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Physical therapy is often the first line of treatment for rehabilitation after acute or chronic musculoskeletal injury. Pelvic muscles can require the same type of rehabilitation. The techniques employed by physical therapists for pelvic pain or dysfunction include taking a detailed history, evaluating posture, stretching the muscles, external and internal myofascial and trigger point release of the muscles, biofeedback, electrical stimulation and exercises to increase control and strength of the pelvic floor, pelvic stability training, having patients keep diaries of pain or incontinence, and instructing the patient in behavior or voiding modifications. This list is not all-inclusive, but specialized physical therapy can contribute much toward improving the function and condition of your pelvic floor.
Gynecologic problems that can benefit from physical therapy can be divided into two broad categories:
1. Disorders of pelvic pain: chronic pelvic pain, dyspareunia, vestibulitis, and vulvodynia.
2. Disorders of pelvic function: pelvic organ prolapse, overactive bladder, urinary urgency incontinence and overactive bladder, stress urinary incontinence, and fecal incontinence.
Physical therapists, like other care providers, have specialized areas of expertise. Women’s health training is not a routine part of a general physical therapy degree and requires coursework after obtaining a degree in physical therapy. The additional courses focus not only on pelvic anatomy and physiology of incontinence but also on specific treatment modalities.
Pelvic Pain and Continence Screening Questionnaire
1. Do you ever leak urine, feces or gas?
2. Do you have strong urges to urinate or defecate that you cannot control?
3. Do you get out of bed to urinate more than once per night?
4. Do you urinate more often than every 2 hours during the day?
5. Do you have pain with urination or bowel movement?
6. Do you have difficulty initiating a urine stream or have to strain for a bowel movement more often than not?
7. Do you have abdominal or genital pain during or after sexual activity?
8. Do you have abdominal or genital pain that prevents you from participating in your regular home, work, social or recreational activities?
9. Do you have fewer than 3 bowel movements per week?
10. Do you have recurrent or unresolved low back, pelvic, tailbone, abdominal or hip pain?
If you answered “yes” to 1 or more of these questions, you may have muscles in your pelvis that are not working correctly. You should talk with your doctor about your complaints and have a medical examination. Treatment with a pelvic floor physical therapist can assist you with the treatment of the pelvic muscles as well as other related musculoskeletal problems.
National Association For Continence (NAFC) www.nafc.org
International Continence Society (ICS) www.ics.org
International Foundation for Functional Gastrointestinal Disorders (IFFGD) www.iffgd.org
National Vulvodynia Association www.nva.org
American Urologic Association (AUA) www.auanet.org
American Urogynecologic Society (AUGS) www.augs.org
Association for Applied Psychophysiology and Biofeedback (AAPB) www.aapb.org
The Simon Foundation for Continence www.simonfoundation.org
International Pelvic Pain Society www.pelvicpain.org
Interstitial Cystitis Association www.ichelp.org
The American Association of Sex Educators, Counselors, and Therapists www.aasect.org