Diagnosis of pelvic floor dysfunction in most cases is missed! That is because both primary care physicians and patients equate pelvic floor dysfunction to incontinence while testicular pain, pain during intercourse, and sexual dysfunction at times still signal a potential pelvic floor issue to some physicians. If Pelvic Floor Dysfunction was the name of a book, incontinence would be a ‘chapter’ of that book and a chapter is just that, a chapter. Tailbone pain, chronic lower back pain, hip mobility issues and pain, poor posture, chronic constipation, fullness in the rectum, are examples of some of the other chapters that are being missed.
Why is Pelvic Floor Dysfunction Misdiagnosed so Often?
We live in a society where you are ‘chopped up’ to pieces and each piece is given to a specialist to diagnose and treat essentially; the solution to a high majority of conditions is medicine and while I don’t wish to digress, I would like to remind you that musculoskeletal conditions do NOT ever get fixed by prescription medication.
The education received by physicians is often based on what is in the journals and ‘national’ guidelines and when it comes to pelvic floor dysfunction, all incontinence cases are now a referral to a pelvic floor therapist trained in the area. This therapist can be a physical therapist, occupational therapist, chiropractor, nurse, or other physician to name a few so they are not only physical therapists.
The issue is that chronic lower back pain, hip mobility issues, hip pain, poor posture, chronic constipation, and fullness in the rectum is almost never looked at as an issue that is directly related to pelvic floor dysfunction! They all have to do with the ‘house’ that the pelvic floor is the ‘floor’ of and yet, they are missed. That is perhaps because we look at issues with a magnifying glass and miss the fact that what we see with that glass is a small part of a much bigger picture!
How is Pelvic Floor Dysfunction Diagnosed?
Anyone coming in with symptoms directly related to the pelvic floor or with chronic muscle-skeletal conditions is screened for pelvic floor dysfunction. This includes those with poor posture with or without symptoms related to their lower back, sacroiliac-iliac joints, and hips. Please study the diagram below to see how these areas are the body of the ‘house’ that the pelvic floor is the ‘floor’ of.
Pelvis bones (courtesy of https://orthoinfo.aaos.org/)
The diagnosis is made with the following ingredients to the examination which is explained in detail in my blog: ‘What is missing in the pelvic floor dysfunction treatment’:
Movement is like a concert and the body parts like the musicians; that the musicians not only need to know their part but to know when to chime in and phase out. That means the pelvis and pelvic floor need to know how to ‘play’ with the rest of the body if they are to sustain their strength and integrity. Postural neurology is only about the neurology behind posture so don’t mistake it with neurological examination to see if your nerves are working right!
Common sense says that the most authentic way to move is the way babies move. After all, all babies from all over the world go through the same developmental stages of movement which means that we are hard-wired to move that way. So if the issue is movement-related or supported, then we should see how we compare to the way we moved as babies. All discrepancies are then highlighted and can be corrected through Dynamic Neuromuscular Stabilization (DNS) exercises which are baby movements.
- Gait Analysis:
The way you walk gives a lot of information as to what is going on neurologically speaking (with regards to movement and balancing) as well as bio-mechanically (how the joints and muscles come together to get you from point A to B).
Doing a foot scan is a part of the gait analysis in my practice to see how you distribute your weight on your feet which are your point of contact. We can’t build strength if the point of contact with the ground is unstable, bear in mind that we are not talking about orthotics here!
Double scale analysis shows if you put more weight on one side vs the other; this gives us a clue how deep the problem of imbalance is and is a gauge to measure going forward with the treatment.
- Breathing:
Listen to my podcast on this very important part of treatment that is mentioned by all pelvic floor therapists but primarily associated with Kegels.
Imagine every single breath is meant to emphasize something and when the breathing is not correct, how every breath delivers the WRONG message!!!
If you are thinking you can skip this one because clearly, you are breathing, think again. Watch this video
An internal manual examination does not have to be a part of the examination for pelvic floor dysfunction at the beginning. Why strengthen the ‘floor’ when the ‘house’ is unstable? You cannot have a floor issue of any kind without a compromised ‘house’ so first thing first, the house comes before the floor.
Contact me if you need help with your pelvic floor dysfunction.
Dr. Shakib
