Pelvic Floor Dysfunction (PFD)
Where does Physical Therapy fit in?
The purpose of Physical Therapy treatment for those who have Interstitial Cystitis (IC), Chronic Pelvic Pain and/or Pelvic Floor Dysfunction is to identify which structures are causing the pain and dysfunction.
In individuals with PFD excessive electrical activity is noted in the pelvic floor; the pelvic floor is in spasm. Biofeedback is used to try to help the patient learn how to relax the pelvic floor from being in spasm. Biofeedback is a mechanism where you can monitor how much electrical activity is being generated by the pelvic floor muscle.
Skeletal muscle has an optimal length for optimal function. If you have a muscle that is too long (overstretched) it will be weak. If you just pushed out a 12 lb baby, your pelvic floor is mostly likely overstretched and weak. Biofeedback is extremely beneficial in that situation to help you locate the muscle and monitor the progress as it strengthens with each active contraction.
Skeletal muscle can also become too short. A muscle that is too short is said to be in a state of contracture. It has the ability to contract, but it will be a weakened contraction with a decrease in its range of motion. A muscle that is too short needs to be lengthened before it can be strengthened. A common example of muscle contracture that most can relate too would be an extremity that has been in a cast. If the arm is broken and in a cast with the elbow fully bent with the hand at the shoulder, when the cast is removed the elbow will be stuck in a fully bent position. Now the biceps muscle is weak because it has not been used for 8 weeks, but it is also too short; a contracture. The biceps would need to be lengthened before it is strengthened.
What to expect on your initial visit.
Our evaluation involves two components: a pelvic exam and a comprehensive musculoskeletal evaluation. The pelvic exam has two components; an internal exam and a computerised muscle assessment. The pelvic exam is focused on assessing the musculature and other pelvic tissues not the organs. The pelvic floor, also know as the levator ani, is evaluated with regards to its function. Can the patient locate the muscle and perform an isolated contraction? Or does she use other muscle groups to assist her in contracting the muscle? This is also known as substitution. Is there difference from the right side to the left? Are there trigger points in the muscles? Trigger points can be a source of pain as well as cause the muscle to not function properly. The therapist will also assess the ability of the pelvic floor to relax after a contraction. The ability of the patient to do a lengthening contraction from the resting position is also evaluated. This is also known as an eccentric contraction. An eccentric contraction is the motion that is required to initiate urination. During the internal exam the therapist will also be assessing the other tissues found within the pelvis; the connective tissue and the neural tissue specifically. A Rehabilitative Ultrasound Imaging assessment will also be conduction to assess muscle function and its affect on your bladder.
Does a pelvic floor exam hurt?
A Pelvic floor exam should never be painful unless you have a problem. The pain that can be experienced is variable. Some patients are so involved, that the light touch of fingers at the vaginal opening can create excruciating pain. Light finger touch is not a burning pain stimulus. What has occurred is that those tissues have become highly sensitised and the sensory receptors have become confused and interpret all stimuli as pain. If you are in the exam and a trigger point is found, then yes there will be pain when palpating the trigger point.
Physical Therapy treatments usually combines manual therapy, myofascial release to the pelvic floor muscles, and other methods to reduce pain such as electrical stimulation, trigger point needling, biofeedback, home exercise and self-care.
Dr. Ruth M. Maher is a Pelvic Muscle Dysfunction Biofeedback Specialist certified by the Biofeedback Institute of America to treat elimination disorders and pelvic pain. The Biofeedback Certification Institute of America (BCIA) was formed in January 1981 to establish and maintain professional standards for the provision of biofeedback services and to certify those who meet these standards.