Stress Urinary Incontinence
Urinary leaking that occurs with a stressor to the body is called stress incontinence. The most common stressors are coughing, laughing, sneezing, jumping, running, and similar activities. While some patients may be prescribed pelvic floor strengthening (“kegels”), it is essential to be evaluated to make sure this is appropriate and squeezes are done correctly. Some individuals may have stress incontinence due to tight pelvic floor muscles in which case kegels would be counterproductive and possibly make the situation worse.
Urge Urinary Incontinence
This is urinary leaking that occurs with a strong urge to urinate and sometimes an overactive bladder. Most patients describe their leaking as, “I just can’t hold it” and may leak with triggers such as hearing running water, arriving home, stepping into the shower, and other activities. Resolving urge incontinence includes bladder training, managing fluid intake, and ensuring healthy pelvic floor muscle range of motion.
Following partial or full removal or the prostate, due to cancer or other reasons, men commonly experience urinary leaking. It may be either stress incontinence, urge incontinence, or both. While the prostate is not part of the pelvic floor muscle group, it is a gland that sits close to the base of the urethral opening and close to the muscles so when removed, the muscles may not be able to contract as strongly as they were previously able to. This, and changes in bladder habits following surgery and possible post-surgical catheterization, may cause urinary leaking.
Fecal incontinence can occur when there is trauma to the perineal area or anal sphincter, such as with childbirth or pelvic surgery. Resolving fecal incontinence includes pelvic floor muscle training and diet management for proper stool formation and consistency.
Other Bladder Issues
Urinary Urgency and Frequency
Over time, some people notice they feel the urge to urinate more frequently than they used to or feel they go much more frequently than their friends and family. The bladder can be hypersensitive and give the signal of an urge before the bladder is actually full. Bladder training, fluid management, and pelvic floor muscle relaxation strategies are part of physical therapy for urinary urgency and frequency.
Also known as painful bladder syndrome, interstitial cystitis is chronic pain that may present like a urinary tract or other infection, even though no infection is present. Symptoms include lower pelvic pressure, discomfort and tenderness. The cause of interstitial cystitis is not known. Pelvic floor physical therapy gives patients techniques to better manage their flares in pain by teaching pelvic floor relaxation and healthy bladder habits.
Other Bowel Issues
Pelvic Muscle Dyssynergia
The term dyssynergia refers to when a muscle or group of muscles that do not contract and relax with the correct timing. When the muscles around the rectum contract instead of relax during a bowel movement, the stool cannot be fully eliminated which results in constipation and incomplete emptying. A pelvic floor physical therapist can teach a patient the correct way to bear down during a bowel movement to better coordinate the pressure needed to eliminate without straining.
Constipation is often used as a coverall term for many types of bowel dysfunction, including a change in bowel habit or decreased frequency of bowel movements. Sometimes this is normal and causes no other symptoms, in which case it is not an issue. Other times, difficulty with bowel movements or decreased frequency comes with other symptoms such as abdominal pain, bloating, and pain passing stool. Constipation is often categorized as either slow motility (where digestion moves slowly through the entire gastrointestinal system) or outlet dysfunction (where stool is formed and waiting in the rectum but unable to be evacuated due the inability to create the correct pressure to bear down). Pelvic floor physical therapy can help with both types of constipation.
Severe tightness or spasm of the pelvic floor muscles that prohibits anything from entering the vagina is called vaginismus. Women come to physical therapy with the goal of being able to have sexual intercourse, tolerate a pelvic exam, and use a tampon without pain. Muscle release, pelvic floor relaxation, and vaginal dilator use may all be included as part of physical therapy treatment.
Vulvodynia is chronic pain of the vulva. Vestibulodynia is chronic pain at the vestibule (vaginal opening). Many patients describe pain as “nerve-like” and list symptoms as burning, stinging, pinching, or scrapping. Pain may be provoked such as with sexual activity, tampon use, tight clothing, or extended periods of sitting. In more severe cases, pain may be generalized and occur without provocation.
Dyspareunia is a term that means painful intercourse. It is a general term and can refer to pain cause by many of the conditions listed on this page. Often causes are muscle dysfunction such as with vaginismus, nerve dysfunction as with vulvodynia, and the presence of scar tissue following childbirth or surgery.
The pudendal nerve is one of the main nerves that innervates muscles of the pelvic floor and gives sensation to the genitals and perineum. Pudendal neuralgia is a chronic condition that may arise if the pudendal nerve is irritated, compressed or damaged, often after a traumatic injury. Symptoms may include pelvic, buttock, and genital pain and are generally worse with sitting or positions that tension the nerve.
Levator Ani Syndrome
The levator ani is a group of muscles that sits deep in the pelvis like a hammock. As as group, they lift up and into the body when engaged to assist with pelvic support, stability, and closing around the urethral and anal openings. Unexplained spasms of the levator ani group can lead to achiness deep in the pelvis or rectum, referred to as levator ani syndrome.
Issues Related to Pregnancy
Sacroiliac Joint Pain
The sacroiliac (or SI) joints are located at the back of the pelvis where the pelvic and lower spine bones come together. They are held together by the shape of these bones and many strong ligaments. During pregnancy, hormonal changes can make the ligaments looser. With the added weight of a growing baby, the SI joint may be less stable and activities like getting up from the floor and out of bed become painful. Physical therapy teaches patients how to create stability without relying solely on the ligaments so they can move with less pain.
Pubic Symphysis Pain
The pubic symphysis is the joint in the front of the pelvis where the right and left sides meet. Much like the sacroiliac joint, the ligaments around the pubic symphysis are also looser due to hormonal changes. Pubic symphysis pain often occurs in the second half of pregnancy, with activities such as putting on pants and stepping into the tub. While this pain typically goes away after delivery, lingering pubic symphysis pain can occur postpartum after a traumatic birth or birth injury. In both cases, physical therapy teaches the patient how to stabilize through the pelvis for reduced pain with self care, walking, and other daily activities.
Diastasis recti is the medical term for an abdominal muscle separation. There is connective tissue that runs vertically down the middle of the abdomen and it can be significantly separated with pregnancy. Patients often notice this is an issue they they see “doming” or “tenting” of the middle abdomen with activities such as sitting up from laying down. While there may have been some normal separation pre-pregnancy, physical therapy postpartum helps the patient return to correct abdominal muscle function. This involves using the deep core and pelvic floor muscles in conjunction with breathing.
Perineal Scar Tissue
Following surgery or childbirth, there may be scar tissue around the perineum (skin and tissue area just in front of the anal opening, between the vagina and anus in women and between the scrotum and anus in men). The perineum is a common attachment site for muscles of the pelvic floor so scar tissue in this area can make these muscles not work properly. Women with scar tissue may notice pain with tampon use, intercourse, or vaginal exams.