Pelvic Health Rehab
What is Pelvic Health Physical Therapy?
Pelvic health physical therapy is the treatment of any issues related to the pelvic floor, including, but not limited to: pelvic pain, bowel and bladder issues, pain with intercourse, constipation, and even diastasis recti (abdominal separation).
The pelvic floor is a muscular sling or hammock reinforced by strong ligmanets attaching from the pubic bone to the coccyx or tailbone.
The pelvic works closely with the diaphragm and abdominal musculature and plays a major role in:
- modulating intra-abdominal pressure to protect your back, pelvis, and sacroiliac joint
- bowel and bladder function
- sexual intercourse
- vaginal wall support
- posture and respiratory function
Pelvic floor issues are more common than you may think. Based on cross-sectional studies, approximately 23.7% of the female population experiences at least one type of pelvic floor disorder. That is almost every 1 in 4 women, or a quarter of the population!
The good news is that pelvic floor problems can often resolve completely with conservative therapy such as physical therapy.
Because the pelvic floor works so intricately with all areas of the body, particularly the diaphragm, spine, pelvis and core, it is difficult to point to one major cause of pelvic floor problems. A full evaluation by a trained pelvic floor physical therapist, someone who can examine your entire kinetic chain, is warranted to really understand what may be the cause of your pelvic floor problems.
Most individuals often attribute pelvic floor issues to a weak pelvic floor, but it can often be due to a overly tight pelvic floor as well, or improper coordination of your diaphragm with your core and pelvic floor when generating intra-abdominal pressure.
Below are the most common pelvic health issues and how physical therapy can help.
Stress Incontinence
Stress Incontinence is when demand on the bladder is increased through impact or abdominal force, and the muscular system or strategy is not strong enough to withstand the pressure placed on it. This causes leaking to occur.
Often, this occurs with activities such as:
- running, jumping, lifting
- coughing, sneezing, yelling
Stress incontinence can often be due to:
- the pelvic floor not contracting properly
- it may not be contracting at the right time
- low or high muscular tone
- imbalance in lower vs. upper abdominals in managing pressure
Dr. Trinh can help with this issue by making sure your pelvic floor is contracting properly. She can examine and treat a tight pelvic floor or help to strengthen a weak pelvic floor. She will also examine how the rest of the neuromusculoskeletal system looks and how your pelvic floor is loading during strenuous tasks. She will also assess your breathing pattern and if you are generating intra-abdominal pressure safely and effectively.
In most cases, there is no loss of consciousness. But if you do lose consciousness, you have most certainly sustained a concussion. Any loss of consciousness should be taken seriously, and any bouts lasting more than approximately a minute are considered severe.
Signs and symptoms of a concussion can last days, weeks, months, or even longer in some cases. Fortunately, in the majority of cases, symptoms usually resolve within 7-10 days.
One of the most common symptoms of a concussion is a headache. Confusion is another common sign. This sign can easily be overlooked by the examiner unless the patient is moderately to severely confused, so ruling out a concussion should not be based on the fact that the patient ‘did not appear confused.’
Other signs and symptoms of a concussion that may be present on their own or in combination are concentration difficulties, decreased attention, difficulty with mental tasks, memory problems, difficulties with judgment, a decrease in balance and coordination, a feeling of disorientation, a feeling of being ‘dazed,’ fatigue, blurred vision, light and/or sound sensitivity, difficulty sleeping or sleeping more than usual, being overly emotional, being irritable or sad, neck pain, a feeling of ‘not being right’, and ringing in the ears. Amnesia may be another symptom. In severe concussions, a change in personality may even occur.
If you or someone you know shows even one sign or symptom listed above, you most likely experienced a concussion and it is very important to get a full evaluation.
Signs and symptoms that are even more severe after an injury to the head, such as recurrent vomiting, a change in pupil size, blood or fluid coming from the ears or nose, seizures, or obvious physical coordination or mental difficulties indicate a severe brain injury and require immediate emergency attention.
In most cases, signs and symptoms appear immediately after the concussion has occurred. In some cases, the signs and symptoms can be delayed by a few hours or possibly even days. For this reason, if the mechanism of injury suggests a concussion despite a lack of obvious symptoms being immediately present, the patient needs to be thoroughly examined before returning to activity.
As the spine ages, several changes occur in the bones and soft tissues. The disc loses its water content and begins to collapse, causing the space between the vertebrae to narrow. The added pressure may irritate and inflame the facet joints, causing them to become enlarged. When this happens, the enlarged joints can press against the nerves going to the arm as they try to squeeze through the neural foramina. Degeneration can also cause bone spurs to develop. Bone spurs may put pressure on nerves and produce symptoms of cervical radiculopathy.
Heavy, repetitive bending, twisting, and lifting can place extra pressure on the shock-absorbing nucleus of the disc. A blow to the head and neck can also cause extra pressure on the nucleus. If great enough, this increased pressure can injure the annulus (the tough, outer ring of the disc). If the annulus ruptures, or tears, the material in the nucleus can squeeze out of the disc. This is called a herniation.
Although daily activities may cause the nucleus to press against the annulus, the body is normally able to withstand these pressures. However, as the annulus ages, it tends to crack and tear. It is repaired with scar tissue. Over time, the annulus becomes weakened, and the disc can more easily herniate through the damaged annulus. If the herniated disc material presses against a nerve root it can cause pain, numbness, and weakness in the area the nerve supplies.
Spinal instability means there is extra movement among the bones of the spine. Instability in the cervical spine (the neck) can develop if the supporting ligaments have been stretched or torn from a severe injury to the head or neck. People with diseases that loosen their connective tissue may also have spinal instability. Spinal instability also includes conditions in which a vertebral body slips over the one just below it. When the vertebral body slips too far forward, the condition is called spondylolisthesis. Whatever the cause, extra movement in the bones of the spine can irritate or put pressure on the nerves of the neck, causing symptoms of cervical radiculopathy.
Urge Incontinence:
Urge Incontinence is getting the sudden urge to pee before the bladder is full and truly needs to empty. The bladder is ready to empty when there is about one and a half to two cups (300-400 mls) of urine in it. The bladder sends signals to the brain to let someone know it is filling up.
Urge incontinence occurs when this signaling has gone awry, and the bladder sends a panic signal when it is only partially full. This makes the individual feelslike it might not be possible to make it to the bathroom, and leaking may or may not occur.
There are also certain cases where a problem in the spine could be causing a signaling disruption to the bladder. Hence, if there is also a history of low back pain, treating the low back pain may improve or resolve urge incontinence.
Dr. Trinh will perform a full assessment to see if the urge incontinence could be due to spinal issues, and treat accordingly. Together, we will also work on strategies to retrain the bladder, identify bladder or nerve irritants, along with pelvic floor training.
Pelvic Organ Prolapse:
Pelvic Organ Prolapse is when the pelvic organs begin to descend down into the vaginal canal or rectum. It often feels like something is in the vagina, and patients will often describe a heavy or full sensation.
Recent research has shown that up to 50% of women have some form of prolapse upon physical exam (Barber & Maher, 2013).
Often, too much pressure downward into the pelvic floor or tearing or stretching during delivery can be a cause of prolapse. Even with fascial damage, proper movement and strengthening can resolve many symptoms.
The first part of treatment involves building awareness and understanding pressure, bearing down, and decreasing tension. Dr. Trinh will work with you on re-establishing pelvic floor function by strengthening the pelvic floor and the rest of the body that influences pelvic floor function. This includes the diaphragm, core, hips, glutes, feet, posture. We then put everything together to improve strategies for everyday function, particularly when loading the pelvic floor through running, jumping, lifting, etc.
Hypertonic Pelvic Floor:
A hypertonic pelvic floor is a pelvic floor with too much muscular tension or tone (hypertonic). This leads to problems such as pain with Intercourse or constipation.
The pelvic floor will often be tight or contain muscle trigger points. Patients often complain of a heavy feeling and difficulty contracting the pelvic floor, or they may feel limited when inhaling downwards. Holding a kegel will often make it worse.
Dr. Trinh will perform a full assessment to see if the hypertonic pelvic floor could be a response to a spinal issue, and treat accordingly. We will then work on strategies to relax the pelvic floor with specific positions and breathing techniques. From there, we will work on strengthening everything surrounding the pelvic floor for proper stability. She will perform a full assessment on the cause of the hypertonic pelvic floor, such as tension, alignment or compensation patterns.
Diastasis Recti (Abdominal Separation):
Diastasis Recti (Abdominal Separation) is a thinning of the linea alba, a connective tissue that connects all of the abdominal muscles in the middle.
Some natural stretching and diastasis formation is completely normal during pregnancy but should resolve within 6 months postpartum. Many patients complain that the abdomen doesn’t have the same tone or lift as it did prior to pregnancy.
Diastasis is a full body issue, as it relates to how someone moves, breathes and loads the body.
Different causes of a diastasis will require different approaches to treatment. Dr. Trinh will perform an evaluation of your breathing pattern, posture and abdominal firing and treat the impairments related to this. We will work on fixing your breathing to ensure your diaphragm is working with your core and pelvic floor when generating intra-abdominal pressure. We will also work on postural alignment to decrease the strain on the diastasis to promote proper healing. Treatment will also include exercises that support muscle balance between the pelvic floor, diaphragm and the different layers of the core.