Sarton Physical Therapy

Hope and healing for pelvic floor dysfunction

Female Pelvic Pain | Sarton Physical Therapy

Female Pelvic Pain

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Pelvic Floor Physical Therapy is a powerful tool for the treatment of pelvic pain.

Pelvic pain can be felt in the lower abdomen, perineum or the pelvis and is considered to be chronic if it lasts longer than 6 months. This can present as an aching pain while others describe it as burning, sharp or stabbing pain. There is frequently a musculoskeletal component such as poor posture, lack of flexibility or strength, core muscle weakness, pelvic floor muscle weakness, sacroiliac joint (SIJ) pain, and past trauma or injury below the waist or involving the spine. Several mechanisms of injury may lead to spasm of the pelvic floor. These include traumatic vaginal delivery, abdominal or pelvic surgery, prolonged driving, occupations that require prolonged sitting (such as office work), gait disturbances, traumatic injury to the back or pelvis, or sexual abuse.

Pelvic floor dysfunction can also arise in response to other common chronic pain syndromes, such as endometriosis, irritable bowel disease, vulvodynia, and interstitial cystitis. A prospective evaluation of patients with chronic pelvic pain of various etiologies found abnormal musculoskeletal findings in 37%, versus 5% of controls (1).

Pelvic floor musculoskeletal disorders are common in women and often go unrecognized during the evaluation of pelvic pain. It is estimated that 40% of diagnostic laparoscopies and 12% of hysterectomies are performed for pelvic pain. Failure to recognize pelvic floor dysfunction contributes to the 24% to 40% negative laparoscopy rate in patients with chronic pelvic pain (2). Many of these patients have a diagnosis that is not surgically correctable or have multiple musculoskeletal and/or neuromuscular causes for their pain, which then persists despite surgery.

Patients with the following symptoms should be assessed by a Pelvic Floor Physical Therapist:

Pain with intercourse
Sacroiliac joint dysfunction that does not respond to traditional physical therapy.
Painful bowel movements
Interstitial Cystitis
Pain with prolonged sitting.
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“Acute or chronic pelvic pain is often due to musculoskeletal disorders, which may go unrecognized during a traditional pelvic examination. Proper evaluation facilitates the diagnosis of spasm or trigger points, and physical therapy often achieves a major improvement in quality of life".

How does Pelvic Floor Physical Therapy Help?

Our evaluation includes an orthopedic musculoskeletal and neuromuscular survey of the spine, pelvis, and hips. We also perform a transvaginal examination to quantify the tension of the pelvic floor and hip musculature. During this examination, we are working to identify the degree of dysfunction and find any musculoskeletal or neuromuscular factors contributing to the patient’s condition. A fundamental component of our treatment is patient education. Most patients have little or no understanding of the musculature within the pelvis. Educating patients about the underlying cause of their pain and providing them with tools to self-treat, where appropriate, is essential. To insure the best possible results, the therapists at Sarton Physical Therapy always spend an hour with each patient during every appointment.

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1) Tu, Frank F., et al. "Physical therapy evaluation of patients with chronic pelvic pain: a controlled study." American journal of obstetrics and gynecology 198.3 (2008): 272-e1.
2) Howard, Fred M. "The role of laparoscopy in chronic pelvic pain: promise and pitfalls." Obstetrical & gynecological survey 48.6 (1993): 357-387.
3) Weiss, Patrice M., Jennifer Rich, and Eric Swisher. "Pelvic Floor Spasm: The missing link in chronic pelvic pain." (2012).