Pelvic Pain
Urinary Incontinence (UI)
Fecal Incontinence (FI)
Bowel Dysfunction
Obstetrical Issues (Prenatal and Post-partum)

Pelvic Pain

“It is normal to hurt during intercourse or with penetration.”

Pain with penetration (dyspareunia) may be caused by many factors and should be evaluated to determine if physical therapy may help. Penetration may be defined as including any insertion into the vaginal vault ( including tampon, finger, pelvic examination, penis, etc).

“Pelvic pain is rare.”

Pain in the pelvic region is a very personal and potentially emotional issue. Many feel they are alone in their pain experience and that few others have similar discomfort. The statistics show that approximately 18% of the population experiences some form of chronic pelvic pain (CPP), and this statistic is undoubtedly low (many do not report their pain). Considering the diffuse region included in the pelvic pain definition (below umbilicus, between hip bones, into upper thighs), many systems are involved and the numbers of people affected are substantial.

“Treatment for pelvic pain will hurt.”

There are techniques, both external and internal, that produce no pain and still are able to alleviate pelvic pain symptoms. It is important to develop a good rapport with your therapist and be sure that she discusses all the options prior to administering any therapeutic interventions. Although many treatments are minimally uncomfortable or pain-free, mild flares of discomfort may occur during or post-treatment in some situations. Your therapist should inform you if that response is anticipated and provide you with guidance on how to reduce unwanted effects.

Urinary Incontinence (UI)

“Leakage is inevitable as I get older.”

Leakage is not inevitable. Steps can be taken to reduce the risk of UI development and to reduce or eliminate UI symptoms once they have begun. Depending on the type of leakage you experience (often mixed with either stress- or urge-dominant pattern), conservative treatments are extremely effective in reducing incontinence.

“Surgery or medication are the only options available to treat urinary incontinence.”

Therapy has been shown to be as effective (or even more effective) in some cases of incontinence. For many, medications can be reduced or eliminated and surgery may be postponed or canceled. There are times when surgery and/or mediation will be necessary. In those cases, attending at least one session of PT would likely improve the surgical outcome and longevity. It’s easier to train a muscle before surgery than after (For example, it is standard procedure to attend therapy prior to and following knee replacement to prepare the region. I am obviously biased, but the same should go for those attending scheduled pelvic surgery as well.)

“I’ve tried Kegel exercises and they don’t work.”

Many people are never informed of Kegel or pelvic floor (PFM) exercises. Those who have heard of them usually are only told in passing to “squeeze” several times daily. Most have never been instructed in HOW to correctly perform PFM exercises. It is similar to being told to start a strengthening program for your shoulders without any guidance. The pelvic muscles do not work in isolation – they coordinate with all of the surrounding structures and with your breath pattern – if they are not, then squeezing them in isolation will not improve your symptoms. Coordination of the pelvic muscles can usually be trained in a short period of time so the exercises can be done independently.

“If I have (or have had) surgery, therapy isn’t necessary and would not help.”

Surgery – regardless of how perfectly completed – is still trauma to the pelvic region even though it may be helpful and/or necessary. Recovery and retraining of coordination is essential for full benefit to be realized. Keep in mind that you want a good outcome from surgery to be supported for a long time – physical therapy can train the region to sustain those good results!

Fecal Incontinence (FI)

“Leakage of feces is rare.”

Reporting of bowel leakage is less than that of UI and even those seeking professional help for UI often have to be prompted to admit to FI. Many will say “it’s only been once or twice”, but even one or two events indicate dysfunction in the pelvic region. Many are embarrassed to report symptoms or have even experienced dismissal from health care providers when they have revealed their FI issues.

“Surgery is the only treatment for FI.”

Physical therapy is able to retrain the internal or external anal sphincters without surgical intervention in many situations. However, fecal incontinence requires surgical intervention for improvement more often than UI, usually due to traumatic initiating factors (ie, childbirth trauma, nerve damage). Your physician will be able to discuss your particular issues and help you decide what role physical therapy may play in your recovery.

Bowel Dysfunction

“I poop every day, so I’m not constipated.”

Bowel movements should be passive (no straining!!) and should be completed in one full bowel movement (instead of multiple trips to the loo). Chronic straining may be due to many issues, one of which is outlet obstruction. Pelvic rehab aims to normalize the pelvic muscle coordination to allow for release of fecal matter without straining.

“Constipation is all about fiber. If I eat more fiber, my constipation will go away.”

Yes, this is partially true. Fiber is a big component of constipation relief. It is not the only factor, though. Fluid intake, medication influence and other nutritional/dietary issues may also be at play. Abdominal functioning may be further restricted due to adhesions (ie, surgical, childbirth). A few sessions of manual interventions combined with simple instructions for self-care may relieve much of the constipation. Instruction in self-care techniques to keep the system moving can be very helpful!

Obstetrical Issues (Prenatal and Post-partum)

“I’m pregnant, so I’m going to hurt.”

We all know pregnancy is not always the most comfortable situation. Pain, though, is different. Pain, numbness, tingling into the legs, into the arms, in the pubic bone or sacro-iliac (SIJ) region are all treatable conditions! Please seek help from a physical therapist trained in OB issues!

“Leakage is just part of pregnancy.”

There is increased bladder pressure due to the growing baby and leakage is more likely. That does not mean there is no way to counter the effects, though! If completing Kegel exercises is not helping reduce or control your leakage, physical therapy may be able to help.