How Pelvic Floor Physical Therapy helps Female Pelvic Pain

In Female Pelvic Pain by Elizabeth AkincilarLeave a Comment

By Elizabeth Akincilar, MSPT, Cofounder, PHRC Lexington

 

Did You Know…

 

  • An estimated sixty-one percent of women with bladder pain syndrome have comorbid chronic pelvic pain, while almost fifty percent of women with endometriosis suffer from chronic pelvic pain.1
  • Seventy percent of women with a previous diagnosis of endometriosis are diagnosed with chronic pelvic pain.2,3
  • Women with a past medical history significant for pelvic trauma or surgery are at a much higher risk of developing chronic pelvic pain compared to the general population. Twenty-eight percent of women develop persistent pelvic pain following an elective cesarean delivery, three months postoperatively, while twenty percent of women continue to have persistent pain six months postoperatively.4
  • Myofascial pelvic pain in women may be the underlying cause of chronic pelvic pain in 14% to 23% of cases and up to 78% of cases of interstitial cystitis.5
  • Pain scores significantly improved proportional to the number of physical therapy visits completed, with 63% of patients reporting significant pain improvement, concluding that transvaginal physical therapy is an effective treatment for chronic pelvic pain resulting from myofascial pelvic pain.6

 

Pelvic Floor Dysfunction and Female Pelvic Pain

 

Female pelvic pain generally refers to burning, itching, aching, or other types of pain in the vulva, vagina, perineum and/or anal area. These pain symptoms may be constant or intermittent. Symptoms can be provoked, such as with intercourse or tampon insertion, or unprovoked and spontaneous. 

 

Women with pelvic pain can also experience other symptoms such as:

 

  • Pain with intercourse
  • Hypersensitivity to underwear or other tight-fitting clothing
  • Pain with sitting
  • An exacerbation of pain with exercise
  • Urinary urgency, frequency and/or hesitancy
  • Abdominal bloating and/or abdominal pain
  • Gastrointestinal distress
  • Constipation

 

Diagnoses associated with pelvic pain include:

 

  • Vestibulodynia
  • Vulvodynia
  • Endometriosis
  • Interstitial Cystitis/Painful Bladder Syndrome
  • Pudendal Neuralgia
  • Irritable Bowel Syndrome
  • Lichens Sclerosis and Lichens Planus

 

Women can develop pelvic pain for a number of reasons. Causes of pelvic pain include:

 

  • Pelvic floor dysfunction
  • Recurrent or chronic vaginal or urologic infections such as yeast infections or urinary tract infections 
  • Chronic gastrointestinal or dermatologic conditions 
  • Prescription medications such as oral contraceptive medications, acne medications, or hormonal suppressive therapies commonly used for conditions such as Endometriosis or Polycystic Ovarian Syndrome
    • Oral contraceptive pills decrease the availability of sex hormones, including both estrogen and testosterone. In 2015 an International Consensus Conference on Vulvar Pain decided that hormonal insufficiencies can cause vulvar pain.
  • Surgical trauma such as a Cesarean section or hysterectomy
  • Orthopedic injuries or trauma
  • Biomechanical or structural dysfunction such as sacroiliac joint dysfunction, hip dysfunction or scoliosis
  • Vaginal childbirth
  • Menopause
  • Genital cutting or mutilation

 

Challenges to diagnosis and treatment

 

Women face many challenges when it comes to diagnosing pelvic pain as well as receiving effective treatment. Research reveals that it can take women suffering with pelvic pain five years to get a diagnosis and up to 11 years for a woman with endometriosis. One of the reasons women are often misdiagnosed is that many of these symptoms mimic other pathologies such as a yeast infection, urinary tract infection, or sexually transmitted infections. Other times the symptoms may be mistaken for primary dysmenorrhea (recurrent menstrual cramps). At the end of the day many medical providers are unaware that pelvic floor dysfunction can be the culprit for many symptoms of pelvic pain leading to misdiagnosis and delay of proper treatment.  

 

What is Pelvic Floor Physical Therapy and how it can help Pelvic Pain

 

Pelvic floor physical therapists specialize in the treatment of pelvic pain and pelvic floor disorders. Pelvic floor physical therapy is often an integral component of the treatment plan for anyone experiencing pelvic pain. Women experiencing pelvic pain will almost certainly benefit from a pelvic floor physical therapy evaluation. During the evaluation the physical therapist takes a comprehensive history to understand exactly how and when the symptoms began, the nature of the symptoms, the woman’s complete medical history, including previous diagnoses and treatments and the effectiveness of those treatments. During the physical examination the physical therapist evaluates the muscles, tissues, joints, nerves and movement patterns. After the examination, the physical therapist reviews and explains their findings and develops a comprehensive treatment plan that is carried out over the next, approximately, 8-12 weeks. Additionally, the physical therapist develops a home exercise program to facilitate the in-person treatment. Importantly, the physical therapist coordinates their care with the other members of the treatment team to ensure the most comprehensive treatment plan.

 

Success Stories

 

Tessa’s Triumph Over Painful Sex

 

A bike accident caused vulvar pain

 

How Jennifer Beat Endometriosis

 

Pain Free After Thirty-Five Years

 

How Pelvic Floor Physical Therapy Helped Me Recover From Vaginismus

 

Recovery From Vaginismus and Painful Sex

 

Additional Resources

 

PHRC YouTube Videos

 

PHRC Blogs

 

Podcasts

 

References

 

  1. Tirlapur SA, Kuhrt K, Chaliha C, Ball E, Meads C, Khan KS. The ‘evil twin syndrome’ in chronic pelvic pain: a systematic review of prevalence studies of bladder pain syndrome and endometriosis. Int J Surg. 2013;11(3):233-7.
  2. Laufer MR, Goitein L, Bush M, Cramer DW, Emans SJ. Prevalence of endometriosis in adolescent girls with chronic pelvic pain not responding to conventional therapy. J Pediatr Adolesc Gynecol. 1997 Nov;10(4):199-202. 
  3. Mowers EL, Lim CS, Skinner B, Mahnert N, Kamdar N, Morgan DM, As-Sanie S. Prevalence of Endometriosis During Abdominal or Laparoscopic Hysterectomy for Chronic Pelvic Pain. Obstet Gynecol. 2016 Jun;127(6):1045-1053. 
  4. Richez B, Ouchchane L, Guttmann A, Mirault F, Bonnin M, Noudem Y, Cognet V, Dalmas AF, Brisebrat L, Andant N, Soule-Sonneville S, Dubray C, Dualé C, Schoeffler P. The Role of Psychological Factors in Persistent Pain After Cesarean Delivery. J Pain. 2015 Nov;16(11):1136-46.
  5. Pastore EA, Katzman WB. Recognizing myofascial pelvic pain in the female patient with chronic pelvic pain. J Obstet Gynecol Neonatal Nurs. 2012;41(5):680-691. doi:10.1111/j.1552-6909.2012.01404.x
  6. Bedaiwy MA, Patterson B, Mahajan S. Prevalence of myofascial chronic pelvic pain and the effectiveness of pelvic floor physical therapy. J Reprod Med. 2013 Nov-Dec;58(11-12):504-10.

______________________________________________________________________________________________________________________________________

Are you unable to come see us in person? We offer virtual physical therapy appointments too!

Due to COVID-19, we understand people may prefer to utilize our services from their homes. We also understand that many people do not have access to pelvic floor physical therapy and we are here to help! The Pelvic Health and Rehabilitation Center is a multi-city company of highly trained and specialized pelvic floor physical therapists committed to helping people optimize their pelvic health and eliminate pelvic pain and dysfunction. We are here for you and ready to help, whether it is in-person or online. 

Virtual sessions are available with PHRC pelvic floor physical therapists via our video platform, Zoom, or via phone. For more information and to schedule, please visit our digital healthcare page.

In addition to virtual consultation with our physical therapists, we also offer integrative health services with Jandra Mueller, DPT, MS. Jandra is a pelvic floor physical therapist who also has her Master’s degree in Integrative Health and Nutrition. She offers services such as hormone testing via the DUTCH test, comprehensive stool testing for gastrointestinal health concerns, and integrative health coaching and meal planning. For more information about her services and to schedule, please visit our Integrative Health website page. 

Do you enjoy or blog and want more content from PHRC? Please head over to social media!

Like us on Facebook,

Subscribe to our YouTube Channel, 

and follow us on Twitter, Instagram, Tik Tok and Pinterest!

FAQ

What are pelvic floor muscles?

The pelvic floor muscles are a group of muscles that run from the coccyx to the pubic bone. They are part of the core, helping to support our entire body as well as providing support for the bowel, bladder and uterus. These muscles help us maintain bowel and bladder control and are involved in sexual pleasure and orgasm. The technical name of the pelvic floor muscles is the Levator Ani muscle group. The pudendal nerve, the levator ani nerve, and branches from the S2 – S4 nerve roots innervate the pelvic floor muscles. They are under voluntary and autonomic control, which is a unique feature only they possess compared to other muscle groups.

What is pelvic floor physical therapy?

Pelvic floor physical therapy is a specialized area of physical therapy. Currently, physical therapists need advanced post-graduate education to be able to help people with pelvic floor dysfunction because pelvic floor disorders are not yet being taught in standard physical therapy curricula. The Pelvic Health and Rehabilitation Center provides extensive training for our staff because we recognize the limitations of physical therapy education in this unique area.

What happens at pelvic floor therapy?

During an evaluation for pelvic floor dysfunction the physical therapist will take a detailed history. Following the history the physical therapist will leave the room to allow the patient to change and drape themselves. The physical therapist will return to the room and using gloved hands will perform an external and internal manual assessment of the pelvic floor and girdle muscles. The physical therapist will once again leave the room and allow the patient to dress. Following the manual examination there may also be an examination of strength, motor control, and overall biomechanics and neuromuscular control. The physical therapist will then communicate the findings to the patient and together with their patient they establish an assessment, short term and long term goals and a treatment plan. Typically people with pelvic floor dysfunction are seen one time per week for one hour for varying amounts of time based on the severity and chronicity of the disease. A home exercise program will be established and the physical therapist will help coordinate other providers on the treatment team. Typically patients are seen for 3 months to a year.

What is pudendal neuralgia and how is it treated?

Pudendal Neuralgia is a clinical diagnosis that means pain in the sensory distribution of the pudendal nerve. The pudendal nerve is a mixed nerve that exits the S2 – S4 sacral nerve roots, we have a right and left pudendal nerve and each side has three main trunks: the dorsal branch, the perineal branch, and the inferior rectal branch. The branches supply sensation to the clitoris/penis, labia/scrotum, perineum, anus, the distal ⅓ of the urethra and rectum, and the vulva and vestibule. The nerve branches also control the pelvic floor muscles. The pudendal nerve follows a tortuous path through the pelvic floor and girdle, leaving it vulnerable to compression and tension injuries at various points along its path.

Pudendal Neuralgia occurs when the nerve is unable to slide, glide and move normally and as a result, people experience pain in some or all of the above-mentioned areas. Pelvic floor physical therapy plays a crucial role in identifying the mechanical impairments that are affecting the nerve. The physical therapy treatment plan is designed to restore normal neural function. Patients with pudendal neuralgia require pelvic floor physical therapy and may also benefit from medical management that includes pharmaceuticals and procedures such as pudendal nerve blocks or botox injections.

What is interstitial cystitis and how is it treated?

Interstitial Cystitis is a clinical diagnosis characterized by irritative bladder symptoms such as urinary urgency, frequency, and hesitancy in the absence of infection. Research has shown the majority of patients who meet the clinical definition have pelvic floor dysfunction and myalgia. Therefore, the American Urologic Association recommends pelvic floor physical therapy as first-line treatment for Interstitial Cystitis. Patients will benefit from pelvic floor physical therapy and may also benefit from pharmacologic management or medical procedures such as bladder instillations.

Who is the Pelvic Health and Rehabilitation Team?

The Pelvic Health and Rehabilitation Center was founded by Elizabeth Akincilar and Stephanie Prendergast in 2006, they have been treating people with pelvic floor disorders since 2001. They were trained and mentored by a medical doctor and quickly became experts in treating pelvic floor disorders. They began creating courses and sharing their knowledge around the world. They expanded to 11 locations in the United States and developed a residency style training program for their employees with ongoing weekly mentoring. The physical therapists who work at PHRC have undergone more training than the majority of pelvic floor physical therapists and as a result offer efficient and high quality care.

How many years of experience do we have?

Stephanie and Liz have 24 years of experience and help each and every team member become an expert in the field through their training and mentoring program.

Why PHRC versus anyone else?

PHRC is unique because of the specific focus on pelvic floor disorders and the leadership at our company. We are constantly lecturing, teaching, and staying ahead of the curve with our connections to medical experts and emerging experts. As a result, we are able to efficiently and effectively help our patients restore their pelvic health.

Do we treat men for pelvic floor therapy?

The Pelvic Health and Rehabilitation Center is unique in that the Cofounders have always treated people of all genders and therefore have trained the team members and staff the same way. Many pelvic floor physical therapists focus solely on people with vulvas, this is not the case here.

Do I need pelvic floor therapy forever?

The majority of people with pelvic floor dysfunction will undergo pelvic floor physical therapy for a set amount of time based on their goals. Every 6 -8 weeks goals will be re-established based on the physical improvements and remaining physical impairments. Most patients will achieve their goals in 3 – 6 months. If there are complicating medical or untreated comorbidities some patients will be in therapy longer.

Leave a Comment