How Physical Therapy Helps Pelvic Pain
Guest blog post written by Maureen O’Keefe, DPT a pelvic health specialist & owner of Purple Mountain Physical Therapy, located in Grand Rapids, Michigan
If you have pelvic pain we understand that you are searching for effective treatment to help your pelvic pain. We are pelvic health physical therapist specialists and we commonly help individuals overcome pelvic pain. Many of our patients come to us after experiencing a long and frustrating road to finding someone who can properly assess and treat their pain.
Why can a pelvic health physical therapist help my pelvic pain?
Licensed Pelvic health physical therapists are highly trained in both orthopedics and pelvic health. This means that most pelvic health physical therapist have advanced training in evaluating and treating lower back pain, hip pain, abdominal pain, knee pain and feet problems. We also have completed post-doctoral education specific to male and female pelvic health rehabilitation. For individuals who experience chronic pelvic pain, it is the combined orthopedic & pelvic expertise of these physical therapists that guide them towards resolution of pelvic pain. Underlying all pelvic pain is a problem called pelvic floor dysfunction. A pelvic health PT can effectively assess and treat your pelvic floor dysfunction.
What is pelvic floor dysfunction?
Pelvic floor dysfunction is a simple term that means that the pelvic floor muscles, lining the base of the pelvis, that support your organs and control your bowel or bladder are not working optimally. These muscles provide us the wonderful ability to walk around and not leak urine or stool. However, when the pelvic floor muscles become dysfunctional we may experience problems related to bladder, bowel, intimacy or pain. Pelvic floor dysfunction often manifests as urinary incontinence, urinary urgency and frequency, pelvic pressure or pelvic organ prolapse, fecal leakage, flatulence (gas) incontinence, constipation, hemorrhoids, abdominal pain, pubic pain, SI joint pain, coccyx (tailbone pain), hip pain, lower back pain, genital pain (orchialgia, penile pain, clitoral pain) Pudendal neuralgia, sciatica, vulvodynia or pelvic floor pain.
If my pelvic floor muscles don’t work well, why would that cause me to have pelvic pain?
Quite often the pelvic floor muscles become too stiff or tight or may have painful spasms. You may read about this as being “high tone pelvic floor” or “non-relaxing pelvic floor” or “pelvic floor spasms”. Regardless of what it is called, this can be painful and contribute to bladder, bowel, pain or intimacy problems. Many of our patients who have pelvic pain push or strain when they pee or have a bowel movement; this is not good for them. Pushing and straining can contribute to ongoing pain, nerves being irritated, abnormal pressure in the pelvis and difficulty with urinating and defecating. Pelvic floor dysfunction can also generate tension through the bones of the pelvis, contributing to tailbone pain (coccydynia), SI joint pain, pubic pain, lower back pain, testicular pain, groin pain and lower abdominal pain. Because the pelvic floor muscles have nerves going into and around them and are lined with fascia, there are also connective tissue (fascia) restrictions and potentially nerve impairments related to pelvic floor dysfunction and pelvic pain. A qualified licensed pelvic health physical therapist will also assess and treat these problems so that your pain reduces.
If my pelvic floor won’t relax, what symptoms might I experience?
Chronic pelvic pain is complex to assess and treat, but once you see a licensed physical therapist who specializes in this, you will find a lot of the confusing symptoms make sense. With pelvic pain there are often a series of symptoms related to bladder, bowel, pain or intimacy. These may include such things as:
- Slow urinary stream and difficulty emptying
- Urinary urgency and frequency
- Urge urinary incontinence or stress urinary incontinence
- Painful urination (dysuria)
- Nocturia (getting up in the night to urinate)
- Painful defecation
- Incomplete defecation and the sensation that you need to empty even after a bowel movement
- Hemorrhoids or anal fissures
- Vulvodynia, provoked vestibulodynia or clitorodynia
- Vaginismus and dyspareunia (painful sex)
- Inability to engage in penetrative sex or to use tampons
- Pubic pain, SI joint pain, lower back pain, tailbone pain (coccydynia)
- Hip pain including piriformis syndrome, gluteal tendinopathy or hip labral injury
- Chronic lower abdominal pain, including pain anywhere from the belly button to the pubic bones.
- Inner thigh or groin pain
- Testicular pain (orchialgia) or penile pain (tip of penis hurts, base of penis may hurt)
- Perineal pain
- Pain in sit bones, hamstrings or inner thighs
What are my treatment options for my pelvic pain? What should I look for to get better?
We have good evidence and many treatment guidelines for a variety of pelvic pain conditions that physical therapy is the first place to start. Physical therapy does not have side effects, does not involve medications and uses the power of your body to overcome this problem, by facilitating healing. A good pelvic floor physical therapist utilizes a holistic approach to assess and treat your pain. At the heart of our methods is typically a variety of expert manual therapy methods that are hands-on treatments to reduce your pain. We may utilize joint mobilization, connective tissue mobilization, fascial release methods, trigger point release or other techniques that help balance your pelvis, restore the ability of nerves to move without being restricted and reduce muscle spasms and stiffness. We also may use very specific exercises that help you learn how to coordinate your breathing, abdominal muscles, low back, hips and pelvic floor. If we find you are weak, we will use strengthening exercises that retrain your movement patterns. For anyone who has misalignment in their pelvis or lower back pain, we employ a comprehensive set of interventions, customized to your specific findings, to help reduce all pain and balance your pelvis and spine.
If my pelvic physical therapist treats my pelvic floor dysfunction, will my pelvic pain go away?
Yes and no. You need treatment to the pelvic floor dysfunction to get better. Plus, you must receive treatment to resolve all the other things in your body that are contributing to your pain and organ (bladder or bowel) dysfunction. For example, underlying connective tissue restrictions, nerve problems or misaligned boney pelvis or lower back joints will also contribute to pelvic pain. We also assess and treat scar tissue related to all abdominal and pelvic surgery, such as hysterectomy, cesarean section, hernia repair or endometriosis excision. Research and clinical experience has taught us that to fully resolve pelvic pain you need to have all of the contributing factors treated that are causing your pain. You can expect your pelvic health physical therapist to fully assess and treat your whole body so that your muscles, ligaments, bowel movements, pelvic organs and hips and lower back are balanced and working without pain. A pelvic health physical therapist will truly treat your holisitically, head to toe. We may treat your low back, posture, hip alignment, ankle stiffness, tightness in your fascia anywhere in your body and any other problem that may be contributing to the potential to generate pelvic pain. It is common that our patients finish an appointment and immediately can notice that they have less pain.
What is the biopsychosocial model of care for my pelvic pain?
A pelvic health physical therapist uses a biopsychosocial approach to assess and treat you. The biopsychosocial model of care acknowledges that your wellbeing and illness are a result of your daily habits, your relationships with others, your psychological state, your social engagements and your body’s overall wellbeing. Research into chronic pelvic pain has found it is very important to treat the whole person and to understand your lifestyle factors, habits, daily stressors, family and relationship considerations, work and career influences on your whole system. The pelvic floor, in particular, is very responsive to daily stress because these muscles have autonomic nervous system (fight or flight, rest & digest) influences. This makes these muscles unique in the human body. Most patients appreciate this holistic approach, because we truly work to understand how we can help you experience success.
If I have pelvic pain or floor dysfunction, are my muscles weak and do I need to do kegel exercises?
Please seek out the expert help of a licensed physical therapist to determine the right exercises for you to do for your pelvic pain. Most people that we treat who have chronic pelvic pain do not benefit from kegel exercises. In fact, many people get worse if they do kegel exercises. Their muscles are unhappy, stiff and often have spasms; kegel exercises may cause more spasms or tightness. If you are serious about improving your quality of life and overcoming chronic pelvic pain, pelvic organ prolapse, vaginismus, overactive bladder, urine incontinence or any other pelvic problem, please look toward a professional who can properly assess and guide you towards the right treatment options.
There is high quality physical therapy for your pelvic pain. You deserve to feel better.
If you are experiencing chronic pelvic pain, you don’t have to live like this. We understand that you may be frustrated and feel that you’ve seen a number of providers who have not been able to resolve your pain. Turn your efforts towards finding a highly skilled pelvic health physical therapist. We are experts at rehabilitating pelvic pain. Purple Mountain Physical Therapy is a specialty pelvic health physical therapy clinic in Grand Rapids, Michigan. We offer treatment that is holistic, compassionate and trauma informed. If you have any questions about how to treat pelvic pain, you can reach our clinic at 616.516.4334. We have further information on pelvic pain at our website: www.purplemountainpt.com
-Dr. Maureen O’Keefe, DPT
Dr. Maureen O’Keefe, DPT is a pelvic health specialist physical therapist who has practiced in the field of pelvic health for 25 years. She is the founder of Purple Mountain Physical Therapy, located in Grand Rapids, Michigan, a specialty clinic with a team of providers known for helping individuals overcome severe, chronic pelvic pain. By working holistically with patients and using the biopsychosocial model, her patients report that pelvic physical therapy has given them their lives back.