Marathon’s approach to pelvic floor dysfunction
Marathon’s approach to clinical education and training
What is Pelvic Floor Dysfunction?
Common symptoms of pelvic floor dysfunction
Conditions treated
How is PFD treated?
What are the pelvic floor muscles?
Glossary
Marathon’s approach to pelvic floor dysfunction
In short, education and problem solving. We believe that the best outcomes are achieved when patients are fully informed, invested partners in the rehabilitative process and when all potential contributing factors are evaluated and considered in developing the treatment plan for each individual.
Marathon has a staff of experienced and innovative physical therapists skilled in the treatment of pelvic floor dysfunction for women and men. We are committed to advancing knowledge and practice in the area of pelvic floor dysfunction through in-house dialogue, collaboration with physicians and other providers in the area of pelvic medicine and rehabilitation and educational partnerships with several university physical therapy programs. As a teaching facility, we are involved in the training of physical therapy students and medical providers through guest speaking engagements and clinical internships.
Marathon’s approach to clinical education and training
Marathon Physical Therapy and Sports Medicine is a proud partner with graduate physical therapy programs across New England and the US in providing high quality clinical education for physical therapy students. We are especially committed to providing clinical education in the area of women’s health and pelvic floor dysfunction (WH/PFD) for interested female physical therapy students. This is a rapidly growing practice area, so much so that there is often a substantial wait to commence physical therapy at a practice specializing in WH/PFD, and there are very few sites to provide clinical education. We want to see a change in both of these trends, and we hope that you will help us support these educational experiences and allow for students to observe and participate in the course of care as appropriate. If you have any questions or concerns, please discuss these openly with your physical therapist.
What is Pelvic Floor Dysfunction?
Pelvic floor dysfunction (PFD), which can affect men and women, is a general term that is helpful in describing any of a number of conditions that may affect the urinary, reproductive, digestive, sexual and/or stability systems in the pelvis. It can indicate the presence of dysfunction in the muscles, joints, nerves, and connective tissues of the pelvis. As such, PFD may present with a wide array of symptoms and impairments, some of which are easily recognizable and others which can be confusing or misleading. The most important thing to know is that while manifestations of PFD are exceedingly common, they are by no means normal and that treatment is available.
Common symptoms of pelvic floor dysfunction:
- Urinary or bowel incontinence
- Difficulty controlling urinary or bowel urges
- Painful urination or bowel movements
- Pressure in the vagina or rectum
- Pain with intercourse or sexual stimulation
- Frequent infections (yeast, urinary tract)
- Constant sense of urinary urge
- Constant or frequent irritation, burning, pain at the vaginal opening
- Pain in the genitals
- Deep pain inside the pelvis
The following list is not exhaustive for all conditions treated at Marathon, nor is it exhaustive of all conditions associated with pelvic floor dysfunction. However it and the glossary below can provide some perspective on the scope PFD and ways to recognize if pelvic floor physical therapy may be of benefit to your condition.
- Urinary stress incontinence
- Urinary urge incontinence
- Urinary urgency, frequency, hesitancy, and other voiding dysfunctions
- Pain disorders including bladder pain, abdominal pain, pelvic pain, vaginal pain, rectal pain, tailbone pain (coccygodynia), pain with sexual activity (dyspareunia), and nerve pain syndromes
- Pre and/or post operative evaluation and physical therapy interventions to optimize surgical outcomes
- Bowel dysfunction including fecal urgency, fecal incontinence, constipation, irritable bowel syndrome (IBS)
For any one of the symptoms listed above, there may be several possible causes that are amenable to medical, surgical, or conservative treatment, including, but not limited to behavioral modification, education, mental health, exercise, manual therapy, and nutrition. Unfortunately, PFD is grossly under-diagnosed and misdiagnosed and for that reason, it is imperative that you find a provider or team of providers that can help you understand the nature and cause of your symptoms and can help guide you to the best possible resolution.
Our pelvic floor physical therapists are skilled in the thorough evaluation of the pelvic floor and associated structures and will design a treatment plan that addresses any dysfunctions in a way that leads to improved function and quality of life. Further, the physical therapists at Marathon firmly believe in the interconnectedness of pelvic floor dysfunction with the lumbar spine, pelvic joints, and hips, respiratory function, and mental health and will evaluate, treat, or recommend other providers as needed, in order to provide a comprehensive and efficacious plan of care.
What are the pelvic floor muscles?
The pelvic floor itself consists of a group of muscles that exist inside of the bony pelvis (Put your hands on your hips. The pelvic floor muscles are inside of the bones and between your hands.). These muscles are generally considered to have 3 primary functions: supportive, sphincteric, and sexual.
- Supportive: The pelvic floor muscles and their associated connective tissue (fascia) work together with the deep abdominals, deep lower back muscles, and the diaphragm to support the weight of the pelvic organs and structures (bladder, vagina, rectum, cervix) and to resist increases in intra-abdominal pressure, which occurs with coughing, changing positions, and lifting.
- Sphincteric: The pelvic floor muscles work to compress the urethra and contract at the anal opening to assist in maintaining continence of urine, feces, and gas. Depending on the situation, this occurs both intentionally and automatically.
- Sexual: The pelvic floor muscles and tissues experience a marked increase in blood flow during sexual arousal and the muscles contract throughout the sexual experience, particularly with orgasm. Further, the tissues that make up the perineum and vaginal wall are required to be flexible and to allow pain-free deformation of the tissues during sexual activity.
In addition, the pelvic floor muscles and tissues help maintain equilibrium between bladder filling, the sensation of urge, and the control one feels as the urge develops. Pelvic floor dysfunction, ie. dysfunction of the muscles, nerve supply, and connective tissues to the pelvic floor, can result in one having problems in any or all of these areas.
- Cystocele: Relaxation of the supportive tissues of the bladder causing it to descend and protrude into the anterior vaginal wall
- Enterocele: Relaxation of the supportive tissues of the small intestine causing it to descend and protrude into the posterior/superior vaginal wall
- Functional Urinary Incontinence: The involuntary loss of urine prior to one’s being able to toilet, secondary to limitations in movement, cognition, or communication. Most common amongst elderly patients with arthritis, parkinson’s, or Alzheimers disease.
- Nocturnal enuresis: Involuntary loss of urine during sleep
- Overflow Urinary Incontinence: Involuntary loss of urine associated with overdistention of the bladder (ICS definition). It may or may not be associated with a detrusor contraction. There tends to be continuous leakage both day and night.
- Post-micturition loss: Loss of small amount of urine after voiding appears to be complete
- Rectocele: Relaxation of the supportive tissues of the rectum so that it protrudes into the posterior vaginal wall
- Retention: >100mL urine remaining in bladder after voiding
- Straining: Use of raised intra-abdominal pressure (IAP) to expel urine
- SUI, Genuine stress incontinence (GUSI): involuntary loss of urine occurring in the absence of a detrusor contraction, when the intravesical pressure exceeds the maximal urethral pressure (ICS definition). This results in a small volume fluid loss, frequently a spot, and occurs at the same time as an increased IAP.
- Urinary Hesitancy: Slow start to voiding
- Urinary Urge Incontinence: Leakage or gushing of urine that follows a sudden, strong urge.
- Urinary Urgency: A very strong urge to void
- Uterine (uterovaginal) prolapsed: Cervix and/or uterus prolapsed into the vagina