofascial release is application of sustained pressure to reduce fascial restrictions to relieve pain, improve range of motion, relax muscles, and relieve neurological dysfunction.
- Transcutaneous electrical nerve stimulation (TENS)
The application of mild electrical stimulation using skin electrodes near or distant to an area of pain; results in interference with transmission of painful stimuli.
- Visceral Manipulation
Adhesions, abnormal tone, or displacement may result in disharmonious movement between internal organs which in turn may lead to chronic irritation and pain. Visceral manipulation uses gentle palpation and manual therapy to evaluate and correct the imbalances.
- Initial visit: