Pelvic Health

What kind of treatments are involved with pelvic health?

Treatments vary according to the issues present, but the following may be included in accordance with a treatment plan created together with the therapist and patient:

  • Manual therapy: internal and/or external soft tissue release, trigger point release, visceral mobilization, myofascial release
  • Breathing retraining
  • Education on and retraining of bowel and bladder habits
  • Pelvic floor muscle relaxation and/or strengthening
  • Core strengthening
  • Training in coordination of the pelvic floor muscles with other muscle groups
  • Joint mobility in the spine, pelvis, and hips
  • Assessment of other areas possibly contributing to pelvic issues
  • Postural retraining
  • General strengthening
  • Pain management and pain science education
pelvic health during pregnancy

Pelvic Health During Pregnancy

Physical therapy during pregnancy can ease the aches and pains associated with the huge changes your body goes through.  PT can also help prepare the body for labor and ease the delivery process, minimizing trauma to the pelvic floor and preventing some common postpartum issues.  Treatment for the pregnant woman may include:  

  • Education on the physical aspects of pregnancy, delivery, and postpartum recovery, and how to feel your best despite the physical changes
  • Management of common areas of pain: low back, hips, sacroiliac joints, pubic bone, tailbone
  • Management of bowel and bladder issues related to pregnancy
  • Core strengthening and management of diastasis
  • Pelvic floor and perineal preparation for delivery
  • Support for fitness: women who are active before and during pregnancy have an easier labor and delivery and better return to function postpartum.
postpartum pelvic health

Postpartum Pelvic Health

Physical therapy for the postpartum mom is a crucial part of the healing process.  In some countries, that is standard care.  In the US, women are underserved.  Every woman should have a PT assessment postpartum.  Areas addressed may include:  

  • Pelvic floor muscle trauma – tearing, episiotomy, prolonged pushing, use of forceps or vacuum
  • Diastasis recti – abdominal muscle separation
  • Musculoskeletal pain – hips, back, tailbone, pubic symphysis separation, sacroiliac pain
  • Pelvic Organ Prolapse – sensation of pressure or pain in the pelvic region or as though something is falling out
  • Bladder & bowel issues
  • Painful intercourse
  • Cesarean birth scar management
  • Posture and positioning during feeding and childcare
  • Recommendation/plan for return to exercise
pelvic pain

Pelvic Pain

Pelvic pain occurs for a variety of reasons.  Pain may be referred into the pelvis from other structures, or may originate in the pelvis.  Often pain is multifactorial.  A thorough assessment of surrounding structures is necessary.  Common issues treated include:  

  • Tailbone, pubic bone, hip, sacroiliac pain
  • Pudendal Neuralgia
  • Vulvodynia (Vulvar Pain)
  • Vaginismus
  • Sexual Pain
  • Interstitial Cystitis/Painful Bladder Syndrome
  • Endometriosis or Adenomyosis
  • Postoperative urogynecologic pain
  • Abdominal pain, painful scars
bladder issues

Bladder Issues

Bladder issues are so common that many people feel they are normal.  However, they are not normal and can be treated succesfully for most people.  Common issues include:

  • Urinary urgency/frequency
  • Urinary incontinence
  • Pelvic Organ Prolapse
  • Painful bladder syndrome
bowel issues

Bowel Issues

While less common than bladder issues, bowel issues are also “common but not normal.”  They may result from pregnancy/delivery or they may result from pelvic floor dysfunction, chronic inflammation which causes muscle pain and tightness, or lack of coordination in the muscle system.  

  • Constipation
  • Fecal incontinence
  • Dyssynergia
  • Pain with bowel movements
  • Bloating
prolapse

Prolapse

Treatment of Pelvic Organ Prolapse involves a whole-body approach. Prolapse can be urethral, vaginal, uteral, or rectal. Physical therapy can relieve symptoms and make a huge difference in your quality of life. Read more on the Integral blog here.

Diastasis Recti

Diastasis

Diastasis recti (vertical separation of the outer abdominal muscles at the linea alba, associated with a doming or pooching of the abdomen with effort, can occur in all age groups and in both males and females, although it is most commonly associated with the postpartum mummy tummy. Dr. Shaw treats this condition in patients of all ages.  It is common in babies but should resolve quickly and when seen in children should be treated whether the child has low muscle tone or is typically developing.  Sometimes it is discovered in elite athletes rehabbing other conditions (typically having developed due to abdominal loading with poor technique). Its cause during pregnancy is more obvious, but the severity can be prevented or minimized with exercises during pregnancy and postpartum.  Restoring good tension control in the abdomen will improve your ability to move and perform well.

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