Pelvic Physical Therapy for Interstitial Cystitis (IC)or Bladder Pain Syndrome (BPS)

   Current Science, and Conservative Care Strategies

                              Questions and Answers                                 

  Pelvic pain is a great challenge for men and women, and individuals can go for years before receiving a diagnosis. Pelvic pain can involve bladder pain, and other symptoms such as urinary urgency, frequency, hesitancy, incomplete emptying, urinary incontinence, and distress. Everybody is different! With bladder pain syndromes, there can be associated back, tailbone, hip or groin pain, bowel problems, and or pain with sexual function as well.

In Interstitial Cystitis (IC), sometimes there is an autoimmune component, with the walls of the bladder showing inflammation, which is viewed on a bladder scope (cystoscopy). In IC, the areas of inflammation are called Hunters Lesions. Or, sometimes women and men are diagnosed with bladder pain syndrome (BPS) based on symptoms. Always see your MD to assess the condition. Pelvic muscles surround the bladder, urethra and outlet into the penis or vagina. The bladder has 2 key jobs, 1.Storage.2.Emptying.

Male and Female Bladder;Urethra to outlet with Pelvic Muscles (minimal view).

You may ask your doctor:

Is your Pain from Hunters lesions (HL IC) or Non Hunters lesions (N-HL IC/BPS)?

Irritation from a UTI or hunters lesion or other aggravating factor will often cause urinary urgency and frequency, that can persist over time. Those with the autoimmune type of IC may also have also have allergies, asthma, fibromyalgia, irritable bowel syndrome, thyroid disorders, ulcerative colitis, or other conditions, some of which can aggravate pelvic pain.

The goal of pelvic PT is to find out your pain provoking items, and put you in the driver’s seat for finding out your triggers and to develop optimum self -care.PT provides evaluation of all components of pain, and helps you discover if you have muscle spasm, shortening, weakness, lax or loose muscles, and helps you to train these muscles as needed. This may include biofeedback, home unit training for relaxation or strengthening, manual therapy/massage, behavioral habit training, bladder diaries, guides to nutrition resources and supplements as approved by the Interstitial cystitis association. Treatments may overlap for the two types of bladder pain problems, and include medical care with urologic testing, and medication, and possible instillations into the bladder.

Why PT for a bladder problem? Because we can address muscle based problems, as well as behavioral training and guide you to nutrition resources.

Conservative Care: PT: What we do: The goal of PT is to reduce and or eliminate your symptoms with conservative care. This involves detective work. Also, PT often uses mind body practices and exercise, such as yoga and meditation for pelvic pain.

A key research study found PT using myofascial therapy helped with significant pain reduction in individuals with IC/BPS (see Fitzgerald et al). 87% of patients with IC/BPS have tender or trigger points in muscles, and there was 59% improved in Pelvic Floor PT, and 26% with general massage! PT and massage therapy are a great combination.

Experts agree: “The vast majority of patients with N-HL IC/BPS need management of their pelvic floor muscles as the primary therapy, complemented by bladder-directed therapies as needed as well as a multidisciplinary team to manage a variety of other regional/systemic symptoms.” (direct quote Han et al).

You may wonder how and why you developed IC/BPS, and according to research, Chronic Pelvic Pain  may be linked to a number of factors, such as :

Birth history (your own history of cesarean vs vaginal birth)

Genetics making you susceptible to autoimmune illness

Environmental influences, (Gut biome, nutrition, and your health history such as UTI, Surgeries, childbirth, exposure to yeast, mold, parasites, or bacteria).

Psychosocial profile: mood, traits, and sleep quality

Adverse Childhood Experiences (ACE)

So with all of this information in mind, consider that there are many elements to improving health and wellness, and many people reduce their bladder symptoms by shifting habits, nutrition, and so forth; consider resiliency and that the bladder can improve with the right combination of treatments over time.

Is your gut involved?

Recent research is looking into the gut biome, which is the network of probiotic and prebiotic organisms in the digestive tract that help us rest, digest, support immunity, create vitamins and nerve transmitters…and found:

 “IC/BPS is associated with significant morbidity, yet underlying mechanisms and diagnostic biomarkers remain unknown. Pelvic organs exhibit neural crosstalk by convergence of visceral sensory pathways, and rodent studies demonstrate distinct bacterial pain phenotypes, suggesting that the microbiome modulates pelvic pain in IC. Stool samples were obtained from female IC patients and healthy controls, and symptom severity was determined by questionnaire.” Testing  “demonstrated significantly reduced levels of E. sinensis, C. aerofaciens, F. prausnitzii, O. splanchnicus, and L. longoviformis in microbiota of IC patients. These species, deficient in IC pelvic pain (DIPP), were further evaluated, and “DIPP species emerged as potential IC biomarkers.” (Braundmeier-Fleming et al).

There is a bladder biome as well, and research is expanding on this topic over time. If your biome is lacking in helpful species, or has an overgrowth of certain bacteria, most patients are left to trial and error in the use of probiotics, as we do not yet have big studies on IC/BPS. You can ask your health care provider if they have a brand they recommend, and patients should start on the lowest dose and note any symptoms positive or negative. Hopefully future studies will clarify the topic.

Attendees at the San Diego IC support group have shared success stories over the years, with strategies that were individualized, and you can connect with others for healthcare support via this link:

For more information on IC/BPS please consult the website and you will find I care videos, which is the Interstitial  Cystitis Awareness Research and Education component developed for those suffering; icarevideos; This includes 15 videos with topics ranging from pain management, strategies for sexual activities, mindfulness, nutrition to dial down inflammation, diagnostic testing, male prostatitis vs IC, and other topics.

Check out other blogs to learn more, including anatomy information, this (pelvic problems, pain, IC, Pelvic PT) is all generally a topic not discussed much and facts and resources for care are expanding over time.

Function Smart PT 10803 Vista Sorrento Parkway, San Diego CA 92121, 858 452 0282  

Maureen Mason DPT, WCS, PYT.


 Bedaiwy MA, Patterson B and Mahajan S. Prevalence of myofascial chronic pelvic pain and the effectiveness of pelvic floor physical therapy. J Reprod Med 2013; 58: 504–510.

Braundmeier-Fleming A, Russel N T, Wenbin Y, et al. Stool-based biomarkers of interstitial cystitis/bladder pain syndrome, Scientific Reports 2016

Cozean N, Pelvic floor physical therapy in the treatment of a patient with interstitial cystitis, dyspareunia, and low back pain, J Women’s Health PT 2017, 41(1)

Fitzgerald MP, Anderson RU, Potts J, et al. Randomized multicenter feasibility trial of myofascial physical therapy for the treatment of urological chronic pelvic pain syndromes. J Urol 2009; 182: 570–580.

Han E, Nguyen L, Sirls L, Peterson K, Current best practice in management of interstitial cystitis/bladder pain syndrome, Therapeutic Advances in Urology 2018,10(7) 197-211

Peters KM, Carrico DJ, Kalinowski SE, et al. Prevalence of pelvic floor dysfunction in patients with interstitial cystitis. Urology 2007; 70: 16–18. 82.

Russell N, Daniels B, Smoot B, et al; Effects of yoga on quality of life and pain in women with chronic pelvic pain: Systematic review and meta-analysis, J Women’s Health  Physical Therapy 2019, 43(3);144-154

 Weiss JM. Pelvic floor myofascial trigger points: manual therapy for interstitial cystitis and the urgency-frequency syndrome. J Urol 2001; 166: 2226–2231. 83.

Constipation Blues,

Tips and Lifestyle Help with Pelvic Physical Therapy

Maureen Mason, DPT, Function Smart PT

   In the realm of Pelvic Physical Therapy (PT) constipation is evaluated and treated with conservative care techniques, and some individuals  are improved rapidly, in a few sessions, while others may need several sessions to achieve results, in addition to lifestyle changes, supplements and pharmaceuticals. Let’s look into the medical side of things you may not know…fluid and fiber, nutrition, exercise, and the mechanics of motility and defecation. We will start with the basics, and then address more complex concerns you may have in your unique case.


  Fluid: drink 6-8 glasses of water a day, or more specifically, ½ body weight in ounces of water per day. This general guide helps a lot of people! Those with bladder leaks tend to limit hydration, which produces constipation, which then aggravates incontinence, so it is a cycle that is difficult. Gradually build up hydration in order to ease constipation. For example;160 # individual drinks 80 ounces per day. Drink most of the water outside of meals, and earlier in the day. You will likely have a need to urinate for several seconds, every 2-3 hours with the fluid intake.

Fiber: Consume 25-35 grams per day, mostly from cooked vegetables and small amounts of fruit. Ground flaxseeds, and or chia seeds may gradually be added to the diet as well. Psyllium fiber, or benefiber can be helpful as a supplement as well. Limit, or even eliminate bananas, bread, white rice, and highly processed foods. Dry fibers as in breads and “energy bars” or even too much raw kale can aggravate constipation, so hydrate, chew foods, and eating mostly cooked vegetables will work the best.

Exercise: Walking, stretching, and also deeply relaxing the abdomen, hips and back, and pelvic muscles helps “move things along” and also promotes “deep body relaxation”, which then facilitates digestive processing. When we are stressed, or only perform tightening and shortening exercises, the pelvic and other muscle clenching sends signals to the colon that it is not “safe” to go. Deep belly relaxation breathing is an important part of exercise as the diaphragm is a piston, a pump of sorts, for the digestive system, and the “relaxation exercise” component of pelvic PT often surprises people and they take a while to get on board with it.

Pay attention: to body “signals” that you need to go, and every time that you may “wait and hold it” this encourages a larger firmer stool. Pay attention to your digestion output. The time for the small intestine and large intestine processing and reacting to food intake 1 to 2 days or more after you eat. You may eliminate right after eating, if the for example, you have a rapid gastro-colic reflex for filling and emptying, but the immediate output is not from the meal you just consumed.

Food intolerances? Note that some people may bloat the next day following high dairy consumption, or wheat, and these are the two main triggers for indigestion as well as food additives, so strive for “whole food”, unprocessed.

Pooping technique: Relax your bottom, actually the pelvic muscles*, and bear down with a gentle firming of the abdomen to eliminate; many clench and tighten and this prevents output. Many use a squatting stool or “squatty potty” to help optimize output.

A colon massage can help you to eliminate.

Complex issues that can make constipation more difficult include medications such as necessary antibiotics for health conditions, which disrupt the gut biome of symbiotic, helpful bacteria. Post antibiotic dysfunction may be constipation, or diarrhea. Pain meds often slow digestion. Body tension, shallow breathing, and insufficient exercise are associated with constipation. A high junk food diet and lots of starchy, low fiber food can cause digestive issues and if this is you, the reader, a great plan is to add one new healthy item per week, and read free online nutrition education.**

What to expect with pelvic PT? A program and plan for your self -care, and in treatment a non-invasive Ultrasound on the abdomen, biofeedback with surface sensors on the pelvic muscles, therapeutic exercise and hands on manual therapy such as a specialty  colon massage and techniques to optimize rib, diaphragm, and pelvic muscle length and tone. Health trackers are provided to help you become a self -care detective as well!


*pelvic muscles see post How to relieve constipation naturally


Chmielewska A, Szajewska H, Systematic review of randomized controlled trials; Probiotics for Functional Constipation, World J Gastroenterology 2010, 16(1)

Cho YA, Kim J, Effect of probiotics on Blood lipid Concentrations; A Meta-Analysis of Randomized Controlled Trials, Medicine 2015 94(43)

Ezenwa L A, Brewer J, Markowski A, A Comprehensive Physical Therapy Approach including Visceral Manipulation after Failed Biofeedback Therapy for Constipation, Tech Colproctol 2016, 20

Krogh K, Chiarioni G, Whitehead W, Management of chronic constipation in adults, United European Gastroenterology Journal 2017, 5(4)

Ma-Re,  Wen N R, Hu Y L, Zhao L, Tuerhongjiang T, et al, Biofeedback -guided pelvic floor exercise therapy for obstructive defecation; an effective alternative, Randomized controlled trial, World J Gastroenterology 2014

Ouwehand AC, A review of dose-responses of probiotics in human studies, Beneficial Microbes 2017, 8(2)

Saeed, Madiha, The holistic prescription, 2017, Rowman and Littlefield Lanham, Boulder, New York, London

Post- Partum Fitness, and Pelvic Floor Dysfunction

A shy pelvis…about exercise…post partum.

Many women are shocked to discover that they have a different body post partum , not only in appearance, but in power, stamina and performance. Although some women bounce back to full function, many have to adjust, and reduce their activities to reduce problems such as bladder leaks, pelvic pain, and other troubles. Our health care system does not prepare women for post partum pelvic floor dysfunction (PFD), yet women’s health advocates are passionate about getting the message out there, Function Smart Pelvic Health team included! Here is a list of unexpected PFD that can occur around the perinatal window, and heads up, recur or become troublesome again around menopause:

Bladder hesitancy, urgency, frequency, pain, and leakage.

Bowel leakage, constipation, straining, pain.

Pelvic pressure, heaviness, aching, bulging, pelvic organ prolapse

Structurally, there may also be birth related over stretch injury to the myofascial structures, at the abdomen:diastasis rectus abdominus, the spine and pelvic joints :low back pain, pelvic girdle pain. Add in all the hormone changes and ta da!The body is in need of support, rest, recharge, and re booting.Medical guidelines concur with a gradual build up of exercise demands, to reach goals.Short home exercise programs can expand to longer sessions, and a return to fitness requires support for childcare for moms as well.As you read this do not despair, we promote health, resiliency, and return to function.Your body is an amazingly adaptable creation that needs your brain to recognize PFD problems and come up with a plan for care, and your own health and wellness, in addition to care demands for your growing family.

The key exercises women need post partum are to work the core, to restore and train foundations, but what is it?Technically the core is an interrelated group of deep muscles, the pelvic floor muscles (PFM), low back muscles (Multifidus), and the deepest abdominal corset, the Transverse Abdominus(TRA). Exercising for gradually increased lengths of time, in varied postures, will rebuild the core so you can get off the floor and spring into action beyond your home, if that is your goal. Consider that new moms have tasks of frequent lifting 7# plus infant, that will quickly ramp up to an 18# plus toddler, so moms have to be fit for child care and all its varied demands as well; lifting, pushing, pulling, and carrying.

PFM, Multifidus and TRA all ideally “turn on” and adjust to the workload for painfree function. Advanced post partum fitness exercises include rotation, agility and sport specific training, with core, upper and lower extremities.Strengthening post- partum can produce rapid results but in most cases it takes months to rebuild the core, especially for community and recreational activities, so pace yourself!

Here is a view of the 3 layers of the pelvic muscles, viewed from below, from the back.At the top area the pelvic muscles connect with the hip, for mobility and stability and painfree function if working optimally.The white bands down the center are deep ligaments (sacrotuberous) that connect the hamstrings and gluteals into the pelvic floor and up into the spine, so everything is “connected” from lower body into the pelvis and on up.If you have symptoms of PFD conservative care such as pelvic physical therapy may be part of your health care team for optimizing function and return to fitness; feel free to call for a Q n A re Physical Therapy.

Buurman M B R, Lagro-Janssen A L M, Womens perception of post -partum pelvic floor dysfunction and their health seeking behavior; a qualitative interview study, Scan J Caring Sci; 2013,27;406-413

Lipshuetz M, Cohen S M, Liebergall-Wischnitzer M, Zbedat K, Hochner-Celnikier D, et al, Degree of bother from pelvic floor dysfunction in women one year after first delivery, Eur J Obstet Gynecol Reprod Biol 2015; 191:90-94

Zourladani A, Zafrakas M, Chatzigiannis B, Papasozomenou P, et al, The effect of physical exercise on postpartum fitness, hormone and lipid levels: a randomized controlled trial in primiparous, lactating women, Arch Gynecol and Obstet 2015; 291, 3

Diastasis Rectus Abdominis and your health,Post Partum

Diastasis Rectus Abdominis (DRA) is a current hot topic in perinatal health and wellness, with lots of research and fitness formats being developed to “help it heal”. It is a thinning and separation of the central insertion site of all the abdominals, the “linea alba”. It occurs most often in pregnancy in the later months, and can persist indefinitely into the post partum time. It can be a small separation that heals naturally on its own, or it can be a cosmetic as well as fitness problem with persistence post partum. Very rarely does it require surgery! Likely it is a natural thinning of the fascia (connective tissue) to allow for growth of the baby. Men and non pregnant women can also exhibit this, and in contrast to a hernia, the internal structures are not bulging out.

Do you have it? If so , how wide, and what region?We have a few methods to assess, with surface belly real time ultrasound being the easiest and most accurate. Is there an associated pain problem in the back, pelvic or hip area? How do you do in attempts at every day living, and your “core”, with rolling over, getting out of bed, lifting, pushing and pulling, and twisting motions? These are motions that can be screened and keyed into exercise prescriptions as needed, in a scaffolding format. In other words, no double leg lifts or planks if you have pain symptoms or doming and bulging of the belly, in my expert opinion. Why not exert to the max even if it hurts or bulges? Because the abdominal wall works with your spine and pelvic muscles for integrity of load transfer, with abdominals optimally providing support like a brace or corset.Overexertion may put pressure into the pelvic area contributing to pelvic floor dysfunction, such as bladder leakage, bowel leaks, pelvic organ prolapse, and /or compensatory clenching of the pelvic and spine associated with pain and loss of mobility and comfort.

The deepest layer of the abdominal wall, the transverse abdominus (TRA) is one of the key factors to address in DRA rehab. TRA functions for support throughout the trunk and its fascia blends all the way into the back, the latissimus dorsi and several other muscles. Sometimes just the upper, or lower sections are working and the rib cage is locked up (stiff).There are easy ways to get TRA to wake up and get back to work again for performance from getting out of bed (a double leg lift, perhaps?) to lifting a baby and carseat, to getting back to Pilates, Yoga, Running or CrossFit, whatever your goals. TRA works intimately with the pelvic floor muscles (kegels) as well, in timing and stamina for each task. There is such a need for this type of progressive fitness programming that we are developing a post partum fitness class this summer, stay tuned, and remember to breathe and relax as well, the diaphragm needs its full excursion for vitality!

Chiarello C, Falzone L, McCaslin K, Patel M, Ulery K, The effects of Exercise on Diastasis Rectus Abdominus in Pregnant Women, Journal of Women’s health physical therapy 2005: (29):1 pgs 11-16 

Dufour S, Bernard S, Murray-Davis B, Graham N, Establishing expert based recommendations for the conservative management of pregnancy-related diastasis rectus abdominis;a delphi concensus study, JWHPT 2019, 43;2

Lee D, Hodges PW, Behavior of the linea alba during a curl up task in diastasis rectus abdominus:  An observational study, JOSPT 

Lee, D, 2017 Diastasis Rectus Abdominus e book,

Litos, K, Progressive therapeutic exercise program for successful treatment of a postpartum woman with a severe diastasis rectus abdominus, J Womens Health Phys Ther 2014 38(2) 58-73    

Mota P, Pascoal A, Carita A, Bo K, Prevalence and risk factors of diastasis recti abdominis from late pregnancy to 6 months postpartum, and relationship to lumbo pelvic pain Manual therapy 2015: 20:1 pgs 200-205

Tuttle LJ, Fasching J, Keller A, Milan P, Saville C, et al, Noninvasive treatment of post- partum diastasis recti abdominus, A Pilot Study, JWHPT 2018, 42(2)

COVID-19 – Implications and Options

The COVID-19 pandemic seems to have stopped much of the world. Once busy streets and shops are empty, activities are cancelled and you may not even be going to work. One thing that the virus has not stopped is pain and injury. Maybe you were seeing your PT when stay at home orders were issued. Maybe you’ve been having more pain and soreness in your back or neck because of all the time you’ve spent in front of the computer working at home, or maybe you hurt yourself over the weekend doing some yard work or exercising to relieve stress. How do you get the care you need without putting yourself or others at risk during this time of social distancing?
Technology like the internet, electronic medical records, online patient portals, smartphones and webcams open up treatment and intervention options that may be new to both you and your provider. Virtual platforms allow one-on-one interactions in real time. You may not be able to go to your PT, but your PT may be able to come virtually to you! Rules and regulations vary from insurer to insurer but in CA, the Governor has mandated that all insurance plans provide coverage of telehealth appointments. The best way to find out what is available to you and how you can benefit from telehealth PT is to contact your physical therapist and ask!
Virtual Visit Tips
  • You’ll need a device with a screen, camera and microphone. This could be a smartphone, tablet, or computer. Our platform works best with Chrome or Firefox browsers and iphones/ipads.
  • You may need a specific app – your therapist will tell you what you need and where to find it
  • Choose a private space where you feel comfortable to conduct your visit. Make sure you have room to move, this is still a PT visit and movement is the whole point!
  • Wear clothes that you can move in, and that your PT can see you move in. Very loose, baggy clothing makes it hard for your PT to see and evaluate your movement
  • Collect any equipment you may have beforehand, so your PT knows what you have to work with. Examples might include resistance bands, foam rollers, yoga mats and blocks, etc.
  • Be ready to get creative and have fun! For many patients and therapists, televisits are a new experience so expect to work together and try new things to find what works best for you.

Male Pelvic Floor Dysfunction and PT

Male Pelvic Floor Dysfunction,

                       The low down on down there,

                                     Conservative Care with Physical Therapy


Maureen Mason DPT

Men come to Function Smart  PT for all sorts of pain problems, of the “usual sort”, such as low back and hip pain. But certain pain areas require a unique analysis in the realm of  PT:Pelvic Specialty.Male Pelvic Floor Dysfunction (PFD) may include pelvic pain, including the genital structures and or the rectal area, bladder and bowel problems, sexual problems, and difficulties with participation in activities as well as problems with rest due to discomfort.Here’s a little background on pelvic PT:

What is Pelvic Physical Therapy?

We have posted info on anatomy and Pelvic PT in this prior post, and this post will give you more insight on male concerns: First, the overview/medical screening and examination can find things that may cause pain into the pelvic area that may be referred from other areas! We have direct access for PT which allows individuals that have not seen a MD come to PT for screening and examination and treatment if indicated. Therefore we look for “red flags” requiring MD attention,or musculo-skeletal signs and symptoms that indicate appropriateness for conservative care with PT.

The abdominal muscles may refer pain into the genital area, and investigation of trigger points may reveal distant sites that spread pain into the pelvic area.Sports hernias, as well as post hernia surgery the muscles and scar tissue may radiate into the pelvis. Nerves can be under compression and cause all sorts of uncomfortable sensations. Bowel, bladder and prostate issues may cause pelvic pain. The prostate surrounds the urethra at the bladder neck, and is involved in urinary control and comfort, as well as sexual function. Often, multiple systems are involved with symptoms that lead to seeing multiple medical specialists.Investigating what is causing the problem is critical to finding the driver of the pain, and not just treat the symptom area!


Lumbar and sacral nerve irritations can spread pain from the spine into the pelvic area.And the most hidden and misunderstood nerve associated with pelvic pain is the pudendal nerve, which has a loopy course from deep in the pelvis over and under stiff ligaments and into the perineum, supplying sensation and motor function and automatic (autonomic) control . Anything from rectal spasm to testicular discomfort to penile shaft and tip pain may be linked to pudendal sensitization.



Myofascial systems such as the hamstrings, gluteals, deep hip muscles and pelvic floor muscles attach into the ligaments pictured here, and into the bony pelvis and may cause weird pains in the “privates”. Falls on the tailbone can leave someone unable to sit, and have pain with activities as well.

The bladder may be a source of pain and this may be from a genetic predisposition, from a disrupted bladder biome, from urinary tract infections, and or prostatitis, benign prosthetic hypertrophy, or post prostatectomy. Also poor bladder habits may be contributory.PT focuses on conservative care with protocols including Bladder training, biofeedback, myofascial and organ specific fascial mobilization, therapeutic exercise, yoga and meditation training, and pain management.



Male pelvic cases we have helped over the past few years, with very grateful clients (these are private and complex matters) include:

Post vasectomy pain, post spine surgery bowel and bladder leakage, post prostatectomy urinary incontinence, urinary distress related to BPH, Interstitial cystitis/painful bladder syndrome, male fitness related groin, abdominal and pelvic pain, coccyx pain, post op colorectal surgery pain, constipation and abdominal pain, sexual dysfunction with penile/abdominal strains, ED,early ejaculation, pain with sexual function, and deep hip, hamstring and pudendal pain.

Feel free to contact us via our e mail on our “staff” Function Smart site, or call for a complimentary 5-10 minute phone Q and A as needed! 858 452 0282






What is Endometriosis?

Endometriosis is unfortunately a common health problem in women, 1 in 10 women are dealing with this diagnosis today. It gets its name from the word endometrium, the tissue that normally lines the uterus or womb. Endometriosis happens when this tissue grows outside of your uterus into other areas of your body where it doesn’t belong. It can most often be found in the ovaries, Fallopian tubes, and in the abdominal area surrounding the uterus. The vagina, cervix, vulva, bowel, bladder, or rectum can also be affected.

Symptoms felt with Endometriosis?

There are several types of symptoms that can occur with Endometriosis and women can present differently with what they may feel. Common symptoms reported are pain – severe menstrual cramps that may progressively get worse with age, or chronic pain in lower back and pelvis area. Pain with intercourse (dyspareunia), can be described as deep or superficial pain with penetration. Intestinal pain, and pain with bowel movements or urination or blood in stool or urine are also reported.

In addition, patients often present with bleeding or spotting between menstrual periods. Other common complaints include difficulties with conceiving/infertility, digestive issues – IBS, constipation, bloating, and/or nausea.

Diagnosis of Endometriosis?

There are several ways a physician may diagnosis Endometriosis.

  • Pelvic exam – During a pelvic exam, your doctor will feel for large cysts or scars behind your uterus. Smaller areas of endometriosis are harder to feel.
  • Ultrasound –  to check for ovarian cysts from endometriosis. Both vaginal or abdominal ultrasound can be helpful in diagnosis.
  • MRI – another common imaging test to help assess.
  • Laparoscopy – a surgical procedure doctors can use to look inside your pelvic area to see endometriosis tissue. Surgery is the only way to be sure you have endometriosis.

Treatment of Endometriosis?

Pelvic Floor Physical Therapy specialists can help to manage and decrease symptoms of endometriosis such as painful menstrual cramping, abdominal discomfort, pelvic floor pain, and painful intercourse by treating connective tissue dysfunction, treating myofascial trigger points, visceral mobilization  (helping restore the proper mobility of the internal organs, such as the uterus, bladder, colon and small intestine), correcting postural and movement dysfunction, and providing patients with the information and advice they need to take charge of their bodies.

Integrative medical options such as Acupuncture, Chiropractic, Massage, Nutritional therapy, Yoga, Meditation, etc. can be extremely helpful as part of your rehabilitation plan.

Medicine – Your doctor may prescribe things like hormonal birth control, Intrauterine device (IUD), and pain medication to help reduce pain and bleeding.

Surgery is usually chosen in cases in which other interventions were not successful overall. During the surgical procedure, the surgeon attempts to locate any areas of endometriosis and remove them. After surgery, hormone treatment is often continued. Pelvic Physical therapy is important in the recovery to help improve abdominal mobility and minimize any adhesions from surgery and surgical scars.

If you or anyone you know is struggling with this, please don’t hesitate to contact our office for help.

Helpful references to learn more:

Pregnancy Pain and Physical Therapy

Pregnancy can be blissful and care free, or some women start to develop musculoskletal problems such as pelvic pain, back pain, hip pain, and bladder pain. Our national organization has links explaining pregnancy related physical therapy, and specifically pelvic pain, check it out:

pregnant-belly-2-1431447-639x961Be an advocate for yourself and speak to your health care provider to obtain a prescription for specialty Pelvic PT, with goals to increase your comfort, confidence, safety, and fitness power during the pregnancy and in preparation for baby care. Direct access also allows women to come in independently for musculoskeletal screening, such as diastasis rectus abdominus testing, load transfer and body mechanics, sacro -iliac and pubic symphysis alignment, pain and spasm, and biomechanic analysis. (Also I screen for red flags such as high blood pressure which may sneak up on you). Pelvic muscles and the abdomen and spine can benefit from mini workouts and longer exercise routines as needed. Women who exercise at their own comfort level and capacity have better pregnancy outcomes in general re shorter labors and interventions.Also, binders, belts and belly bands may help and we can offer expert advice and equipment sampling.

Here is a direct quote from a recent systematic review of Physical exercise during pregnancy, Nascimento, S, Surita, F, and Cecatti J, Current Opinion,, Lippincot Williams and Wilkens; “Exercises during pregnancy are associated with higher cardiorespiratory fitness, prevention of urinary incontinence and low back pain, reduced symptoms of depression, gestational weight gain control, and for cases of gestational diabetes, reduced number of women who required insulin.”

The trouble with musculoskletal pain is, it may limit your ability to participate in activities of daily living as well as fitness programs. Feel free to call for a complimentary question and answer as you may need,

I often provide yoga and pilates exercises adapted for therapeutic purposes, to make programs fun and mind body spirit engaged. All the best to you,

stay fit and functional, of 2 girls!

What exactly is the “PELVIC FLOOR”?

This is the same question I had several years back even coming out of my program when first introduced to Pelvic Floor Physical Therapy. Surprisingly enough, most Physical Therapy Programs offer little education on the Pelvic Floor throughout their curriculum. If seeking a specialist in this field they will have (should DEFINITELY have) several years of additional continuing education in this specialty in order to treat your pelvic floor diagnosis/symptoms appropriately.

Unfortunately, the Pelvic Floor is often a forgotten land. Rarely will someone go to the gym to work on their Pelvic Floor, or seek nutritional advice to improve this part of their body. However, if you have a specific “problem” with anything associated with your Pelvic Floor then it is THE MOST IMPORTANT part of your body and you will do ANYTHING to get rid of your symptoms, whatever they might be.

I think it’s important to note that both women and men have a Pelvic Floor, and can have pain/symptoms associated with this area. They are essentially made up of the same structures with differences in external parts. Statistically (according to the Journal of American PT Association – Sept 2012, and what we normally see in our clinic today) the ratio of female to male patients seeking help with Pelvic Floor symptoms is approx. 92% female to 8% male.

Anatomically speaking, your Pelvic Floor, sometimes referred to as the Pelvic Diaphragm, consist of three layers of several very important muscles (seen in images below) attaching to your sacrum and iliac bones (your hip/pelvic bones).

Superficial perineal layer: Bulbocavernosus, Ischiocavernosus, Superficial transverse perineal, external anal sphincter (EAS).

Deep urogenital diaphragm layer: Compressor urethra, Ureterovaginal sphincter, Deep transverse perineal

Pelvic diaphragm: Levator ani: pubococcygeus (pubovaginalis, puborectalis), iliococcygeus, Coccygeus/ischiococcygeus, Piriformis, Obturator internus


Surprising to see how much is “down there” right? And that isn’t including organs, blood supply, or external genitalia.

The Pelvic Floor has many functions which make all these muscles very important. To name a few it helps supports pelvic floor organs, assists in urinary and fecal continence, aides in birthing children for women, aides in sexual performance, stabilizes connecting joints, and supplies and acts as a venous and lymphatic pump for the pelvis overall.

And this is all assuming everything is working properly of course!

Now that we can identify WHAT and WHERE the Pelvic Floor is, we can discuss some of the MANY diagnosis and symptoms that can occur effecting this area and that can alter, most of the time SEVERELY alter, our lives in many ways.

  • Urinary Incontinence – Involuntary loss of urine
  • Stress urinary Incontinence – Involuntary loss of urine with stress (i.e. cough, laugh, sneezing, exercise)
  • Encopresis – Involuntary loss of stool
  • Pelvic Organ ProlapseCystocele, Rectocele, Enterocele, Uterine Prolapse, Rectal Prolapse.
  • Dyspareunia – Pain with Intercourse
  • Vulvodynia/Vestibulitis – Pain/Inflammation at the Vulva
  • Interstitial Cystitis – pain, pressure, or discomfort associated with the bladder
  • Rectus Diastasis – Separation of Rectus Abdominus resulting in pain or dysfunction
  • Constipation/Irritable bowel Syndrome/Other
  • Endometriosis
  • Pubic Bone Pain/Tail bone pain
  • PGAD – Persistent genital arousal disorder
  • Post Prostatecomy symptoms
  • Penile Pain
  • Other post-partum complications/symptoms
  • General Pelvic instabilities

Of course I could go into specific details about each and every diagnosis listed here (which I plan to do in future blogs, especially if feedback requests for info on a certain topic) yet the important KEY POINT to take from this in general is your Pelvic Floor is NO LONGER a “forgotten land” and many times the answer that’s normal at your age, It’s all in your head, you just need to relax, and/or You just had a baby not too long ago, give yourself more time is NOT the end all. There is help!

I feel like I should say that again, THERE IS HELP! Specialists that CARE and can aide in decreasing any symptoms you may have.

So at this point you might ask…What is the first step?  Who can I talk to?  Who can I contact for more information in my area?

Great question! First speak with your physician about seeing a Pelvic Floor Physical Therapist. If you are in our area please don’t hesitate to contact us for any information needed or to set up an appointment for an evaluation.

There are also thousands of pelvic floor therapist around the world.

Here are a couple websites that can help you find one is your area.

Please contact FunctionSmart Physical Therapy for any questions you may have!

Visit our website for more information:



Pediatric Pelvic Floor Therapy


Potty training for any family is rarely described as an easy process. Yet when the child also struggles with functional constipation (no signs of abnormalities physically, seems to be of functional cause) and/or encopresis (involuntary defecation) it turns into a frustrating process that is difficult to get a handle on. Other factors and diagnosis that can prolong toilet training are Hirschsprung disease, Crohn’s, Imperforate anus, Celiac disease, slow transit systems, developmental delays, sensory processing disorders, Autism spectrum disorders, etc.

Pelvic Floor Therapy using Biofeedback (surface EMG)/Real Time Ultrasound (RTUS), therapeutic exercises, nutrition advice, and life style modifications can help navigate this difficult process and improve symptoms associated with chronic constipation, encopresis, and chronic laxative use.
Several studies have concluded positive outcomes with Pelvic Physical Therapy interventions.

A study completed by Zivkovic et al in 2012 looked at the use of diaphragmatic breathing exercises and retraining of the pelvic floor in children with dysfunctional voiding. They defined dysfunctional voiding as urinary incontinence, straining, weakened stream, feeling the bladder has not emptied, and increased EMG activity during the discharge of urine. Although this study focuses primarily on urinary issues, it also includes constipation in the treatment and outcomes. Forty-three patients between the ages of 5 and 13 with no neurological disorders were included in the study. The subjects underwent standard urotherapy with included education on normal voiding habits, appropriate fluid intake, keeping a voiding chart, and posture while voiding in addition to pelvic floor muscle retraining and diaphragmatic breathing exercises. Results showed 100% of patients were cured of their constipation, 83% were cured of urinary incontinence, and 66% were cured of nocturnal enuresis.

A recent study by Farahmand et al in 2015 researched the effect of pelvic floor muscle exercise for functional constipation in the pediatric population. Stool with holding and delayed colonic transit are most often the causes for children having difficulty with bowel movements. Behavioral modifications combined with laxatives still left 30% of children symptomatic. Forty children between the ages of 4 and 18 performed pelvic floor muscle exercise sessions at home, two times per day for 8 weeks. The children sat for 5 minutes in a semi-sitting (squatting) position while being supervised by parents. The patients increased the exercise duration 5 minutes per week for the first two weeks and stayed the same over the next six weeks. The results showed 90% of patients reported overall improvement of symptoms. Defecation frequency, fecal consistency and decrease in fecal diameter were all found to be significantly improved. The number of patients with stool withholding, fecal impaction, fecal incontinence, and painful defecation decreased as well.

Children and parents gain confidence and knowledge to take control of stooling and urination issues when they have the right information and tools to do so. Overall, it is important to know toileting problems are common in children and Pediatric Pelvic PT can help your family engage in a plan for success.

Call us with any questions and speak with your health care provider if a family member may be in need of this specialty.