Women’s Health and Pelvic Floor Disorders

Women’s Health Physical Therapy is an area of physical therapy that specializes in the unique needs of woman throughout the women’s lives. Physical Therapists are specialists in musculoskeletal disorders. With their specific training physical therapists provide effective management for women with various dysfunctions throughout women’s lives. From the young female athlete, before, during and after pregnancy, menopausal and elderly woman all can receive benefit from physical therapy intervention.

During Pregnancy and Postpartum

Woman’s body experiences many changes that affect their skeletal system. In particular, the increase in hormone levels may cause joints to become loose to prepare for delivery. Joint laxity along with postural changes and poor body mechanics contribute to the etiology of low back pain, pelvic pain, sacroiliac dysfunction, sciatica, upper back pain, diastasis recti (abdominal muscle separation) carpal tunnel syndrome, urinary incontinence (involuntary leakage of urine), dyspareunia (painful sexual intercourse) and organ prolapse. These are some of the woman’s health conditions a physical therapist can successfully treat.

Postpartum Checkup

Have you recently had a baby and are experiencing:

  • Pain in the pelvis, hip or back
  • Abdominal muscle separation (diastasis recti)
  • Painful sexual intercourse
  • Episiotomy or cesarean abdominal scar pain
  • Leakage of urine with sneezing, coughing, laughing, jumping, or exercising
  • Trouble holding back or passing gas
  • Constipation
  • Trouble initiating urine flow
  • Heaviness in the vaginal/perineal area from pelvic organ prolapse
  • Urinary frequency

Do you have pelvic floor dysfunction? If so, you may benefit from this postpartum checkup!

Click here and take the Cozean Pelvic Floor Screening test.

Urinary Incontinence

An involuntary leakage of urine. Four types of urinary incontinence are successfully treated by physical therapists.

  • *Stress Urinary Incontinence
    Leakage of urine that occurs during coughing, sneezing, laughing, exercise and lifting. Leakage occurs when the intra abdominal pressure exceeds the urethral closure pressure. A combination of weak pelvic floor and abdominal muscles contribute to this disorder. A history of low back pain and pelvic pain can also add to inhibition and weakness of these muscles which can exacerbate this condition.
  • *Urge Urinary Incontinence
    The leakage of urine associated with a strong urge to urinate. Those suffering with this condition will frequently leak urine during the sound of running water, or as they are trying to run to the bathroom.
  • *Mixed Urinary Incontinence
    A combination of both stress and urge urinary incontinence. So those suffering from mixed incontinence leak during coughing, sneezing laughing and during the strong urge to urinate.
  • *Functional Incontinence
    When you are functionally limited and can not get to the bathroom in time. An example may be elderly woman who has severe arthritis and moves slowly. She may not be able to remove her clothing fast enough or moves very slowly secondary to hip or knee pain and can not functionally get to the toilet in time.

    Physical therapy intervention may include a combination of therapeutic exercises to strengthen the pelvic floor and abdominal muscles. Muscles surrounding the hips and spine are also addressed. Other treatment options may be bladder training, education on bladder irritants, EMG biofeedback and electrical stimulation.

Pelvic Pain

Common diagnoses of pelvic pain are: Dyspareunia, Interstitial Cystitis (IC), Levator Ani Syndrome, Vulvodynia, Pelvic Floor Dysfunction, Endometriosis

(In addition to urinary incontinence), A woman’s health physical therapist can treat women suffering from pelvic pain. Pelvic pain can originate from many areas in the body but still present itself as pelvic girdle, vaginal, rectal or perineal pain. It can originate from the bladder, uterus, other abdominal organs or joints in the spine or hips. All of these areas of dysfunction can present itself as similar symptoms of vaginal pain, pain with intercourse, killer pain during, before or after periods, or pain in the back, hip or pelvis that radiates to the front or back of the thighs. Some woman also experience burning vaginal or anal pain.

Pain in this area can be caused from musculoskeletal dysfunctions such as pelvic girdle or spine dysfunction.sacroiliac rotation, pubic symphysis separation, upslip or downslips, or a lumbosacral spine dysfunctions. Other possible causes of pelvic pain are from scar adhesions from an episiotomy, cesarean or other previous abdominal surgical scars. Decreased abdominal organ mobility also known as visceral restrictions can also contribute to pelvic pain. If there is pain, restriction or any dysfunction in the joints of the low back, abdomen or pelvic girdle the pelvic floor muscles can become hypertonic or a state of a contraction (spasm) that does not relax. Tight and non-relaxing pelvic floor muscles can be a great contributor of pelvic pain. A skilled pelvic floor PT will identify and treat the root causes of your pelvic pain.

  • What to expect during therapy:
    A woman’s health physical therapist will provide a thorough subjective and objective evaluation and develop a treatment program specific to your problems and goals.

    Treatments may include one or more of the following:

    • Manual therapy to reduce muscle guarding and spasms, joint mobilization or muscle energy techniques to correct a rotated pelvis, sacroiliac joint or misaligned cervical, thoracic or lumbar vertebrae.
    • Therapeutic exercises will be prescribed to correct areas of muscle weakness, muscle imbalances or muscle tightness.
    • Neuro-muscular reeducation is provided to instruct patients on proper posture alignment, spine stabilization and facilitation techniques for weak muscles such as those in the pelvic floor.
    • EMG biofeedback is also utilized to re-educate weakness or hypertonus in the pelvic floor muscles.
    • Specific functional training will be provided geared toward your specific goals. Functional activities may include instructions on proper posture while nursing your infant. Correct body mechanics education to learn how to correctly lift or bath your toddler to eliminate undue stress to your joints. For a woman suffering from urine leakage, functional training may include education on bladder training or foods that may irritate their bladder and cause urgency and frequency. Constipation tips such as fiber, hydration and positioning tips will be provided for those suffering with any pelvic floor condition.
  • *EMG Biofeedback
    A device that utilizes electrodes to pick up, measure and treat muscle weakness in pelvic and abdominal areas. The electrodes transmit this electrical signal to a computer screen so the patients can see when and how strong their muscles are contracting so they can learn to strengthen very weak muscles. If pelvic muscles are very weak it may be difficult to find and exercise the correct muscles. Physical therapists may utilize EMG biofeedback or manual techniques to help women identify and strengthen the correct muscles.
  • *Electric Stimulation
    Another device that may be utilized is electrical stimulation. This device utilizes a vaginal electrode that stimulates the pelvic floor muscles to contract artificially. With this facilitation, the patient can identify the correct muscles and begin their rehabilitation process.

    The Woman’s Health section of the American Physical Therapy Association has developed 3 brochures detailing 3 areas of Women’s Health Physical therapy. They are: Back Pain: Pregnancy and Low Back Pain (.pdf), Pelvic Pain: Pregnancy and Pelvic Pain (.pdf) and Incontinence: Pregnancy & Incontinence (.pdf)

For more information here are a list of reputable websites:

  • pelvicpain.org: The International Pelvic Pain Society
  • nva.org: National Vulvodynia Association
  • ics.org: International Continence Society
  • nafc.org: National Association for Continence
  • augs.org: American Urogynecologic Society
  • acog.org: American Academy of Obstetrics and Gynecology

Back in Motion PT no longer offers treatment for Pelvic floor disorders. This includes:

  • Incontinence
  • Pelvic and Vaginal Pain
  • Pelvic Organ Prolapse
  • Urinary and Bowel Dysfunction

However, our sister company, Physical Therapy Your Way and Advanced Specialty Care PLLC offers treatments for all of these services. Physical Therapy Your Way performs internal pelvic floor evaluation and treatments for bowel, bladder and sexual dysfunction.

For further information please visit their website: www.PhysicalTherapyYourWay.net or call them at 571-312-6966.

Back in Motion PT does however continue to treat women of all ages including prenatal and post-partum women suffering from pelvic girdle pain, upper and low back pain, sacro-iliac dysfunction and pubic symphysis separation, osteoporosis, lymphedema, carpal tunnel syndrome and more. Back in Motion PT offers more traditional spine and pelvic girdle treatments which can be treated externally.

* Services not offered at Back in Motion PLC and now offered at Physical Therapy Your Way PLLC.

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