Bladder and Bowel Dysfunction
Problems with urinary or fecal continence or voiding may be addressed wholly or in part through pelvic floor physical therapy. The pelvic floor muscles which sling across the bottom of our pelvis perform critical roles in helping to maintain continence, and allow for emptying when the time is right. A full assessment of the function of the pelvic floor will allow for a greater understanding of potential contributing factors in bladder and bowel dysfunction, and can therefore also be a key part of treatment.
Conditions treated include but are not limited to:
Stress urinary incontinence
Urge urinary incontinence
Urinary frequency
Fecal incontinence
Constipation
Frequently Asked Questions
How much leakage is normal after having a baby?
Some urinary incontinence is considered normal within the first 6 months after having a baby, and the trend should be improvement of symptoms. Generally though, you can start working with a pelvic health PT much sooner than that – so why not be proactive?
What if leakage isn’t my issue, and I’m having a hard time actually going to the bathroom?
Pelvic floor muscles function on a full spectrum of activity, and healthy bladder and bowel habits rely on them being able to both relax and contract appropriately. Pelvic floor muscles can absolutely be involved in retention or “shyness” and working with a pelvic health specialist can be helpful in those cases as well.
Pelvic Pain
Pain in the pelvic region can be harder to pin down or describe than other bodily pains. This is probably in part because the average person doesn’t talk about it much, and also because the pelvic region is fairly complex. The pelvic floor muscles attach to the pubic bone at the front of the pelvis, and sling back to the coccyx, or tailbone. As postural muscles which are deeply integrated into the way we move our bodies, problems with this muscle group can present in a variety of ways.
Treatment of pelvic pain is almost always multifactorial, and requires a full-body perspective to establish WHY pain has started and allow for long-term management. The empowerment of understanding our own bodies as best we can has both psychological and physical effects.
Conditions treated include but are not limited to:
Dyspareunia/pain with intercourse
Vaginismus
Interstitial Cystitis
Coccyx pain
Anorectal pain
Abdominal pain
Sciatica
Frequently Asked Questions
Why do I feel like I have a urinary tract infection, but antibiotics don’t seem to be doing anything for me?
If you have been working with your physician and even the right antibiotic isn’t changing your symptoms, you may be dealing with another condition, such as Interstitial Cystitis. A holistic treatment plan for these kinds of pelvic pain conditions is the first choice, and a physical therapist is often an important member of that team.
Is pain with sex normal?
Not if you don’t want it to be. Intercourse should not be inherently painful, and specialized physical therapy can help to figure out why you are experiencing pain, and what can be done to diminish or resolve the issue.
Orthopedic conditions
As a physical therapist, Dana is able to evaluate and treat all orthopedic problems appropriate for rehab. Specialist training in pelvic health lends a more holistic perspective to the typical physical therapy complaints. Sprained ankles or knees, injured shoulders, and chronically sore backs don’t exist in a world all their own, and may respond better when considered in relation to the whole person.
Conditions treated include but are not limited to:
Sport or overuse injuries of the
hips
pelvis
shoulders
elbows
ribs
knees
ankles & feet
Back pain
Neck pain and headaches
Rehabilitation after surgery
Frequently Asked Questions
When should I see a physical therapist for an orthopedic condition?
Whenever it makes sense for you. Since a physician’s referral is not required to be evaluated by a physical therapist in the state of New York, PT could be your first stop in trying to figure out a new ache or pain. On the other end of the spectrum, PT might be your last stop, helping to get you back to being YOU after a surgery.
Is it possible that my hip or low back pain is associated with my pelvic floor function?
YES. Studies have demonstrated that both of these conditions can be associated with urinary incontinence. We also have evidence that supports associations between low back or hip pain and knee function, as well as low back or hip pain and foot mechanics. There have even been studies examining the effect of ankle position on pelvic floor function.
Prenatal and Postpartum
The changing body during pregnancy and the postpartum period can come along with its own particular aches, pains, and surprises. Specialist physical therapist perspective and training in this phase of life allows for us to safely and effectively keep moms-to-be and new moms healthy and moving.
Conditions treated include but are not limited to:
Sciatica
Rib and mid-back pain
Hip and leg pain
Pubic symphysis pain
Perineal pain
Coccyx pain
Urinary or fecal incontinence
Dyspareunia/pain with intercourse
Diastasis Rectus Abdominus
Frequently Asked Questions
My kids aren’t babies anymore, but I never knew I could address some of the ways my body changed during pregnancy or birth. When does “postpartum” stop?
While we love to address issues in the body as soon as safely possible, there are some perspectives that consider a person postpartum for life after having born a child. It is never too late to learn about our bodies or make changes.
Pediatric pelvic health
Bladder and bowel control affect us throughout life. Physical therapy with a pelvic specialist may be a key treatment for children who struggle with these issues.
Conditions treated include but are not limited to:
Chronic constipation
Encopresis
Urinary incontinence
Urinary frequency or urgency
Painful bladder or bowel elimination
Urinary retention
Frequently Asked Questions
Is there any harm in taking a “wait and see” approach and letting my child grow out of their issues?
There may be. A lot of the bladder and bowel habits that follow us for the rest of our lives start in childhood. I find that it isn’t uncommon to uncover a history of childhood constipation, bedwetting, or incontinence while interviewing an adult about current issues. If we are able to learn better habits earlier, we may be able to decrease the risk of more problems in adulthood.
Preparing for birth
When I tell people that I specialize in pelvic floor physical therapy, the most common response (other than a blank stare) is “Oh, so you work with postpartum moms mostly?” The reality is that I work with people all across the age and gender spectrums, but postpartum people are a pretty logical assumption! Pregnancy and birth are Major Life Events for the pelvic floor, and can be a source of trauma or injury to those tissues.
So why am I mostly seeing these patients only after this Major Life Event occurs?
The more we know about our bodies and what the birth experience might look like, the more proactive we can be in setting ourselves up for success. Don’t get me wrong, the phrase “We make plans and the gods laugh” has never been more true than in the birthing process, but knowing what we want and knowing what the different possibilities are is a huge factor in empowering birthing people. And empowered people are happier people. And happier people are healthier people.
Preparation for Birth Sessions can be used to address questions that pregnant people or their partners have about the birthing process. Some points we may want to touch on are:
What do you envision your birth experience to be? Do you have any goals or boundaries that you want to work with?
What is the pelvic floor?
How is it affected by pregnancy, vaginal birth, or cesarean birth?
How can you prepare your body for birth? What positions can be used in labor to promote an easier birth?
How can your partner play an active role in easing your birth experience?
What can you expect from your body immediately postpartum?
Frequently Asked Questions
Are You a Doula?
I have gone through a doula training specifically for pelvic floor physical therapists, but have not gone through the full process of doula certification. I do not generally assist at births, but do hope to help prepare birthing people and their partners ahead of time to be more confident and empowered in their birthing journeys.
Male Pelvic Health
Pelvic floor dysfunction affects males too, though less commonly than in females, and discussed or recognized even less often. The male pelvic floor consists of muscles which run from the public bone at the front of the pelvis, to the tailbone at the back. Dysfunction can cause penile, testicular, groin, or abdominal pain, erectile dysfunction, urinary urgency or frequency, or constipation. Whether pain is chronic or new, or if you are dealing with the consequences of a recent prostatectomy, pelvic floor rehabilitation can help.
Conditions treated include but are not limited to:
Persistent low back, hip, or leg pain
Sciatica
Prostatitis
Genital pain
Anorectal pain
Coccyx pain
Pudendal neuralgia
Ejaculatory or erectile dysfunction
Abdominal pain
Frequently Asked Questions
Is physical therapy helpful before a prostatectomy?
Sure! If you are able to do some “prehab” before your surgery, you’ll be ready to feel proactive and productive from the start. And you’ll have a better sense of what to expect, which can really help in managing anxiety during a potentially stressful event.
Prolapse
Prolapse is another common presentation of pelvic floor dysfunction. Pelvic organ prolapse (POP) occurs when an organ of the lower abdomen has moved from its starting location to one that may cause discomfort, urinary or bowel symptoms, or feelings of instability. Though a prolapse diagnosis can be daunting, specialized and individualized pelvic rehab can help to decrease symptoms and keep patients moving and doing the things that they love.
What are the symptoms of pelvic organ prolapse? Some of the most common descriptions are:
A feeling of heaviness in the lower abdomen
A “dragging” discomfort in your vagina
Feeling like there is something pressing down into your vagina
Feeling or seeing a bulge coming out of your vagina
Frequently Asked Questions
Can physical therapy really help with prolapse?
Often. While some more severe grades of prolapse will likely not change with physical therapy alone, milder ones certainly can. Additionally, physical therapy addresses some of the underlying factors which contribute to prolapse, so even if you do decide to pursue a surgical repair, working with a pelvic health physical therapist can help to make your surgery a success in the longer-term.