If these options are unsuccessful, your Physical Therapist may ask you to visit your health care provider or specialist again to discuss other treatment options. These may include medication, acupuncture, pessaries, interventional therapies or surgery.
Bowel Incontinence
Some people with pelvic floor injuries experience bowel incontinence which results in the inability to control the release of gas or feces. Like those with bladder problems, many people living with bowel or fecal incontinence (FI) never tell anyone, including their doctor. However, there are treatments available that are specifically designed to treat incontinence of gas or feces.
Symptoms:
Bowel incontinence occurs when there is a sudden urge to empty the bowels or there is loss of control resulting in leakage of gas or stool (liquid or solid). Fecal urgency occurs when there is a sudden urge to empty the bowels, which can result in not making it to the bathroom in time. Bowel incontinence can be a source of anxiety, embarrassment, and frustration, and frequently results in isolation and avoidance of social situations and community mobility.
Diagnosis:
Even though you might feel uncomfortable discussing bowel incontinence with your doctor, it is important to seek medical attention. Your doctor will probably begin by asking you a series of questions concerning when and how often you are unable to control your bowels. After that, your doctor will examine your anus and the area between your anus and genitals to see if there is any physical cause for your problem. It may be helpful to undergo more specialized tests, such as an MRI or CT scan to check your spine, before you doctor can determine a specific reason for the leakage and then recommend a treatment customized for your condition.
Treatment:
If your incontinence issues are caused by pelvic floor weakness, spasm or injury, your doctor should recommend Physical Therapy. Your first appointment at Specialized Physical Therapy will include an initial assessment and examination, as well as plenty of time for you to ask questions. Our priority is that you feel safe and comfortable at your appointments and we encourage you to bring your spouse, partner or friend with you to your appointments if that would make you feel more comfortable. Your customized treatment program will be based on your Physical Therapy evaluation. This may include:
- Pelvic floor exercises
- Biofeedback
- Muscle stimulation
- Bowel retraining
- Relaxation techniques
- Lifestyle changes, including diet, exercise and stress management
Pelvic Organ Prolapse
In women, if the pelvic floor muscles and ligaments become stretched and injured, the bladder, rectum or uterus may drop down into the vaginal walls. This is called pelvic organ prolapse. Depending on how bad the prolapse is, the uterus may just bulge into the top part of the vagina or it could stick all of the way out of the opening.
Source: http://www.merckmanuals.com/home/sec22/ch249/ch249a.html
Symptoms:
Uterine prolapse can cause a range of symptoms, depending on how far the uterus is protruding into the vagina. Common symptoms include:
- A distinct lump or bulge in the vagina
- A constant ache in the vagina
- Feelings of heaviness or pressure in the vaginal area
- Abnormal tissue sticking out of the vagina
- Persistent ache in the lower back or over the tailbone
- Problems urinating
- Frequent urinary tract infections
- Bleeding or vaginal discharge (more than normal)
- Pain during sex
Some women find that their symptoms are worse when they are standing up, straining or coughing and tend to disappear when they are lying down or relaxing. Very mild cases of uterine prolapse may cause no symptoms at all until the woman gets older.
Diagnosis:
To check to see if your uterus has prolapsed, your doctor will do a pelvic exam. To do this, he or she will insert a speculum to spread apart the walls of your vagina. During the examination, your doctor may ask you to stand up, bear down on your pelvic floor muscles (like you do when you are having a bowel movement) or cough. All of these activities put more pressure on your pelvis and make any abnormalities or disorders more obvious.
Based on the result of the exam, your doctor will be able to diagnose and categorize your prolapse. The three types of uterine prolapse are:
- First degree (mild) – the bottom of the uterus, called the cervix, protrudes into the top of the vagina
- Second degree (moderate) – the cervix is near the opening of the vagina
- Third degree (severe) – the entire uterus protrudes out of the vagina
Treatment:
In mild to moderate cases, pelvic floor exercises can correct uterine prolapse. These are the same exercises used to treat incontinence issues. Because some people have trouble contracting the correct muscles, a Physical Therapist at Specialized Physical Therapy will be able to help you get the most out of these exercises. Your Physical Therapist may also recommend:
- Inserting a cone-shaped device in your vagina to help you focus on contracting the correct muscle
- Biofeedback therapy
- Electrical stimulation to ensure the correct muscles contract
In severe cases, pelvic floor exercises will probably not be enough to pull your uterus back into its normal location. As a result, your doctor may recommend that you use a vaginal pessary. This doughnut-shaped device is inserted into the vagina to help prop up the cervix and uterus. This is only a short-term solution though, and surgery may be needed to completely repair the damage.
Sexual Dysfunction
Women:
The pelvic floor muscles play an important role in a woman's sexual pleasure. Purposely squeezing pelvic floor muscles contribute to sexual sensation and arousal. Also, weak pelvic floor muscles can have a devastating affect on a woman's libido. One study that looked at 301 women over the age of 40 linked pelvic floor symptoms to low sexual arousal, infrequent orgasms and painful intercourse [4]. Weakened or damaged pelvic floor muscles can also reduce vaginal sensation.
One of the easiest ways to increase your libido is to tighten up your pelvic floor muscles through exercise. Research has shown that pelvic floor exercises increase the amount of blood to the pelvic region, increasing arousal and vaginal sensation. The Physical Therapists at Specialized Physical Therapy can help you make sure that you are targeting the right muscle groups.
Men:
Strong pelvic floor muscles are also important for male sexual health, as they are essential for gaining and sustaining an erection. As a result, weak pelvic floor muscles are a major contributing factor for erectile dysfunction. This means that men may want to try doing pelvic floor exercises before taking medications like Viagra and Cialis.
According to a 2004 clinical study, pelvic floor exercises and biofeedback were more effective than lifestyle changes for erectile dysfunction [5]. Four out of ten men who participated in the study said their sexual performance was back to normal after six months of doing regular pelvic floor exercises. A further 35% said their performance had improved somewhat.
Call Specialized Physical Therapy to Make an Appointment
If everyone knew how to tone their pelvic floor muscles then no one would ever have to suffer from the negative effects this type of muscle weakness can cause. If you are dealing with any of these conditions or hope to prevent them from ever occurring, the professional Physical Therapists at Specialized Physical Therapy would be happy to talk to you. They will also be able to answer any questions you might have about whether Physical Therapy is right for you.
