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Pelvic Health Blog

November 21, 2016

pelvic-health-letterhead

Speaking Up About Your Pelvic Pain

 

Most individuals who experience pelvic pain suffer in isolation and are often hesitant to disclose their concerns for fear of the unknown or the likely pelvic examination. Pelvic pain is most often caused by dysfunctions like: tightening and/or shortening of the pelvic floor muscles, fascia, and ligaments. When pelvic floor muscles are functioning optimally, they maintain urinary and fecal continence and allow for pleasurable and pain-free sexual intercourse.

Pelvic pain can cause the muscle to be hypertonic (increased tension in the muscles and ligaments) or to have trigger points. This can result in:

  • Urinary symptoms including frequency, urgency, painful urination, or incomplete emptying of the bladder.
  • Bowel dysfunction like constipation and diarrhea, a constant need to strain to achieve a bowel movement, incomplete emptying and pain with bowel movements.
  • Unexplained shooting and sporadic pain into your low back, pelvic region, hips, and genital (vaginal and/or rectal) areas.
  • Pain during or after intercourse, orgasm, or sexual stimulation.

 

“What is causing my pelvic pain?”

 

Common Causes of Pelvic Pain

  • Interstitial Cystitis/Painful Bladder Syndrome: Pain, frequency, and urgency.
  • Endometriosis: The tissue that lines the uterus or womb grows outside of the uterus on other organs or structures in the body.
  • Myofascial Trigger points (Hypertonic muscles): Pain in the pelvic floor region, as well as urinary urgency and frequency.
  • Vulvodynia: A broad category of pelvic pain that is often diagnosed as:

 

  1. Vestibulodynia: Pain at the vestibule or “front porch” of the vagina.
  2. Vulvodynia: Pain in the superficial tissues of the vulva, particularly the labia majora and minora.
  3. Clitordynia: Pain at the clitoris.
  4. Dyspareunia and Vaginismus: Painful vaginal intercourse or inability to achieve penetration due to pain.

 

  • Constipation: Can be a  cause of effect of pelvic floor muscle dysfunction.
  • Sacroiliac Joint (SIJ) dysfunction: Leads to irritation in the lumbar spine and pelvic region.
  • Pudendal Neuralgia: The pudendal nerve supplies the rectum, vagina/penis, perineum, and mons pubis. Irritation of this nerve can cause pain in the aforementioned areas. This nerve is often compromised during excessive sitting postures and activities like cycling.
  • Surgery: Surgical trauma can change the strength and integrity of the pelvic floor musculature and can lead to pain.
  • Psychological factors: Stress, anxiety, depression, reduced self-esteem and decreased quality of life can influence pain.

Treatments to Improve Your Health

Here at Eramosa Physiotherapy Associates, we strive to have all patients pain-free and healthy at the end of their treatment. In regards to pelvic health, we address the causes of your pelvic pain using a comprehensive health history. An internal and external assessment will be conducted to view your ability to contract and relax the pelvic floor muscles. There will also be an assessment of your lower back, hips, and sacroiliac joints as these joints can stress your pelvic floor muscles and refer pain into your pelvic area.

Hands-on techniques to address the tissue health in the pelvic floor region will also be conducted in your assessment. Once your tissue health has been addressed, strengthening exercises will be introduced. To keep you educated about your condition, your physiotherapist will keep you updated on the specific progression of any strengthening and stretching exercises as well as education about activities that can exasperate your symptoms.

Female Incontinence: Your Concerns Addressed

Many women believe that incontinence; the involuntary loss of urine, is a normal occurrence after childbirth or aging. Continence concerns are common but NOT normal and issues are varied. Stress incontinence (SI) refers to leakage that is noticed during a cough or sneeze, when laughing, or during strenuous activities. Sometimes women get the sudden and urgent need to get to a bathroom. Urge incontinence (UI) is the loss of urine that is accompanied by this sudden, urgent feeling. Mixed incontinence (MI) refers to the most common form of incontinence, which is a combination of both SI and UI.

Your urinary leakage may have started off with minimal and tolerable amounts of leakage that occurred with that cough or sneeze. Eventually, leakage can accelerate to amounts that are substantial enough to wear protective padding or to avoid activities that were once enjoyed.  If you are tired of worrying about that inconvenient leaking, booking an assessment with Eramosa Physiotherapy Associates will put you on the Path to Improved Health.

Female Incontinence: Common Causes

  • Childbirth: It is common but NOT normal for women to experience continence complaints after giving birth, particularly if you have experienced difficult labours, tearing, or experienced additional trauma to the pelvic floor through the use of forceps or suction.
  • Aging: It is common, but again NOT normal to notice increased incontinence with aging. This is partly due to changes in our hormones which affect the muscle and pelvic floor tissue’s integrity.
  • Weak and/or tight Pelvic Floor Muscles: The pelvic floor muscles function like all other muscles in our body. A muscle that is weak may not generate the required force to support the internal organs. In addition to weakness, a tight pelvic floor can create Trigger Points (TP) which consequently also result in weakness.
  • Pain or Trigger Points (TP): Can occur within the pelvic floor tissue, muscles, or even the surrounding abdominal muscles. These trigger points can create weakness and pain in the pelvic floor.

Female Incontinence: Treatment to Improve Your Health

 Eramosa Physiotherapy Associates will get you on the Path to Improved Health by addressing the causes of continence concerns using treatments such as:

  • A comprehensive assessment including a thorough review of your Bladder History
  • Hands-on techniques to address both external and internal muscle weakness, pain, or trigger points
  • Inclusive assessment of areas that can contribute to continence concerns such as the low back, hips, and bones of the pelvis, in addition to an assessment of the strength of the core abdominal muscles
  • Education of the specific progression of pelvic floor exercises, the importance of hydration, and correct toileting practices
  • Therapeutic modalities, when indicated, including acupuncture, muscles stimulation, and biofeedback

Male Incontinence: Your Concerns Addressed

If you are a male with continence concerns, you are not alone. Many men feel isolated as to the reasons behind their pelvic health concerns. Men, like women, can experience incontinence or urinary leakage. Unlike women, who are often under the misconception that incontinence is normal, men are acutely aware that it is not normal or expected.

Incontinence can be dramatically recognized following prostate surgery and/or radiation. Men are alarmed by the immediate decrease in their quality of life that comes with being reliant on urinary pads throughout the day. The leakage that results when you exert pressure on your bladder during laughing, coughing, lifting, or exercising is termed Stress Incontinence (SI). The leakage of urine that happens with a sudden, uncontrollable need to go to the bathroom is termed Urge Incontinence (UI) and is also known as “overactive bladder”.

Like women, many men’s pelvic health concerns go beyond urinary leakage. Men may suffer painful pelvic health complaints such as: post ejaculatory pain, post-urination dribble or excruciating and often unpredictable sharp pain that can often radiate through the rectum and testicles. This unpredictable pain is often likened to the ‘sciatica’ of the pelvis – and is called Pudendal Neuralgia.

Male Incontinence: Common Causes

  • Surgical Trauma: As with many surgeries, the trauma of the surgery can change the strength and integrity of the pelvic floor.
  • Progressive Weakness of the Pelvic Floor: The pelvic floor can become weakened over time from activities such as heavy lifting, chronic straining (as with constipation and Irritable Bowel Syndrome), as well as higher impact activities such as running and jumping.
  • Weak and/or Tight Pelvic Floor Muscles: The pelvic floor muscles function like all other muscles in our body. A muscle that is weak may not generate the required force to support the internal organs. In addition to weakness, a tight pelvic floor can create Trigger Points (TP) which consequently result in weakness.
  • Pain or Trigger Points (TP): These can occur within the pelvic floor tissue, muscles, or even the surrounding abdominal muscles. These trigger points can create weakness in the pelvic floor.
  • General Health: The risk for incontinence increases with those men who have higher abdominal obesity, those who smoke, and those who have suffered from chronic low back pain.

Male Incontinence: Treatment to Improve Your Health

 Eramosa Physiotherapy Associates will get you on the Path to Improved Health by addressing the causes of continence concerns using treatments such as:

  • A comprehensive assessment including a thorough review of your Bladder History
  • Hands-on techniques to address both external and internal muscle weakness, pain, or trigger points
  • Releasing scar tissue, connective tissue, and nerve tissue
  • Inclusive assessment of areas that can contribute to continence concerns such as the low back, hip, and bones of the pelvis, in addition to an assessment of the strength of the core abdominal muscles
  • Education of the specific progression of the pelvic floor exercises, the importance of hydration, and correct toileting practices
  • Therapeutic modalities, when indicated, including acupuncture, muscle stimulation, and biofeedback

Male and Female Incontinence: When will the incontinence go away?

 At Eramosa Physiotherapy Associates, our goal is to get you back to being you as quick and effective as possible by keeping your on the Path to Improved Health™. Your commitment is typically 2-3 times a week for 40 minute sessions during the first 4-6 weeks, along with an individually tailored at-home exercise plan. Most continence complaints are significantly improved with measurable changes in leakage within 8-12 weeks.

 If your continence complaints have not resolved in a timely manner based on your diagnoses, we will work with your healthcare provider to request further tests and necessary treatment. We want to help you reach your continence goals!

Male and Female Incontinence: What happens after I am discharged?

 To help keep your on the Path to Improved Health, you will receive a home-based program tool for you to maintain your continence achievements. With your permission, your primary healthcare provider will also receive an overview of changes, improvements of continence and overall function.

 It is EPA’s priority to keep your at the peak of your Path to Improved Health. Thus, we will follow up with you on your progress upon your discharge from our clinic. Continence care can be a lifelong process, and we are here to support you as you move towards maintaining an independent program. Should you ever experience any recurrence or regression in your symptoms, we invite you to return to the clinic at your convenience.

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