Is An Internal Exam Necessary?
While assessing the pelvic floor with an internal exam can be helpful, it oftentimes is not necessary or even possible when first starting treatment. Depending on your pain level, condition, and comfort level, an internal exam is hardly ever a part of the first appointment.
We will work together to establish a treatment plan based on what you’re comfortable with, both physically and mentally, in order to relax your muscles. I have found that working on the body externally and the tissues and muscles connected to your pelvic floor has made the transition to internal treatment that much more seamless.
While you’re under my care, my utmost priority is to maintain your comfort at all times. I will thoroughly explain what the assessment and treatment will involve (which will always include proper draping when necessary), give you alternative options, and obtain your consent before proceeding. You are in control and may withdraw consent at any time. When the pelvic floor muscles are assessed this way, the research has shown that the interventions carried out by a physical therapist for pelvic floor problems are highly successful and should be the first line of treatment for incontinence, pelvic organ prolapse, and pelvic pain.
Which Pelvic Floor Dysfunctions and Disorders Do We Treat?
A variety of pelvic floor disorders lead to many different symptoms, most of which can be treated with pelvic floor physical therapy! The following are some of the dysfunctions and issues that we treat: urinary incontinence, pelvic organ prolapse, endometriosis, interstitial cystitis, dyspareunia (painful intercourse), dysmenorrhea, vulvodynia, vaginismus, coccydynia, pudendal neuralgia and entrapment, erectile dysfunction, constipation, and prenatal/postpartum care.
How Common Is Pelvic Floor Dysfunction?
While it may seem that you are the only one suffering from pelvic pain and unwanted symptoms, pelvic floor dysfunction is quite common–you are not alone. One in three women will experience a pelvic floor dysfunction in their lifetime, and 50 percent of women over the age of 55 are affected.
According to Rebalance Physical Therapy and Wellness, “10% of men will experience pelvic pain symptoms; 50% of men will deal with prostate problems at some point in their lives; 97% of the men who experience prostatitis symptoms will be treated with antibiotics despite no evidence of prostate or bladder infection; The majority of men who do not show signs of infection can have pelvic floor dysfunction and can be treated with physical therapy.”
What Factors Increase Your Risk of Developing Pelvic Floor Dysfunction?
- Post-menopause (Hormonal Changes)
- Over 40 (1 in 3)
- Pregnancy and childbirth
- Multiparous: Having had more than one child
- Obstetric trauma (from forceps, suction, tearing)
- Gynecological or urinary surgery
- Chronic Illness
- Chronic straining (constipation or heavy lifting)
- Radical Prostatectomy
- Prostate enlargement
How Can You Prevent Pelvic Floor Dysfunction?
- Avoid constipation – your stool should be soft and easy to pass.
- Drink plenty of water – your urine should be the color of pale lemonade.
- Sit on the toilet, don’t hover. Position knees higher than hips while having a bowel movement by using a stool to prop feet on.
- Limit straining while urinating or having a bowel movement.
- Avoid using the bathroom to urinate “just in case.”
- Get rid of a permanent cough.
- Breath deep within your stomach, not your upper chest.
- Maintain a healthy body mass index.
- Participate in regular exercise and recreational sporting activities to keep you fit and healthy.
- Exercise your pelvic floor. Consult with a pelvic floor physical therapist to assess if you are doing exercises correctly.
Are Your Pelvic Muscles Too Tight or Too Loose?
Many people with pelvic pain have pelvic floor dysfunction and have muscles that are too tight. When these muscles have too much tension, they can cause pelvic pain or urgency and frequency of the bladder and bowels. When the muscles are too loose, incontinence and pelvic organ prolapse can occur. It is also possible to have a combination of muscles that are too tense and too relaxed.
When your pelvic floor muscles are tight and weak, the tension is treated before the weakness. Once the muscles have reached a normal resting tone, and are able to relax fully, their strength is reassessed and strengthening exercises may be recommended.
Persistent pain education is an essential part of treating pelvic floor dysfunction. The pelvic floor is an area where we hold tension (like the neck and shoulders with tension headaches). Anxiety and stress can contribute to the pain in our pelvis. Understanding how our pain system works has shown to be an effective way of reducing the threat of ongoing pelvic floor dysfunction and pain.
Pelvic health physical therapy has become more established in the literature as the first line of defense against incontinence, pelvic organ prolapse, and pelvic pain.
Are Kegels For Everyone?
Kegels (a pelvic floor strengthening exercise) are not for everyone, and even when indicated, are often done improperly due to the lack the awareness of where these muscles are and what they should feel like when contracting.
Kegels may sometimes aggravate or enhance symptoms. Most times, the state in which the pelvic floor muscles are in is unknown until an internal exam is complete. Therefore, whether or not Kegels should be performed as an exercise at that time is dependent on exam results.