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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!

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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.

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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.

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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

 

 

 

 

 

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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:

http://endometriosis.org/

www.womenshealth.gov

www.endofound.org

www.acog.org

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: http://www.womenshealthapta.org/patients/

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, http://www.co-obgyn.com, 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,

Maureen.mom 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

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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.

http://www.womenshealthapta.org/pt-locator/

https://pelvicrehab.com/

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

Visit our website for more information: http://www.functionsmart.com/

 

 

Pediatric Pelvic Floor Therapy

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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.

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What is Pelvic Physical Therapy?

What is pelvic physical therapy?

Pelvic physical therapy is a specialization within physical therapy that addresses musculoskeletal dysfunction of the muscles of the pelvic floor as well as the muscles stabilizing the hips and core. Dysfunction in these muscles can lead to urinary or fecal incontinence, constipation, pelvic pain (including pain with sexual activity), difficulty reaching orgasm and even erectile dysfunction.

Who can benefit from pelvic physical therapy?

Men, women and children can all benefit from pelvic physical therapy. Some common diagnoses include:

  • Children with constipation, bed wetting, soiling of urine/feces during the day.
  • Women with pelvic pain, urinary incontinence, prolapse and post-partum.
  • Men with pelvic pain (including testicular and penile pain), erectile dysfunction, and urinary incontinence post-prostatectomy.

Who can practice as a pelvic physical therapist?

A physical therapist who completes post-graduate advanced education on the evaluation and treatment of pelvic floor dysfunction. These physical therapists often have additional post-graduate education on other systems including orthopedic, gastrointestinal, pediatric, reproduction/sexual health and are experts in treating musculoskeletal conditions of the pelvis.

A New Resource for Pelvic Floor Physical Therapy

This site is currently being constructed to serve as a resource for physicians, therapists and patients seeking more information about treatment options for a variety of pelvic floor dysfunctions.  The site will be managed by San Diego Pelvic Floor specialist Renee Cinco, PT of FunctionSmart Physical Therapy.  We will feature articles from experts both local and national to provide an online resource for men and women seeking options for care.  Many men and women suffer in silence with symptoms of incontinence, pelvic pain, painful intercourse, chronic constipation and much more.  We feel it’s time to break the silence.  Thank you for visiting.