Pelvic pain can be felt in the lower abdomen, perineum or the pelvis and is considered to be chronic if it lasts longer than 6 months. Pelvic pain may present as an aching pain while others describe it as burning, sharp or stabbing pain. Several mechanisms of injury may lead to spasm of the pelvic floor. These include traumatic vaginal delivery, abdominal or pelvic surgery, prolonged driving, occupations that require prolonged sitting (such as office work), gait disturbances, traumatic injury to the back or pelvis, or sexual abuse. Pelvic floor dysfunction can also arise in response to other common chronic pain syndromes, such as endometriosis, irritable bowel disease, vulvodynia, and interstitial cystitis. Acute or chronic pelvic pain is often due to musculoskeletal disorders, which may go unrecognized during a traditional pelvic examination. Fortunately, pelvic floor physical therapy is a powerful tool for the treatment of pelvic pain.

Patients with the following symptoms or diagnoses should be assessed by a pelvic floor physical therapist:

• Coccydynia
• Vulvodynia
• Pain with intercourse
• Sacroiliac joint dysfunction
• Painful bowel movements
• Interstitial cystitis
• Pain with prolonged sitting.

Coccydynia is a medical term for pain in the coccyx (tailbone) area. Most resources conclude that the most common cause of coccyx pain is idiopathic, a medical term which means a condition that occurs for unknown reasons. The second most cited cause is trauma. For example, a hard fall on buttocks, trauma during childbirth, or activities which place repetitive stress on the tailbone such as biking or horseback riding. Other causes, though rare, can include cysts, abscesses or tumors, so getting your tailbone checked by a medical professional is a must.

Physical therapy treatment of the coccyx is essential in the recovery process and for minimizing the possibility of recurrent episodes of coccyx and low back pain. Coccyx treatment requires a physical therapist with advanced training in manual treatment to restore proper alignment and mobility of the tailbone. In addition, physical therapy treatment includes exercises to work on muscles in the region as well as in-depth posture and body mechanics training. This combination results in a high success rate with treatment of coccydynia.

Our practice focuses on both preventive care as well as specialized rehabilitation in the event of prepartum musculoskeletal problems. We can address new problems that arise due to the physical stress the body is under and/or help patients who have existing dysfunction that exacerbated during pregnancy. Our therapists enjoy working with patients and their physicians with the goal of ensuring a healthy, active, and comfortable pregnancy.

Common prepartum complaints that our physical therapists treat:

• Painful intercourse
• Low back pain
• Urine leakage due to strained pelvic muscles
• Separation of the rectus abdominis muscles (diastasis recti)
• Neck pain or headaches due to posture changes
• Colorectal dysfunction
• Sciatic, hip, sacral, pubic, symphysis or tailbone pain
• Urinary urgency and frequency
• Tightness and pain in the legs due to the flattening of the feet

Women can easily increase their potential for successful vaginal deliveries with less perineal tearing, postpartum pain and dysfunction.

Our practice focuses on both preventive care as well as specialized rehabilitation in the event of postpartum musculoskeletal problems. The physical therapists at Nesin Therapy are specifically trained to meet the special obstetric needs of women. We follow the American College of Obstetrics and Gynecology guidelines for exercise during and after pregnancy and are trained to assist in all the specific musculoskeletal needs during pregnancy and after the arrival of the new baby.

Common postpartum complaints that our physical therapists treat:

• Separation of rectus abdominis muscle
• Pain at episiotomy site or perineal tear
• Diminished orgasm
• Dyspareunia (pain with intercourse)
• Urinary and fecal incontinence
• Pelvic floor pain
• Pubic symphysis sprain
• Mid-back and neck pain associated with breastfeeding
• Low back and leg pain
• Decreased capacity for exercise
• Abdominal pain or weakness
• Scar pain and/or hypersensitivity
• C-section

Pain during intercourse, also known as dyspareunia, is very common. Nearly 75% of women have had pain during intercourse at some time during their lives. For some, the pain is only temporary; for others, it is a long-term problem. For many women, the search for a cure for painful intercourse can be a frustrating and unproductive journey of referrals from one doctor to another (gynecologist, urologist, pain specialist). Adding to the frustration, many are told to consult a psychologist or psychiatrist because the pain “must be in your head”. But the pain persists because it actually occurs in the pelvis, precisely where they feel it.

Patients require the help of a physical therapist to elongate the muscles, eradicate trigger points, and make both the fascial and muscular systems healthy again.

Many patients with interstitial cystitis (IC) and their physicians are turning to manual physical therapy to help ease IC symptoms and pain. This type of therapy is especially helpful if the patient has pelvic floor dysfunction (PFD), and it has been found that 87% of IC patients have PFD.

Many of the urinary, bowel, or sexual symptoms IC patients experience can be signs of PFD including:

• Urinary urgency, frequency, hesitancy, stopping and starting, or incomplete emptying
• Painful urination
• Constipation, straining, or pain with bowel movements
• Unexplained pain in the lower back, pelvic region, genital area, or rectum
• Pain during or after intercourse or orgasm

Studies have demonstrated the benefit of physical therapy for tight and tender pelvic muscles associated with IC. One study reported that 70% of IC patients who were treated with manual physical therapy to the pelvic floor for 12 to 15 visits experienced moderate to marked improvement. Call Nesin Therapy to schedule your evaluation.

When the muscles that hold the pelvic organs become inefficient, the pelvic organs (the bladder, uterus, small bowel, and rectum) can drop from their normal location and push against the wall of the vagina. Pelvic organ prolapse is most often associated with pregnancy and childbirth. Risk factors for developing or worsening pelvic organ prolapse include: hysterectomy, obesity, chronic, constipation or straining with bowel movements, a long lasting cough, smoking, pelvic tumors, pelvic surgery, neurological disorders, menopause, and family history.

Some common symptoms of pelvic organ prolapse are:

• A feeling of pressure on the vaginal wall or fullness in the lower abdomen
• A feeling like “something is falling out of the vagina”
• Dyspareunia (pain with intercourse)
• Incontinence
• Constipation
• Lower back pain
• In severe cases, tissue may be seen protruding from the vaginal opening

Manual physical therapy can be instrumental in the relief of the symptoms of pelvic organ prolapse.

Physical therapy can be a first line of defense against fecal incontinence. This potentially embarrassing condition affects somewhere between 2-24% of the adult population. Because fecal incontinence is one of the most psychologically and socially embarrassing conditions found in an otherwise healthy individual, it is often unreported and therefore untreated. Continence requires the complex integration of signals among the smooth muscle of the colon and rectum, puborectalis muscle, and the anal sphincters. In essence, any process that interferes with these mechanisms, including trauma from vaginal delivery or neurological injury, can result in fecal incontinence.

Physical therapy can:

• Improve functional strength and coordination of the pelvic floor musculature
• Increase frequency of normal bowel movements
• Increase functional activities without fecal incontinence
• Eliminate diarrhea, fecal incontinence and/or constipation
• Decrease paradoxical puborectalis contractions

A study by Rieger et. al (1997) found that pelvic floor rehabilitation by a physical therapist should be considered the initial treatment for patients with fecal incontinence with improvement expected in up to 67% of patients. Initial good results can predict the overall outcome.

Urinary incontinence affects four out of every ten women, one out of every ten men, and 17 percent of children under the age of 151. Additionally, 28 percent of male and female athletes between 18-21 years old experience stress incontinence 2. Pregnant women are also at a higher risk for urinary incontinence because their pelvic floor muscles and the pudendal nerve are significantly stretched during pregnancy.

Our expert physical therapists treat the 3 most common types of incontinence:

• Stress: urinary leakage caused by coughing, sneezing, laughing or exertion
• Urge: a sudden and strong urge to urinate, along with the inability to control urination
• Mixed incontinence: a combination of stress loss and urge loss together

According the American Physical Therapy Association (APTA), proper preventive measures and treatment by a pelvic floor physical therapist can help patients manage, or alleviate urinary incontinence. Fortunately, Nesin Therapy offers the highest level of conservative treatment for this common condition.

Constipation is a common disorder. According to the Mayo Clinic, 50% of patients with chronic constipation have pelvic dysfunction (PFD). In addition to ruling out anatomic, disease and diet related causes for a patient’s constipation, attention should be directed to the pelvic floor. These muscles must relax and contract properly to maintain urinary and fecal continence, sexual function, and proper voiding habits.

PFD is constipation is characterized by reduced coordination between the pelvic floor and muscles and abdominal wall motion, which is necessary for normal defecation. This can then lead to straining with bowel movement and feelings of incomplete voiding.

“Successful physical therapy for patients with puborectalis dyssynergia is associated with improvements in constipation-related symptoms and in quality of life.”