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.
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.
- 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!