Pelvic floor physical therapy

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Pelvic floor physical therapy

Postby Alyssa » 03 Dec 2014, 01:40

What is Pelvic Floor Physiotherapy?

To Kegel or NOT?

That is the question!! Kegels are not for everyone, and even when indicated are often not done properly!

Specialized Physiotherapy is becoming more established in the literature as a first-line of defence against Incontinence and Pelvic Pain. Pelvic Floor Dysfunction can be caused by:

HYPOTONICITY (Weak pelvic floor muscles): contributing to stress incontinence, urge incontinence and pelvic organ prolapse. Incontinence is NOT a normal part of aging.
HYPERTONICITY (Tight pelvic floor muscles): contributing to Urinary and Fecal Urgency, Urge Incontinence, Chronic Pelvic Pain, Dyspareunia, Vaginismus, Vulvodynia, Pudendal Neuralgia, Interstitial Cystitis and Chronic Prostatits.
Kegels are NOT always indicated for pelvic floor problems. Sometimes they do more harm than good, and often they are NOT performed correctly.

The Cochrane Collaboration 2010 concluded that Physiotherapists with specialized training in pelvic floor rehabilitation (using internal examination to teach the exercises) should be the first line of defence, before surgical consultation, for stress, urge and mixed incontinence in women.

Many people with pelvic pain have pelvic floor dysfunction, but specifically hypertonic muscles, or muscles that are too tight. The pelvic floor muscles are a group of muscles that attach to the front, back and sides of the pelvic bone and sacrum. They are like a hammock or a sling, and they support the bladder, uterus, prostate and rectum. They also wrap around your urethra, rectum, and vagina (in women).

These muscles must be able to contract to maintain continence and relax to allow for urination, bowel movements, and in women, sexual intercourse.

When these muscles have too much tension (hypertonic) they will often cause pelvic pain or urgency and frequency of the bladder and bowels. When they are low-tone (hypotonic) they will contribute to stress incontinence and organ prolapse. You can also have a combination of muscles that are too tense and too relaxed.

Hypertonic muscles can cause the following symptoms:

Urinary frequency, urgency, hesitancy, stopping and starting of the urine stream, painful urination, or incomplete emptying
Constipation, straining, pain with bowel movements
Unexplained pain in your low back, pelvic region, hips, genital area, or rectum
Pain during or after intercourse, orgasm, or sexual stimulation
Uncoordinated muscle contractions causing the pelvic floor muscles to spasm
Pelvic floor dysfunction is diagnosed by specially trained doctors and physiotherapists by using internal and external “hands-on” or manual techniques to evaluate the function of the pelvic floor muscles. They will also assess your ability to contract and relax these muscles. Your bones and muscles of your lower back, hips and sacro-iliac joints will need to be assessed as well since these joints can stress your pelvic floor muscles.

If an internal examination is too painful, the connective tissue of your abdomen, thighs, groins and low back are often very tight. The connective tissue forms the container of the muscles, and this tissue often needs to be relaxed before any internal work can be done.

When your pelvic floor muscles are tight and weak, the tension is treated before the weakness. Once the muscles have reached a normal resting tone, and are able to relax fully, their strength is reassessed and strengthening exercises are prescribed, if appropriate.

Self-care is an important part of treatment. Avoid pushing or straining when urinating and ask your health care provider about how to treat constipation. Relaxing the muscles in the pelvic floor area is important, and doing reverse kegels may be one way to help lengthen and relax these muscles. Using methods such as warm baths twice daily can also be helpful.

Medication such as compounded vaginal or rectal diazepam can be quite helpful and may be prescribed by your doctor. These medications can be used as local muscles relaxants in the vagina or rectum. Good posture to keep pressure off your bladder and pelvic organs, and other stretching techniques such as yoga, can be helpful to avoid tightening and spasms in the pelvic floor muscles as well.

Persistent pain education is an important part of treating pelvic floor dysfunction since the pelvic area is an area that we often hold our stress. Anxiety, stress and our thoughts, attitudes and beliefs can perpetuate the pain in our pelvis; understanding how our pain system works has shown to be an effective way of reducing the threat of ongoing pelvic floor dysfunction.
2/14 Fissure developed
3/14 Diagnosed w/ fissure given Nifedipine
4/14 Referred to Pelvic Floor Physical Therapy=Pelvic Floor Dysfunction
5/14 Fissure declared "healed"/chronic anal pain persists
9/5/14 Botox to pelvic floor
9/22 biofeedback
Alyssa
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Re: Pelvic floor physical therapy

Postby Artvandelay » 14 Dec 2014, 23:31

I have been seeing a specialist for 5 weeks now and doing much better with the spasms. Wish I would have know these specialist existed long ago!
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Re: Pelvic floor physical therapy

Postby sweetpea » 18 Dec 2014, 22:28

Artvandelay, can you describe what you've done in your sessions? i think it's wonderful you are doing so much better.

thanks!
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Re: Pelvic floor physical therapy

Postby Alyssa » 19 Dec 2014, 01:28

These are some examples of pelvic floor physical therapy...

http://www.healingpelvicandabdominalpain.com/
2/14 Fissure developed
3/14 Diagnosed w/ fissure given Nifedipine
4/14 Referred to Pelvic Floor Physical Therapy=Pelvic Floor Dysfunction
5/14 Fissure declared "healed"/chronic anal pain persists
9/5/14 Botox to pelvic floor
9/22 biofeedback
Alyssa
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Posts: 735
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Joined: 29 Apr 2014, 11:24
Location: San Jose, CA
Has thanked: 136 times
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Re: Pelvic floor physical therapy

Postby Alyssa » 31 Mar 2015, 17:50

Here are some questions to ask a pt...

1. Do you have experience treating pelvic pain? How many years of experience?

2. Do you ONLY see pelvic pain patients? If not, what percentage of your practice is dedicated to only pelvic pain?

3. Do you spot treat or do you assess alignment for global restrictions (Spot treating would be only treating the painful area; a PT who works on the whole body - globally - assessing for restrictions everywhere.

4. Have you ever seen someone with my specific onset and symptoms? If so how did you treat them?

5. What techniques do you use/what kind of training do you have?

6. Should I expect to feel better or worse after treatment?

7. Do you do internal and external work?

8. Do you give homework/ what kinds of homework do they assign?

9. How soon should I see changes/how long do you think I will need treatment?
How often would I see you?

10. Of the books they have read, which ones do they find most helpful & why?

11. What professional organizations do they belong to?

12. What experience did they have as part of their training that made them decide to specialize in PFPT?

13. What other training besides PFPT do they have, like yoga, cupping, massage, or Pilates?

14. How do they coordinate care with other professionals - is this person going to communicate directly with your PCP, counselor, Ob/Gyn, etc. via email--or will you have to do that work on your own behalf?
2/14 Fissure developed
3/14 Diagnosed w/ fissure given Nifedipine
4/14 Referred to Pelvic Floor Physical Therapy=Pelvic Floor Dysfunction
5/14 Fissure declared "healed"/chronic anal pain persists
9/5/14 Botox to pelvic floor
9/22 biofeedback
Alyssa
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Re: Pelvic floor physical therapy

Postby pafen » 03 Apr 2015, 17:44

Hi,

Thanks for the information Alyssa. Valuable tips for anyone with pelvic floor pain.

I am seeing a physiotherapist that specifically deals with pelvic pain only. Overall it has made an improvement in my pain levels. I have had some myofascial release of the obturator internus as well as stretches which target the muscles directly.

Its also good to see a pelvic floor physiotherapist to identify which muscles are in spasm as a form of diagnosis.
Hemroidectomy, anal abscess, fissure, LIS
Pelvic floor Dysfunction since late 2012
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Re: Pelvic floor physical therapy

Postby Alyssa » 03 Apr 2015, 18:23

Pafen,

I'm so happy for you; you're finally seeing the light at the end of the tunnel.. I just started seeing a new pt 3 weeks ago... And she is doing techniques that the previous never did on the 11 months spent with her. My new pt doesn't understand why I only had sessions once a month; I don't understand it either. I'm and because I wasted almost a year with her; a year that if I would have had the right care I would probably be doing much better. Now this pain is centralized which means its going to take some time to fully eliminate this pain.
2/14 Fissure developed
3/14 Diagnosed w/ fissure given Nifedipine
4/14 Referred to Pelvic Floor Physical Therapy=Pelvic Floor Dysfunction
5/14 Fissure declared "healed"/chronic anal pain persists
9/5/14 Botox to pelvic floor
9/22 biofeedback
Alyssa
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Re: Pelvic floor physical therapy

Postby Alyssa » 11 Apr 2015, 02:01

Are you looking for a pelvic floor physical therapist?

This list includes NHS and private physiotherapists who are registered in the UK and who have an interest in pelvic pain. Some of them treat men and women.

http://www.pelvicphysiotherapy.com/Manu ... pists.html

http://www.pelvicphysiotherapy.com

http://www.apta.org/apta/findapt/index. ... 0737422525
2/14 Fissure developed
3/14 Diagnosed w/ fissure given Nifedipine
4/14 Referred to Pelvic Floor Physical Therapy=Pelvic Floor Dysfunction
5/14 Fissure declared "healed"/chronic anal pain persists
9/5/14 Botox to pelvic floor
9/22 biofeedback
Alyssa
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Posts: 735
Topics: 26
Joined: 29 Apr 2014, 11:24
Location: San Jose, CA
Has thanked: 136 times
Been thanked: 41 times
Gender: Female

Re: Pelvic floor physical therapy

Postby Artvandelay » 08 Jun 2015, 15:10

I have not been here in a while as I feel "for now" I am 95% cured! The internal dilation I had done for 6 weeks along with home dilation has stopped the spasms and also helped stop the tearing. Being so tight back there caused tears. This was the best thing I have done myself after years of fighting this. I continue to dilate at home if I feel spasms returning and I will use a bulb syringe with warm water if I feel constipated. If you have on of the professionals in your area I would recommend looking them up. My therapist did internal and external work on my pelvic floor muscles.
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