When I see a new patient, the very first question I ask is “Have you been to pelvic PT before?” Nine times out of ten the answer is “no”.
I follow up with “Do you know what pelvic PT is?” which is usually met with “not really.”
Despite limited knowledge of the pelvic floor, everyone relies on their pelvic floor daily. People tend to take their pelvic floor for granted….until the pelvic floor stops doing its best work, and that is called pelvic floor dysfunction.
I can’t talk about pelvic floor dysfunction without a quick crash course into the pelvic floor.
The pelvic floor are three layers of muscle, nerves, vascular supply, and connective tissue that make up the inside of the pelvis. The pelvic floor has support, sphincteric, sexual, core stability, pressure regulation functions.
The third layer of pelvic floor muscles are visible on this female model.
permission to use copyright image from Pelvic Guru, LLC
How do you know if you are experiencing pelvic floor dysfunction?
Nicole Cozean PT, DPT, WCS, CSCS made this pretty simple by developing a quick and effective tool that patients and practitioners can use to identify individuals who are suffering from pelvic floor dysfunction.
Cozean developed the tool in part by looking at her patients and determining that across the board a large percentage of patients with pelvic floor dysfunction experience pelvic pain, incontinence, urinary frequency and urgency, orthopedic pelvic pain, and pain with sitting (Cozean, 2018).
The Cozean Pelvic Dysfunction Screening Protocol was developed so that patients can get the help they need sooner. Checking three or more boxes indicates likely pelvic floor dysfunction. The tool covers bowel, bladder, sexual health, and pain which are all areas that pelvic PTs specialize in. The link to the tool can be found here: https://docs.wixstatic.com/ugd/d1026c_42a0fda8e5644930950d754619586614.pdf
There are many conditions associated with pelvic floor dysfunction which are common but perceived as normal. There is a big difference between common and normal.
Leakage
A healthy pelvic floor and bladder work together with the sympathetic and parasympathetic nervous system to store urine and feces until the appropriate time to void or have a bowel movement. Childbirth, trauma, anxiety, high impact activities, menopause, or stress contribute to the weakness, imbalance, or overactivity (yes leakage can be caused by a tight pelvic floor too) that causes urinary or fecal incontinence.
Frequency
With recommended fluid intake, individuals should void 5-8 times per 24 hour period (Al Afraa et. al, 2012). This number can vary with different medical conditions or increased fluid intake due to breastfeeding or athletic training. Voiding more frequently than every two hours should warrant some questions.
Effort
Whether it’s number 1 or number 2, pushing and straining are not normal. In a healthy pelvic floor, the brain, organs, and pelvic floor all work in unison to contract appropriately and relax where necessary to easily pass stool or urine.
Pain
Tampon use, medical exams, sex, sitting, caring for babies etc. should never be painful. A variety of factors contribute to pain including orthopedic trauma, soft tissue and fascial restriction and nerves but also anxiety, sexual trauma, medical and diseases like endometriosis.
Bowel, bladder, sexual health, and pain are serious quality of life problems. At Hudson Valley Physical Therapy, we specialize in the treatment of pelvic floor dysfunction. If you find yourself checking off 3 or more boxes on the Cozean screening tool, don’t hesitate to seek out the help of a pelvic floor physical therapist.
Megan Fosko PT, DPT
Al Afraa, T., Mahfouz, W., Campeau, L. et al. Int Urogynecol J (2012) 23: 681. https://doi.org/10.1007/s00192-011-1568-z
Nicole Cozean – https://hermanwallace.com/blog/simple-screening-questionnaire-for-pelvic-floor-dysfunction
Link to free tool here: https://docs.wixstatic.com/ugd/d1026c_42a0fda8e5644930950d754619586614.pdf