PHYSICAL THERAPY

A piece of our multimodal treatment for incontinence, pelvic floor dysfunction and pain, and interstitial cystitis is physical therapy. In many patients, symptoms and pain can be eased through physical therapy.

Many of the urinary, bowel, or sexual symptoms IC patients can be signs of pelvic floor dysfunction, including:

• Urinary urgency, frequency, hesitancy, stopping and starting, painful urination, or incomplete emptying
• Constipation, straining, pain with bowel movements
• Unexplained pain in your low back, pelvic region, genital area, or rectum
• Pain during or after intercourse or orgasm

The pelvic floor is a group of muscles that attaches to the front, back, and sides of your pelvis and to the tailbone and sacrum. These muscles support your pelvic organs, including the bladder, uterus or prostate, and rectum, and wrap around your urethra, vagina (in women), and rectum. Coordinated contraction and relaxation of these muscles helps control bladder and bowel function.

In patients who have IC or other pelvic pain conditions, these muscles may be tight or in spasm, have a combination of tightness and weakness, or have pain-triggering spots or knots called “trigger points.” Pain “referred” from internal organs, such as the bladder, may set off these muscle problems, but the muscle problems themselves can also set off bladder symptoms. Pain can also be “referred” to the skin and other muscles, such as in your lower abdomen, lower back, buttocks, thighs, and perineal area. Pain there can also “refer” back to your internal organs, contributing to your symptoms.

Physical therapy to treat these problems can go a long way toward easing your pain and bladder symptoms. The physical therapy techniques that help relax and lengthen tight muscles and release trigger points are different from the ones that help incontinence patients, who mainly need to strengthen the pelvic floor through Kegel exercises.

Your physical therapist (PT) should be specially trained in the techniques that help IC and pelvic pain patients.

When you start working with a knowledgeable PT, she or he will usually do an assessment before starting therapy. Assessment can include looking for external muscle problems and an internal exam. If you cannot tolerate an internal exam, that can be postponed until you can.

Your PT may also look at how you stand, walk, and sit to judge whether your joints and posture may affect your pelvic floor. Bone and muscle problems in your low back, hips, sacroiliac joint, buttocks, or thighs can stress your pelvic floor muscles, contributing to your pelvic pain.

 

_{(information adapted from ICA. and Northern Physical Therapy. For more information, visit: http://www.ichelp.org/Page.aspx?pid=383)}