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Pelvic Floor Course hosted at CPFT

Educating the public and Pelvic Floor therapists has to become the focus

Pelvic floor dysfunction encompasses a collection of dysfunctions and a pelvic floor dysfunction cure means addressing the pelvic floor muscles as well as looking into the pelvis and nearby areas such as the hips and lower back that throughout the years were mismanaged in treatment. Patients and the medical community tend to look at lower back pain, hip pain, sacroiliac pain, tailbone pain, incontinence (urinary incontinence or fecal incontinence), pain in the vagina or testicles, pain during intercourse, and weakness of the pelvic floor as separate issues. How can the malfunction and issue in one area stay isolated to that area without any impact on the surrounding issues? Pelvic floor dysfunction is the outcome of mistreated and under-treated pelvic issues and their associated areas. I strongly recommend you pause to read my blog on what pelvic floor dysfunction is because to find the cure, you first need to understand the problem.

The ‘cure’ to pelvic floor dysfunction requires a detailed history of your injuries and lifestyle, the assessment of all areas involved in pelvic floor dysfunction with or without pain, as well as looking at your breathing and posture for subtle clues. If the pelvic floor is the floor of a house, the foundation of the house is the pelvis, the anchors are the hips, the back wall is the spine, the front and side walls are the abdominal muscles, the roof is the abdominal diaphragm, and all contents in the house need to not be piled up and compressed. 

Step By Step Process to Treat Pelvic Floor Dysfunction

Let’s face it, how many people do you think look at their supposed normal lower back pain (btw, there is no such thing as normal lower back pain) and think that they are at risk for pelvic floor dysfunction? Frankly, most people think pelvic floor dysfunction is something for old folks and women who have gotten pregnant and given birth. You have no idea how many times in my practice I have heard women claim to experience the ‘normal’ leaking that all women have after giving birth. Regardless of your age, gender and lifestyle, pelvic floor dysfunction consultation and examination ought to have the following components and the ‘cure’ must include addressing every finding in each category. The following is a list of items to be checked by the pelvic floor therapist who may or may not be a physical therapist trained in pelvic floor therapy.

  • Functional assessment of the pelvis, hips, and spine individually and then in groups.
  • Visceral assessment of the abdominal organs (external exam).
  • Checking the muscles of the pelvis (externally and not necessarily externally), hip stabilizers, and lower spine.
  • Assessing the synchronicity of breath in performing certain moves when lying down and when upright.
  • Depending on the findings, it is necessary to then do a Postural Neurology assessment to see how off the ‘blueprint’ of movement might be. To understand what this entails, pause and click on Postural Neurology to see why that is so important and then appreciate why your conditions contributing to the pelvic floor dysfunction are old.
  • Once all these areas are treated, then the internal pelvic floor muscle work should be performed.
  • Evaluating the work and activity environment that may be the feeder of the problem.

Who Treats Pelvic Floor Dysfunction?

While most pelvic floor therapists are physical therapists trained in pelvic floor therapy, there are nurses, occupational therapists, chiropractors, and other physicians that have taken training courses in treating pelvic floor patients. While in a high majority of cases, pelvic floor treatment includes almost exclusively internal manual work, it should never be only focused on the internal work when pelvic floor dysfunction includes so many other areas other than the muscles of the pelvic floor with such limited access. Pelvic floor muscles are the muscles that line the floor and the wall of the pelvis and with internal manual work, we are only able to access the inside of the pelvis through the vagina and/or anus and as far as the index finger allows. Is that sufficient enough for complex conditions such as pelvic floor dysfunction? The answer is obvious.

FAQ About Pelvic Floor Treatment

I have done several blogs on pelvic floor dysfunction and the following are a few that you may find interesting. Remember, if pelvic floor dysfunction was the name of a book, all different symptoms and presentations would be different chapters of the book. Reading a chapter and thinking you read a book is a mistake and when it comes to pelvic floor dysfunction treatment, we see more of that case. Check out my blogs and website to see if you can relate to what is discussed and contact me if you need help figuring out where you are on the spectrum of pelvic floor dysfunction.

Dr. Shakib