Pelvic Pain Rehab

By Anelyn Delmonte-Purifoy, PTCivilian Supervisor of Physical Therapy

Fort Belvoir Community Hospital in Virginia

Pelvic Pain Definition

• Pelvic pain according to the Mayo Clinic Staff is pain in the lowest part of your abdomen and pelvis.

• Pelvic pain may be dull or sharp, constant or intermittent, vary in intensity from mild, moderate, or severe.

• Pain with bladder, bowel, or sexual function.

Causes of Pelvic Pain

• After surgeries-pelvic reconstruction (bladder slings, mesh), hysterectomies, C-sections, prostate surgeries, multiple abdominal surgeries

• Women’s Health disorders-Interstitial cystitis, endometriosis, irritable bowel syndrome, pelvic organ prolapse, diastasis recti

What are we treating in Physical Therapy?

• Musculoskeletal with MFTP, spasms, neuromas, nerve irritations and impingements

• Postural alignment, improved body awareness, soft tissue normalization

• Function with voiding/eliminating when you want and the ability to control till you can void/eliminate

• Pain with vaginal coitus, erection/ejaculation, voiding/difficulty voiding, constipation, chronic incontinence

Pelvic Floor Anatomy

Pelvic Floor Anatomy

Pelvic Pain ICD-9• Commonly used diagnoses codes

564.6 Proctalgia Fugax

564.8 Spasms, anus/ani sphincter

595.1 Interstitial cystitis

625.0 Dyspareunia

625.7 Vulvodynia

625.1 Vaginismus

625.9 Pelvic pain (female), unspecified symptoms

724.79 Coccygodynia/coccydynia

728.85 Pelvic floor muscle spasms

Pelvic Pain Evaluation

History of current condition and symptoms

Onset

Mechanism of injury

Aggravating/alleviating factors

Pelvic Pain Evaluation

Incontinence affected?

How frequent

Amount (drops, soaking undergarments/clothing, streaming down the leg/full bladder leakage)

Use of any protection (panty liners, pads, diapers)

Pelvic Pain Evaluation

Past Medical/Surgical History

Any abdominal surgeries/GI disorders

Pregnancy Complictions (lacerations, prolonged pushing)

Pasted Cancer RX Radiation? Chemotherapy?

Pelvic Pain Evaluation

Current Functional Status/Prior

Job/Daily Routine

Recreational Physical Activities

Sexual Active, Ability to have Clitorial and/or Vaginal Orgasms

Pelvic Pain Evaluation

Objective Measurements

Screen the Spine, Pelvis, and the Hips (ROM, Pain, Functional Movement Patterns)

Abdominal muscle efficiency

Pelvic Pain Evaluation

TALK to your patients on the process of the pelvic assessment before and during.

Pelvic Assessment

Introitus (Clock method-assess pain and sensation)

Palpation of pelvic floor anatomy (Muscle tone, spasms, atrophy, integrity of soft tissue/scar tissue/neuromas, MFTP and reproduction of symptoms)

Pelvic Pain Evaluation

Pelvic Assessment

Pelvic floor strength (sustained contractions)

Pelvic floor coordination (quick flick contractions)

Diaphramatic Breathing

Pelvic Pain Rehab Goals

Normalize pelvic floor musculature

Increase pelvic floor contractions to 3+/5 with 10 sec hold/10X

Increase pelvic floor quick flicks to 10X in 10 sec

Ability to manage bowel and bladder function

Ability to engage in vaginal coitus managing pain

Pelvic Pain Rehab Goals

• Other Goals

Engage in regular low impact cardio routine and low resistance weight training

Postural and Dynamic spinal stabilization training

Pelvic Floor Physical Therapy RX

• Normalization of soft tissue using Manual techniques, MFTP releases, contract relax, vaginal dilators

• Neuro-muscular re-education of the pelvic floor using manual cueing, biofeedback, assistance for significant other

• Functional training in the clinic for dynamic stretching and stabilization

• Return to vaginal coitus

Tools of Practice

Pelvic Pain Rehab

• Take home message is You have to include the significant others. It will be hard to reach success with function without active participation specifically of the spouse. As a physical therapist you can return patients to normalized and improved recruitment with efficiency of the pelvic floor musculature, but functionality rarely takes place unless a gentle nudge of reassurance and confidence is added to the rehab component.

Pelvic Pain Rehab

Questions?