Pelvic Floor Conditions

+ Pelvic Inflammatory Disease (PID)

An infection of the reproductive organs which can result in scar tissue formation or pelvic adhesions. PID may result in chronic pelvic pain.

Symptoms:

• Lower abdominal pain
• Fever
• Painful intercourse
• Painful urination
• Foul smelling vaginal discharge
• Irregular menstrual bleeding
• Pain in the right upper abdomen

Physical therapy can help to break down scar tissue, once the infection has resolved, and aid in increased mobility of reproductive connective tissue. This, in turn, may decrease pelvic pain and help with infertility issues.

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+ Pelvic Organ Prolapse

About one third of women are affected by prolapse or a similar condition in their lifetime. Prolapse is the decent or dropping of a pelvic floor organ. This can be the bladder, uterus, vagina, small bowel, or rectum. These organs can descend through the vagina or through the anus. Anything that puts increased pressure on the abdomen can cause pelvic organ prolapse. Examples are pregnancy, over exertion during exercise or activity, obesity, respiratory issues like chronic cough, constipation, pelvic organ cancers, connective tissue disorders that cause laxity, or surgical removal of pelvic organs such as the uterus. Prolapse can occur through a weakening and stretching of the pelvic floor tissue, or could be caused by a hypertonic tight pelvic floor that causes weakness and in turn contributes to prolapse. Prolapse can be named for the organ that is descending. A cystocele is a prolapse of the bladder, urethrocele is a prolapse of the urethra, uterine prolapse is a prolapse of the uterus, vaginal vault prolapse is prolapse of the vagina, enterocele is prolapse of the small bowel, rectocele is prolapse of the rectum through the vagina. You can also get a rectal prolapse through the anus.

Symptoms:

• Pressure or fullness in the pelvic area
• Low back pain
• Painful intercourse
• Feeling that something is falling out of the vagina
• Urinary urgency or urinary leakage
• Constipation
• Bleeding from the vagina

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+ Pudendal Neuralgia

Pudendal neuralgia is a condition that causes pain, discomfort, or numbness in the pelvis or genitals. The pudendal nerve runs from the back of the pelvis to near the base of your penis or vagina. Damage or irritation of this nerve can make it hard to use the bathroom, have sex, or sit down.

Symptoms:

• Pelvic pain with sitting, but improvement with standing or sitting on a toilet seat
• Discomfort with tight clothing
• Bladder and/or bowel symptoms (hesitancy, frequency, retention, constipation)
• Dyspareunia and/or pain/spasm after orgasm
• Pudendal nerve block may assist in decreasing symptoms

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+ Pelvic Congestion

A third of all women will experience chronic pelvic pain in their lifetime. Ovarian veins and pelvic varicose veins are not visible externally, but can cause chronic pelvic pain, worse with sitting or standing, and sometimes are associated with varicose veins in the thigh, buttocks, or perineum. Blood backs up in the veins, making them enlarged or engorged. The pain can manifest in the pelvis, back, legs, and during sex.

Symptoms:

• Chronic pelvic pain
• Dyspareunia
• Urinary frequency and urgency
• Infertility
• Erectile dysfunction
• Pain in back of leg
• Dull ache which is aggravated by physical activity

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+ Dyspareunia

Genital pain that occurs just before, during, or after sexual intercourse. May be due to pelvic floor muscle tenderness, tightness, scarring or adhesions. Different conditions also cause pain with intercourse, including vaginismus, pelvic congestion, endometriosis, vulvodynia, vulvar vestibulitis, and interstitial cystitis.

Symptoms:

• Pain, pressure, or ache in the abdomen, sacrum, coccyx, rectum, or vagina

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+ Vulvodynia

A chronic pain syndrome that affects the vulvar area and occurs without an identifiable cause. The pain may occur during or after sexual activity, when tampons are inserted, or when prolonged pressure is applied to the vulva, such as biking or prolonged sitting.

Symptoms:

• Burning, stinging, irritation, or sharp pain in the vulva and entrance to the vagina

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+ vulvar vestibulitis syndrome

Pain that is localized to the vestibular region of the vulva. The pain may occur with prolonged pressure from sitting, biking, or sexual activity.

Symptoms:

• Burning or cutting type pain in the vestibular region of the vulva

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+ Coccydynia

Pain and tenderness that occur at the tip of the tailbone between the buttocks. Sitting often aggravates the pain.

Symptoms:

• Pain related to the tailbone / the bottom of the spine
• Pain worsened with movement or after defecation
• Typically caused by a fall involving the coccyx, although in a third of patients no cause is noted

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+ Endometriosis

Endometriosis is a common health problem in women. Endometriosis happens when tissue similar to the lining of the uterus grows outside of the uterus or on other areas of the body. During menstruation, normal endometrial tissue of the uterus is expelled, but in a woman with endometriosis, this displaced tissue is not expelled. This leads to physical symptoms such as pain and bowel and bladder issues.

Symptoms:

• Pain
• Abnormal bleeding or spotting
• Infertility
• Digestive disorders

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+ Hypertonic Pelvic Floor

A hypertonic pelvic floor occurs when the muscles in the pelvic floor become too tense and are unable to relax. Many people with a tense and non-relaxing pelvic floor experience pelvic health concerns such as constipation, painful sex, urgency and pelvic pain. A hypertonic pelvic floor may also be accompanied by tension in the surrounding hip and pelvic muscles such as the piriformis, obturator internus, coccygeus and hamstrings. There is no one defining cause of a hypertonic pelvic floor. There are certain behaviors that can contribute to a hypertonic pelvic floor. For instance, someone who spends a lot of time working out and clenching their abdominal muscles and not letting them go can develop permanent tension, high levels of stress or anxiety can contribute, someone with a history of holding their bladder or bowels for hours due to inconvenience may have a hypertonic pelvic floor. Also, people with pelvic female health diseases, gastrointestinal dysfunctions like IBS or Crohn's or Colitis, traumatic birth experiences, or scarring from birthing or surgery in the pelvic area are at higher risk.

• Constipation
• Incomplete emptying of the bowels
• Straining when emptying the bowels
• Pelvic pain
• Low back pain
• Hip pain
• Coccyx pain
• Painful sex
• Vaginismus
• Urinary incontinence
• Incomplete emptying of the bladder
• Slow flow of urine
• Hesitancy or delayed start of urine stream
• Urinary urgency
• Urinary frequency
• Painful urination

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+ Hip injury or dysfunction

A hip injury or dysfunction can be a cause of chronic pelvic pain. Many patients with pelvic pain and pelvic floor muscle dysfunction have an underlying or related hip disorder. That is because the hip bone is attached to the pelvis. The muscles of the hip and the pelvic floor muscles work together to provide stability and mobility of the hip and pelvis. A labral tear in the hip, for example, will cause pain and spasms in the pelvic floor muscles. One particular muscle, the obturator internus, is responsible for external rotation of the hip, and provides rotation and stability of the leg on the pelvis. This is a common site of dysfunction and pain.

Symptoms:

• Pain on the outside of the hip, lower abdomen, or groin
• Pain near the sit bone or deep inside the pelvis
• Painful sitting
• Urinary urgency or frequency
• Urinary leakage
• Sexual dysfunction
• Deep pain in buttocks without toileting

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+ Nerve Compression or Entrapment

The nerves that are present near the abdominal wall, in or around the pelvic cavity, and in the groin or perineum can be the cause of pelvic pain if they are under compression or entrapment by other structures in the body. This can be due to excessive stretching, trauma or impact, repetitive injury, prolonged sitting or pressure on the nerve, abdominal or other surgeries, or childbirth.

• Pain when sitting, relieved when standing
• Pain that radiates to the genitalia
• Pain between the rectum and the penis or vagina
• Pain that radiates to the abdomen or low back
• Pain during or after intercourse
• Pain when urinating or having a bowel movement
• Burning pain, numbness, the feeling of being swollen, or weakness

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+ Lichen Sclerosus

A chronic inflammatory skin disorder that presents as thin, whitened, wrinkled skin. It most commonly affects women before puberty or after menopause. It can affect men as well, but it is not as common in men. In women, lichen sclerosus usually occurs near the clitoris, on the labia, or in the anal region. In men, it usually occurs on the glans of the penis or the foreskin. The skin changes from lichen sclerosus cause difficulty and pain with urination, defecation, and intercourse. The presence of thin, easily irritated, and torn skin affects physical activity and clothing choice. The cause of lichen sclerosus is not completely known, but a number of factors may be involved. Genetics may play a role, it may be an autoimmune response, it may be caused by an infection, or hormones or urine may be the cause.

• Vulvar itching
• Anal itching, bleeding, or pain
• Anal fissures
• Painful intercourse

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+ Levator ani syndrome

Refers to pain, pressure, or ache in the sacrum, coccyx, rectum, and/or vagina caused by unusual tension in the levator ani muscles. The pain may increase with intercourse, sitting, defecation, or constipation. Pain may be referred to the coccyx/sacrum, thigh, groin, gluteal region, or abdomen. The pain may be severe with urination, and present as a sharp, burning, or aching pain.

• Rectal pain not brought on by having a bowel movement
• Rectal pain made worse by sitting or lying down
• The feeling not having completely emptied bowels
• Pain with urination or bladder pain
• Increases urinary urgency without being able to start flow easily
• Urinary incontinence
• Pain before, during, or after intercourse
• Can mimic prostatitis in men

+ Common Postpartum Issues

20% of first-time moms experience severe pelvic floor muscle injury after a normal pregnancy and delivery

The natural changes caused by pregnancy and delivery (vaginal or C-section) affect the pelvic floor muscles and connective tissue, often causing discomfort and pain for women either during pregnancy or after delivery.

Symptoms:

• Change in urinary urgency, frequency, or retention
• Pain or difficulty controlling gas or bowel movements
• Pain during intercourse
• Pelvic Organ Prolapse
• Pelvic Girdle Pain
• Painful Intercourse

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+ Diastasis Recti

Also known as abdominal separation - diastasis recti occurs when the two large vertical banks of muscles called rectus abdominis that meet in the center of the abdomen (the “six-pack”)—pull apart from their attachment point, resulting in a rounded, protruding belly. About 30% of women will have some degree of diastasis recti past 6 weeks. The vast majority of women can create the proper amount of tension in their mid lines and flatten their abdominal walls with rehabilitation via pelvic floor focused physical therapy.

Symptoms:

• A visible and palpable separation of the rectus abdominis muscle
• Feelings of “flabbiness” in the abdominal muscles
• Urinary or bowel issues (incontinence, leakage, constipation)
• Low back or pelvic or hip pain
• Poor posture
• Feeling weak through the midsection
• Sexual pain

+ General Bladder Conditions

The following definitions explain bladder conditions as they relate to pelvic floor dysfunction. In all of these bladder conditions, irritation in the lining of the bladder or urethra can also irritate surrounding tissues, including skeletal muscle tissue. If this irritation persists and continues to irritate the surrounding muscles, trigger points can result. Trigger points result in increased tightening and shortening of the muscle, which can create more pain, irritation, and musculoskeletal imbalance. Physical therapy can help by increasing the tissue mobility and decreasing trigger points in the muscles of the pelvis.

Symptoms:

• Urinary frequency-greater than one bathroom trip for every two awake hours
• Urgency, hesitancy, retention and/or incomplete empyting
• Nocturia- nighttime urinary frequency: more than one trip to the bathroom in the night
• Pain in the urethra, bladder, and/or pelvis; pressure, spasming, or difficulty with initiating urination
• Weak urine stream and/or a stream that stops and starts

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+ Interstitial Cystitis (IC) / Painful Bladder Syndrome (PBS)

Recurring pain or discomfort in the bladder and the surrounding pelvic region.

Symptoms:

• Urinary urgency, frequency, or retention
• Dyspareunia
• Pain in the back, suprapubic area, and/or abdomen
• Nocturia (nighttime urinary frequency)
• Pain before, during, or after urination

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+ Chronic Pelvic Pain Syndrome

For reasons that are not well understood, some men start with pain in one organ and develop pain from overly tight pelvic muscles and sensitized nerves. Another phrase to describe overly tight pelvic floor muscles is a hypertonic pelvic floor. This results in the situation now called Chronic Pelvic Pain Syndrome (CPPS). This condition is poorly understood and often not recognized because it doesn’t show on scans. Unfortunately, many men are treated with antibiotics for ‘Chronic Prostatitis’ for a long time when no infection is present.

There are many conditions that can initiate CPPS, and may different symptoms.

Symptoms:

• Pain in the perineum, penis, or abdomen
• Painful urination, increased urgency or frequency of urination
• Constipation or diarrhea
• Sexual dysfunction or pain

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+ Urinary Incontinence

An accidental loss of urine from the bladder. This can be due to muscle weakness or muscle spasm/tightness. Incontinence can be categorized as urge incontinence, which is urine loss due to a strong desire to urinate (urgency), with only a quick warning. Stress incontinence, which is urine loss due to an increase in abdominal pressure such as coughing, sneezing, lifting, laughing, jumping or running. And mixed incontinence is a combination or urge and stress incontinence.

+ Bowel Disorders

Musculoskeletal dysfunctions caused by IBS, constipation, and the other bowel disorders can be treated with physical therapy through releasing myofascial trigger points in the abdomen, back, gluteals, and pelvic floor, and re-education of these muscle groups.

Symptoms:

• Bowel frequency, urgency
• Retention,and/or incomplete emptying
• Gas
• Diarrhea
• Constipation
• Bloating
• Rectal and/or abdominal pain, pressure, or spasm
• Difficulty with initiation
• Incontinence
• chronic anal fissures
• pain or muscle spasm around anus

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+ Inflammatory Bowel Disease (IBD)

This includes bowel disorders such as Crohn's disease and ulcerative colitis. Crohn's disease is an inflammation of the digestive tract (anywhere from mouth to anus). It can affect all layers of the intestine and most commonly affects the small intestine (ileum). Ulcerative colitis is an inflammation of the top layer of the lining of the large intestine (colon and rectum). The inflammation can result in ulcers in the top layer. Signs and symptoms of both may include abdominal pain, diarrhea, rectal bleeding, weight loss, fever, arthritis, and skin problems. These diseases can result in tightening of the surrounding musculature, due to irritated tissue and/or from 'holding' or gripping the muscles.

Symptoms:

• Increased bowel frequency or urgency
• Rectal and/or abdominal pain, pressure, or spasm
• Chronic anal fissures
• Gas, Diarrhea, or bloating

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+ Irritable Bowel Syndrome (IBS)

The most common disorder of the gastrointestinal system. This condition is characterized by abdominal pain and discomfort, bloating, gas, more frequent bowel movements, diarrhea, or constipation. IBS may cause tightening, weakening, and/or incoordination of the pelvic floor and abdominal musculature.

Symptoms:

• Abdominal pain or discomfort
• Bloating
• Gas
• More frequent bowel movements
• Diarrhea and/or constipation

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+ Fecal Incontinence

An unexpected leakage of stool. This can be due to pelvic floor muscle weakness, pelvic floor muscle tightness and/or a hypertonic pelvic floor, or muscle incoordination.

- Dyspareunia

Pain with initial penetration, deep penetration, or thrusting. The pain may be due to scarring, adhesions, skin irritation, muscle tenderness, muscle tightness or tone, or any of the conditions that refer pain or cause dysfunction to the pelvic floor.

Symptoms:

• Painful intercourse
• Pain following orgasm