Pelvic Floor Health for Men and Women
The goal of St. Claire Pelvic Floor Therapy is to empower both men and women to overcome pelvic pain and incontinence. We provide the tools necessary to help men and women get stronger, reduce pain, go to the bathroom with ease or meet other personal function goals.
The pelvic floor provides support for abdominal organs, maintains urinary and fecal continence, and allows for sexual function. When these muscles stop functioning properly, it can be a source of pain and embarrassment for both men and women. While pelvic floor disorders are common in people of all ages, they are not a normal or acceptable part of aging. The good news is there are excellent conservative treatments available. St. Claire's specialty outpatient therapy service offers a comprehensive approach to treating many of these concerns.
Our specialty trained occupational therapists evaluate and treat men and women with the following diagnoses: pelvic pain (including but not limited to: vulvodynia, vestibulodynia, prostatitis, dyspareunia, vaginismus, pelvic floor muscle dysfunction, myofascial pelvic pain syndrome), urinary and fecal incontinence, constipation, pre- and post-pelvic surgery, and pregnancy and postpartum musculoskeletal conditions.
Common Pelvic Floor Issues
- Urinary Incontinence: Urinary leakage at inappropriate times. With urinary incontinence, you may experience difficulties initiating the urine stream or inefficient emptying of the bladder. Urinary continence involves functional use of the pelvic floor muscles. Appropriate pelvic floor muscles act as a trampoline or a bowl to support internal organs and control muscles that allow passage of urine or bowel.
- Urge Incontinence: Urinary leakage accompanied by a strong impulse to urinate.
- Stress Incontinence: Urinary leakage secondary to increased pressure on the bladder. Pressure can be caused from a cough, sneeze, laugh, or jump.
- Mixed Incontinence: Both urge and stress incontinence combined.
- Functional Incontinence: Inability to physically make it to the bathroom in time to urinate on the toilet. Limitations may include difficulties walking to the bathroom, manipulating clothing or sitting safely.
Therapy will focus on determining pelvic floor dysfunction. Sometimes incontinence can occur when your muscles do not have appropriate tone (elasticity), strength and length. With your permission, you will undergo an internal pelvic examination to determine tone and length of your pelvic floor muscles. If you have high tone, manual therapy techniques will be utilized to decrease tone. Once tone is appropriate, therapy will focus on improving muscle awareness to strengthen the muscles used to maintain the bladder. Postural control, core stabilization and ergonomics are important to decrease pressure on your pelvic floor and bladder. Should you have functional limitations causing incontinence, therapy can focus on improving dexterity of your hands, compensatory strategies for clothing and functional mobility to the toilet. The other aspect of therapy for urinary incontinence focuses on patient education regarding bladder retraining, urge-control techniques, bladder education and dietary education.
Urinary Urgency and Frequency
- Urinary Urgency: Presence of a strong urge to urinate and the inability to delay it. No urinary leakage occurs, however, you have to get to the bathroom as quickly as possible.
- Urinary Frequency: Need to urinate frequently. You feel like the fluids you take in are passing through you quickly. You are constantly looking out for a bathroom and when you can go next.
Typical urinary episodes occur every two to four hours. Therapy will place you on a personalized schedule in order to improve your own routine without causing any pain or leakage. Bladder retraining, urge-control techniques, bladder education, dietary education and strengthening will be initiated as appropriate.
- Nocturia: Frequent urinary episodes while you are trying to sleep. The most significant issue with nocturia is that your deep sleep is limited, which is important for your overall health. In normal pelvic floor and bladder function, one urinary episode or less during sleeping hours is typical. Nocturia can be caused by several things including post partum habits, caregiver or animal responsibilities, stress or anything that regularly wakes you up.
Therapy will focus on your current daily routine, including urinary patterns and possible bladder irritants. Bladder retraining and urge-control techniques will be implemented in order to promote improved sleep. Sometimes excess fluid can build up throughout the day in your legs. Positioning techniques and exercises will be provided in order to promote elimination of excess fluid prior to sleeping hours. If you are experiencing inefficient emptying of your bladder, manual therapy techniques may be utilized in order to relieve any restrictions.
C-Section Scar Adhesion
- C-section Scar Adhesion: Many layers of skin, as well as your uterus, are cut in order to perform a C-section. Following a C-section, your body immediately begins the healing process through scar tissue. The role of scar tissue is to adhere like glue in order to maintain the integrity of your skin and uterus. Sometimes, scars can cause adhesions. Adhesions occur when the scar attaches to an internal organ. If left untreated, the adhesion can cause menstrual pain, pelvic pain or constipation.
Therapy will focus on scar mobilization (a technique used to break up the scar tissue) in order to promote appropriate gliding of the skin with internal organs. Once the scar is broken up, focus of therapy will transition to strengthening the muscles along the surgical site. Postural control and ergonomic training will also be included in your treatment session in order to decrease risk of other issues.
- Pelvic Organ Prolapse: Your pelvic floor muscles are the base of support for your pelvis and internal abdominal organs. A prolapse is when an organ "descends" out of place.
- Cystocele: A condition where the bladder is bulging back into the vaginal canal. You may experience a feeling of "falling out" or notice a bulge when wiping following toileting or hygiene. Other clinical symptoms can include recurrent urinary tract infections, inefficient urinary voiding, dribbling or urge to return to the toilet following urination, and pain with sexual activity or tampon use.
- Rectocele: A condition where the rectum is bulging forward into the vaginal canal. You may experience inefficient emptying or find that you benefit from splinting with bowel movements. (Splinting refers to inserting your finger into your vaginal canal during bowel movements in order to efficiently empty). You may also have a feeling of "falling out," pain with sexual activity or loss of stool with sexual activity.
- Uterine Prolapse: A condition where the uterus is falling down the vaginal canal. You may experience a feeling of "falling out," pelvic pressure that worsens near the end of the day, and pain with sexual activity and tampon use. Symptoms may worsen with lifting or standing on your feet for prolonged periods of time.
Therapy will focus on isolating specific muscles that are associated with the specific prolapse you have. Pelvic floor strengthening will be initiated in order to improve functional strength of the muscles within your pelvis. You will be instructed on daily habits and routines in order to improve your symptoms. Core strengthening, protection techniques and ergonomics will be provided in order to decrease tension on your pelvic floor muscles. If necessary, manual therapy will be provided to decrease scar tissue and pelvic floor tone.
After Pelvic Surgery
Some common pelvic surgeries include, but are not limited to, bladder suspensions, prolapse repair, partial or total hysterectomy, episiotomy site repair, hymenectomy, endometriosis, uterine fibroid surgery, or tissue repair. Like any other surgery, a pelvic surgery may cause symptoms such as pelvic pain, pain with sitting, pain with urination, pain with sexual activity, pain with tampon use, pain with gynecological exams, incomplete emptying of bladder or urinary loss.
Surgery consists of a healing process that often results in the development of scar tissue, nerve irritation or a change in organ position. Even with the most skillful surgeon and successful surgery issues can develop. Therapy can be a good component to aid in your recovery.
Frequently Asked Questions
What can I expect the first day?
A thorough history and physical examination will be conducted the first day specifically related to the problem you are coming to therapy for. For pelvic floor related conditions (ie: incontinence, constipation, pelvic pain), it is likely an external and internal pelvic floor muscle examination will be conducted, a speculum will not be used. Based on the results of the examination, your therapist will devise with you a specific plan of care to treat your condition.
How long should you expect before seeing improvements?
The improvement process is unique for each individual. Some individuals see improvements in their symptoms within the first few appointments. More chronic issues require increased time prior to seeing relief. Improvement rate increases with your own commitment to the home program provided by your therapist. Research suggests that it takes at least three months of consistent treatment to create a permanent change to your body.
How long will it take to get better?
Unfortunately, there is no easy answer for that question. Every person/body and diagnosis is different. Your occupational therapist will work with you to attain your goals as safely and efficiently as possible. Your therapist can talk to you specifically about your goals, plan of care, and anticipated prognosis.
What if I have my period, can I still come to my appointment?
Having your period is not a contraindication to what we do. As long as you are comfortable, it is perfectly fine to attend your appointment during your menstrual cycle.