Pelvic Pain Rehab By Anelyn Delmonte-Purifoy, PT Civilian 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?