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PELVIC PAIN AND PELVIC FLOOR DYSFUNCTION

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PELVIC PAIN AND PELVIC FLOOR DYSFUNCTION

What is pelvic pain and pelvic floor dysfunction?

There are a number of conditions which cause pain and pelvic floor dysfunction. We have discussed a few of those conditions here today. Fortunately most of the conditions are treated with physiotherapy interventions.

Pelvic area

Pelvic pain and dysfunction

Common conditions related with internal pelvic structures:

Provoked vestibulodynia: In this your pelvic area is very sensitive to touch or pressure. You will feel pain with

  • light touch,
  • pressure,
  • inserting tampons,
  • wearing tight pants or
  • intercourse.
  • urinary urgency

Vaginismus: You feel difficulty and/or pain with vaginal penetration. This will lead to avoidance of sexual activity or internal pelvic examination.

Bladder pain syndrome: You feel pain and pressure with urge to urinate at any time. You will get an increased urge to urinate. Symptoms usually starts with bladder infection.

Dysmenorrhea: You will feel painful cramps with mensuration. It affects about 90% of the women. This could include pelvic adhesions, pelvic inflammatory disease and cervical stenosis.

pelvic pain

Pelvic pain

Conditions related to activities and damage to structures:

Dyspareunia: It is pain with sexual intercourse. Damage to the structures like:

  • episiotomy,
  • tears,
  • reduced mobility of cervix or soft tissues,
  • bladder pain,
  • overactive  muscles and
  • inflammation

Coccyx pain:  It is the pain in tail bone are with sitting, sit to stand, sexual activity, or with bowel movements. Usually caused by any trauma, inflammation or muscle imbalance.

Conditions involving neurological structures:

Pudendal Neuralgia: There is pain and numbness in the area supplied by nerve from anus to penis or clitoris. You will feel pain with sitting, fecal and urinary incontinence.  There are other underlying conditions that can restrict your pelvic mobility. This leads to compression of your pudendal nerve.

Male pelvic pain issues:

Certain conditions such as dysfunction of pelvic muscles, non-bacterial inflammation of prostate, Pudendal neuralgia, anal fissures, Coccydynia, bladder pain causes pelvic pain in male patients.

If you want more information about the conditions which cause pelvic pain visit this link https://www.onhealth.com/content/1/pelvic_pain_causes

Experiencing any of the above symptoms?

Pelvic floor therapist helps you with thorough assessment and  treatment based on the diagnosis. Educating you about the cause of the pain. Managing with home exercise program.

Pelvic health

Treatment techniques done by pelvic floor physiotherapists:

For vestibulodynia:

Physiotherapy is considered as the first line of treatment for you. Your physio will treat with tissue care, manual techniques for painful points, muscle imbalance,  relaxation techniques. You will learn to avoid wearing tight clothes and diet modification.

For Dyspareunia:

Relaxation techniques along with dilator insertion helps to relieve tension in the vaginal area. Pelvic therapist will  releases scar tissue in the vaginal area which reduces pain. Soft tissue techniques improves the mobility of the cervix and scar tissue.

Bladder pain syndrome:  Releasing the tension in pelvic floor muscles and posture correction helps to reduce your symptoms. Incontinence can be treated with pelvic floor muscle training, positioning and certain stretches of the muscles in the pelvic floor area.

Vaginismus: Treatment involves stretching of pelvic floor tissues with external and internal techniques, scar mobilization, muscle overactivity with dilators and relaxation techniques.

Dysmenorrhea: Techniques involve breaking the adhesions in the pelvic floor area and release the narrowing in the cervix.

Techniques to help to reduce your pain:

  • Relaxation techniques,
  • stretches,
  • soft tissue release

Injury with any activity:

Pudendal neuralgia: Your Physio will treat you with nerve release, stretches, and posture correction. Sensory re-education to reduce the numbness in the pudendal nerve supply.

Coccyx pain: Treatment involves pelvic floor relaxation techniques,  mobilization of coccyx. We will mobilize it internally and externally. Proper positioning with cushion, exercises to improve the mobility  helps to reduce the pain the coccyx.

Male pelvic pain: Treatment includes release of pelvic floor muscles to ease up the pain. We will treat you with stretches, positioning, mobilization, relaxation.

DON’T WAIT TO START PHYSIOTHERAPY  TREATMENT

If you notice any of the above symptoms, it’s important to consult your pelvic floor physiotherapist. You can reduce the risk of complications by taking early treatment.. Book a consultation at PhysioNOW with a Registered Physiotherapist today.

 

General Category, Pelvic Health, Pregnancy Mississauga

Pregnancy related Pelvic pain

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Pregnancy Related Pelvic Pain
Pregnancy Related Pelvic Pain

                        Pregnancy and Pelvic girdle pain


Pregnancy Related Pelvic Pain: Words Can Hurt

Pregnancy related Pelvic pain can create great challenges. Imagine you are 32 weeks pregnant with your first child and you start to have pain in the low back and pubic area when you change position. Pregnancy related pelvic pain can happen when you sit, stand for longer periods or when you walk. The pain makes it very difficult for you to function. As a result, you may worry about whether you can continue to work and manage your household.

Pregnancy Related Pelvic Girdle Pain: Words Can Hurt

Now imagine you have seen your health care provider and have been told that your pelvis is separating. They tell you this is because of the hormone Relaxin. Then you are told that you may need to put up with this until after you have your baby .

In addition, you are told, “it will probably get better afterwards”. “Be careful” “If it hurts, don’t do it”, “Your pubic bone is splitting”, “Your pelvis is unstable”. These are common words of advice or explanations pregnant women with pelvic girdle pain (PGP) receive from their healthcare providers. (From the Canadian Physiotherapy Association – Pain Science Division)

What is Pregnancy related pelvic girdle pain?

Pregnancy related Pelvic pain is characterized by pain around the pubic and sacroiliac joints. It can present as pain in the inner groin and adductor area, the buttocks or the sides of the hips. As a result, it is aggravated most commonly by maintaining sustained postures or changing position.

This Pelvic pain affects approximately 16-25% (Kanakaris 2011) of pregnant women, although it is very likely under reported and dismissed as a normal consequence of pregnancy.

Prognosis for Pregnancy related pelvic pain

The prognosis for pregnancy related pelvic girdle pain is very good. The majority of women improve within a few months after delivery. Only approximately 5-8.5% (Kanakaris 2011) go on to have persistent symptoms. Understanding this issue is the role of your Physiotherapist. Physiotherapists can help!

How does Breast feeding affect pregnancy related pelvic girdle pain?

Urban myths regarding breastfeeding being associated with laxity-related musculoskeletal pain should be put to rest. Suggestions to “be careful” (suggesting fragility), restrict function (reinforcing disability), to rest more and avoid activity (usually makes symptoms worse) should be set aside.

Too many women have weaned their babies early. They have done this in hopes this would alleviate their Pelvic girdle pain. This decision is based upon “helpful” advice, often from their Health Care Provider, despite the fact that there is no evidence to support this. As a result, many women are sadly advised not to lift their babies for several weeks after delivery. They are told to avoid doing this in order to avoid aggravating their Pregnancy related Pelvic girdle pain.

The good News!

The good news is that Pregnancy related Pelvic girdle pain can be managed very successfully! You can be shown effective self management programs which allow you to take control of your own care. This will allow you to become more confident, comfortable and active during your pregnancies.

Good strategies can be integrated into daily activities. As a result, it is possible to manage work, daily activities and child/baby care independently during pregnancy and postpartum.

Studies have also shown that vaginal deliveries are not only safe for women with Pregnancy related Pelvic Girdle pain, they are even preferable. Bjelland (2012) found a 2-3 fold increased risk of severe Pregnancy related Pelvic girdle pain (PGP) postpartum in women with PGP after a planned Cesarean Section.


Pregnancy related Pelvic Girdle pain Leads to a significant decrease in Quality of Life

Pregnancy related Pelvic Girdle pain Leads to a Significant Decrease in Quality of Life:

Five main categories emerged:

1. Pelvic girdle pain affects the ability to cope with every day life a) Postpartum depression- 3x more prevalent in this group of women (Gutke 2007)

2. Coping with motherhood and changing roles a) 20% avoid future pregnancies because of fear of Low Back pain and Pregnancy related pelvic girdle pain (Brynhildsen 1998)

3. Relationship between partners often reached the breaking point

4. Questioning one’s identity as defined by profession and work

5. Lack of acknowledgement of pain and disability Elden H. et al: Life’s pregnant pause of pain: Pregnant women’s experiences of pelvic girdle pain related to daily life: A Swedish Interview Study. Sexual & Reproductive Healthcare. (2013) Engeset J. et al. Pelvic girdle pain affects the whole life—a qualitative interview study in Norway on women’s experiences with pelvic girdle pain after delivery. BMC Res Notes. (2014) 7: 686.

How Can Physiotherapy help with Pregnancy related pelvic girdle Pain?

We at PhysioNow believe that Physiotherapists have a privileged role in helping to shape the experience of pregnant women with Pelvic girdle pain. Physiotherapists are in the ideal position to calm anxiety and correct misconceptions. We are happy to educate you about your condition. We explain it in a way that decreases the threat of your pain and gives you permission to move.

Exercise during pregancy
Pregancy related pelvic pain

Physical activity is now seen as a critical part of a healthy pregnancy. Pregnant women should accumulate at least 150 minutes of moderate-intensity physical activity each week over a minimum of three days per week. However, being active every day is encouraged. Following the 2019 Guideline for Physical Activity throughout Pregnancy can reduce their risk of pregnancy-related illnesses such as gestational diabetes, high blood pressure and preeclampsia by 25 percent. (https://csepguidelines.ca/guidelines-for-pregnancy/)


Pain Management in Pregnancy: Joint SOGC/CSEP Clinical Practice Guidelines Nov 2018 P

  1. Muscle training for the pelvic floor (e.g., Kegel exercises) may be performed on a daily basis to reduce the risk of urinary incontinence. Physiotherapist Instruction in proper technique is recommended to obtain optimal benefits.

2. Pelvic floor muscle training with a Physiotherapist is recommended to prevent urinary incontinence during pregnancy and after delivery

3. Core stability training with a Physiotherapist is recommended to prevent and treat back and pelvic pain during and following pregnancy.

4. Pregnant women who experience lightheadedness, nausea, or feel unwell when they exercise flat on their back should modify their exercise position to avoid this position.

Supervised antenatal and postnatal pelvic floor muscle training has been shown to be protective against Urinary Incontinence(UI), particularly in high risk groups Boyle et al 2012, Stafne et al 2012, Reilly et al 2002. 

If you or someone you know suffers from Pregnancy related pelvic girdle pain, we can help! We have highly trained Physiotherapists ready to help you with this very unpleasant condition. Please call PhysioNow today to get started!

General Category, Pelvic Health, prostate surgery

The Mysterious Pelvic Floor

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Pelvic Floor Muscles


The Mysterious Pelvic Floor


What is The Mysterious Pelvic Floor??

The Pelvic Floor. Perhaps you have heard this referenced before but did not have a definitive idea of what it was. Is it just a region in the body? A single muscle? Let us explore this very important topic.

The Pelvic floor is a group of extremely important muscles located on the inside of the pelvis with a hammock like orientation. They attach to the tailbone (coccyx) at the back, the pubic bone in the front and span side to side.

Functions:

These muscles are involved in several complex functions but are often overlooked in their contribution due to their “out of sight, out of mind” presence. These functions include:

1. Bowel and Bladder Function and Support

Assists in control of the bladder and bowel (helping to prevent incontinence) in males and females. In females, the pelvic floor supports the uterus and other organs located in the pelvic cavity. This helps to prevent prolapse. Prolapse is the lowering down of a pelvic organ from its normal position. 

Contribution to our Core Muscles?

The pelvic floor acts as the base of our core together with the deep back muscles and diaphragm. Core muscles help to provide strength and stability of the spine.

Involvement in Sexual Function

The pelvic floor plays a role in sensation during sexual intercourse. As a result, dysfunction of these muscles may lead to painful intercourse. In addition, it can lead to decreased sensation, and reduced erectile function amongst other symptoms. 

Involvement in pregnancy and delivery

The strength of the pelvic floor muscles is very important during pregnancy. They help to support the extra weight of pregnancy. This can reduce certain symptoms of discomfort. They can also help to decrease the incidence of incontinence (bladder leakage), and prolapse. Additionally, they play a large role during delivery in guiding the baby’s head down the birth canal.

Symptoms of Dysfunction?

When the pelvic floor is working in harmony, it plays a big role in a variety of our functions. What happens when something is not quite balanced in the pelvic floor? Symptoms may arise. For example, they can be as a result of one of two scenarios: weakness in the pelvic floor or increased tension in the pelvic floor.

What about Kegels?

It is common to assume that any pelvic floor concerns are automatically as a result of weakness. Many people think that kegels should immediately be practiced. However, kegels are NOT always the answer! If the primary problem in the pelvic floor is tension, kegels can in fact do more harm than good. The Mysterious Pelvic Floor issues can be solved with a little Pelvic Physiotherapy!

So, what are some of the symptoms associated with pelvic floor dysfunction?

  • Urinary issues, such as the urge to urinate, incontinence (bladder leakage), urinary frequency and painful urination.
  • Bowel concerns such as constipation and incontinence
  • Lower back pain
  • Pain in the pelvic region, genitals, or rectum.
  • Discomfort during sexual intercourse for women.
  • Pressure in the pelvic region or rectum.
  • Muscle spasms in the pelvis.

What are some of the Risk Factors for issues with The Mysterious Pelvic Floor ?

  • A history of back pain
  • Previous trauma to the pelvic region such as a fall or pelvic radiotherapy
  • Ongoing constipation (i.e. for example, regularly straining to empty your bowels)
  • A chronic cough or sneeze (e.g. due to asthma, smoking or hayfever)
  • Being overweight, or having a body mass index above 25, and
  • Heavy lifting on a regular basis – either at work or at the gym most commonly
  • During pregnancy and post-partum, some factors may arise
  • Women who are going through, or have been through, menopause
  • Women who have had gynaecological surgery (e.g. hysterectomy)
  • Men who have had prostate surgery
  • Elite athletes such as gymnasts, runners or trampolinists.
What is a Pelvic Physiotherapist and How Can We Help?

What is a Pelvic Physiotherapist and How Can We Help?

A Pelvic Physiotherapist has advanced training . They assess and treat the pelvic floor through a combination of external and internal examinations. This treatment is for both males and females. Internal examination allows the Physiotherapist, to evaluate the pelvic floor directly. As a result, this will help to identify contributing factors to your concern.

Typically, tension or weakness are underlying imbalances in the pelvic floor. The Mysterious Pelvic Floor issues are usually treatable!

Although this is an area less known for its muscle contribution, the parallel of a shoulder injury should be drawn here, for example. In order to help treat a shoulder problem, a Physiotherapist would still have to evaluate all the muscles around it. We would check to see where the problem lies. Once found, these same muscles would be treated directly.

This is the same principle to keep in mind when trying to understand pelvic floor problems and treatment.

Treatment of The Mysterious Pelvic Floor?

Once a full examination has been completed, the Pelvic Physiotherapist discusses the results with you. Together, they will develop a treatment plan with you. Pelvic Physiotherapy treatments vary, however, some of the methods often used can include:

  • Postural training
  • Release and mobilizations , (often the low back, hips, etc. are involved).
  • Connective tissue release. Connective tissue is the thin layer found above our muscles. Sometimes, it can cause tension pulls and compression in areas. As a result, this causes pain and poor function.
  • Dilator work
  • Internal techniques to release areas of tension. We teach contraction exercises AND relaxation techniques. These are often overlooked
  • Exercises: These are positional to alleviate pain and pressure. They strengthen, stretch, and activate muscles. As a result, they help to build endurance, and improve coordination.
  • Breathing techniques

In cases where internal assessment or treatment may be painful, external treatment can be started first. This can often reduce the tension causing the internal discomfort. Improvements can be made to achieve your ultimate goals.

It is also important to note that Physiotherapists are primary health care providers. Therefore, you can see a Physiotherapist without a doctor’s referral. However, if your Physiotherapist feels that you may benefit from further testing, we will reach out to your doctor of choice.

Summary of The Mysterious Pelvic Floor

The Mysterious Pelvic Floor doesn’t need to be so mysterious!

Two of the most common phrases that I hear patient’s mention during or after a pelvic physiotherapy assessment are:

  “I didn’t even know that this type of Physiotherapy existed” and

         “I wish I knew about this sooner”

These phrases are often derived from patients who have a pelvic concern. In most cases, it has significantly affected their function. It has resulted from the belief that nothing could be done, besides “living with it.”

My hope is that Pelvic Physiotherapy becomes well known! My hope is that you seek treatment as often as our rotator cuff friends. Afterall, they both involve muscles that can be easily treated. Take care of your pelvic floor, it is literally of foundational importance!

If you or someone you know suffers from Pelvic Floor issues, PhysioNow can help! We have specially trained Pelvic Floor Physiotherapists available at all of our clinics to help. Call today to get started on your treatment!

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PELVIC FLOOR: POSTURE

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PELVIC FLOOR: POSTURE

Pelvic Floor: Posture

PELVIC FLOOR: POSTURE is a very important area if you have issues with urinary incontinence, pelvic pain, etc.  The muscles of the pelvic floor support the abdominal and pelvic viscera.  These muscles are active in standing and sitting. Furthermore, because the abdomen is a fluid-filled cavity, intra-abdominal pressure  is distributed in all directions.  The Pelvic Floor muscles, which form the floor of the abdominal cavity, contribute to its muscle control.

As a result of this contribution to control of intra-abdominal pressure, the muscles of the pelvic floor are likely to contribute to control of the spine and pelvis. The slouched posture places a lot of pressure on our internal organs and pelvic floor. This can cause a worsening of:

  • urinary incontinence,
  • pelvic pain,
  •  symptoms related to prolapse,
  • and rectus diastasis.

Pelvic Floor: Posture, sitting slumped

  • Research has shown that when we sit in a slumped posture, our pelvic floor muscle activity is much less than when we are sitting tall.
  • Pelvic Floor: Posture IS VERY IMPORTANT!
  • slouched sitting postures decrease the activity of your transverse abdominal muscles.
  • A Proper breathing pattern encourages the pelvic floor to move more dynamically.
  • Dysfunctional breathing patterns inhibit this dynamic movement of the pelvic floor.

Pelvic Floor: Posture,  

  • An assessment by a Pelvic Health Physiotherapist includes a thorough postural examination.
  • Your Pelvic Health Physiotherapist will be able to identify your unique postural compensations
  • They can help guide you on the road to improved body posture awareness.

CHECK OUT THIS LINK FOR FURTHER INFORMATION.

At PhysioNow, we have fully trained Pelvic Health Physiotherapists that can help to assess and treat pelvic issues like the following conditions:

  • Constipation
  • Dyspareunia
  • Endometriosis
  • leakage of urine
  • pain with intercourse
  • pelvic organ prolapse
  • pelvic pain
  • urinary incontinence
  • vaginismus
  • erectile dysfunction

If you or someone you know suffers from one of these conditions, give us a call today.  We would be happy to help!

  1. Sapsford, RR. et al (2006) Sitting posture affects pelvic floor muscle activity in parous women: an observation study. Aust L Physiother. 52(3):219-22
  2. Reeve, A., Dilley, A., (2009) Effects of posture on the thickness of Transverse Abdominal Muscle and Pelvic Floor Muscle Exercises for Stress Urinary Incontinence: A Randomized controlled Trial. J Phys Ther Sci. 26(8): 1161-1163.
Applewood Physionow, Applewood Sports & Physiotherapy Ltd, Dyspareunia, Endometriosis Physiotherapy, Erin Mills Physionow, Erin Mills PhysioNow, Erin Mills Physiotherapy Ltd., General Category, Health and Wellness, Lorne Park PhysioNow, Lorne Park Sports & Physiotherapy Ltd., Manual Therapy, pain with intercourse, Pelvic Health, Pelvic Health Physiotherapists, pelvic pain, PhysioNow, Registered Physiotherapist Mississauga, Registered Physiotherapy Mississauga, Seniors, Urinary Incontinence, Vaginismus

Vaginismus

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Vaginismus

Vaginismus and Physiotherapy

Vaginismus is a painful feeling of discomfort or inability when inserting a tampon, finger, penis or during a doctor’s internal pelvic exam. It occurs when there are involuntary contractions of the muscles in the outer third of the vagina.

Primary Vaginismus: when a woman has never been able to have pain free intercourse due to pelvic floor muscle spasm.

Secondary Vaginismus: pain that develops sometimes later in life after a traumatic event such as childbirth, surgery, or a medical condition.

With Vaginismus, there is usually significant Connective Tissue Dysfunction that needs to be addressed first before any internal work. It is suggested that you follow up the self-help treatment for connective tissue dysfunction before embarking on the stretching exercises with the dilators.

Pelvic floor exercises and Desensitisation techniques

A physiotherapist may be able to teach you pelvic floor exercises, such as squeezing and releasing your pelvic floor muscles, that can help you gain control over the muscles causing the vagina to close involuntarily. Occasionally, a technique called biofeedback may be useful. A small probe is inserted into your vagina. This monitors how well you are doing the exercises by giving you feedback as you do them.
Biofeedback can help with the following:

• Teach you strategies that may help to relax the muscles that are contracting involuntarily
• Teach you appropriate timing of the contraction and relaxation of the pelvic floor muscles.
• Educate you about your condition and why it might be occurring.
• Teach you various strategies for getting the muscles to relax
• help you to Use manual therapy to release the muscles either externally and/or internally that are causing the contractions.

More information about Vaginismus can be found here.

Some general tips about pelvic floor muscle exercises:

• Choose a convenient time and place where you can exercise regularly.
• Put a reminder about pelvic muscle exercises somewhere obvious to you (or set an alarm on your watch or mobile phone).
• Avoid quick pelvic floor muscle exercises where you don’t hold the contraction. This tends to cause an increase in pelvic floor muscle resting tone.
• Be aware that it will take 6 to 8 weeks of regular exercise before you can expect to see improvement. It will take approximately 3 months for the pelvic muscles to strengthen.
• You could try inserting one finger into the vagina to check the strength of your squeeze as you pull in the pelvic muscles. Alternatively, you may be able to feel a pelvic floor contraction if you place the tip of your index finger on the perineal body (on the outside, between the vagina and back passage).

Other tips to reduce Vaginismus:

• If you are overweight, try reducing your weight.
• Try not to become constipated, as a full bowel will put pressure on the bladder. Straining to empty your bowel will weaken the pelvic muscles.
• If your job involves lifting, think of your pelvic muscles as well as your back. Pull up your pelvic muscles when lifting a heavy weight.
• If you smoke, consider quitting. Frequent coughing puts a strain on the pelvic muscles.

If you or someone you know suffers from Vaginismus, please call PhysioNow today! Our specially trained Physiotherapist can start your treatment Now!