Monthly Archives: April 2014

Pelvic Floor Involvement in a Female Athlete

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In 2013, The International Journal of Sports Physical Therapy published a fascinating case report. “A 45-year-old female distance runner was referred to physical therapy for proximal hamstring pain that had been present for several months”. The differential diagnosis of hamstring syndrome was placed on this patient and she was treated appropriately. However, there was much more involved in her pain than just the hamstrings. “Further examination led to a secondary diagnosis of pelvic floor hypertonic disorder. Interventions to address the pelvic floor led to resolution of symptoms and return to running.”

This is a great case of the varied complaints a patient with an overactive pelvic floor may report, but when treated appropriately, patients can regain their optimal level of function.

Do you have any difficult patients where you believe the pelvic floor may be involved? Or are you a patient who is suffering from pelvic girdle pain and you think your pelvic floor might be involved? Find a local Pelvic Floor PT to help you on your journey!

Burning Itching and Pain, Oh My!

Most of us women at one time or another in our lives will see our doctor for treatment for a yeast infection. However, if you are someone who has “swore” you had a yeast infection, only to go to the doctor and have them tell you everything “looks fine”, or maybe you just self- treat frequently with over the counter meds for frequent burning and itchiness, then this post is for you! And, if you’ve ever had any “weird sensations” in your pelvis or vulvar area (see below) then this post is for you too!

While you may have heard of your pelvic floor, a group of muscles in your pelvis that are responsible for maintaining bladder and bowel control (among other things), most people don’t think much about the nerves that supply the area of your pelvis. Just like you can move the wrong way and irritate a nerve in your back, get carpal tunnel syndrome, or get compression of your sciatic nerve that can cause leg pain, the nerves in your pelvis can also become irritated!

One nerve in particular, the pudendal nerve, is responsible for supplying sensation to the clitoris, labia, and areas around the vagina and anus. In addition, the pudendal nerve also is responsible for innervating some of the pelvic floor muscles, including the urethral sphincter and external anal sphincter (which helps with bowel control). When the pudendal nerve or a portion of it, becomes irritated you may feel many different symptoms. You may feel like you have a yeast infection, are “on fire down there”, feel itchy, feel like your urethra is irritated, have clitoral pain ,experience shooting pains into your vagina, or feel like you have hemorrhoid, or feel like you are sitting on a “rock” to name a few.

FemalePudendalNerveMalePudendalNerve

So, how does the nerve get irritated? Irritation to the nerve typically happens either if the nerve is compressed, stretched, or restricted so that it does not glide normally. Nerve irritation can sometimes happen if you cycle a lot (which puts pressure on the nerve), with prolonged sitting, after working out, or after having sex. Childbirth can also stretch the nerve, causing it to be irritated. In addition, if you had an episiotomy or tore during childbirth requiring stiches, scar tissue can form, restricting the nerve and causing symptoms.

So, if you notice these symptoms, what can you do about it? Obviously if your burning or irritation is accompanied by unusual discharge, a fever or other symptoms you would want to seek out your health care provider for treatment as this could signal a potential infection. But, if no red flag symptoms exist and you feel the irritation may be more of the nerve variety, seek out a physical therapist certified in the treatment of the pelvic floor. Pelvic floor treatment includes helping to relax tight muscles that might be compressing the nerve, as well as massaging or mobilizing the tissue around the nerve to help it move more freely. Sometimes, patients will feel better immediately, and other times, it takes a few visits before the symptoms subside.

And what about all of the men who might be reading this? You have a pudendal nerve as well. Pudendal nerve irritation for you can cause pain in the penis, scrotum and around the anus as well as some difficulty with erection. If you think you may be having symptoms pelvic floor therapy may help you as well!

Written by: Kim Osler PT, DPT, WCS

 

App of The Week

contraction timer

Contraction Timer Plus by iBirth

The value of a contraction timer is found in its simplicity and ease of use. In labor, timing contractions is just one of the many items you’ll be attending to. This app is intended to make timing contractions so easy that you won’t be distracted from what really matters – caring for mom.

Features:

√ Simple and easy to use interface

√ Quickly send an email report of contraction history

√ Tracks duration of each contraction

√ Tracks interval between each contraction

√ History report for tracking labor progress over time

√ Calculated averages for reporting the latest progress at a glance

Ortho therapists… This one’s for you.

Jessica and I recently spoke at the South Carolina APTA’s annual conference and the topic of discussion was Pelvic Floor Dysfunction in the Orthopedic Population.

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The information we presented was well received and I thought it may be beneficial to share some tidbits about the role of the pelvic floor in orthopedic diagnoses. So here it goes:

– Don’t assume that because you are treating “orthopedic” patients or athletes that you won’t see pelvic floor involvement.

  • The prevalence of urinary incontinence in women is 25-45% (Eliasson 2008)
  • The prevalence of urinary incontinence in men is about half that of women (12-25%) (Shamliyan 2009)
  • The prevalence of urinary incontinence in female athletes is 30- 41%. Athletes involved in high-impact sports are at a greater risk. (Jacome 2011)
  • What this means is that if you see 10 patients in a day, at least 2 women and 1 man will have some urinary complaints.

– Patients are unlikely to report symptoms of bowel, bladder, or sexual dysfunction UNLESS you ask the tough questions!

  • 90% of women do not report urinary problems to their healthcare providers if they are not directly asked. (Carls 2007)
  • Greater than 50% of community-dwelling, middle-age women experiencing symptoms of UI have NOT discussed it with their physician. (Kinchen 2003)

So how do you do this?

  • Ask direct questions! Say This: Do you ever leak urine when you cough or sneeze? Not That: So umm…… do you….umm…. Ever…well, you know…. have accidents?
  • Use professional wording. Say This: Often times, people experiencing hip pain can have difficulties with sexual activity. Are you having any problems with this? Not That: When you and your husband are, you know, doing it, does it hurt?
  • Be considerate of privacy.
  • Remember: You are a medical professional!

– The pelvic floor muscle group is responsible for WAY more than just “holding back urine, gas, or stool”.

  • The pelvic floor has a significant role in STABILIZATION of the spine and pelvis, support of pelvic organs, sexual function, and of course sphincteric control.
  • Pel & Colleagues examined how pelvic stabilization from the pelvic floor would occur with 3D simulation models in 2008. They found that the pelvic floor activation patterns provided stabilization of the coccyx and together with the transverse abdominus prevented SI shear forces when the pelvis experienced perturbations
  • The point here is that the pelvic floor is crucial to stability and for patients with core instability, incorporation of the pelvic floor into stabilization would be highly effective.

– The pelvic floor can refer pain throughout the lumbopelvic region, hips, and abdomen.

  • If you have found it difficult to accurately reproduce your patients’ symptoms, consider the pelvic floor’s possible involvement.

PF referral

  • Pain can also be reported in the hip, buttocks, lumbar spine, and suprapubic region.

– Kegels are NOT always appropriate

  • Kegels should only be utilized with true pelvic floor muscle weakness and this is unlikely in a patient with pelvic girdle pain. Know that trigger points in the pelvic floor will become aggravated with Kegels

– And lastly, remember:

  • ASK the tough questions, or you will not get the answers.
  • Be aware that patients with postural instability may have weakness and/or trigger points in their pelvic floor muscles.
  • Recognize that the pelvic floor and obturator internus muscle tension/trigger points can present as hip, groin, abdominal, low back or tailbone pain.
  • Don’t ignore the coccyx.
  • Educate your patients and yourself!

 

 

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