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Importance of Pelvic Floor Rehabilitation

03/25/2014, 2:00pm EDT
By Lacey Welch, PT, DPT

Don't Worry You Can Keep Your Pants On


Lacey Welch, PT, DPT

Many of my colleagues are very interested in talking about women's health/pelvic floor physical therapy, but are just as uninterested in treating those patients. Understandably so - it's not for everyone. However, I do believe we all, as physical therapists, should be able to identify the need for an intervention from, or collaboration with, a pelvic rehabilitation/women's health physical therapist when necessary.

 

Pelvic floor dysfunction can manifest itself in many different ways, from back pain to falls, plus many other more frequently reported impairments. It's important that we know how to question and evaluate the function of our patients' pelvic floor even when they present with primary symptoms elsewhere. Expanding our knowledge of pelvic floor function/dysfunction will help us ask the right questions at the right time. Below are a few examples of pelvic floor dysfunction associated with more commonly reported musculoskeletal impairments and sample interview questions to assist in screening this area.

 

§  Incontinence

o   Types of  Incontinence:

§  Urge (urinary): Involuntary loss of urine with urgency. For example, leaking as they rush to the bathroom.

§  Stress (urinary): Involuntary loss of urine with activity, or excessive intra-abdominal pressure.

§  Mixed (urinary): Combination of stress and urge incontinence.

§  Urinary urgency and/or increased frequency without incontinence

§  Anal: any involuntary loss of solid, liquid or gas.

§  Fecal: Involuntary loss of fully formed stool.

o   May correlate to back pain, sacroiliac dysfunction, abdominal pain and falls due to weakness/poor control of the pelvic floor.

o   Interview questions:

§  Do you ever experience any loss of urine during the day or at night?

§  Do you urinate more than every 3-4 hours?

§  Do you ever leak gas or stool?

§  Constipation

o   Technically defined as less than three bowel movements per week.

§  Normal bowel function can range from three bowel movements per day to three per week.

o   Possible correlation to back pain, SIJ dysfunction, abdominal pain, or coccygodynia due to increased pelvic floor muscle tension/incoordination or scar tissue (from surgery/episiotomies).

o   Interview questions:

§  How often do you have a bowel movement?

§  Do you require the use of laxatives/stool softeners to have a bowel movement?

§  Dyspareunia

o   Defined as painful sexual intercourse.

o   May be associated with back pain, SIJ dysfunction, hip pain, coccygodynia due to pelvic floor muscle imbalance, increased tension/muscle guarding, or scar tissue.

o   Interview questions:

§  Do you ever experience pain with sexual intercourse?

§  Do you (or did you) have pain with insertion of tampon?

§  Have you experienced pain with a pelvic examination?

§  Diastasis Recti Abdominis

o   It is the result of separation of the rectus abdominis at the linea alba.

o   Could be related to back pain, abdominal pain, SIJ dysfunction, postural abnormalities due to abdominal muscle weakness.

o   Interview questions:

§  Have you experienced pregnancy?

§  Do you have history of a hernia (abdominal/umbilical)?

 

As we look through our patients' medical history, it's likely that some of these impairments may be revealed. Make a mental, or literal, note and delve further into it if you think there could be a correlation to their reported primary impairments by asking similar questions as mentioned above. Consider dusting off your Netter's Atlas and review the anatomy of pelvic floor to help explain to our patients how their pelvic floor dysfunction could be related to their primary area of concern. If the patient answers 'yes' to any of these questions, it would be wise to seek assistance from, or refer out to a PT specializing in treatment of pelvic floor dysfunction.

 

This has been a brief, and not exclusive overview of pelvic floor dysfunction and possible correlation to more commonly reported orthopedic impairments. However, my hope is that it will prompt us to think more critically and ask questions about the involvement of the pelvic floor in a variety diagnoses as we evaluate and treat our patients. This could end up being the missing piece to resolving their impairments!

 

Summarized impairments and interview questions for brief pelvic floor screening:

 

Impairments

(Reported and observed)

 

Interview Questions:

Lumbago, Hip Pain,

SIJ Dysfunction

- Do you ever experience any loss of urine during the day or at night?

- Do you urinate more than every 3-4 hours?

- Do you ever leak gas or stool?

- How often do you have a bowel movement?

- Do you require the use of laxatives/stool softeners to have a bowel movement?

- Do you ever experience pain with sexual intercourse?

- Do you (or did you) have pain with insertion of tampon?

- Have you experienced pain with a pelvic examination?

- Have you experienced pregnancy?

- Do you have history of a hernia (abdominal/umbilical)?

Abdominal Pain

- Have you experienced pregnancy?

- Do you have history of a hernia (abdominal/umbilical)?

- How often do you have a bowel movement?

- Do you require the use of laxatives/stool softeners to have a bowel movement?

- May also include questions pertaining to dyspareunia

Postural Abnormalities

- Have you experienced pregnancy?

- Do you have history of a hernia (abdominal/umbilical)

- Could ask lumbago/SIJ dysfunction questions as well

Falls

- Do you ever experience any loss of urine during the day or at night?

- Do you urinate more than every 3-4 hours?

- Do you ever leak gas or stool?

- Do you feel the need to rush to the bathroom at times?

 

 

For further information and research, below are a few articles regarding pelvic floor dysfunction and associated impairments:

 

Recognition and Management of Nonrelaxing Pelvic Floor Dysfunction

Stephanie S. Faubion, Lynne T. Shuster, and Adil E. Bharucha

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3498251/?report=reader

 

The Association of Chronic Back Pain and Stress Urinary Incontinence: A Cross-Sectional Study

Bush HM, Pagorek S, Kuperstein J, Guo J, Ballert KN, Crofford LJ.

http://www.ncbi.nlm.nih.gov/pubmed/23794961

 

Diastasis Rectus Abdominis and LumboPelvic Pain and DysfunctionAre They Related?

Parker, Meredy A. PT, DPT1; Millar, Lynn A. PT, PhD, FACSM2; Dugan, Sheila A. MD3

  • http://www.meredyparkerpt.com/pdfs/Meredy%20Article.pdf​​
Sponsored by Lacey Welch, DPT

Lacey Welch, DPT

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Lacey graduated from the University of Central Arkansas in 2010 with a Doctor of Physical Therapy degree. She then moved back to her roots in Texas to practice in outpatient physical therapy. In 2011, she accepted a position to facilitate the development of a women's health program, which is where her passion lies. She seeks opportunities to educate the community and other healthcare providers on the availability and importance of pelvic rehabilitation and women's health physical therapy. Check her out at: LinkedIn and Twitter. 

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