Pelvic Floor Rehabilitation Can Reduce Pelvic Pain, As Well As Bladder and Bowel Problems
As many as one-third of women experience the symptoms of pelvic floor dysfunction (PFD), a wide range of issues that often go undiagnosed and undertreated. The incidence of PFD increases with age.
There are things known today about pelvic floor dysfunction that weren’t known just a few years ago.
“We know that more women (and men) are suffering from some type of PFD, because there is more research and more public awareness,” says Jaclyn Bonder, MD, medical director of Women’s Health Rehabilitation at Weill Cornell Medical Center. “We also know that the pelvic floor muscles, bones, nerves, and other structures can be a significant source of pain, and that a multidisciplinary approach to treatment is helpful.”
WHAT YOU SHOULD KNOW
Symptoms of pelvic floor dysfunction include:
➤ Pelvic pain, pelvic floor muscle spasms
➤ Pain in the lower back, genital area, and/or rectum
➤ Urinary urgency, frequency, hesitancy
➤ Straining during bowel movements, constipation
➤ Pain during or after intercourse
Pelvic floor rehabilitation
Fortunately, research has shown that symptoms of PFD such as bladder and bowel problems, as well as pelvic pain, may be relieved by as much as 80 percent with pelvic floor rehabilitation (Female Pelvic Medicine & Reconstructive Surgery, September/October 2013). (See What You Should Know for other PFD
symptoms.)
“A pelvic floor rehabilitation program usually refers to multidisciplinary but non-surgical treatment options for PFD,” says Dr. Bonder. “The largest component of this type of program is usually physical therapy, such as biofeedback, pelvic floor muscle re-education, relaxation and strengthening exercises, and bladder/bowel training.”
Dr. Bonder adds that patients are taught appropriate exercises, depending on the cause of their PFD, but the goal is often to decrease spasms of the muscle, increase strength, and improve muscle control.
In addition, many physical therapists perform manual therapy, such as myofascial release and massage, to help decrease tension in the muscles. Physical therapy is often but not always done in conjunction with medication management for pain or bladder/bowel dysfunction.
Getting help
“My advice (in finding a physician who can diagnose PFD and offer treatment such as a pelvic floor rehab program) is to contact a local academic institution that is likely to have both physicians and physical therapists who treat this sub-specialty,” says Dr. Bonder.
She suggests that if you are having more urinary symptoms and dysfunction, speak to a female pelvic medicine and reconstructive surgeon or a urogynecologist. If you are having more bowel dysfunction, ask about a colorectal surgeon or gastroenterologist.
If you are having pain symptoms, find out if your local medical center has a physiatrist (physical medicine and rehabilitation doctor) who can evaluate all of these issues.
The embarrassment factor
“Many women are embarrassed to talk to their physicians about the symptoms of PFD, such as bladder or bowel incontinence and pelvic pain,” says Dr. Bonder. “Make sure you see a physician who sees patients with PFD regularly to ensure that he or she will support you through the symptoms and make you feel as comfortable as possible.”
One practical way to discuss the symptoms is by keeping a diary. This can help you and your doctor decide what may be causing or contributing to the symptoms and how to make lifestyle changes that may help. It also can help the doctor determine the proper treatment.
Know your options
“Most women assume that, if they have PFD, the only solutions are medications or surgery. As a result, they often choose to live with their symptoms, and their quality of life suffers. Women need to be educated that there are non-surgical and non-pharmacological treatment options available. With this knowledge, they can go to their health care providers, discuss their symptoms, and find out which options are best for their specific condition,” concludes Dr. Bonder.
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