Diagnoses

 
 

Female Pelvic Pain

Pelvic pain can be felt in the lower abdomen, perineum, hips, vagina, anus, or any other area of the pelvis. This can be described as aching, burning, sharp, tingling, numbness, or stabbing. There are numerous mechanisms that can cause pelvic pain and may lead to spasms of the pelvic floor muscles or holding/guarding of the surrounding tissues. These include vaginal delivery, C-section, sexual trauma, any form of abuse, abdominal or pelvic surgery, hernias, occupations that require prolonged sitting, gait disturbances, and injury to the back or pelvis.

Pain with Sex

Men and women can both experience pelvic floor muscle dysfunction that can lead to discomfort with intercourse. Pain during sex (dyspareunia) is very common. For many, the search for help can be a frustrating and unproductive journey of referrals from one doctor to another (gynecologist, urologist, pain specialist, urogynecologist, psychiatrist/phsychologist)- adding to the frustration. Some patients even have surgery for issues related to dyspareunia with unfortunately no change in symptoms. A missing link can be your pelvic floor muscles and also the mind/body connection to these muscles. After being evaluated by a physician to rule out other medical conditions, musculoskeletal causes of painful sex need to be explored.

Interstitial Cystitis (IC) - Painful Bladder Syndrome

Interstitial cystitis or painful bladder syndrome is a common, yet often unrecognized cause of chronic pelvic pain (CPP). CPP is defined as non-cyclical pelvic pain for at least 6 months. The bladder is one of the most sensitive organs in the pelvis and one of the most common sources of pain in patients with CPP.(1) Up to 81% of patients with CPP will have bladder involvement.(2) Journeying through doctors and diagnoses related to IC can be very lonely, uncomfortable, and frustrating.

Pudendal Neuralgia

Pudendal neuralgia is a painful condition that occurs in both men and women. This happens when the pudendal nerve becomes compressed or irritated as it runs its course through the gluteal and pelvic floor muscles. Patients who suffer from pudendal neuralgia often describe their pain as burning, numbness, pins and needles, stabbing, stinging or cramping along the path of the pudendal nerve- often times in the genitals or the anal-rectal area. Often times, finally being diagnosed with pudendal neuralgia can be a difficult and long journey through medical providers.

Postpartum Pelvic Floor

During pregnancy, the uterus and your precious cargo are growing for over 30 weeks! This increased weight and pressure on the pelvic floor and surrounding ligaments can cause weakness and stretch injuries. During delivery of your special babe, it is very common for muscle tears to occur. With a C-section, the lower abdominal wall is cut in order to deliver your babe into this world. You are one special woman! That is a lot for one Momma to handle.

Pelvic Organ Prolapse (POP)

Prolapse is when any of the pelvic organs drop increasing pressure in the vagina and on the pelvic floor. There are many different causes of pelvic organ prolapse:

  • Pelvic floor muscle weakness,

  • Hormonal imbalances,

  • Repeated straining which happens during childbirth, chronic constipation, and chronic cough

Some prolapse can be prevented through functional pelvic strengthening, corrected body mechanics when lifting, avoidance of straining, controlling and treating constipation, weight control, and kegels (performed initially under supervision of a physical therapist to ensure proper muscle recruitment).

Diastasis Recti

The word diastasis means separation. Diastasis recti is a separation of the rectus abdominus or the outermost abdominal muscles. The force that can cause this separation includes a growing uterus and baby during pregnancy and using abdominal muscles incorrectly during heavy lifting and intense abdominal exercises. Every woman will have some degree of diastasis during pregnancy. Not having your abdominal muscles acting as your body’s natural corset can cause imbalance and pain postpartum.

Urinary Incontinence

Over 25 million Americans are affected by incontinence. Your pelvic floor muscles must be correctly coordinated and work together in order to provide proper support to the bladder and urethra. 

There are three major types of urinary incontinence: stress, urge, and mixed incontinence. 

  • Stress incontinence: urinary leakage caused by coughing, sneezing, laughing or exertion

  • Urge incontinence: a sudden and strong urge to urinate, followed by the inability to control it

  • Mixed incontinence: a combination of both stress and urge loss of urine

Fecal Incontinence

Fecal continence is maintained by the structure and function of the anorectal unit as part of the performance of the pelvic floor. Causes of pelvic floor dysfunction leading to fecal incontinence can include disruption of appropriate signaling, weakness or decreased control of the pelvic floor muscles, and/or trauma.

Constipation

Constipation is such a common disorder. In addition to addressing any anatomic, disease, and diet related causes for a patient’s constipation, the pelvic floor muscles should be addressed. According to the Mayo Clinic, 50% of patients with chronic constipation have pelvic floor dysfunction. 

The pelvic floor muscles must contract properly to maintain urinary and fecal continence and relax properly in order for you to have proper bowel movements without too much straining.

When the pelvic floor muscles fail to relax and contract properly this can cause constipation, which is referred to as dyssynergic defecation or anismus. This can then lead to straining with bowel movements and feelings of incomplete evacuation. In patients with constipation related to pelvic floor dysfunction (PFD), the muscles around the anal region often contract instead of relax during attempted bowel movements. Unfortunately, PFD is not widely recognized as a possible cause of chronic constipation. As a result, many patients with constipation do not receive the treatment that enables them to recover normal bowel habits.

Breast Cancer Rehab

You have already been through so much. Now, your body needs time and proper healing. Decreased breast and shoulder mobility after mastectomy and/or resultant reconstruction surgery can cause pain and discomfort. Skin thickening after radiation, decreased mobility of scar tissue, abnormal healing, and capsular contractions of implants can all cause shoulder and chest dysfunction. Decreased scapular strength and poor posture can lead to rotator cuff problems including tendonitis and impingement. Physical therapy will assist with increasing range of motion, strength, improving posture, and increasing neural mobility. This will increase your quality and speed of recovery.

Men’s Health

Pelvic floor muscle dysfunction is not only limited to women. Men and women possess similar anatomy in terms of their pelvic floor muscles and the way they function. Men can suffer from numerous conditions that can decrease the quality of life: urinary and fecal incontinence, pelvic pain, anus pain, tailbone pain, rectal prolapse, and chronic constipation. These conditions may arise from various reasons including surgery, hernias, prostate conditions, sport activity, and injury.