Menopause encompasses more than just hot flashes, night sweats, and mood swings. Despite being a common phase affecting roughly half of the population, menopause is often misunderstood, both by the public and many healthcare providers. This gap in knowledge can lead to unnecessary suffering, as many individuals are not fully informed about effective treatments.
Perimenopause, the transitional phase leading up to menopause, typically begins in a person’s 40s, with menopause itself usually occurring in the early 50s. While systemic symptoms like hot flashes and mood changes are well-known, many people also experience less obvious but equally impactful genitourinary symptoms. These can include painful intercourse, urinary urgency, frequent urination, leakage, burning sensations, recurrent vaginal and urinary tract infections, and vaginal dryness. Collectively, these symptoms are part of the Genitourinary Syndrome of Menopause (GSM). Additionally, many women experience pelvic floor dysfunction, which affects nearly 50% of women by their 50s and can overlap with GSM symptoms.
While systemic hormonal therapy is commonly used to manage menopause symptoms, it may not address the specific needs of those experiencing GSM. The North American Menopause Society recommends the use of vaginal estrogen as an effective treatment for alleviating GSM symptoms and improving quality of life.
Menopause encompasses more than just hot flashes, night sweats, and mood swings. Despite being a common phase affecting roughly half of the population, menopause is often misunderstood, both by the public and many healthcare providers. This gap in knowledge can lead to unnecessary suffering, as many individuals are not fully informed about effective treatments.
Perimenopause, the transitional phase leading up to menopause, typically begins in a person’s 40s, with menopause itself usually occurring in the early 50s. While systemic symptoms like hot flashes and mood changes are well-known, many people also experience less obvious but equally impactful genitourinary symptoms. These can include painful intercourse, urinary urgency, frequent urination, leakage, burning sensations, recurrent vaginal and urinary tract infections, and vaginal dryness. Collectively, these symptoms are part of the Genitourinary Syndrome of Menopause (GSM). Additionally, many women experience pelvic floor dysfunction, which affects nearly 50% of women by their 50s and can overlap with GSM symptoms.
While systemic hormonal therapy is commonly used to manage menopause symptoms, it may not address the specific needs of those experiencing GSM. The North American Menopause Society recommends the use of vaginal estrogen as an effective treatment for alleviating GSM symptoms and improving quality of life.
Differential Diagnosis:
GSM or Pelvic Floor Dysfunction
Symptoms of pelvic floor dysfunction and Genitourinary Syndrome of Menopause (GSM) can overlap and include:
- Urinary urgency, frequency, burning, nocturia
- Feelings of bladder or pelvic pressure
- Painful sex
- Diminished or absent orgasm
- Difficulty evacuating stool
- Vulvovaginal pain and burning
- Pain with sitting
An experienced healthcare provider, whether a pelvic floor physical and occupational therapists or a medical doctor, can conduct several assessments to diagnose pelvic floor dysfunction, hormonal deficiencies, and pelvic organ prolapse. These evaluations include a vulvovaginal visual examination, a Q-tip test to pinpoint areas of pain, and a digital manual examination.
Without appropriate medical management, all women may eventually experience symptoms of Genitourinary Syndrome of Menopause (GSM). Many are unaware that a pelvic floor physical and occupational therapy evaluation can be highly beneficial for addressing the musculoskeletal issues contributing to their discomfort. Combining pelvic floor physical and occupational therapy with medical treatments can be crucial for improving sexual enjoyment and resolving urinary and bowel problems.
Virtual pelvic floor therapy for menopause—contact us to get started!
FACTS
From: https://www.letstalkmenopause.org/further-reading
- Every day, approximately 6,000 women reach menopause.
- In the United States, around 50 million women are currently navigating menopause.
- About 84% of women experience genital, sexual, and urinary discomfort related to menopause, which often does not resolve without intervention, yet fewer than 25% seek assistance.
- An estimated 80% of OB-GYN residents acknowledge feeling inadequately prepared to address menopause-related issues.
- Genitourinary Syndrome of Menopause (GSM) is clinically identified in 90% of postmenopausal women, yet only one-third report experiencing symptoms in surveys.
- Barriers to treatment include women needing to initiate discussions about their symptoms, a belief that these issues are simply part of aging, and a failure to connect symptoms with menopause.
- Only 13% of healthcare providers routinely inquire about menopause-related symptoms with their patients.
- Even after a diagnosis of GSM, many women remain untreated. This is partly due to healthcare providers’ reluctance to prescribe treatments and patients’ concerns about the safety of topical vaginal therapies, despite evidence showing that GSM significantly affects quality of life.
Hormone deficiency can lead to itching in the labial and vaginal areas. Additionally, other dermatological conditions, such as Lichen Sclerosus and cutaneous yeast infections, should also be considered.
During menopause, individuals are particularly susceptible to frequent vaginal and urinary tract infections due to:
- pH and tissue changes
- incomplete bladder emptying
- pelvic organ prolapse compromising urinary function
Recurrent infections are a major contributor to pelvic floor dysfunction. It’s crucial to address these infections promptly, as ongoing visceral-somatic input from untreated infections can lead to increased pain and further dysfunction even after the infection has been resolved. Without appropriate hormone therapy, infections may persist, leading to severe consequences. Untreated infections can cause unprovoked pain, make sexual activity difficult or impossible, and undiagnosed urinary tract infections (UTIs) may progress to kidney issues and other serious complications.
We recommend consulting with a menopause specialist to effectively monitor, prevent, and treat Genitourinary Syndrome of Menopause (GSM) since these issues are both significant and manageable. It’s important to normalize discussions about GSM; there’s no need for embarrassment. With appropriate care, individuals can lead fulfilling lives. Combining virtual pelvic floor physical and occupational therapy with medical management is essential for optimal results.
Treatment:
How We Can Help You
If you’re experiencing sexual dysfunction, it’s beneficial to consult a pelvic floor physical and occupational therapists online. They can assess whether any issues with your pelvic floor are contributing to your symptoms. During your initial virtual evaluation, the therapist will review your medical history, including previous diagnoses, treatments, and their effectiveness. They understand that many patients feel frustrated by the time they seek help.
The therapist will examine your nerves, muscles, joints, tissues, and movement patterns. After the assessment, they will discuss the findings with you and set both short-term and long-term therapy goals. Typically, physical and occupational therapy sessions occur once or twice a week over a period of approximately 12 weeks. Your therapist will also coordinate with other specialists on your treatment team and provide you with a personalized home exercise program. Our goal is to support your recovery and help you achieve the best possible quality of life.
Get virtual pelvic floor therapy for menopause. Book your online consultation today!
Treatment:
How We Can Help You
If you are having issues with your sexual function, it is in your best interest to get evaluated by a therapist for pelvic floor therapy, so they can establish what part, if any, of your pelvic floor may be contributing to the symptoms you are experiencing. During the course of the examination, the physical and occupational therapists will talk to you about your medical history and symptoms, including what you have been previously diagnosed with, the treatments or therapies you have had, and how effective or ineffective these therapies have been for you. It is significant to mention that we fully comprehend what you’ve been dealing with and that the majority of individuals are angry by the time they make it to see us. The physical and occupational therapists will conduct an evaluation of the patient’s nerves, muscles, joints, tissues, and movement patterns while doing the physical examination. After the examination is finished, your therapist will go over the results of the assessment with you. The physical and occupational therapists will conduct an evaluation to determine the cause of your symptoms and will establish both short-term and long-term therapy goals based on the results of the evaluation. Physical therapy treatments are typically administered between once and twice each week for a period of around 12 weeks. Your physical and occupational therapists will assist you in coordinating your recovery with all the other experts on your treatment team. They will provide you with an exercise regimen to complete at home and the sessions you attend in person. We are here to assist you in getting better and living the best life possible.
Get virtual pelvic floor therapy for menopause. Book your online consultation today!
By Stephanie Prendergast, MPT, Cofounder, PHRC Pasadena
Urinary leaking during sneezing and coughing is common. Constipation affects millions of people. Irritative bladder symptoms plague women at multiple points in their life for a number of reasons, and bother men too. If one stops to think about orthopedic surgeries for broken ankles and shoulder dysfunction, why isn’t pelvic floor physical and occupational therapy part of the standard of care after all pelvic surgeries?
If you fall into any of the categories listed above you should consider an evaluation with a pelvic floor physical and occupational therapists. When people find us on their own their first question is often “why didn’t my doctor tell me?.” The fact is almost all medical schools lack information on various pelvic pain and pelvic floor disorders and therefore most physicians do not know that pelvic floor physical and occupational therapy exists and can help their suffering patients!
Let’s explain these six reasons that no one thinks to call a PT about:
Urinary leaking
Leaking urine is a symptom. Millions of people leak, and therefore this treatable symptom gets chalked up to part of the aging process or because you just had a baby. The reality is leaking is a sign of pelvic floor dysfunction and it should be addressed
Constipation
Constipation also plagues millions of people. In order for humans to evacuate stool the pelvic floor muscles have to autonomically and voluntarily relax. If the muscles are not functioning properly constipation can occur.
Bladder irritability
Irritative bladder symptoms can be miserable. Did you know pelvic floor dysfunction can mimic the symptoms of urinary tract infections? One should always undergo cultures to rule out infection. If the cultures are negative, consider an evaluation with a pelvic floor physical and occupational therapists.
Postpartum
All postpartum women should see a physical and occupational therapists. Pregnancy, labor and delivery are exceptional physiological situations and women need to rehabilitate afterwards.
Gender affirming surgery
Gender affirming surgeries essentially reorganize the pelvis. We are here to help people recover and live their best life!
Pelvic Surgery
Pelvic surgeries such as prostatectomy, pelvic organ prolapse repair, and hysterectomy are major surgeries that influence how your pelvic floor functions. Pelvic physical and occupational therapy should be offered prior to surgery to help with recovery and after surgery for rehabilitation.
While all of these scenarios are common, they are not normal and a sign of pelvic floor dysfunction. A good pelvic evaluation will help you learn what your individual impairments are and how to help.
Common reasons for these symptoms and pelvic floor dysfunction exist.
In general, most symptomatic people fall into one or a combination of these categories:
- Tight and painful pelvic floor and girdle muscles.
- Weak pelvic floor and girdle muscles.
- Tight and weak pelvic floor muscles.
- Coordination issues of the pelvic floor and girdle muscles.
- Presence of a diastasis recti.
- Nerve or muscle involvement after surgery or childbirth.
The pelvic floor muscles are an integral part of our core, playing crucial roles in urinary, bowel, and sexual function, as well as contributing to our overall comfort. Seemingly minor symptoms, such as leaking when sneezing, indicate that these muscles are not functioning optimally. It is important to seek evaluation and treatment early to prevent the development of more significant and disruptive symptoms.
While general categories of impairment exist, people with the same symptoms often have different underlying causes. This is why we do not use protocols, a one-size-fits-all approach is more like one-size-fits none. We pride ourselves on helping our patients best understand their bodies and help them restore their pelvic health!
How Do We Do Pelvic Floor Physical and Occupational Therapy?
At PHRC we focus our in-person visits on things our patients cannot do for themselves. This may include manual therapy such as myofascial release and connective tissue manipulation, joint manipulation and neuromuscular re-education. We also provide impairment-specific home exercises to lengthen, strengthen, or help to improve neuromuscular control. We establish short term goals that are typically expected to be achieved in six to eight visits. We also establish long term goals which are tied to someone’s desired functional outcome, such as not leaking, having easy bowel movements, and urinating no more than six to eight times in a 24 hour period with distress or urgency. People should not have to think about their bladders!
People often ask if they have to do their exercises and home program forever. The answer is it depends, sometimes yes and sometimes no.
Have questions? So do many other people. Please see our FAQ list below and message us with your comments and questions!
Frequently Asked Questions
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 therapy?
Pelvic floor therapy is a specialized area of physical and occupational therapy. Currently, physical and occupational 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 and occupational therapy curricula. The Pelvic Health and Rehabilitation Center provides extensive training for our staff because we recognize the limitations of physical and occupational therapy education in this unique area.
What happens at pelvic floor therapy?
During an evaluation for pelvic floor dysfunction the physical and occupational therapists will take a detailed history. Following the history the physical and occupational therapists will leave the room to allow the patient to change and drape themselves. The pelvic floor physical and occupational therapists 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 and occupational therapists 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 and occupational therapists 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 and occupational therapists will help coordinate other providers on the treatment team. Typically patients are seen for three months to a year.
______________________________________________________
Check out our recently published e-book titled “Vulvodynia, Vestibulodynia, and Vaginismus,” designed to empower and inform individuals on their journey towards healing and understanding.
Did you know we opened our 11th location in Columbus, OH? Now scheduling new patients- call (510) 922-9836 to book!
Are you unable to come see us in person in the Bay Area, Southern California or New England? We offer virtual physical and occupational therapy appointments too!
Virtual sessions are available with PHRC pelvic floor physical and occupational therapistss via our video platform, Zoom, or via phone. For more information and to schedule, please visit our digital healthcare page.
Do you enjoy or blog and want more content from PHRC? Please head over to social media!
Facebook, YouTube Channel, Twitter, Instagram, Tik Tok
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 and occupational therapy?
Pelvic floor physical and occupational therapy is a specialized area of physical and occupational therapy. Currently, physical and occupational therapistss 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 and occupational therapy curricula. The Pelvic Health and Rehabilitation Center provides extensive training for our staff because we recognize the limitations of physical and occupational therapy education in this unique area.
What happens at pelvic floor therapy?
During an evaluation for pelvic floor dysfunction the physical and occupational therapists will take a detailed history. Following the history the physical and occupational therapists will leave the room to allow the patient to change and drape themselves. The physical and occupational therapists 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 and occupational therapists 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 and occupational therapists 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 and occupational therapists 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 and occupational therapy plays a crucial role in identifying the mechanical impairments that are affecting the nerve. The physical and occupational therapy treatment plan is designed to restore normal neural function. Patients with pudendal neuralgia require pelvic floor physical and occupational 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 and occupational therapy as first-line treatment for Interstitial Cystitis. Patients will benefit from pelvic floor physical and occupational 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 and occupational therapistss who work at PHRC have undergone more training than the majority of pelvic floor physical and occupational therapistss 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 and occupational therapistss 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 and occupational 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.
By Cambria Oetken, PHRC Westlake Village
June is Men’s Health month, and men suffer from pelvic pain too. Research shows that up to 16% of men suffer from Chronic Pelvic Pain Syndrome (CPPS) at some point in their life. However, we suspect this number is lower than the actual prevalence because it is so commonly misdiagnosed as a bacterial infection aka prostatitis. In today’s post we are going to share an all-too-common problem men face and the pelvic floor physical and occupational therapy solutions. Keep reading through the end to hear what Josh had to say in his own words.
Background
Josh is a 27-year-old male who came to PHRC with a 3-year history of the following symptoms:
- Urinary urgency and frequency
- Splitting of urine
- Urinary incontinence
- Post void dribble
- Groin pain that radiates into the penis (pelvic pain)
Josh also had decreased libido due to fear of urgency following intercourse and increased anxiety levels about his condition. Josh works full time, which requires him to enter and exit a work truck multiple times throughout the day, which would aggravate his symptoms and even cause urinary incontinence. Josh was an avid soccer player, winning championships in his career, which did lead to injuries including hamstring and adductor strains on several occasions. Josh now plays soccer recreationally but has stopped for several months due to worsening of his symptoms. Josh had seen multiple physicians over the years who told him he had prostatitis despite negative findings in urinalysis and blood tests. Josh was put on multiple rounds of antibiotics to “treat” his prostatitis, but none of which were helpful. Josh had to urinate every 5 minutes with only a few drops coming out at a time, which then led him to dig deeper into what he was dealing with. Upon discovering through his own research that pelvic floor muscles could be driving his symptoms, he stumbled upon Pelvic Health and Rehab Center and decided to seek treatment.
Josh’s Goals
- Determine if his pelvic floor muscles were the driver of his symptoms
- Decrease pelvic pain and discomfort (pain relief)
- Work a full day without urinary urgency interrupting
- Return to soccer
Physical Findings:
Upon physical examination, physical findings include myofascial restrictions to:
- Medial thigh hip flexors (iliacus)
- Deep hip rotators (obturator internus and piriformis)
- Gluteal muscles
- Myalgia and restrictions to the right ischiocavernosus and bulbospongiosus (some of our pelvic floor muscles)
- Difficulty performing a “pelvic drop”
- Difficulty relaxing his pelvic floor muscles after completing a pelvic floor contraction
- Decreased hip internal and external rotation mobility
Plan and Outcome
The findings listed above likely began following injuries to his right hamstrings/adductors and a lack of stretching and mobility over the years that was not prioritized during his soccer career. Beginning his job a few years ago led to increased stress and anxiety levels, likely exacerbating his physical symptoms to appear 3 years ago. We call this the “perfect storm”.
To start, I provided Josh with a home exercise program that included:
- Diaphragmatic breathing with pelvic floor drops
- Pelvic floor relaxation exercises to target his areas of restrictions and pain
- Happy baby pose
- Child’s pose
- Piriformis stretch
- Adductor rock backs
- Foam rolling to his inner thighs, hamstrings and glutes
After a few sessions, Josh began to notice a stronger urine stream and did not notice his symptoms worsened as much toward the end of his work day. On Josh’s 4th visit he reported he had a period of normalcy and only urinated 3 times during his work day whereas previously he had to go up to 20 times during his day.
Chronic Pelvic Pain Treatment included:
Manual therapy
including myofascial manipulation and connective tissue mobilization to UGT, medial thighs and deep rotators
Motor control training
to pelvic floor muscles to improve pelvic floor drops.
Education
on the nervous system’s involvement in the pain cycle
Reading
“Explain Pain” pages
Body scans
to bring awareness of increased clenching through the glutes and abdominals
Progression of Home Exercise Program:
- At home symptom management (massage gun, heat, stretch routine)
- Single leg strength training and stability to prepare for a safe return to soccer
- Dynamic warm up and cool down routine for soccer
Through Josh’s commitment to his home exercise program and consistency with physical and occupational therapy sessions, in 3 months he was able to have the confidence and ability to try soccer again, and in 4 months was playing symptom free, without fear and discomfort. Being able to be a part of his treatment team after getting his chronic pelvic pain diagnosed is something we are grateful for! Chronic pain can be tricky to diagnose without a multidisciplinary approach.
Josh’s Story:
My journey with Chronic Pelvic Pain Syndrome began in 2019 when one day I just had the urgent need to urinate more than 10 times per hour, sometimes going more than 60 times per day. As per usual my first instinct was to make an appointment with my doctor to determine the cause of it. After testing negative for bacteria with a urine culture I was told that I needed to take antibiotics and it left me wondering if this was necessary. I eventually took the first round of antibiotics and it did nothing, went back with my doctor and again after testing negative for bacteria in a urine culture I was given Bactrim and this seemed to do the trick because my urge was completely gone. Unfortunately they only helped for so long*, the symptoms eventually returned once more and it took a complete toll on my life as I was crushed mentally dealing with it. My Dr. told me there was nothing he could do at this point and referred me to a Urologist who eventually also prescribed an antibiotic, which was Cipro. After reading and researching on my own I decided not to take it because of the very bad side effects and also because I previously had taken other antibiotics with no great help or any help. At this point I was desperate to find a solution. On doing my own research I found that I could potentially have Chronic Pelvic Pain Syndrome and researched clinics around my area that would take me in. Unfortunately many do not treat men, but I was able to find Pelvic Health and Rehabilitation Center and they were able to take me in. They completely changed and gave me my life back. Upon finding that my urinary issues were due to Chronic Pelvic Pain Syndrome was a complete sense of relief because I knew I had finally found an answer to my problem. I had finally got the answers that I had been looking for.
My Chronic Pelvic Pain Syndrome originated from my early years of playing sports causing my muscles to tighten up as well as sitting for long periods at work and also due to stress. Cambria has been amazing at treating my condition, she is very knowledgeable in this and in any questions that may come up she has the answers. With her help and techniques that I have acquired from PHRC I have better outlook for the future knowing there is a solution to Chronic Pelvic Pain Syndrome. I will forever be grateful for the center for doing what they have done and continue to treat myself and other patients.
* The reason Bactrim temporarily helped Josh is because it is what is called a “broad-spectrum” antibiotic. When it is indicated people usually have a pain-causing infection and this medication includes an analgesic (pain reducing) component in addition to the antibiotic to fight the infection. This gives our patient the false sense that they have an infection because the analgesic may reduce their chronic pelvic pain symptoms while they are taking the medication.
______________________________________________________________________________________________________________________________________
Check out our recently published e-book titled “Vulvodynia, Vestibulodynia, and Vaginismus,” designed to empower and inform individuals on their journey towards healing and understanding.
Did you know we opened our 11th location in Columbus, OH? Now scheduling new patients- call (510) 922-9836 to book!
Are you unable to come see us in person in the Bay Area, Southern California or New England? We offer virtual physical and occupational therapy appointments too!
Virtual sessions are available with PHRC PFPT via our video platform, Zoom, or via phone. For more information and to schedule, please visit our digital healthcare page.
Do you enjoy or blog and want more content from PHRC? Please head over to social media!
Facebook, YouTube Channel, Twitter, Instagram, Tik Tok
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 and occupational therapy?
Pelvic floor physical and occupational therapy is a specialized area of physical and occupational therapy. Currently, physical and occupational therapistss 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 and occupational therapy curricula. The Pelvic Health and Rehabilitation Center provides extensive training for our staff because we recognize the limitations of physical and occupational therapy education in this unique area.
What happens at pelvic floor therapy?
During an evaluation for pelvic floor dysfunction the physical and occupational therapists will take a detailed history. Following the history the physical and occupational therapists will leave the room to allow the patient to change and drape themselves. The physical and occupational therapists 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 and occupational therapists 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 and occupational therapists 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 and occupational therapists 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 and occupational therapy plays a crucial role in identifying the mechanical impairments that are affecting the nerve. The physical and occupational therapy treatment plan is designed to restore normal neural function. Patients with pudendal neuralgia require pelvic floor physical and occupational 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 and occupational therapy as first-line treatment for Interstitial Cystitis. Patients will benefit from pelvic floor physical and occupational 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 and occupational therapistss who work at PHRC have undergone more training than the majority of pelvic floor physical and occupational therapistss 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 and occupational therapistss 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 and occupational 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.
Pride Month and Pelvic Floor Physical and Occupational Therapy Part 2!
By Danae Narvaza PT, DPT, PHRC Encinitas
Cis-gendered people who have sought help for pelvic floor dysfunction will tell you accessibility and awareness makes finding the right help harder than it should be. June marks Pride Month and to celebrate we want to shed light on another underserved population seeking help: the transgender and non-binary population. If you have not seen my blog post Pride Month and Pelvic Floor physical Therapy Part 1: What is Binding? Please check it out! We want to help to be a part of the solution of this pelvic healthcare disparity. In this post we will be breaking down different practices that are used within gender affirming care and how this impacts safety and health, and what we can do about it from a PT, referring healthcare provider, peer, and/or patient perspective. In this specific blog, we will be discussing the practice of tucking and how physical and occupational therapy can be implemented into patient care
What is Tucking and Why Is It Used?
WHAT
- Genital tucking is the practice of reducing the appearance of one’s genitals or gonads.
HOW
- This is often done by pushing one’s gonads into the inguinal canal and/or pulling up the shaft of the penis and moving it in between the legs.
WHY
- Transfeminine, gender diverse, intersex, and non-binary people may practice tucking to affirm their gender identity, alleviate dysphoria, feel a better sense of safety, reduce discrimination, and/or feel more comfortable in certain clothing. Gender affirming practices (with tucking being one example) was reported to be a crucial contributor to mental health and safety – with positive outcomes including improvements in mood and reduced suicidality, anxiety, and depression. This gives individuals the sense of safety to leave their homes to do basic activities of daily living and participate in social, work, and familial activities without being subject to violence or discrimination for their physical appearance.
Safety Considerations of Tucking?
NEGATIVE SIDE EFFECTS
With the above positive outcomes in consideration, it is important then to provide informed consent of the negative and harmful impacts of tucking. In a research article from The Annals of Family Medicine in March/April 2024 (Kidd et. al 2024), a survey was conducted where patients reported the following symptoms that they attributed to tucking:
- Pain in gonads
- Genital pain
- Itching and/or rash
- Urinary tract infections
- Twisting of gonads
- Skin infection, and
- Infertility
65% of the respondents had at least one side effect from tucking with only 10% of the respondents seeking medical care for their side effects. This gap demonstrates an apparent disconnect and need for improving access, competency, and awareness of gender affirming care.
SAFETY CONSIDERATIONS
- It should not be painful
- You should take regular breaks
- It should not be done while sleeping or playing sport
- It should be done with an appropriately fitted gaff
- It should be done with medical grade tape and not duct/packing tape
- It should be gradually introduced (starting off slow and carefully), and
- You should be gentle with adjustment of gonads and penis
- An alternative tucking method that some may use is wearing multiple layers of fitted underwear. If this method is being used, make sure the underwear is not too restricting and tight, as this can cause pelvic pain and/or injury.
Why Should Healthcare Providers Know and Care About Tucking?
As a healthcare provider, parent, friend, and human being coexisting with the gender diverse community, it is vital to recognize how gender affirming techniques are most dangerous when driven underground due to judgment of peers, family members, colleagues and healthcare providers. A survey was conducted where it was revealed that: “While 70% of respondents felt they would be comfortable or very comfortable discussing tucking with their healthcare provider, only 23% reported having discussed tucking. A majority of participants felt that it would be helpful for clinicians to openly discuss the potential risks and benefits of tucking. Suggestions for clinicians included: asking permission, using inclusive and empathic language, explaining the reasoning behind broaching the topic, and being knowledgeable about methods and potential risks of tucking.” (Kidd et. al 2024).
Relevance to Pelvic Floor Physical and Occupational Therapy
With considerations of potential tension and compression forces put on the pelvic myofascial tissues with tucking, this may put users at risk for pelvic and/or genital pain related to nerve and/or muscle contributions. Seeing a pelvic floor physical and occupational therapists could be helpful to balance the use of tucking by managing residual pain secondary to tucking. A pelvic floor physical and occupational therapists is advisable to better assess the current state of your tissues involved with tucking such as: the tone pelvic floor muscles, gluteal muscles, adductors, core, and more!
Reasons you should be advised to see a pelvic floor PT include the following:
- Pelvic Pain
- Abdominal Pain
- Genital Pain
- Painful Sex
- Sexual Dysfunction
- Urinary Urgency and/or Increased Frequency of Urination
- Urinary Incontinence
- Constipation
- Gluteal, Pelvic Floor, and/or Lower Extremity Weakness/Pain
Would you like more information? Check out our Tucking Series on Instagram!
Frequently Asked Questions
Q: Why is pelvic health important for the LGBTQ+ community?
A: Pelvic health is vital for everyone, but the LGBTQ+ community may face unique challenges and stigmas that can impact their overall well-being. Understanding and addressing these specific needs ensures better healthcare outcomes and fosters a more inclusive healthcare environment.
Q: Are there specific pelvic health issues that affect the LGBTQ+ community?
A: Yes, certain pelvic health issues may be more prevalent or present differently within the LGBTQ+ community. For example, transgender individuals may experience unique pelvic health concerns related to hormone therapy or surgical procedures. It’s essential to address these issues with specialized knowledge and care.
Q: How can healthcare providers create a welcoming environment for LGBTQ+ patients?
A: They can create a welcoming environment by using inclusive language, displaying LGBTQ+ affirming symbols, offering training on LGBTQ+ health issues, and ensuring privacy and respect during consultations. Building trust through culturally competent care is crucial.
Q: Where can LGBTQ+ individuals find resources about pelvic health?
A: There are various resources available, including LGBTQ+ health organizations, online forums, and specialized healthcare providers who focus on LGBTQ+ pelvic health. Reputable websites like the American Psychological Association and the World Professional Association for Transgender Health also offer valuable information.
Q: Is there any other information you can give us in regards to pride month physical and occupational therapy?
A: We have a section on our site about Transgender PFPT services.
Resources
Physical and Occupational Therapy Rehab After Gender Affirming Surgeries
Gender-Affirming Surgery + Pelvic Floor PT: IG Live w/ Dr. Jun
Sources:
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Check out our recently published e-book titled “Vulvodynia, Vestibulodynia, and Vaginismus,” designed to empower and inform individuals on their journey towards healing and understanding.
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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 and occupational therapy?
Pelvic floor physical and occupational therapy is a specialized area of physical and occupational therapy. Currently, physical and occupational therapistss 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 and occupational therapy curricula. The Pelvic Health and Rehabilitation Center provides extensive training for our staff because we recognize the limitations of physical and occupational therapy education in this unique area.
What happens at pelvic floor therapy?
During an evaluation for pelvic floor dysfunction the physical and occupational therapists will take a detailed history. Following the history the physical and occupational therapists will leave the room to allow the patient to change and drape themselves. The physical and occupational therapists 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 and occupational therapists 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 and occupational therapists 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 and occupational therapists 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 and occupational therapy plays a crucial role in identifying the mechanical impairments that are affecting the nerve. The physical and occupational therapy treatment plan is designed to restore normal neural function. Patients with pudendal neuralgia require pelvic floor physical and occupational 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 and occupational therapy as first-line treatment for Interstitial Cystitis. Patients will benefit from pelvic floor physical and occupational 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 and occupational therapistss who work at PHRC have undergone more training than the majority of pelvic floor physical and occupational therapistss 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 and occupational therapistss 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 and occupational 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.