*Pregnancy Related Pain and PT

PREGNANCY RELATED PAIN

Pregnancy is a special time in a woman’s life.  The body goes through tremendous changes in posture and increased joint mobility that make back, neck, arm, and sacroiliac pain more likely.  Difficulty with bladder control (incontinence) may occur during and after pregnancy.  Problems may also continue after birth, with back pain and bladder issues being the most common issues. 

Common problems during pregnancy:

• Back pain 
• Sacroiliac pain: back , buttock and leg pain resulting from problems in the joint between the sacrum (part above the tailbone) and the illium (pelvic bone).  More likely during pregnancy due to the hormonal changes causing looseness in the joints of the pelvis.
• Sciatica: Low back, buttock, and leg/ foot pain from compression or irritation of the sciatic nerve.  
• Incontinence:   loss of bladder or bowel control.
• Diastasis Recti:  separation of the middle of the “six pack” abdominal musles due to the growing pregnant uterus. 
• Pubic Symphysis Separation (severe pain at pubic bone)
• Weakness of abdominal wall and pelvic floor muscles
• Rib or thoracic  pain
• Carpal Tunnel Syndrome:  wrist pain and finger numbness associated with increased fluid retention and swelling during pregnancy.
• Thoracic Outlet Syndrome:   arm pain, numbness, and weakness associated with fluid changes during pregnancy and baby holding / breast feeding postures.  
• Scar tissue from tearing, episotomy, c-section
• Poor posture and lifting techniques

Conservative Physical Therapy Management of pregnancy related pain may include: 

• Manual Therapy:  “hands on” treatment to improve pain and restore function and movement. 
• Mobilization:  movement of a joint to improve pain and restore functional movement.
• therapeutic exercise:  specific exercise to improve pain and restore functional movement.  
• Kegel exercises or Pelvic Floor Retraining:  exercise to correct pelvic floor muscle  dysfunction.   It is important to get proper training in doing this exercise correctly to avoid problems. 
• Biofeedback:  a way of using a computer or other device to “see” and improve body functions such as muscle activity or indicators of stress.  Also used to “see” the function of the pelvic floor muscle to improve therapeutic exercise.  
• Functional Movement Training:  exercises to improve posture and movement
• Bracing:   support for the pelvis and abdomen

Not all physical therapists work with the pelvic floor.  There are women's health physical therapists who specialize in pelvic floor rehabilitation.  They work with conditions that may include incontinence, pelvic pain, pregnancy, and osteoporosis.  You can get more information on this specialty area of physical therapy or locate a PT who works with these conditions at the website for the Section on Women's Health of the American Physical Therapy Association here.

*Links are given to provide a general overview of a topic and not intended to suggest complete or authoritative information on a particular subject.  The information provided is always subject to change.*

*Pelvic Organ Prolapse (POP) and PT

PELVIC ORGAN PROLAPSE

Pelvic organ prolapse is the dropping of a pelvic organ into the vaginal cavity and may actually protrude from the vaginal opening. The bladder is the most common organ involved, although this can also occur to the rectum, intestines, or uterus.  Symptoms may include a heavy feeling in the pelvis or leakage of urine.  It can be caused by weakness in the pelvic floor muscle or loss of the structures that support the pelvic floor organs.   This can be seen with pregnancy and childbirth (especially after multiple vaginal births) or simply the aging and loss of the supportive function and weakness of the pelvic floor.  

Common types of prolapse include:

• Cystocele:  dropped bladder
• Rectocele:  dropped rectum
• Entrocele:  dropped small intestine
• Uterine:  dropped uterus

Conservative Physical Therapy Management of pelvic organ prolapse due to pelvic floor dysfunction may include: 

• modalities such as heat and ice
• Manual Therapy:  “hands on” treatment to improve pain and restore function and movement. 
• Mobilization and Manipulation:  movement of a joint to improve pain and restore functional movement.
• Therapeutic exercise:  specific exercise to improve pain and restore functional movement.  
• Functional Movement Training:  exercises to improve posture and movement
• Kegel exercises or pelvic floor retraining:  exercise to correct pelvic floor muscle.  dysfunction.   It is important to get proper training in doing this exercise correctly to avoid problems. 
• Biofeedback:  a way of using a computer or other device to “see” and improve body functions such as muscle activity or indicators of stress.  Also used to “see” the function of the pelvic floor muscle to improve therapeutic exercise.   
• Electrical Stimulation or TENS:  used to help improve pain, inflammation, muscle spasm, muscle function, and circulation.

Not all physical therapists work with the pelvic floor.  There are women's health physical therapists who specialize in pelvic floor rehabilitation.  They work with conditions that may include incontinence, pelvic pain, pregnancy, and osteoporosis.  You can get more information on this specialty area of physical therapy or locate a PT who works with these conditions at the website for the Section on Women's Health of the American Physical Therapy Association here.

*Links are given to provide a general overview of a topic and not intended to suggest complete or authoritative information on a particular subject.  The information provided is always subject to change.*

*Incontinence and PT

INCONTINENCE

Incontinence   is an involuntary loss of bladder (urine) or bowel (feces).  Urinary incontinence affects over 25 million people. This problem is seen in people of all ages including men and children, but is seen more often in women and people over 65, and during and after childbirth. It takes a huge toll on sufferers in regards to medical cost and worry.  Here is a slideshow on symptoms, causes, and treatments for incontinence.

Types of incontinence:

• Stress incontinence: involuntary loss of urine that occurs with physical exertion and increased abdominal pressure. Leakage of small amount of fluid. Often occurs with coughing, sneezing, straining, jumping, or running. This occurs due to under active pelvic floor muscles. Stress incontinence  may be caused by pregnancy and childbirth, injury or trauma, surgery involving the vagina or rectum, episiotomy (during childbirth), and/or lack of exercise and lack of use.
• Urge incontinence: leakage of medium to large amounts of urine when a person feels a sudden strong urge to urinate.  For example, this type of incontinence often occurs when putting the key in the door or hearing running water. Possible causes include poor sensation or not being aware that the bladder is full, neurological problems,  enlarged prostate in men, and bladder pain. 
• Mixed incontinence: includes symptoms of both stress and urge incontinence.
• Functional incontinence: urine leakage that occurs when a person is unable to get to the toilet in time. The causes may include joint pain, dementia, poor eyesight, or just difficulty in getting up and walking.  This type is more common in the elderly.  
• Fecal or Bowel incontinence:  involuntary loss of feces. 

Conservative Physical Therapy Management of incontinence due to pelvic floor dysfunction may include: 

• Manual Therapy:  “hands on” treatment to improve pain and restore function and movement. 
• Mobilization and Manipulation:  movement of a joint to improve pain and restore functional movement.
• Therapeutic exercise:  specific exercise to improve pain and restore functional movement.  
• Functional Movement Training:  exercises to improve posture and movement
• Kegel exercises or pelvic floor retraining:  exercise to correct pelvic floor muscle.  dysfunction.   It is important to get proper training in doing this exercise correctly to avoid problems. 
• Biofeedback:  a way of using a computer or other device to “see” and improve body functions such as muscle activity or indicators of stress.  Also used to “see” the function of the pelvic floor muscle to improve therapeutic exercise.   
• Electrical Stimulation or TENS:  used to help improve pain, inflammation, muscle spasm, muscle function, and circulation.

Not all physical therapists work with the pelvic floor.  There are women's health physical therapists who specialize in pelvic floor rehabilitation.  They work with conditions that may include incontinence, pelvic pain, pregnancy, and osteoporosis.  You can get more information on this specialty area of physical therapy or locate a PT who works with these conditions at the website for the Section on Women's Health of the American Physical Therapy Association here.

*Links are given to provide a general overview of a topic and not intended to suggest complete or authoritative information on a particular subject.  The information provided is always subject to change.*

*Pelvic Pain and PT

PELVIC PAIN

Pelvic pain predominately affects women, though men may suffer with pelvic and/or rectal pain as well. It can be a debilitating form of pain, causing difficulty with sitting, urinating, and intercourse. Once your doctor rules out other medical causes (such as fibroids, cysts, enlarged prostate, or infections),dysfunction of the pelvic floor muscle may be the cause.  There are several conditions that fall under “pelvic pain”.  Here is a slideshow of potential causes of pelvic pain (not all are appropriate for PT).    See below for a list of specific medical diagnoses potentially related to pelvic floor dysfunction that may respond to physical therapy treatment. 

Common Symptoms related to pelvic pain: 

• Pelvic, abdominal, or low back pain
• Pain or difficulty with urination or bowel movements
• Frequent urination
• Constipation or diarrhea
• Painful intercourse
• Heavy feeling in pelvis
• Incontinence or loss of bladder control

Different Types of pelvic pain conditions possibly related to dysfunction in the pelvic floor muscles that may benefit from conservative physical therapy treatment:

• Dyspareunia:  painful intercourse. 
• Vaginismus:  painful intercourse related to pelvic floor muscle spasm.
• Vulvodynia or Vestibulodynia / Vestibulitis :  pain in the genital area or vaginal opening.
• Pelvic Floor Muscle disorder / spasm/ myalgia:  Tightening of the pelvic floor muscles  causing pain and dysfunction .
• Levator Ani Syndrome and proctalgia fugax :   painful spasm of the pelvic floor muscle causing rectal pain.
• Pudendal Neuralgia / Alcock Canal Syndrome, and Persistent Genital Arousal Disorder (PGAD) / Persistent Sexual Arousal Syndrome (PSAS) or Restless Genital Syndrome (RGS):    pelvic and genital pain and sympotms related to compression or irritation of the pudendal nerve in the pelvis.  
• Chronic Prostatitis / Chronic Pelvic Pain Syndrome (CP/CPPS),  Chronic nonbacterial prostitis, Prostatodynia:  pelvic pain from pelvic floor muscle dysfunction in men. 
• Interstitial Cystitis, Bladder pain syndrome/interstitial cystitis (BPS/IC) :  a bladder disease that can cause pain, urinary urgency and frequency.  It can also cause pain with activities such as intercourse or sitting. 
• Overactive Bladder:  Condition including symptoms of urinary urgency and frequency.  Not always associated with pain but may accompany any condition that irritates the pelvic floor muscle such as interstitial cystitis. 
• Cocygodynia or Tailbone pain:  Pain in the coccyx or tailbone worsened by sitting that may be related to pelvic floor muscle dysfunction. 
• Endometriosis:  a condition in which uterine lining cells appear in the abdomen leading to pain.  Mostly managed medically with medication or surgery, but physical therapy may help with pain. 

Conservative Physical Therapy Management of pelvic pain due to pelvic floor dysfunction may include: 

• modalities such as heat and ice

• Manual Therapy:  “hands on” treatment to improve pain and restore function and movement. 
• Mobilization and Manipulation:  movement of a joint to improve pain and restore functional movement.
• Therapeutic exercise:  specific exercise to improve pain and restore functional movement.  
• Functional Movement Training:  exercises to improve posture and movement
• Kegel exercises or pelvic floor retraining:  exercise to correct pelvic floor muscle.  dysfunction.   It is important to get proper training in doing this exercise correctly to avoid problems. 
• Biofeedback:  a way of using a computer or other device to “see” and improve body functions such as muscle activity or indicators of stress.  Also used to “see” the function of the pelvic floor muscle to improve therapeutic exercise.   
• Electrical Stimulation or TENS:  used to help improve pain, inflammation, muscle spasm, muscle function, and circulation.

 Here is an article on treatments for pelvic pain including PT.

Not all physical therapists work with the pelvic floor.  There are women's health physical therapists who specialize in pelvic floor rehabilitation.  They work with conditions that may include incontinence, pelvic pain, pregnancy, and osteoporosis.  You can get more information on this specialty area of physical therapy or locate a PT who works with these conditions at the website for the Section on Women's Health of the American Physical Therapy Association here.

*Links are given to provide a general overview of a topic and not intended to suggest complete or authoritative information on a particular subject.  The information provided is always subject to change.*

*Fibromyalgia and PT

FIBROMYALGIA

Fibromyalgia is a disorder characterized by widespread pain.   The primary symptoms are muscle and joint pain, but sufferers also commonly experience chronic fatigue, poor sleep, poor bowel function, headaches, TMJ– jaw pain , and bladder pain. There is no definitive test for fibromyalgia. Diagnosis is difficult in that there is not a specific “test” for fibromyalgia.  Classification is based on criteria that include a history of widespread pain for over 3 months and multiple tender points found throughout the body.  Here is a slideshow on fibromyalgia symptoms, tests, and treatments. 

Physical Therapy does not “cure” this problem but can be helpful in improving pain and function.  Exercise is very beneficial and a PT can help introduce and progress movements in ways to get the most benefit with less pain and discomfort. 

Conservative Physical Therapy Management of fibromyalgia related pain may include: 

• Modalities: such as heat and ice
• Manual Therapy:  “hands on” treatment to improve pain and restore function and movement. 
• Mobilization and Manipulation:  movement of a joint to improve pain and restore functional movement.
• Therapeutic Exercise:  specific exercise to improve pain and restore functional movement.  It is important with fibromyalgia to start exercise carefully and progress slowly. 
• Functional Movement Training:  exercises to improve posture and movement.
• Biofeedback:  a way of using a computer or other device to “see” and improve body functions such as muscle activity or indicators of stress.   
• Electrical Stimulation or TENS:  used to help improve pain, inflammation, muscle spasm, muscle function, and circulation.

Physical Therapists are specialists in restoring movement and function related to muscle, bone, or joint dysfunction.  They often work to improve pain and disability.  To learn more about PT or find one in your area, check out a consumer oriented site on PT here   or the main site of the American Physical Therapy Association (APTA) here.

*Links are given to provide a general overview of a topic and not intended to suggest complete or authoritative information on a particular subject.  The information on the links are always subject to change.*