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The pelvic floor includes the muscles that support the reproductive and urinary tracts. This group of muscles also controls the bladder and bowels, and if they are weak or don’t work as they should, they would result in pelvic floor dysfunction. To address the problem related to the pelvic floor, a specialized program of functional retraining called Pelvic Floor Physical Therapy could be given to improve pelvic floor muscle strength, endurance, power, and relaxation in patients.

How Is Pelvic Floor Dysfunction Diagnosed?

Physicians and physical therapists, specially trained in treating pelvic floor dysfunction, diagnose the condition during a physical examination. Using external or internal “hands-on” approaches or manual techniques to assess the function of the pelvic floor muscles, these specialists can assess the ability to contract and relax these pelvic floor muscles.

To develop an accurate treatment plan, an internal exam of the pelvic floor may be done to assess the pelvic floor muscles using, such as:

  • Pelvic girdle assessments — The licensed therapist will examine the health of the pelvic girdle, a complex ring of ligaments, joints, and muscles that connect the skeleton to the lower limbs and on the pelvic floor.
  • Pre- and post-partum abdominal screening will examine the abdominal muscles to determine if they are separated (abdominal diastasis).
  • Electromyography testing and biofeedback — Biofeedback sensors with a low-grade electrical current will also be used to stimulate a muscular response, which detects neuromuscular abnormalities.

On the other hand, urologists may also take a medical history, symptoms history, and family health history and run diagnostic tests to diagnose the root of a patient’s pelvic pain. An active urinary tract or bladder infection will be determined through urine analysis. Aside from that, patients may also undergo cystoscopy or CT scan to further the urologist’s recommendation.

What Are The Common Pelvic Floor Dysfunction Issues?

Problems on the pelvic floor can occur in many forms for both men and women. Fecal or urinary leakage and pelvic pain are common pelvic floor problems. When having a pelvic floor dysfunction, the pelvic muscles can’t relax or work together as they should, which causes:

  • Constipation
  • Peeing frequently
  • Erectile dysfunction in men
  • Pain during sex in women
  • Erectile dysfunction in men
  • Trouble controlling the urine or bowels, leading to leaks

Also, pelvic floor dysfunction may trigger through the following:

  • Pelvic surgery
  • Aging
  • Pregnancy
  • Being overweight
  • Overuse of the pelvic muscles
  • Serious injuries to the pelvic area

How Can This Therapy Help With Dysfunction And Pain?

The manual techniques, exercise programs, diet and activity modifications, and education on Pelvic floor physical therapy helps break the cycle of muscle tension and tissue restriction leading to pain and more tension. The connective tissue manipulation technique releases connective tissue restrictions in areas surrounding the pelvis, including the groin, abdominals, buttocks, inner thighs, and low back. Manual release of pelvic floor muscles and relaxation exercises can also help alleviate muscle tension and associated pain. 

Additionally, physical therapists prescribe exercises and stretch to address muscle dysfunction and tightness. Lifestyle modifications such as adjusting daily activities held positions, and diet help addresses pelvic pain’s underlying causes and triggers.

What Are The Conditions That Pelvic Floor Physical Therapy Can Treat?

Pelvic floor physical therapy treats all types of disorders classified under pelvic floor dysfunction. It can be subdivided into hypotonic (low tone) and hypertonic (high tone) disorders.

To highlight, muscle tone refers to the amount of resting tension in a muscle when it is not contracted. Different forms of pelvic floor dysfunction can result in too much or too little tone in the pelvic floor muscles.

Low Tone Disorders (Hypotonic)

When a muscle has a low tone, it is more relaxed and looser than normal, making it difficult to contract actively. When there is a low tone in the pelvic floor muscles, the core cannot be adequately supported, and the control over the bladder and bowel movements may be affected. Below are the disorders caused by having a low tone on the pelvic floor:

  • Anal incontinence- The involuntary leaking of gas, fluid, or stool from the rectum.
  • Overactive bladder- A condition characterized by urinary urgency, frequency, and urge incontinence when the bladder involuntarily contracts.
  • Pelvic organ prolapse- The abnormal descent of the pelvic organs, including the uterus, vagina, bladder, or rectum, from their normal positioning.
  • Stress incontinence: An involuntary leaking of urine during activities that increase intra-abdominal pressure, including coughing, sneezing, laughing, squatting, and heavy lifting.

High Tone Disorders (Hypotonic)

When pelvic floor muscles are in a high tone, they become tighter and more restricted than normal. This can often cause pain when relaxing or stretching the muscle. Due to high tone muscles, a person may experience pelvic pain, muscle spasms, and difficulty with insertion during intercourse or a gynecological exam. 

Below are the disorders caused by having high tone muscles on the pelvic floor:

  • Dyspareunia: A pain during sexual intercourse from vaginal penetration.
  • Pelvic floor myofascial pain is a chronic pain resulting from tightened pelvic floor muscles.
  • Vaginismus is an uncontrolled, involuntary spasm of the muscles surrounding the vagina that occurs with penetration.
  • Vulvodynia: A pain and discomfort in the vulva, often referred from tight and dysfunctional pelvic floor muscles.

What To Expect During the Pelvic Floor Physical Therapy?

After the physical therapist has completed the external and internal examinations and made a clinical assessment of the possible causes of the symptoms, follow-up sessions will be scheduled for the patient. Each session will take place in an intimate or private treatment room. 

Typically, the treatment may consist of the following:

  • Kegels. It is among the popular exercises to relax or contract the pelvic floor muscles.
  • Manual therapy. The physical therapist often performs this technique internally to relieve trigger points and relax the pelvic floor muscles.
  • Biofeedback. This technique uses a sensor pressure probe that is inserted into the vagina or rectum to check the strength of contractions of the pelvic floor muscles.
  • Electrical stimulation. This technique helps elicit pelvic floor muscle activation.
  • Vaginal dilators. They are cylindrical objects of varying widths inserted into the vagina to stretch the pelvic floor muscles and relax with insertion gently.
  • Weighted cones. These are inserted into the vagina or rectum during contraction exercises to provide increased resistance.

Who Can Receive The Pelvic Floor Physical Therapy?

Generally, the ideal pelvic floor physical therapy candidates are those looking for a conservative treatment approach and whose condition does not immediately require surgery or is not a good candidate for surgical intervention.

How Many Sessions Of This Therapy Are Required?

The required number of sessions would depend on what a patient is being treated for. One visit per week is a common starting protocol for pelvic floor physical therapy for six to eight weeks. The length and duration of therapy will depend on the patient’s diagnosis.

The Bottom Line

When muscles that comprise the pelvic floor weaken or don’t properly work, it can lead to dysfunction, pain, and common chronic issues. CaTara Medical Spa offers Pelvic Floor Physical Therapy to help patients regain normal tone, strength, and feedback so that the pelvic floor can adequately support and control regular urination, bowel movements, and sexual function. The therapy will employ manual techniques, exercise programs, diet and activity modifications, and education to break the cycle of muscle tension and tissue restriction leading to pain and more tension.

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