PELVIC FLOOR Physical Therapy for Men, Women, Children
EMH PT has been successfully treating patients with pelvic floor dysfunctions for over 15 years. Pelvic floor symptoms can include one or a combination of the three systems of pelvic floor region: urinary (leaking, urgency, hesitancy); bowel (constipation, incontinence, rectal pain) and sexual (dysparuenia, vestibular pain in women and erectile dysfunction/perineal pain in men), Patients experiencing persistent hip pain may also have an underlying condition related to their pelvic floor muscles.
Research documents that a significant number of people with one or combination of pelvic floor symptoms may feel too embarrassed to discuss their sexual, urinary and bowel issues with their health care practitioners, thinking that they have to “live with it: or their symptoms are a “normal part of aging” . In turn, the health care practitioners did not ask the specific questions to discover if there was a pelvic floor problem.
Many patients with pelvic floor dysfunction have consulted a large number of physicians in a variety of specialities, without getting relief or a clear understanding of their condition. This is due to the lack of medical schooling teaching the future doctors how dysfunctional muscles, connective tissues and joints can cause pain and disruption of pelvic floor function. Only in the recent 10 years have physical therapists, specializing in pelvic floor dysfunction, noted that tight, weak, spasmed, incoordinated muscles of the pelvic floor, lower abdominals, lumbar spine and hips were the primary cause for a wide range of pelvic floor symptoms. Ongoing research and our own experience at EMH Physical Threrapy with the thousands of patients we healed, demonstrates that physical therapy can provide understanding, education, effective treatment and relief of pelvic floor symptoms.
OUR ENVIRONMENT IS SET UP FOR OPTIMUM HEALING
EMH Physical Therapy has six, comfortable closed-door treatment rooms for full privacy. Many traditional physical therapy practices have open gym- like settings with curtained treatment tables where you can hear everyone around you. At EMP Physical Therapy, you will be seen by the same licensed DPT (Doctor of Physical Therapy) at the Initial Evaluation (approximately one hour) and at each follow up treatment session for a full 40+ minutes. Many traditional practices have staff PT’s treating 3 to 4 patients simultaneously and treatments can be adminstered by non licensed “PT Aides” or licensed “PT Assistants”. Not at our practice. Having the same DPT from start of care to successful discharge, allows development of trust, ability for your DPT to adjust treatment as you improve, and you will achieve faster relief of pain and pelvic floor symptoms.
WHAT HAPPENS AT THE INITIAL EVAULATION FOR PELVIC FLOOR DYSFUNCTION?
The Initial Evaluation is time set aside so you and your licensed DPT can discuss, learn, share information, do tests and measurements, hear treatment solutions and plan for your full recovery. It includes the following: History, Education, Physical Examination, Discussion of Findings, Instruction in Relief Technique, Scheduling Follow up Treatments.
HISTORY: The Initial Evaluation first involves a detailed history/discussion of all your symptoms related to the pelvic floor. The licensed physical therapist will listen to your main concerns. then will ask questions about specific complaints of lower back pain; hip pain; abdominal pain/bloating; surgeries that may have resulted in increased scar tissue/adhesions. Questions will be asked about bladder symptoms such as leaking, urgency, “key in lock”, hesitancy. Questions about bowel symptoms such as constipation, fecal incontinence manual disimpaction; if you spend more than 5 minutes straining on the toilet. Questions about sexual symptoms such as painful intercourse, erectile dysfunction, perineal pain, fear of penetration and difficulty with orgasm. It very common that patients may be referred to PT with one pelvic floor diagnosis, and during our history taking, we realize that there are some other pelvic floor symptoms. For example, a woman may have a diagnosis of “Stress Urinary Incontinence” and we discover there is a concurrent symptoms of constipation and dysparuenia.
EDUCATION: After our detailed history taking and answering your questions, your DPT will educate you on anatomy of the pelvic bones and muscles using our anatomical model. This helps you visualize and understand the structures your DPT will be examining. We believe that education is empowering, so we spend time to review the anatomy, review the purpose and step by step of our pelvic floor physical examination. When you are ready to commence with the physical examination, we will ask for your permission. We understand the need for privacy, comfort, respect and patient’s involvement in their return to full pelvic floor health.
EXAMINATION You will be comfortably positioned and draped before your DPT visually inspects the pelvic floor region for skin color, tissue alignment while at rest. After the visual inspection, your DPT will ask you to perform some pelvic floor movements,. Such as asking you to contract or tighten your pelvic floor (sometimes known as “Kegel”). Then your DPT will ask you to relax the pelvic floor, observing the quality of the movement, then to “bear down” . Your DPT observes the excursion, hestitancy or inability to perform these movements. Many patients may not know how to do one or all of these movements and this is a common response especially when the pelvic floor muscles are in spasm, or weak or uncoordinated. Next, your DPT will palpate or feel the skin, connective tissues and muscles of the external hip, thigh, abdomen and pelvic floor regions to note for pain, mobility, restrictions, banding, referred pain to other regions.
With your permission, the internal exam follows. The internal exam is where the DPT inserts her gloved (non latex) lubricated (K-Y or astroglide gel) index finger intravaginally or intrarectally up to the level of the pelvic floor muscles, which is approximately 1 inch from the anal or vaginal opening. Your DPT will palpate or feel for tissue excursion, if one side is more flexible vs the other side, again noting pain, adhesions, trigger points and if her palpation over specific muscles reproduces your symptoms (a good sign).
Muscle strength testing of the pelvic floor follows with the DPT’s index finger remaining internally to feel for quality of muscle contraction. Your DPT will measure how strong your pelvic floor muscles are, how long can your muscle maintain that strong contraction up to 10 seconds and can the initial strength with time held can be repeated up to 10 repetitions.
Biofeedback testing may be next. “Bio” means body and “Feedback” means receiving information about a physiological activity. Biofeedback measures the electrical activity of the muscle and transmit that information to either a range of numbers and/or sounds. The patient sees the numbers and learns how to retrain their pelvic floor muscles with the guidance of the physical therapist. For adults, your DPT will either insert either a vaginal sensor (width and length of a female index finger) intravaginally or use a rectal sensor (width and length of a female pinky finger) which is inserted intrarectally slowly, and with concious use of breath. For children/teenagers, small round surface electrodes are placed externally on the skin near the anus for most accurate reading of pelvic floor muscle activity. For the adults, the internal sensors have small metal strips on them to pick up the electrical activity of the pelvic floor muscles. Your DPT will measure the electric voltage (microvolts) that your pelvic floor muscles elicits during rest, during slight contraction, during full contractios. We will measure if your muscle returns to full baseline rest following contractions, whether your muscles have good endurance etc. Biofeedback training is utilized during follow up physical therapy treatments to help you learn how to properly recruit your pelvic muscles and regain normal function.
DISCUSSION OF FINDINGS As licensed physical therapists, we are specifically educated to examine all the musculoskeletal details relating to pain, movement patterns and have studied a wide range of therapies to correct these dysfunctions. We the discuss our finding and tests results with you and then discuss your treatment plan. Treatment can include manual techniques such as myofascial release, visceral mobilization, connective tissue massage (skin rolling), trigger point massage to release intramuscular tension, improve mobility of connective tissue, and improve the mobility of organs that lie beneath the skin and muscles. We will also teach you a tailored therapeutic exercise routine to improve flexibility, strength, balance and coordination.
INSTRUCTION IN PELVIC FLOOR RELIEF TECHNIQUE You will be taught a specific posture, body awareness technique, self massage, or given a stretch so you can immediately incorporate all that you have learned in the Initial Evaluation and start on your road to recovery.
SCHEDULING FOLLOW UP TREATMENT Your licensed DPT will inform you what is the best frequency of treatment for your specific condition. After 17 years of healing thousands of patients, is is our experience that consistent PT treatments along with our patients follow thru in performing their tailored home exercise program required to make excellent gains in their return to pain free normal function. Skin, connective tissue, muscles and joints that have been in faulty movement patterns for weeks, months and years (we see many patients with 10 to 20 years of pelvic floor symptoms) requires time to reduce spasm, adhesions, restrictions and require regular, gentle manual guidance by our trained hands to reverse these patterns. It is common for our patients to “clear their busy schedules” to attend PT 3 times a week for the first 2 weeks, then decrease frequency to twice a week for the next 6 to 8 weeks. An individualized home program is also instructed from day one and added, modified as progress is made.
The Director of EMH Physical Therapy, Evelyn Hecht, PT, ATC, a licensed physical therapist for over 25 years, oversees all patients referred to her practice. She reviewes your findings by your DPT, discusses and guides your treatment plan, reads your daily “SOAP”notes that are written by your DPT and reads every MD report before it is sent to your physician. In 2002, Evelyn developed and for the next seven years, taught the first APTA (American Physical Therapy Association) approved educational courses in pelvic floor dysfunction & women’s health for the Doctor of PT candidates at NYU and Stony Brook University. She lectures regularly to physicians in speciality fields such as Internal Medicine, OB/GYN, Urology, Gastroenterology and Surgery about physical therapy evaluation and effective treatments for their patients diagnosed with pelvic floor dysfunction.
Whether you’ve experienced symptoms for two months or 20 years, we can help you find relief, decrease pain, and return to normal function.
WHAT IS PELVIC FLOOR DYSFUNCTION (PFD)?
PFD is a term used to describe pain and disruption of bladder, bowel &/or sexual function due to restrictions of the muscles and nerves of the pelvis.
The pelvis is a bowl-shaped bony structure which holds the organs of digestion, elimination (bladder & bowel) and sexual function. The pelvic floor muscles (PFM) are located at bottom of the bowl, attaching like a hammock from the front pubis to the back coccyx bones. The PFM supports the viscera, maintains continence (bladder and fecal), assists in core/trunk stability and enhances sexual function. The pudendal nerve and its branches also travel through the PFM.
Injury to both muscle and nerves can result in the following symptoms:
- Painful intercourse (Dysparunia)
- Vaginal Pain (Vulvodynia)
- Pubic Bone Pain
- Coccyx Pain
- Prolapse (Bladder, Rectum)
- Low sexual desire/sexual distress
- Frequent Urination
- Urinary/Fecal Incontinence
- Penial Pain
- Diastasis Recti (abdominal separation)
- Rectum/Anal pain
- Core weakness
- Poor erection/ejaculation
PFD can also occur following surgical removal of the prostate gland in men, which can be managed with physical therapy.
HOW DOES PHYSICAL THERAPY TREAT PFD?
A wide range of manual therapies are performed to release restrictions of pelvic floor muscles, hip, abdominal, low back muscles & internal visceral organs. Biofeedback testing and training is utilized to increase awareness of the pelvic floor muscles. Relaxation &/or strengthening exercises are taught. A bladder retraining schedule is implemented to stop urinary frequency. The “brace and bulge” technique is taught for functional bowel elimination. Pelvic stability and function is restored.
(212)288-2242 or email firstname.lastname@example.org to schedule a PT appointment or ask a question to our director, EVELYN HECHT, PT, ATC