These issues are common but shouldn't be considered normal
Pelvic pain and issues in this region don’t discriminate. Teens and men may feel unexplained pain in the hips or low back, new moms might experience urinary leakage, or menopause might bring on pain in the pelvic region. Often misdiagnosed, the pain can go on for years, but there is a way to treat these conditions.
What is the pelvic floor?
The pelvic floor is a series of muscles that support your bladder, uterus, bowels, as well as your bony structures such as your spine. Issues in this area can result in leakage, ‘having to go’ all the time, constipation, painful intercourse, and pain in the low back, hips, and tailbone. While these symptoms are common, they shouldn’t be labelled as normal. These issues are often long-lasting and people feel awkward talking to their physician or health care provider, but waiting will only make the issues worse. Unfortunately, when not treated by a proper pelvic health specialist, these issues are often misdiagnosed or the symptoms are treated but the cause is missed.
Questions? Email Terri, one of our pelvic health specialists.
Healing women, men, and children
Coccygodynia refers to pain that originates at the coccyx, the small bone at the very bottom of the vertebral column. Pain is usually felt when sitting, moving from a sitting to standing position (or vice versa) or when trying to have a bowel movement. The pain with coccygodynia is described as a pulling or piercing pain felt at the tailbone that may also refer pain to the hip, low back or anus. Often, the cause of coccygodynia is unknown, however, it may be related to a subluxation (displacement) or contusion (bruising) of the coccyx due to a fall on the tailbone. Injury may also occur during difficult child delivery. Physical therapist can use joint mobilization and soft tissue mobilization to improve the position of the coccyx and decrease pain. Posture and body mechanic training is also used to modify sitting posture and decrease pressure on the coccyx with daily activities.
Considered a symptom, not a disease. Criteria for constipation include straining for more than 25% of bowel movements, fewer than 3 bowel movements per week, sensation of incomplete evacuation or anorectal blockage for more than 25% of bowel movements, lumpy or hard stool in more than 25% bowel movements or the necessity of digital manipulation in more than 25% bowel movements. May have simple constipation with mild to moderate symptoms which usually respond to conservative treatment. Secondary constipation can be associated with mechanical, endocrine, psychological and medication effects. Symptoms may include headaches, decreased energy, bad breath, difficulty concentrating, decreased appetite, coating on the tongue, abdominal bloating, gas/flatulence, skin problems, depression, diarrhea. Physical therapy can assist with the understanding of internal and external influences on bowel function.
Defined as partial or complete wasting away of a part of the body. Causes of atrophy include mutations, poor nourishment, poor circulation, loss of hormonal support, loss of nerve supply to the target organ, and disuse or lack of exercise or disease intrinsic to the tissue itself. Atrophy of a muscle can lead to decreased functional abilities and can affect organ and musculoskeletal function. Physical therapy helps to locate specific muscle groups that are affected and need to be treated through individualized exercise programming.
Dyspareunia is defined as painful intercourse. Pain may be experienced before, during or after intercourse. Dyspareunia does affect both men and women, but, it most often affects women. Pain may be experienced during vaginal penetration due to insufficient lubrication/vaginal dryness or because of muscle spasm. Pain may also be present during deeper penetration which may be related to other medical conditions such as endometrioses, pelvic inflammatory disease, interstitial cystitis, irritable bowel syndrome, uterine prolapse, ovarian cysts, etc. Emotional factors may also result in painful intercourse. Stress, fear of intimacy, fear of pain, and history of abuse may also contribute to painful intercourse.
Treatment of dyspareunia often times is multidisciplinary in order to treat the physical and psychological components of this disorder. Physical therapy can utilize modalities such as electrical stimulation, ultrasound and biofeedback to address pain. Manual therapy techniques to decrease muscle tone/tightness and relaxation techniques are also useful for decreasing pain with vaginal penetration. Medications and counseling may also be incorporated in the management of dyspareunia.
Interstitial cystitis (IC) is a chronic condition characterized by a combination of uncomfortable pressure or pain that is perceived in the bladder or pelvis. Symptoms can range from mild burning or discomfort to severe pain. In addition to pain, some people affected by IC will also experience frequent or urgent urination. Interstitial cystitis will frequently occur with other disorders such as irritable bowel syndrome, fibromyalgia and chronic fatigue syndrome.
Treatment of interstitial cystitis involves many modes including medication, diet/behavior modification and physical therapy. Foods such as caffeine, chocolate, citrus fruits, milk, alcohol and carbonated beverages can irritate the lining of the bladder making symptoms of IC worse. Physical therapy can help with pain management and bladder retraining to decrease urinary frequency and urgency.
The lack of ability of muscles to work together smoothly which can lead to functional weakness. Physical therapy is used to identify specific triggers or muscle groups involved that require further neuromuscular reeducation to allow restoration of normal coordination.
Pelvic Pain / Hip Pain
Pain can be defined as an unpleasant sensory and emotional experience associated with actual or potential tissue damage. Pain can be inflammatory or chemical, mechanical, ischemic, neurogenic or central in nature. Varied origination of pain can lead to varied treatment regimens. Pain in the pelvis and hips can be associated with nerve entrapments, muscle strain, abnormal muscle tension, muscle weakness, ligamentous laxity, scar tissue. Physical therapy can complete a thorough evaluation of the musculoskeletal system along with prior medical history and environmental influences to develop an individualized plan for potential recovery from pain.
After a radical prostatectomy (surgery to remove the prostate gland), a patient may suffer from urinary incontinence and erectile dysfunction. Physical therapy helps such patients to strengthen their pelvic floor muscles, significantly improving post-prostatectomy urinary incontinence, post-micturition dribble and erectile dysfunction. Whether they have had surgery or not, all men should master pelvic health exercises to maintain normal function.
The sacroiliac (SI) joint is formed by the sacrum, which is a large wedge shaped bone at the bottom of your spine, and the iliac bones, which form the pelvis. The sacrum and iliac bones are held together by strong ligaments and supported by many muscles. Overall there is very little motion occurring at the SI joint, however it must bear the weight of the entire upper body when we are in an upright position. This subjects the joint to the possibility of increased stress and possible dysfunction. SI joint dysfunction is characterized by pain in lower back, hip, buttock or groin and can be the result of many factors.
Many problems that affect other joints in the body can also affect the SI joints.
Examples of these problems include:
- Osteoarthritis (wear and tear arthritis)
- Rheumatoid arthritis
- Ankylosing spondylitis
- Changes during pregnancy
- Any problem that changes normal walking pattern— ex. leg length difference, pain in hip, knee, ankle or foot
- Use of poor posture and body mechanics
The most common symptom of SI joint dysfunction is pain, which is often located in the lower back, hip or groin. The pain is oftentimes worse during walking or standing activities and is alleviated after lying down. If you experience these symptoms, your doctor will perform an evaluation during which they may ask many questions and perform testing to diagnose you with SI joint dysfunction.
After diagnosis from your doctor, referral to a physical therapist can help treat your condition. Treatment begins after a formal evaluation to determine the best plan for your symptoms. The PT will work to stabilize a joint that is too mobile or improve mobility in a joint that is not moving appropriately. The therapist will also likely prescribe specific exercises to improve strengthening, stabilization, and flexibility exercises as well as use of hands on techniques to restore proper mobility and function. The therapist may also recommend the use of a SI joint belt if stability is needed.
The term describes a common muscle pain disorder that is conceptually similar to fibrositis, fibromyalgia, and myofascial pain syndrome. Some medical facilities use the terms generalized, regional, and localized to describe this disorder. The recommended treatment approach includes reassurance, elimination of contributing factors, physical therapy to restore normal neuromuscular function, conditioning, and medications.
Trigger points are tiny knots that develop in a muscle when it is injured or overworked. Commonly a cause of most joint pain, they are known to cause headaches, neck and jaw pain, low back pain, tennis elbow, and carpal tunnel syndrome. It is called a trigger point because it “triggers” a painful response. But a trigger point is more than a tender nodule. It affects not only the muscle where the trigger point is located, but also causes “referred pain” in tissues supplied by nerves.
Trigger points are located in a taut band of muscles fibers. The trigger point is the most tender point in the band. Your physical therapist can treat these trigger points using deep tissue massage or trigger point release. He or she can also teach you specific stretches to target the muscles with the trigger points, and teach you strengthening exercises to stabilize them and avoid re-occurrence.
Defined as persistent or recurrent problems with any vaginal insertion which may include penis, finger or any other object despite the intent. This may include sexual activities, pap smears examinations or tampon insertion. May be associated with involuntary spasm, phobia, fear. Classified as a sexual dysfunction.
Vulvar Pain Syndromes
May include vulvodynia, vestibulitis , pudendal neuralgia, vulvar congestion syndrome. Chronic in nature. Characterized by vulvar pain, burning, stinging, irritation, rawness or dryness.
1 in 4 women suffer from pelvic pain or urinary leakage.
Physical therapy can help even the most personal symptoms
“Pelvic floor therapy is so personal and private, it takes a special person with the right training to be able to make the patient (me) feel at ease so the therapy can be helpful and lifelong. Terri has all those qualities!” – Mary L., Coopersville patient
Physical therapy can help before, during, and after your pregnancy.