Pelvic Health

What is Pelvic Health?

  Pelvic health refers to the state of optimal function and comfort of the organs, muscles, joints, nerves and other soft tissue that make up the area between our belly buttons and pelvic floor. Pelvic health requires the optimal function of all of the systems in our body including the urinary, reproductive, circulatory, nervous, respiratory, integumentary (skin), and musculoskeletal systems. Pelvic health is a generic term that is not specific to either gender. It relates to all conditions involving the pelvic area; it is not limited to certain ones like urinary incontinence.

  All of these organ systems are treated by various medical and integrative health-care providers, but physical therapists approach the issues pertaining to the pelvis slightly differently. PT's treat movement imbalances that limit function. They are trained in evaluation and treatment of dysfunction primarily of the joints, muscles and nerves. However, when these structures interfere with movement or quality of function of the other systems, then physical therapists are able to integrate treatment to facilitate restoration of normal function of all of the involved systems. Pelvic health is important for many reasons - the pelvis is the base on which our spine stands. It is the support for all of our internal organs and the outlet for much of what goes on within these internal organs. And of course the pelvis is important for its role in intimacy and reproduction. Specially trained physical therapists are best able to integrate the various systems involved in pelvic function and health.

  Physical therapists who specialize in pelvic health acquire most of their training following the completion of a graduate level program in physical therapy. Classes they take range from workshops in musculoskeletal function of the spine, sacrum, and hips to soft tissue treatment techniques including myofascial release, visceral manipulation, and connective tissue massage. Additional instruction is received in the evaluation of pelvic floor muscle quality. Treatment techniques usually include patient education regarding the involved structures and their function, manual therapy, exercises, and guidance in understanding how poor mechanics is related to pain and dysfunction.

  Urinary incontinence is one of the most common conditions treated by physical therapists practicing in this area. It is often thought that urinary incontinence is a  normal part of aging for both men and women. Recent studies estimate only one-quarter of all women suffering from urinary incontinence seek help. Often the help they receive is inadequate, nothing more than a hand-out relaying instructions of how to perform Kegels (pelvic floor exercises). Such information can be counterproductive as it seems to be the answer, but if the individual is so weak she can not identify the appropriate muscles, the exercises alone most often fail. Attempting them only reinforces the imbalances that already exist. A person can also have extremely tight muscles in the pelvic floor region that interfere with normal ability to perform an appropriate contraction. Failure to identify the underlying cause can result in the individual failing at the exercise program and feeling as if there is nothing that can be done to help them with this often life-altering condition.

  Physical therapists trained in pelvic health issues can also treat painful conditions that limit one's ability to void, move, sleep, be intimate, and reproduce. The American Journal of Obstetrics and Gynecology reported in their September 2001 issue (Vol. 185, p.545) that 16.7% of women between the ages of 20-59 have pelvic pain that has lasted greater than six months. The article also reported that of those women, only 40% sought medical help. The numbers are not much different for men suffering from pelvic pain. Many of these conditions are caused by either too much tension in the pelvic floor muscles or by disease processes that make the pelvic muscles tense. In the latter case, pain that would be manageable becomes unbearable. In an article in the Journal of Urology (166:2226-2231, 2001), Jerome Weiss MD states that it is essential that patients should undergo a physical therapy evaluation and treatment to correct any predisposing or perpetuating condition. Some of the diagnoses that are successfully treated by physical therapy intervention include painful menses, pudendal nerve entrapment, interstitial cystitis, endometriosis, prostatitis, sacroiliac joint dysfunction, abdominal adhesions, tail-bone pain, vulvodynia, and uterine and bladder prolapse.

  If you are experiencing any concerns related to the pelvic region of your body and its function, it is important that you see an appropriate health-care provider to rule out any serious medical condition that may be the cause of pain or dysfunction. Once this is complete, if your physician does not offer a physical therapy referral, ask for one!


Important Websites for Pelvic Health:
www.vulvodynia.com  for Dr. Howard Glazer's Vulvodynia website
www.womenshealthapta.org Section on Women's Health at the American Physical Therapy Assoc.
www.pelvicpain.org for the International Pelvic Pain Society
www.nva.org for the National Vulvodynia Association
www.hersfoundation.com for Hysterectomy Alternatives and After effects
 www.spuninfo.org  Society for Pudendal Neuralgia
www.pudendal.com  The Pudendal Nerve


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Homer Physical Therapy LLC
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