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Conditions We Treat

Common conditions and diagnoses that affect the pelvic floor muscles and pelvic health include:

Abdominal pain
  • Generalized abdominal pain can be the result of many different factors. Physical therapy can help to alleviate this pain if it is the result of one of the following conditions: constipation, scar tissue or connective tissue adhesions from past gynecologic or abdominal surgeries including cesarean sections, endometriosis, pelvic floor dysfunction or pelvic floor trigger points which can refer pain to the abdomen, or peripheral nerve entrapment.

Cancer rehabilitation
  • Some women may experience persistent pain or soft tissue changes following surgery or radiation therapy for cancer in the genital or pelvic region. This can impact daily functions such as activity tolerance, bowel and bladder control, or sexual function. Physical therapy can help to minimize pain and restore normal function by improving the mobility of tight muscle or scar tissue, desensitizing painful areas, and facilitating optimal neuromuscular control.

Cesarean section rehabilitation
  • The current average rate of cesarean births in the United States is currently just under 32 percent. Sometimes this is an elective procedure, but sometimes it is unplanned. Having a cesarean section is a major surgery, and there is often not the opportunity for women to have ample time or support to recover from this procedure while they are undertaking all of the new demands of motherhood. It is important to ensure proper rehabilitation of the abdominal wall, manage scar tissue, and teach safe body mechanics for daily movements and childcare tasks in order to decrease pain and facilitate good long-term outcomes.

Coccygodynia (coccyx or tailbone pain)
  • Coccygodynia can be a debilitating condition of persistent pain in the tailbone region which can impact sitting tolerance, defecation and sexual activity. Whether the result of a fall, an injury during childbirth, or of unknown causes this condition can be significantly improved with physical therapy. Many muscles including the pelvic floor muscles internally and the gluteus maximus externally attach to the tailbone. Tightness or spasm of these muscles or dysfunction of the joint between the tailbone and the sacrum can contribute to pain in this region. Physical therapy can identify the causes of this pain and offer treatment by way of soft tissue release, stretching, postural education, or joint mobilization to provide relief.

Constipation
  • The pelvic floor muscles are very much involved in the process of defecation. The pelvic floor muscles including those that surround the anal opening need to be able to adequately relax in order for stool to pass. Sometimes tightness or pain of the pelvic floor or poor coordination with relaxing these muscles can lead to difficulty passing stool or a feeling of the bowels being incompletely emptied. Constipation can also be impacted by soft tissue restrictions throughout the abdominal and pelvic region, poor posture when sitting on the toilet, or impaired breathing mechanics. These are all musculoskeletal components that can be addressed by physical therapy.
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Diastasis recti (abdominal separation)
  • Diastasis recti occurs when the rectus abdominis muscles on the right and left sides of the abdominal wall separate. This is typically a result of a thinning of the linea alba which is the connective tissue band that normally joins these muscles together. Under normal circumstances, the linea alba is an important structure which allows for proper utilization and recruitment of the abdominal wall muscles and for proper stabilization of the spine and pelvis. Diastasis recti is a common finding during pregnancy with some studies indicating that as many as 100 percent of women will exhibit this by the end of their third trimester. As pregnancy progresses, the linea alba stretches and thins which allows the abdominal wall to accommodate the growing baby. Depending on the degree of separation, diastasis recti can lead to poor stabilization of the spine and pelvis and cause abdominal or low back pain during or after pregnancy. It can also lead to “doming” or “coning” in the middle of your abdomen; it can look like a football shape is protruding from your belly. This can indicate that you are not able to properly stabilize your abdomen and the increased pressures that occur with movements such as getting in and out of bed. Physical therapy can help to promote improved utilization of the abdominal muscles, teach proper body mechanics for daily activities and child care tasks, and facilitate optimal stability of the spine and pelvis.

Dyspareunia (pain with vaginal penetration including intercourse, tampon use, or gynecologic exam)
  • Some women may experience pain with attempts at vaginal penetration which can occur during sexual intercourse, tampon use, or gynecologic exam. Pain can be a result of many factors including pelvic floor muscles that are too tight or in spasm, sensitive scar tissue in the perineal region due to episiotomies or obstetrical tears, vaginal dryness during a period of decreased estrogen levels such as during menopause or while a woman is breastfeeding, or certain dermatological conditions of the vulvar area such as lichen sclerosis. Sometimes this pain is present with a woman’s first attempt at intercourse or vaginal penetration and other times the pain can develop over time. Physical therapy can help to identify and treat musculoskeletal components of dyspareunia. Treatment may include manual release techniques for tightened muscles, mobilizing tight perineal scar tissue, stretches for the hips or pelvis, relaxation and breathing exercises, desensitization of painful perineal scars, or vaginal dilators for gentle stretching. 

Endometriosis
  • Endometriosis is a disease process where tissue inside the uterus begins to grow where it should not. This endometrial tissue can grow on the ovaries, the bowels or the walls of the pelvic cavity. In some cases, the tissue implants in the ovaries or fallopian tubes, which can cause infertility. Each month, this misplaced tissue responds to the hormonal changes of the menstrual cycle. It builds up, breaks down and bleeds. But, the blood has nowhere to go. This causes surrounding tissue to become inflamed or swollen. It can also cause scar tissue, chronic pain and heavy periods. While physical therapy cannot cure endometriosis, it can help to treat the musculoskeletal and connective tissues affected by endometriosis. Treatment may include manual release techniques for connective tissue, scar tissue and muscles tension, stretches for the hips and pelvis, relaxation exercises and mindfulness techniques to decrease components of chronic pain associated with endometriosis. 

Fecal incontinence
  • Fecal incontinence is involuntary leakage of stool which can be loose or solid. It may occur with a strong urge or with no sensation at all. This can be due to weakness of the muscles that surround the anal opening or muscles that are too tight to function properly. Sometimes, people can also experience fecal incontinence if they attempt a bowel movement but are unable to completely empty their bowels. Treatment may include manual techniques to restore normal mobility of the muscles and soft tissue, strengthening exercises, biofeedback to encourage improved coordination of the muscles, or balloon retraining to normalize sensation of the nerves that communicate with the brain to control bowel function.

Interstitial cystitis or painful bladder syndrome
  • Interstitial cystitis or painful bladder syndrome is a chronic issue that is typically characterized by a frequent sensation of bladder pain and/or pressure. It can also be accompanied by symptoms that mimic those seen during a urinary tract infection including pelvic pain, pain with urination, urgency or frequency of urination, and difficulty emptying the bladder. Physical therapy can help to ease these symptoms by focusing on techniques that relax the muscles of the pelvic floor and surrounding musculature, identifying unhealthy habits that can exacerbate symptoms, and teaching strategies that can decrease urinary urgency and frequency.

Low back pain
  • Low back pain is one of the most common complaints that would prompt someone to seek physical therapy care. Low back pain is also common during pregnancy. A multitude of changes are occurring throughout the body which can lead to postural changes, decreased range of motion of the hips and spine, tightness of the muscles that attach to the spine and pelvis, altered walking patterns, and decreased core stability. Physical therapy can help to improve all of these changes in order to decrease pain and improve ease of movement.

Pelvic girdle pain, sacroiliac joint pain, or pubic symphysis pain
  • Pelvic girdle pain is another common complaint during and after pregnancy. It can be located in the front or back of the pelvis and involve either the pubic symphysis joint, sacroiliac joints, or both. Pain of the pelvic girdle can make even simple movements such as standing up from a chair or turning over in bed very difficult. The joints of the pelvis can become less stable due to weakness of the supporting muscles, weight changes, altered movement patterns, and increased muscle tension that places unnecessary strain through these joints. Physical therapy can help to correct muscle imbalances that are contributing to pelvic girdle pain. Treatment may include manual therapy techniques to mobilize the bones of the pelvis or decrease soft tissue restrictions, exercises to strengthen weakened muscles or increase core stability, or the use of support garments or belts. It will also include education on how to perform daily activities safely and with less pain.

Pelvic organ prolapse
  • Pelvic organ prolapse is a pelvic floor dysfunction in which the organs of the pelvis (bladder, uterus, and rectum) drop or press into the vaginal canal or even outside of the vaginal opening. This occurs because of weakness or damage to the muscles and tissues that support these organs. Prolapse can cause discomfort in the vaginal area or a sense of heaviness or pressure; pain can sometimes go into the low back. Depending on what organs have dropped downwards, prolapse can interfere with the ability to urinate or defecate normally. Physical therapy can help to improve the strength and control of the pelvic floor muscles in order to provide better support to the pelvic organs. Treatment will also include education about how to prevent worsening of prolapse with considerations for breathing and body mechanics with activities requiring physical exertion.

Perineal lacerations and scar management
  • Some women may experience tearing of the perineal region or undergo surgical incision to increase the vaginal opening (episiotomy) during childbirth. Tearing can range from mild to severe and the resulting scars that develop are important to address during the healing process. Scars from childbirth can cause persistent pain or sensitivity in the perineal region or a feeling of tightness at the vaginal opening or the area between the vagina and anus. These symptoms can lead to pain or difficulty with sexual activity or limit mobility with movements that stretch the tissues in this region. Severe tears can also lead to poor control of bowel movements. Physical therapy will focus on improving the mobility of the scar and surrounding tissues, desensitizing the area, and restoring normal function of the pelvic floor.

Sciatica
  • Sciatica is a commonly used term to describe pain that often originates in the low back or buttocks region and travels down the leg. This can be accompanied by other sensory symptoms including numbness or tingling. Sciatica is a common complaint during pregnancy and can be a result of muscles in the low back or buttocks region that have become too tight. These muscles can put increased pressure on the sciatic nerve which then creates pain. These muscles may become overly tightened due to changes in movement or walking patterns that are common in pregnancy, weakness of the hip muscles, or instability of the spine or pelvis. Physical therapy can help to correct these changes or imbalances in order to decrease pain.

Sexual Dysfunction
  • Sexual Dysfunction is a complex condition that may include physical, medical, hormonal and/or emotional components that interfere with intercourse or other sexual activity. Many of these components are influenced by our connective tissue and surrounding pelvic musculature leading to dysfunction and pain. Physical therapy can help to treat the musculoskeletal components and symptoms of sexual dysfunction. Therapy can address soft tissue restrictions and emphasize relaxation techniques in order to improve mobility of the pelvic floor muscles for improved blood flow and sexual function.

Stress or urge urinary incontinence
  • Urinary incontinence is involuntary leakage of urine that can occur in different scenarios. Stress incontinence occurs with maneuvers such as coughing, laughing, sneezing or physical exertion when the amount of pressure in the abdominal cavity increases and the pelvic floor muscles are not able to provide the proper closure around the urethra to prevent leakage. Urge incontinence is characterized by leakage that occurs when someone has a strong urge to urinate and cannot control that urge. They may experience leakage of urine on the way to the bathroom of just a few drops or full bladder emptying. This is can be influenced by our behavioral habits, what we eat or drink, and if there is too much tension in the pelvic floor muscles which prevents adequate relaxation. Someone may also experience mixed incontinence which is a combination of both stress and urge incontinence. Physical therapy can be significantly beneficial for both types of incontinence and is an excellent first-line option for conservative care.

Thoracic pain or rib pain
  • Pain in the thoracic area or upper and mid regions of the back is a common complaint during and after pregnancy. Decreased range of motion of the spine, postural changes, impaired breathing pattern, and decreased mobility due to a growing baby can lead to pain and stiffness in the thoracic region. Some women may also experience rib pain. If not addressed, this can persist after pregnancy and be exacerbated by all of the new demands of motherhood and childcare. Lifting, carrying, and holding a new baby and/or car seat put even more stress on an area of the body that may already be weakened due to poor postural habits. Physical therapy can improve mobility and ease pain of this area by emphasizing proper upright posture, teaching correct body mechanics with normal daily activities including childcare tasks, restoring normal joint mobility of the spine, facilitating good breathing pattern, and providing soft tissue mobilization to muscles and connective tissue that may be too tight. 

Urinary frequency
  • Normal urinary frequency during hours of wakefulness is every two to four hours or about five to seven times per day. Sometimes this frequency can become significantly increased to the point that it becomes disruptive to daily or work activities. Frequency of more than every 1.5 hours per day can sometimes be attributed to too much tension in the pelvic floor. This increased tension can lead to an increased sense of urinary urgency and can also hinder one’s ability to fully empty their bladder each time they try to urinate, thus creating a sensation that they need to take more frequent trips to the bathroom. Other factors than can contribute to increased urinary frequency include consumption of foods, beverages, or medications that irritate the bladder. Physical therapy can provide education about ways to normalize one’s urinary frequency as well as through manual techniques to improve relaxation of the pelvic floor muscles.

Urinary urgency
  • Urinary urgency is a sudden, compelling urge to urinate. It can be accompanied by urge incontinence and urinary frequency. Typically, when a person gets an urge to urinate, they should be able to delay that urge until a time that is convenient to them. With urinary urgency, the urge cannot be suppressed and is only relieved with urination. If someone is unable to immediately urinate, the strong sense of urgency can cause significant discomfort. Physical examination often reveals tightened pelvic floor muscles and surrounding tissues. Therapy can address these soft tissue restrictions and will emphasize relaxation techniques and urge suppression strategies in order to decrease urgency.

Vaginismus (a type of dyspareunia caused by involuntary muscle tightening)
  • Vaginismus is a type of pelvic floor dysfunction in which the muscles involuntarily tighten or spasm during attempts at vaginal penetration. This can include trying to insert a tampon, undergoing a gynecologic exam, or during sexual intercourse. Vaginismus is often accompanied by pain and can occur even despite a woman’s desire to engage in sexual intercourse. Physical therapy can be significantly beneficial in facilitating improved relaxation of the pelvic floor through gentle stretching, education about breathing and relaxation techniques, teaching proper coordination of the muscles, and dilator use.

Vulvodynia or vestibulitis
  • Vulvodynia and vestibulitis refer to pain located in the vulvar area. This pain can be constant in nature or provoked and cause difficulty with sitting for prolonged periods, sexual activity, or wearing tight clothing. Pelvic floor muscles often come tightened and dysfunctional in the presence of chronic pain. Physical therapy can help promote improved muscle relaxation and desensitization of the vulvar area as well as provide education about avoidance of irritants and activity modifications to decrease pain.
Pelvic Health Physical Therapy
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