Pelvic floor dysfunction is any condition that affects the pelvis including issues related to the internal organs within the pelvis, the balancing/coordination of movement of the pelvis, and anything in between. If pelvic floor dysfunction was the name of a book, it would have many chapters such as:
- Incontinence
- Bladder inflammation
- Painful intercourse
- Pelvic pain
- Tailbone pain
- Lower back pain
- Hip mobility issues
- Sacroiliac joint pain and
- Poor posture to name a few
Common Treatments For Pelvic Floor Dysfunction
Oftentimes, symptoms of pelvic floor dysfunction are misdiagnosed as being an unrelated issue. For instance, the medical and insurance industry views chronic lower back pain, hip pain, sacroiliac pain, and poor posture as stand-alone issues when they are all associated with pelvic floor dysfunction. Now, by the time the patient is referred to a pelvic floor therapist, many months/years of improper treatment have passed.
Typically the following is done before the patient sees a pelvic floor therapist who may or may not be a physical therapist. For instance, chiropractors, nurses, occupational therapists, and physical therapists who are trained in pelvic floor dysfunction are all considered pelvic floor therapists.
Medications
The following are commonly prescribed medications for symptoms of pelvic floor dysfunction. Like most medications, they come with side effects and do not address the root cause of the issue.
Muscle relaxants:
Medications such as baclofen or diazepam are used to help relax and relieve tension in the pelvic floor muscles.
Pain relievers:
Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or acetaminophen can be used to manage pain associated with pelvic floor dysfunction.
Anticholinergics:
To help control bladder spasms and reduce urinary frequency and urgency.
Antidepressants:
Certain types of antidepressants, such as tricyclic antidepressants (TCAs) or selective serotonin reuptake inhibitors (SSRIs) may be prescribed. They can be used to manage chronic pain and improve mood.
Topical creams:
Local anesthetics or lidocaine creams can be applied topically to alleviate pain and discomfort in the pelvic area.
Physical Therapy
This area is the only treatment for pelvic floor dysfunction that involves exercises and more hands-on treatment. However, within the field of physical medicine and rehab, almost all treatment involves internal manual therapy. In practices such as mine, the focus is on stabilizing the pelvis first which in almost all cases resolves the issue without addressing anything internally. After all, without a stable pelvis, none of the work done on the muscles of the floor will be long-lasting.
Following is the outline of what I do in my practice with great success and discussed in my blog: “Is Yoga Safe for Pelvic Floor Dysfunction” :
- “Behavior modification is always part of the solution list to all issues (your behavior about life changes how you do everything in life). It is not going to correct any dysfunction fully but addresses some of the feeders of the problem.
- Postural Neurology: Movement is like a concert and the body parts are like the musicians. 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. This is what Postural Neurology is all about.
- Functional Movement: 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 (Developmental Kinesiology) 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.
- Kegels? There are machines like the Emsella Chair that do 400 Kegels per minute involving all of the muscles of your pelvic floor. Not just the ones you hope you are engaging. Note that Kegel exercises are not for all types of incontinence and pelvic floor muscle issues.
- Breathing is what babies do automatically and that is what we need to do to sustain the bottom of the breathing apparatus. Which is the pelvic floor!
- Internal manual work which ideally should be done to assess the muscles inside the pelvis. But this does not have to be done in all cases.
- Nutrition: Avoid citrus, caffeine, soda, artificial sweeteners, and spicy foods. Take collagen, vitamin C, vitamin D, Omega 3, and protein if no conflict with any other conditions.
- Ergonomics: Sit on an exercise ball vs a chair. Get a keyboard that is as wide as your shoulders. Limit your sitting to no more than one hour and alternate with standing. Make sure the middle of your monitor is at eye level to name a few.
- Postural Awareness: It is important to pay attention to the posture and catch yourself when not standing on both feet! Be aware of slouching and shifting the pelvis forward and in front of the ankles. It is best to associate the increase in attention with activities done each day! For example, when talking to someone pay attention to your feet and pelvis positioning.
- Sleeping habits: do not sleep on the stomach and if you are a stomach sleeper, get a body pillow to minimize that.”
Biofeedback and Electrical Stimulation
The goal of biofeedback is to improve muscle control, strength, and coordination of the pelvic floor muscles. It is often used in conjunction with other treatments, such as pelvic floor exercises and behavioral modifications. This is attempt to provide a comprehensive approach to pelvic floor dysfunction management. With this, sensors are attached to specific areas near the pelvic floor muscles and detect muscle activity to provide feedback.
Visual or auditory feedback:
The sensors are connected to a monitor or a device that produces visual or auditory cues. The individual can see or hear real-time information about their muscle activity.
Muscle contraction and relaxation training:
The individual is guided to perform specific pelvic floor muscle exercises, such as contracting and relaxing the muscles. The feedback from the sensors helps them understand the correct muscle engagement and monitor their progress.
Correcting muscle coordination:
Biofeedback can help individuals learn to coordinate the relaxation and contraction of their pelvic floor muscles with other muscle groups involved in bladder and bowel control.
Reinforcing proper technique:
The immediate feedback from biofeedback encourages the individual to adjust and refine their muscle activation techniques, ensuring they are performing the exercises correctly.
Home practice:
In some cases, individuals may be provided with portable biofeedback devices to continue practicing the exercises at home and monitor their progress independently.
Surgical Interventions
Regardless if surgical intervention is required, pelvic floor therapy needs to be followed to assure proper functioning movement is in place to prevent a future downward spiral of factors that lead to pelvic floor dysfunction in its many forms.
If you have pelvic floor dysfunction and are not happy with the treatment you have received or if you suspect to have pelvic floor dysfunction and wish to be treated holistically, contact me.
Dr. Shakib
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