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


  After 12 years of working with MD's in Madison, WI (even at UW Hosp) I had little to no relief from my Trigeminal Neuralgia - nor did I have an accurate diagnosis. In 14 months of physical therapy I've gone from having CONSTANT headache pain daily at levels of 5-9, on a 1-10 scale, to having intermittent pain; still daily however at levels of 0-6, most often in the 2-4 range - when I have pain. I've weaned down from

* 60 mgs of MS contin 3X daily +
* 60 mgs of Oxycodone 3-4X daily
* 15 mgs of MS contin 3X daily +
* 25 mgs of Oxycodone 3X daily

  On the lesser dose - with physical therapy - I have more pain-free hours than I ever had at higher levels.
  Through education and resources available at Homer Physical Therapy, I've come to understand more about how my body works as a WHOLE SYSTEM and that several things caused the Trigeminal Neuralgia - these include a 2nd and 3rd degree burn scar on my right leg from 1988; my hypermobility that causes my body to become out of alignment, as well as the dysfunction in my pelvic area which includes endometriosis, ovarian cysts and a surgery for their removal in 1986.
  I've learned that I can help decrease my pain through diet choices (keeping a balanced PH level), exercises that stretch muscles that need to be stretched versus muscles that are already hypermobile, resting when I need to rest, and coming to see my physical therapist weekly for manipulations that continue to release the fascia that is binding my nerves.
  The thing that surprised me the most was finding out how connected my pelvis and head really are. As time went on I developed terrible burning and stinging pain during intercourse and annual exams. I did NOT relate this to my head pain at all. However, through a technique called "skin rolling" that released the fascia, my intercourse pain was much better and my head pain was reduced as well!
  I now understand so much more about my condition and my body as a whole that I thank Goodness, God, or the Universe each day for helping me to find Sallie and Homer Physical Therapy. They have literally saved my life. - Name Withheld for Privacy

 In the fall of 2012 I decided to address the issue of pelvic pain with my physical therapist. I have received treatment for all sorts of other issues over the years, so I decided to overcome my shyness about the issue of pelvic pain and see if I could be
 For several years I have had discomfort and pain during intercourse. Sallie Rediske asked me about the nature of my pain, did a thorough internal exam, and then did an exam of the external pelvic area. She asked me if various places caused me pain when she palpitated them internally and none of them hurt during the exam. I learned that my discomfort was related to issues that Sallie found while palpating the external region.
 If I am remembering correctly, her diagnosis was that my discomfort stemmed from a combination of factors: extensive scar tissue and adhesions from 2 abdominal surgeries as well as muscular tightness caused from long term postural issues. She warned me that during the course of treatment we might not see any improvement for a long time. We were both pleasantly surprised when my pain during intercourse disappeared entirely after only two sessions of deep tissue work in that area. I would encourage anyone suffering from pelvic pain to try physical therapy as a possible solution to their problem.
I am a 60 year old woman in Homer, Alaska. January 2013


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