By Rachel Levy PT, DPT, CIMT
Are you experiencing pelvic pain, low back pain, incontinence (urinary leakage) and/or pain with sexual activity? The good news… pelvic floor physical therapy can help.
The International Pelvic Pain Society estimates 25 million women experience chronic pelvic pain and 78% of women with low back pain also have pelvic floor dysfunction (1). Nearly half of women who exercise will experience urinary incontinence (2). Nearly half! And that holds up across all fitness levels. 50% of elite female endurance athletes experience urinary leakage (3). If you are experiencing pelvic pain, urinary leakage with exercise or incontinence you are not alone!
Let’s be upfront. To evaluate the pelvic floor, your PT performs an internal and/or external palpation exam depending on your symptoms and comfort level. Internal muscle assessment is typically performed by inserting a single finger into either the vaginal or rectal canal. Gentle pressure is applied to the muscles to evaluate muscle tenderness and tension. For many women, the exam is much less invasive than a gynecological exam (we do NOT examine the cervix or uterus). If an internal exam is not indicated or the client is not comfortable, an external muscle exam can also be performed. This can be done on the superficial muscles through clothing. But why do we need to examine the muscles of the pelvic floor?
Similar to other muscles, your pelvic floor muscles cycle between active and relaxed states. When muscles are too active, they become painful and tight. Have you ever tried holding your hand in a tight fist for a prolonged period of time? Your hand will be stiff and painful after just a few minutes. Similar to the tight fist, overactive pelvic floor muscles will cause symptoms that include pain with sexual activity, pelvic pain, low back pain, difficulty emptying your bladder, difficulty holding your bladder, and altered bowel control. On the flip side, pelvic floor muscles can also be weak or overstretched. The symptoms will include bladder and bowel control problems, pelvic pain, and low back pain. Only your PT can assess whether your pelvic floor issues are due to overactivity or underactivity (or both!) After a comprehensive history, your PT will assess not only your pelvic floor but other muscles and joints that may be contributing to your condition. A unique treatment program will be devised for you to address your deficits and meet your goals!
2). McKenzie S, Watson T, Thompson J, Briffa K. Stress urinary incontinence is highly prevalent in recreationally active women attending gyms or exercise classes. Int Urogynecol J. 2016;27(8):1175-1184. doi:10.1007/s00192-016-2954-3
3). Poświata A, Socha T, Opara J. Prevalence of stress urinary incontinence in elite female endurance athletes. J Hum Kinet. 2014;44:91-96. Published 2014 Dec 30. doi:10.2478/hukin-2014-0114
