Endometriosis

ENDOMETRIOSIS

Endometriosis occurs when tissue that should line the uterus forms on other areas.

Endometrial tissue that should line the inside of the uterus sometimes forms on the ovaries, fallopian tubes, and other areas outside of the uterus. Endometriosis affects up to 15% of women of reproductive age, and the severity of symptoms can vary greatly.

Excessive bleeding caused by endometriosis often results in swelling and bloating, commonly known as the “endo belly. 

In some cases, endometriosis causes infertility. Endometriosis becomes painful because the inflammation forms scar adhesions, which causes myofascial dysfunction throughout the abdominal and pelvic regions.

Pelvic floor therapy can normalize the pathological tissues causing pain and the “endo belly.” Reducing scarring and restoring circulation to the area reduces pain and inflammation. 

Treatment options may include:

• Scar Mobilization
• Manual Myofascial Techniques
• Visceral Manipulation
• Neuromuscular Reeducation
• Biofeedback
• Pelvic Floor Muscle Training

The goal in therapy is to control pain and restore normal function to your pelvis.

Vaginal Bulges (Prolapses)

VAGINAL BULGES (PROLAPSES)

It is estimated that 50% of women who have had children have some sort of prolpse.

Vaginal bulges, or prolapses, occur when a pelvic organ falls into the space of the vagina and creates a bulge. These can occur for a variety of reasons and are classified according to what organ is bulging and the descent of the bulge.

It’s easy to understand how pregnancy can cause a loss of pelvic organ support. Postpartum women who exercise are especially vulnerable to prolapse. [source]

Prolapse can occur at any time in a woman’s life. Prolapse can disrupt function of urination, defecation, and sexual activity. Women will often report a sensation of heavy pressure but will be unaware of any shifting of their internal pelvic organs.

Many stage 1 and stage 2 prolapse do not occur until later in the day, while a woman is in a standing position or after exercise, so they can be difficult to detect. Many prolapses are seemingly asymptomatic. Women do not often recognize the challenges prolapse can create for the diaphragm and posture.

Prolapse is treatable and even reversable with therapy. Conditioning the pelvic floor muscles is proven to recede prolapses. Therapy may include:

• Pelvic Floor Muscle Training
• Neuromuscular Reeducation
• Biofeedback
• Adaptive Techniques
• Recommendation for a Pessary

It is our recommendation that each postpartum woman receives a therapy evaluation to prevent or treat prolapse, especially if the woman is returning to athletics. It cannot be stressed enough that the earlier a woman seeks therapy for prolapse, the better her outcome is likely to be. We also recommend women over 60 be seen in therapy to understand the details of preventing prolapse. Stage 3 prolapse is common for senior women. Women are often understandably frantic and confused when a bulge is falling out of their vagina. 

Prolapse is treatable, even for women in their 90s. It is also preventable with pelvic floor therapy.

Citation:

Hagen, S., & Stark, D. (2011). Conservative prevention and management of pelvic organ prolapse in women. The Cochrane database of systematic reviews, (12), CD003882. DPI: 10.1002/14651858.CD003882.pub4

Piriformis Syndrome (Sciatica)

PIRIFORMIS SYNDROME

Frequently women with piriformis syndrome will not completely rehabilitate without pelvic floor therapy.

Piriformis Syndrome, often called sciatica, is a musculoskeletal problem that involves the piriformis muscle and sciatic nerve. 

Piriformis Syndrome presents as numbness or weakness in the structures neurologically supplied by the sciatic nerve including the gluteal region, posterior thigh, leg, or foot. It can cause pain when walking upstairs, a dull soreness or ache in the buttocks area, increased pain after sitting 15-20 minutes, an inability to move the hip, and/or drop foot. 

Women are diagnosed with Piriformis Syndrome six times more often than men. This ratio can be explained by the wider quadriceps femoris muscle angle in the coxae of women.

Due to the anatomical location of the piriformis, deep in the gluteus maximus, pelvic floor therapy is more effective to loosen the piriformis compared to the moist heat or ultrasound modalities used in traditional physical therapy.

Treatment options may include:

• Manual Myofascial Techniques
• Nerve Gliding Manipulations and Exercises
• Neuromuscular Reeducation
• Biofeedback
• Ultrasound
• Therapeutic Exercise

The goal in therapy is to loosen the tension on the piriformis and sciatic nerve to function pain free.

Vaginal Tightness (Vaginismus)

VAGINAL TIGHTNESS

Vaginal tightness, vaginismus, is a frequently overlooked condition of vaginal tightness due to involutary spasms of the pelvic floor muscles that create long-term muscle restrictions.

There are a variety of reasons vaginismus occurs. When left untreated, vaginismus makes the use of tampons, menstrual cups, and sexual intercourse painful. Pelvic floor therapy is effective in the treatment of vaginismus. 

Treatment options used may include:

• Manual Treatment
• Neuromuscular Reeducation
• Biofeedback
• Pelvic floor muscle training
• Dilators

The goal in therapy is to normalize the muscle tone of the pelvic floor muscles so you can be pain free.

Hover mouse over image to show changes evident in vaginal tightness.

Pain with Sex (Dyspareunia)

PAIN WITH SEX

Therapy to restore sexual function is truly a life-changing and relationship-saving investment.

Pain with sex, or dyspareunia, can occur for a variety of reasons, such as vaginismus, vulvodynia, endometriosis, or scarring from gynecological surgeries such as hysterectomy or cesarean section.

Pelvic floor therapy serves to normalize the pathological tissues causing pain. Treatment options may include:

• Scar Mobilization
• Manual Myofascial Techniques
• Visceral Manipulation
• Neuromuscular Reeducation
• Biofeedback
• Pelvic Floor Muscle Training

The International Urogynecological Association recognizes the significant clinical effects of pelvic floor therapy in treating pain with sex [source]. If you are experiencing pain with sex, ask your medical provider if therapy is right for you. An evaluation and individualized treatment plan will have you on your way to feel like a natural woman again.

Citation:

Berghmans B. (2018). Physiotherapy for pelvic pain and female sexual dysfunction: an untapped resource. International urogynecology journal, 29(5), 631–638. DOI: 10.1007/s00192-017-3536-8

Coccyx Dysfunction (Coccydynia)

COCCYX DYSFUNCTION

The position of the coccyx will affect everything that attaches to it!

Coccyx Dysfunction, or coccydynia, is often the root cause of low back and pelvic pain that does is not resolved after traditional physical therapy. A key symptom of coccyx dysfunction is pain and intolerance of sitting.

There are many internal structures that attach onto the small surface area on the coccyx. The coccyx also provides support to important organs such as the rectum and anus.

The position of the coccyx will affect everything that attaches to it, which is why pelvic floor therapists are uniquely qualified to treat coccydynia. In fact, medical research cites therapy to be 90% effective in treating coccydynia [source]. 

Therapeutic treatments can include:

• Manual Techniques
• Joint Mobilization
• Pelvic Floor Muscle Training
• Biofeedback
• Transcutaneous Electrical Nerve Stimulation
• Cryotherapy/Thermotherapy

The goal for each patient is to finally be pain free.

Citation:

Lirette, L. S., Chaiban, G., Tolba, R., & Eissa, H. (2014). Coccydynia: an overview of the anatomy, etiology, and treatment of coccyx pain. The Ochsner journal, 14(1), 84–87.

Menstrual Cramping (Dysmenorrhea)

MENSTRUAL CRAMPING

Muscular overactivity of the uterine wall aggravates hypertonic pelvic floor muscles

Menstrual cramping, also known as dysmenorrhea, is experienced as pain in the lower abdominal area during one’s menstrual cycle or with inflammation. Nearly 85% of women report menstrual pain [source].

Cramps can range from mild discomfort to severe pain that interferes with work, school, and other daily responsibilities with one in four women reporting absenteeism due to menstrual pain [source].

Menstrual cramping is essentially caused by muscular overactivity of the uterine wall, which aggravates hypertonic pelvic floor muscles. The muscular pain with dysmenorrhea is why some women experience cramps with exercise or bloating even while not on their period.

There are two types of dysmenorrhea: primary and secondary. Both can be treated with pelvic floor therapy. Primary dysmenorrhea results from elevated prostaglandins while secondary dysmenorrhea is from a gynecological disorder such as endometriosis, fibroids, adenomyosis, or a history of gynecological surgery. High levels of pelvic torsion and some hormonal contraceptives are also associated with elevated menstrual pain.

Myometrium causes cramps.

Studies confirm that pelvic floor therapy has higher rates of effectiveness to help reduce menstrual pain [source].

Therapeutic treatment modalities can include:

• Connective Tissue Manual Techniques
• Pelvic Floor Muscle Training
• Biofeedback
• Electrical Stimulation
• Cryotherapy/Thermotherapy

Our goal for each patient is to reduce their menstrual pain.

Citations:

1. Grandi, G., Ferrari, S., Xholli, A., Cannoletta, M., Palma, F., Romani, C., Volpe, A., & Cagnacci, A. (2012). Prevalence of menstrual pain in young women: what is dysmenorrhea?. Journal of Pain Research, 5, 169–174. DOI: 10.2147/JPR.S30602

2. Gerzson, Laís Rodrigues et al. Physiotherapy in primary dysmenorrhea: literature review. Received from the University Center Fransciscano, Santa Maria, RS, Brazil. . Revista Dor [online]. 2014, v. 15, n. 4 [Accessed 14 June 2021] , pp. 290-295. ISSN 2317-6393. DOI:  10.5935/1806-0013.20140063.