Pelvic Floor Physical and Occupational Therapy In Lexington, MA

At the evaluation appointment, the first thing we do is interview the patient. We are looking to understand the full history and how they ended up in our office. The interview portion helps us gather background data, helps us understand the impact the problem has had on the patient’s life and their understanding of pelvic floor dysfunction. The interview also allows us to gain the necessary information to know the most essential areas of the body to evaluate as it is impossible to examine the entire person on day 1. The examination consists of a visual exam looking at posture, alignment, and movement patterns followed by a manual evaluation of the external structures. Typical areas of the body we palpate include the abdomen, inner thighs, bony pelvis (i.e. sit bones, pubic bones, hip bones, etc.), and buttocks. We are looking for myofascial trigger points, tight muscles, connective tissue restrictions, joint dysfunction, imbalances from side to side, and other impairments around the areas of pain/dysfunction. During the internal pelvic floor muscle exam, we are evaluating for muscle tone, trigger points, strength, and motor control. We examine for diastasis recti, pelvic organ prolapse, skin lesions, and dermatologic changes. Additionally, we are screening for irritability in the peripheral nerves of the pelvis, and vaginal and anal tissue integrity. Throughout the evaluation, short-term and long-term goals are written down for the patient to reach. Typically the duration of a physical and occupational therapy treatment plan can last between a few weeks to several months, or longer, depending on the severity of the situation. We use short incremental goals to justify our treatments and collectively achieving the short-term goals results in achieving the patient’s long-term goals. At the end of the appointment and after the patient is once again dressed, we review what we found. It is important to us that our patients understand what we found, how we plan to help them with the problem areas, and how we are collaborating with their other providers.

A typical treatment may include manual therapy techniques such as connective tissue manipulation, trigger point release externally, trigger point release internally, neural mobilizations, joint mobilizations, and neuromuscular re-education. We focus on the muscles of the pelvic girdle and pelvic floor; however, we incorporate daily postures, movements, breathing patterns, and behaviors. For instance, if a patient has constipation, we will spend time teaching them why bowel movements are difficult for them, how we will help address the impairments, and what they can do at home to help. Some people will need more help with neuromuscular control and some people may benefit more from manual therapy. Generally speaking, manual therapy is often part of a treatment session for people with pelvic pain whereas coordination and strengthening may be more involved in post-operative rehabilitation or for people with low-tone pelvic floor disorders. However, “hybrid” situations do exist and are treated accordingly.

The treatments we provide in each session are customized to the individual and their needs. Based on your response to the initial questioning, we focus on the areas that we believe are the biggest factors in your limitations. This means that one treatment may incorporate more manual therapy while the next treatment may be focused on re-training your habits, postures, and movements. Typically, each treatment session requires some internal manual therapy or manual biofeedback since these conditions almost always produce some form of pelvic floor dysfunction and this is the best way to understand how your pelvic floor muscles are working.

Near the end of each appointment, we review what the patient is working on at home, why these are the areas of focus, and we may add new exercises or changes to their home program.

At the evaluation appointment, the first thing we do is interview the patient. We are looking to understand the full history and how they ended up in our office. The interview portion helps us gather background data, helps us understand the impact the problem has had on the patient’s life and their understanding of pelvic floor dysfunction. The interview also allows us to gain the necessary information to know the most essential areas of the body to evaluate as it is impossible to examine the entire person on day 1. The examination consists of a visual exam looking at posture, alignment, and movement patterns followed by manual evaluation of the external structures. Typical areas of the body we palpate include the abdomen, inner thighs, bony pelvis (i.e. sit bones, pubic bones, hip bones, etc.), and buttocks. We are looking for myofascial trigger points, tight muscles, connective tissue restrictions, joint dysfunction, imbalances from side to side, and other impairments around the areas of pain/dysfunction. During the internal pelvic floor muscle exam we are evaluating for muscle tone, trigger points, strength, and motor control. We examine for diastasis recti, pelvic organ prolapse, skin lesions, and dermatologic changes. Additionally, we are screening for irritability in the peripheral nerves of the pelvis, and vaginal and anal tissue integrity. Throughout the evaluation, short term and long term goals are written down for the patient to reach. Typically the duration of a physical and occupational therapy treatment plan can last between a few weeks to several months, or longer, depending on the severity of the situation. We use short incremental goals to justify our treatments and collectively achieving the short term goals results in achieving the patient’s long term goals. At the end of the appointment and after the patient is once again dressed, we review what we found. It is important to us that our patients understand what we found, how we plan to help them with the problem areas, and how we are collaborating with their other providers.

Pelvic floor physical and occupational therapy can be for anyone and everyone. If you have ever experienced any of the following, pelvic floor therapy is for you:
-male pelvic pain (Chronic Pelvic Pain Syndrome/male pelvic pain, Nonbacterial chronic prostatitis, Interstitial Cystitis/Painful Bladder Syndrome, Pudendal Neuralgia, Tailbone pain/coccygodynia, Sacral pain, Abdominal and groin pain, Testicular pain, Perineal pain, Penile pain, Anal/rectal pain, Post-ejaculatory pain)
-female pelvic pain (Vulvodynia/Vestibulodynia, Interstitial Cystitis/Painful Bladder Syndrome, Pudendal Neuralgia, Endometriosis, Clitoral pain, Tailbone pain/coccygodynia, Abdominal pain, Sacral pain, Anal/rectal pain, Dyspareunia/pain with intercourse)
-bowel dysfunction (Constipation, Hemorrhoids/fissures, Difficulty evacuating, Dyschezia/painful bowel movements, Fecal Incontinence, Anal pain, anal burning, Pelvic Organ Prolapse)
-bladder dysfunction (Stress Urinary Incontinence, Urge Urinary Incontinence, Post-prostatectomy urinary incontinence, urinary urgency/frequency, dysuria, retention, hesitancy, nocturia, Associated pelvic pain diagnoses: Interstitial Cystitis, Chronic Pelvic Pain Syndrome/male pelvic pain, Pelvic Organ Prolapse)
-currently pregnant or postpartum
-going through post-surgical rehab (Pelvic reconstruction, Pudendal Nerve Decompression, Gender affirmation procedures, Laparotomy/laparoscopy, Prostatectomy, Cesarean section, Vestibulectomy, Hernia Repair)
-Pelvic Organ Prolapse

Each treatment session is typically one hour just like the evaluation. The first treatment after the evaluation often begins with answering any questions the patient may have after the initial encounter. Every treatment session begins discussing symptoms they have experienced over the last week, new exercises or habits they are working on, and changes they have noted (whether for better or for worse) since the initial evaluation.

The PT will often ask specific questions about their symptoms. For example, if the person has pain with urination, we will ask detailed questions about the nature of the pain, intensity, how long it lasted and if the treatment or exercise provided relief. The answers to these questions help us decide what to tackle during each session.

A typical treatment may include manual therapy techniques such as connective tissue manipulation, trigger point release externally, trigger point release internally, neural mobilizations, joint mobilizations, and neuromuscular re-education. We focus on the muscles of the pelvic girdle and pelvic floor; however, we incorporate daily postures, movements, breathing patterns, and behaviors. For instance, if a patient has constipation, we will spend time teaching them why bowel movements are difficult for them, how we will help address the impairments, and what they can do at home to help. Some people will need more help with neuromuscular control and some people may benefit more from manual therapy. Generally speaking, manual therapy is often part of a treatment session for people with pelvic pain whereas coordination and strengthening may be more involved in post-operative rehabilitation or for people with low-tone pelvic floor disorders. However, “hybrid” situations do exist and are treated accordingly.

The treatments we provide in each session are customized to the individual and their needs. Based on your response to the initial questioning, we focus on the areas that we believe are the biggest factors in your limitations. This means that one treatment may incorporate more manual therapy while the next treatment may be focused on re-training your habits, postures, and movements. Typically, each treatment session requires some internal manual therapy or manual biofeedback since these conditions almost always produce some form of pelvic floor dysfunction and this is the best way to understand how your pelvic floor muscles are working.

Near the end of each appointment, we review what the patient is working on at home, why these are the areas of focus, and we may add new exercises or changes to their home program. As previously mentioned, the patient is a key player in the road to recovery so the things they do at home are just as important as the time they spend in the clinic.