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!
Pride Month and Pelvic Floor Physical and Occupational Therapy!
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. 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 physical and occupational therapists, referring healthcare provider, peer, and/or patient perspective. In this specific blog, we will be discussing the practice of binding.
What is Binding and Why Is It Used?
WHAT
- Binding is the act of using special undergarments to tightly wrap around the breast tissue in order to achieve a flatter chest contour.
WHY
- Some may do this with or without the intention of having gender-affirming chest surgery. The purpose of binding is to help individuals feel more aligned with their gender identity or expression, and to help with gender dysphoria.
- Gives individuals the sense of safety to participate in basic activities of daily living (ex: the ability to leave their homes confidently to work, socialize, run errands, etc) without being subject to violence or discrimination for their physical appearance.
BENEFITS FOR PEOPLE WHO BIND
- It is a crucial contributor to mental health and safety – having positive outcomes including improvements in mood and reduced suicidality, anxiety, and depression (Hughto et. al 2020)
What are Safety Considerations of Binding?
RECOMMENDATIONS
- Do not wear a binder for over eight hours
- Schedule binding breaks if you need to go longer than eight hours
- Do not sleep with the binder on
- Do not exercise with your binder on (unless advertised as exercise-safe binder)
- Get appropriately sized for a binder
- Take one or more days off of binding throughout the week
DANGERS OF STIGMAS
- If an individual lives in an environment where binders are not accessible (ex: living in an unsupportive household or being in an environment with caregivers/parents/family members who disapprove of or do not understand your needs for gender affirmation), many turn to elastic binding – which is not advised. This informal way of binding is not recommended, because it is linked with negative health outcomes (seen in the following paragraph). In other cases, some may get access to a binder, but have to hide it due to the home environment, hindering them from regularly washing it and puts them at risk for skin irritation and infections. Another obstacle of consideration may be an inaccurately sized binder, which is also problematic, where too tight or too loose binders could affect someone’s trunk mobility and/or function.
NEGATIVE HEALTH OUTCOMES
- Binding may affect your skin, muscles, and movement, while excessively tight binders can damage nerves and muscles, and restrict breathing leading to gastrointestinal and/or pelvic issues. A cross sectional study in 2020 covered negative physical health outcomes involving pain, musculoskeletal, neurological, gastrointestinal, general, respiratory, and skin/soft tissue systems in 97% of the 1800 participants with 18 of 27 symptoms observed having an average time of onset of under 1 year, assuming average intensity of binding to 10 hours per day. Meanwhile, more rare and serious symptoms took longer to emerge, such as rib fractures, muscle wasting, respiratory infection, scarring, swelling, and skin infections (Peitzmeier et. al 2021). Additionally, in rare occasions, incorrect binding can lead to rib fractures.
Why Should We Care About Binding?
It is crucial to recognize how gender affirming techniques are most dangerous when driven underground due to judgment of peers, family members, colleagues and healthcare providers. In a national cross sectional study in 2020, more than half of the nonbinding cohort participants reported that their parent was a barrier to them binding their chest, which was also consistent with the past of those participants who were currently binding. The study highlighted the resourcefulness of the youth who do not have access to commercial grade binders, due to the barrier of finances and/or parental support, leading to participants using miscellaneous items for binding to mitigate the distress they were experiencing (ex: tarps, pantyhose, girdles, etc.). While resourceful, the potential harm of these items supports the argument that medical providers should be asking more questions when patients present with chest dysphoria or discomfort. The authors recommended that medical providers then learn how to size and fit a patient for a binder, advocate for insurance companies to provide coverage for this medical device, and work with trans affirming binder companies to provide in-clinic binders.
Relevance of Binding to Physical and Occupational Therapy
Binding may result in back, chest, and/or shoulder pain, numbness, or scarring. In addition, with the chest, ribs, and posture potentially impacted, this may affect myofascial tissue extensibility – which we would want to be at an adequate state prior to surgery in order to prevent post op complications. Seeing a physical and occupational therapists would be helpful to determine if you need manual work done for your myofascial mobility and/or exercises to correct muscle length, posture, and biomechanics related to presentations secondary to binding.
Check out our Binding Series on Instagram!
Stay tuned for more in our Tucking Series!
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: Providers 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.
Resources
Physical and Occupational Therapy Rehab After Gender Affirming Surgeries
Gender-Affirming Surgery + Pelvic Floor PT: IG Live w/ Dr. Jun
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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.
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.
Recognizing Pelvic Pain Awareness Month
By PHRC TEAM
May is recognized worldwide as Pelvic Pain Awareness Month, an observance that aims to raise awareness about pelvic pain and encourage education, research, and advocacy. Despite the prevalence of this condition, it often remains underdiagnosed and undertreated due to lack of awareness and understanding. The entire team at the Pelvic Health and Rehabilitation Center is committed first and foremost to using evidence-based evaluation and treatments. Beyond our desire to help our patients we help the community in other ways.
Did You Know?
- Less than 60% of OBGYNs feel comfortable diagnosing and treating vulvodynia? Most do not receive ANY specialized training in medical school regarding sexual health and pain (1).
- Urologists do not receive training about pelvic pain in medical school.
- Pelvic floor physical and occupational therapy is first line treatment for people with pelvic pain and those of us at PHRC will continue to improve awareness and training for those who are interested!
Awareness and Education
We understand all too well the barrier people face trying to get help for their symptoms. We promise, it is getting better but we have a long way to go so here is what we are doing this year to help. We actively engage in education via community outreach, educational workshops, and seminars for patients and providers. PHRC cofounder Elizabeth Akincilar is co-director of an organization, the Jackson Clinics Foundation, bringing formalized pelvic floor physical and occupational therapy education to Kenya! Many members of the PHRC clinical team donated their time to help develop the curricula and to travel to teach the students. PHRC cofounder Stephanie Prendergast and PHRC director of education Jandra Mueller teach via the International Pelvic Pain Society (IPPS) and The International Society for the Study of Women’s Sexual Health
Over the next 2 years students will experience a robust online curriculum and 6 in person segments with expert teachers from the US. But the goal is to have this program independently run by Kenyans. Please visit their GoFundMe directly for more information about the program and/or donating. This gofundme will raise money to support our volunteer TAs and also go to purchase a few teaching supplies (books, models) that we would like to provide to the students to enhance their learning.
Understanding Pelvic Pain
A number of diagnoses are associated with the general term ‘pelvic pain’ but here are the most common:
- Vulvodynia/Vestibulodynia/Vaginismus
- Interstitial Cystitis/Painful bladder syndrome (IC/PBS)
- CPPS/Non-bacterial Chronic Prostatitis (CP/CPPS)
- Pudendal Neuralgia
- Endometriosis
- Lichen Sclerosus and Planus
- PolyCystic Ovarian Syndrome (PCOS)
- Pelvic Venous Disorders (PeVD)
While all of the diagnoses have different etiologic factors, most patients with these diagnoses have pelvic floor dysfunction and this dysfunction contributes to their pain or symptoms. The good news is that pelvic pain is treatable! Pelvic floor physical and occupational therapy is recommended as the first-line treatment (Torosis, et. al, 2024).
PHRC and Pelvic Pain Awareness Month
In honor of pelvic pain awareness month this year, the Pelvic Health and Rehabilitation Center hosted a fundraiser for two important nonprofit organizations: Tight Lipped, a grassroots patient-led advocacy group raising awareness to medical providers about the importance of pelvic pain; and Riley Hooper, a documentarian film-maker who is raising awareness about a specific condition called ‘neuroproliferative Vestibulodynia’ with her film, Vestibule, sharing her story. We also published our first e-book Vulvodynia, Vestibulodynia and Vaginismus!! All registrants received a copy of our book which is full of resources. Vulvar experts Drs. Jill Krapf, Rachel Rubin, and Sarah Cigna joined for a Q&A, all proceeds go to Tight Lipped and Vestibule. If you are interested in donating please visit: Tight Lipped Donations, Vestibule Donations.
In addition to fundraising and volunteer work we also help commercial and academic institutions recruit for their projects. Check out a cool project regarding the effects of surfing on pelvic pain, led by Jason Kutch, PhD at USC! If you experience pelvic pain, this blog is for you!
Research Opportunity
Overall Aims for this project: “In this project, we will use a randomized controlled trial to test the hypothesis that repetitive transcranial magnetic stimulation (rTMS) directed at a cortical site that controls pelvic floor muscles can reduce pain, and improve brain and muscle activity in women with IC/BPS.” (USC 2024).
Do you experience unwanted and/or persistent feelings of genital arousal (Persistent Genital Arousal Disorder/Genito-Pelvic Dysesthesia)? You might be eligible to participate in the Sexual Health Implications of PGAD Study (SHIPS)! To participate, or to find out more, please contact us directly at [email protected].
The Goal: To learn about the role of the group in pelvic pain patients’ experience of their condition, treatment, and social identities. Interested in participating? Please contact [email protected]. This research has been approved by the NYU Institutional Review Board (IRB-FY2024-8482).
At PHRC, we will continue to do all we can to help, not just in May but all year. If you have a project you need help (chronic pelvic pain or pelvic health related) with or want to suggest more avenues for us to help out please share your comments! Thank you for reading and we hope this post inspired you to help out too!
Our Educational Resources for Pelvic Pain
Additional resources we recommend
Just a few podcasts of so many…
- iCareBetter: Endometriosis Unplugged
References:
- Karpel, H. C., MS. (2024, May 29). Are Ob-Gyns Comfortable Discussing Sexual Trauma With Patients? Contemporary OB/GYN. Retrieved from https://www.contemporaryobgyn.net/view/are-ob-gyns-comfortable-discussing-sexual-trauma-with-patients-
- Torosis, M., Carey, E., Christensen, K., Kaufman, M. R., Kenton, K., Kotarinos, R., Lai, H. H., Lee, U., Lowder, J. L., Meister, M., Spitznagle, T., Wright, K., & Ackerman, A. L. (2024). A Treatment Algorithm for High-Tone Pelvic Floor Dysfunction. Obstet Gynecol, 143(4), 595-602. https://doi.org/10.1097/AOG.0000000000005536
- University of Southern California. (2024). Projects. USC Ampl. Retrieved May 29, 2024, from https://sites.usc.edu/ampl/projects/
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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!
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 Stephanie Prendergast, MPT, Cofounder, PHRC Los Angeles
Dear Patients and Colleagues,
Change is a constant part of life, and after ten rewarding years in West LA I have made the decision to transition to PHRC’s Pasadena location. I started to fall in love with Pasadena when I opened this location in 2022, though I never imagined we would move here! My husband and I decided it was time for a change, so we packed up our two dogs and moved from Playa Vista to a historic home in Pasadena in March.
While I am excited about this change I also feel sadness as I transition from our West LA office. In 2014, I moved from the San Francisco Bay Area to open PHRC West LA, and for the past 10 years West LA has been home. During this time I had the pleasure of treating hundreds of patients, forming strong and valued relationships in the medical community, and growing our PHRC West LA team. I love being a pelvic floor physical and occupational therapists, a trusted medical colleague, and a mentor to PHRC staff. It is exciting to watch our West LA branch continue to grow and expand! While I am no longer treating patients in that location, I know the office is in good hands with Amanda Stuart, Jillian Ferran, and Sabrina Dickerson. Please be assured we are currently accepting new patients in West LA!
I want to express my deepest gratitude to everyone who has been a part of my journey at PHRC West LA. Your support, friendship, and encouragement have meant the world to me, and I am profoundly grateful for the opportunity to have been a part of this incredible community.
Starting this week I am accepting patients with pelvic pain disorders in Pasadena. I am excited to work alongside Alexa Savtiz, PT, DPT!
Now is a good time to share a little more about my interest in pelvic pain syndromes and why I hope you chose to come to PHRC Pasadena for your care.
Here is a little about me:
I am co-founder of the Pelvic Health and Rehabilitation Center (PHRC), which I established in San Francisco in 2006 alongside Liz Akinicilar. Together, we have expanded PHRC’s footprint to encompass 11 locations, including SF, Berkeley, Walnut Creek, Los Gatos, West Los Angeles, Westlake Village, Encinitas, Pasadena, CA; Columbus, OH; Lexington, MA; and Merrimack, NH.
Liz and I pioneered the first continuing education course focused on Pudendal Neuralgia, delivering the two-day program 37 times from 2006 to 2013. I was elected to the Board of Directors of the International Pelvic Pain Society in 2002, in 2013 I was honored to be elected as the first physical and occupational therapists to assume the presidency of the Society.
I am also an author, with numerous publications in peer-reviewed journals and textbooks. I enjoy lecturing at medical conferences and within the community on numerous pelvic health-related topics. As you can imagine, I have a LOT to say about pelvic pain and constantly advocate for our patients and pelvic floor physical and occupational therapistss. Therefore, Liz and I co-authored a book, “Pelvic Pain Explained,” in 2016. In 2019, we introduced a second continuing education course, “Advanced Management of Pelvic Pain Syndromes which we are proud to teach. Physical therapy schools do not include pelvic floor dysfunction in their curricula, it is part of our mission to help newer physical and occupational therapistss acquire the needed knowledge to help this patient population. Within PHRC we have trained over 50 physical and occupational therapistss and are very proud of our formalized training program! The therapists of PHRC undergo weeks of manual and didactic training, following the formal training program everyone here continues with 2.5 hours of weekly mentoring with our senior leadership team. As knowledge of pelvic floor disorders evolves we pride ourselves on staying current to offer our patients the highest quality of care.
In response to the evolving landscape of healthcare, me and Liz unveiled a groundbreaking virtual health/telehealth platform in 2020, extending our services globally to individuals seeking pelvic health consultations and mentoring for professionals in the field. In addition to clinical practice and teaching, I am proud to serve as an Associate Editor for the Journal of Sexual Medicine and I am currently faculty for the International Association for the Study of Women’s Sexual Health.
I am an advocate for individuals suffering from pelvic floor dysfunction. I am honored to become faculty for the Tight Lipped patient advocacy group, we are working to bring pelvic pain education into OBGYN residency programs. Similar to lack of pelvic floor knowledge in PT schools, OBGYNS are also not trained in pelvic pain syndromes in medical school. We will continue to help in any way we can! Recently we published an e-book “Vulvodynia, Vestibulodynia, and Vaginismus,” alongside Jandra Mueller and Liz. PHRC continues to make waves with its award-winning blog, “As The Pelvis Turns,” published every Thursday. Please connect with me on Twitter and LinkedIn Instagram, YouTube, TikTok, Facebook!
I am looking forward to serving the Pasadena community and continuing to advocate for this field!
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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.
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!
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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.