The Secret World of Pelvic Physical Therapy

Everybody has…a pelvis, with so many functions “down there”. Pelvic health problems are often not reported to health care providers, and suffered in silence. There is a big list of pelvic health conditions and associated problems that can be addressed by physical therapy.

I started off in Physical Therapy (PT) to work with sporty things, simple pain problems, and the MUSCULOSKELETAL system. I saw a few “high groin strains” nobody else would treat (gasp, near the “privates”, working near the groin makes many PT’s uncomfortable!). I attended to musculoskeletal treatment of the adductor (inner thigh muscle), hamstrings and hip flexor muscles and these patients recovered well. And I thought the muscle system ended when you reached the pelvis!

And then the postpartum moms with neck, back, hip and pubic pain began to appear on my schedule, some of whom had bladder leaking, which I knew nothing about. And then the big HMO director asked me to take a course on BLADDER TREATMENT and the course instructor Kathe Wallace teased us at each break asking if we REALLY NEEDED TO GO or were going “just in case”. So I found out you can have a sense of humor and really help people with “private” problems.

I began to provide pelvic rehabilitation with bladder continence and urgency treatment programs. I talked about “winking” the pelvic muscles at a lecture I gave for the therapy staff, only to be winked at by colleagues after that talk. Well, the eye is a sphincter or a circular muscle, and the pelvic muscles have sphincters at the outlets, as well as deeper sphincter-like supports. (Note: it’s not all about tightening or “winking). This further developed my sense of humor with the topic of pelvic PT.

And then the HMO MD’s began to send me PELVIC PAIN cases, which I knew little about, and began self -study and a search for more courses. This is a huge topic, pelvic pain! And then the BOWEL problems began to show up for evaluation, with constipation, or loss of control, fecal incontinence, and that required several courses to understand the foundations and to provide care programs.

PELVIC ORGAN PROLAPSE is another problem that is in the arena of hidden problems, and it involves mild to severe hernia like changes in the support of the pelvic organs, and can be often helped by pelvic PT. The bladder, uterus, bowel or all three can be lowered in the body after pregnancy and birth, with some women noticing changes in pressure (a bulge sensation)and in pelvic functioning.

SEXUAL HEALTH problems also began to be referred for care, with pain, discomfort, and all the relationship concerns this created for the patients and required specialty course work to develop screening, evaluation, and treatment protocols.

Conservative care in the medical treatment of pelvic health concerns with bladder, bowel, pain, and sexual dysfunction is appropriate for those without “red flags”, indicating more serious conditions. Severe pain, inability to eliminate or total loss of control of bladder or bowel and other factors require immediate medical attention.

Conservative care with PT does the least harm, and involves full health history screening, physical examination and impairment assessment, habit training, muscle synergy, assessment, functional control of tightening and relaxing, fluid and fiber management, and nutritional training. Biofeedback, real time ultrasound, electrical stimulation, manual therapy, and progressive therapeutic exercise programs are standards of care. Some patients may receive treatment before, or after surgeries to support optimum function.

Pelvic health is vital health, with natural body functions ideally comfortable at rest and in motion. As a pelvic health specialist, I have devoted the majority of my career to providing care in this area, including education, empowerment, yoga for pelvic health, and all aspects of physical therapy.

This blog is an adaptation of a talk I provided at the Academy of Integrative Health and Medicine’s annual conference. That conference in 2017 led to a request by Handspring Publishing for me to write a book on Pelvic Rehabilitation, which is in the works for 2021 publication. Stay tuned for brief blogs that will be developed more in the textbook!

References

Bo, K, Berghmans B, Morkved S, Van Kampen M, Evidence based physical therapy for the pelvic floor, Churchill Livingstone 2015

Faubion S S, Shuster L T, Bharucha A E, Recognition and management of nonrelaxing pelvic floor dysfunction, Mayo Clin Proc 2012, 87(2), 187-193

Menon H U, Handa V L, Vaginal childbirth and pelvic floor disorders, Women’s Health 2013, 9(3)

Ramanayake R P, Basnayake B M, Evaluation of red flags minimizes missing serious diseases in primary care, J Fam Med Prim Care 2018, 7(2), 315-318

Resources

https://aihm.org/page/vision/

https://www.handspringpublishing.com/our-authors/maureen-mason

https://hermanwallace.com

https://hollyherman.com

https://kathewallace.com