Make strides with pelvic floor therapy

By Stephanie Mosquera-DiFolco

The pelvic floor is a grouping of muscles at the base of the pelvis that creates a sling to assist with support of the pelvic organs. It assists with maintenance of urinary and fecal continence. The pelvic floor also works as a supportive structure of the core by working with the back, abdominal and diaphragmatic muscles to support the spine and control intra-abdominal pressures.

More specifically, these muscles work together in women to help prevent leakage. These muscles are also in close proximity to the rotators of the hip. They can mimic symptoms similar to sciatica and SI joint dysfunction, but can also occur in conjunction with those conditions. Other presentations of dysfunction can include urinary and fecal incontinence, pelvic pain, increased frequency, pain with intercourse, and pelvic organ prolapse. Most of these symptoms can be assessed and treated by physical therapy.

Pelvic floor therapy is initiated with an assessment of incontinence history. The physical therapist assesses the nature of the dysfunction based on the historical interview, and is follows with a physical exam. This physical exam evaluates pelvic position, posture, and flexibility for the low back and hips. An internal exam is also performed to assess pelvic floor strength, muscle tension and/or trigger points.

Based on the results of this evaluation and assessment, a treatment plan is created. This plan may consist of all or some of the following treatments: Manual techniques, including muscle energy techniques, soft tissue mobilization, trigger point release and myofascial release. Therapeutic exercises can also be integrated into treatment for pelvic floor strengthening, core strengthening, along with flexibility of both the hip and the pelvic diaphragm. Further, neuromuscular re-education can be performed utilizing biofeedback to allow for improved proprioceptive awareness as to how to contract and relax the pelvic floor. Pelvic floor re-education can also be performed utilizing breathing and relaxation techniques, or urge inhibition.

In summary, pelvic floor dysfunction can be treated using physical therapy through education, retraining and exercise, or relaxation and breathing techniques. Asking for help from your medical professional is the first step with this potentially debilitating problem and can lead to an improvement in daily function.

— Stephanie Mosquera-DiFolco received her doctorate in physical therapy from the University of St. Augustine for Health Sciences in 2005. In 2012, she initiated her education on treatment of urinary incontinence and has completed two levels of coursework. She offers pelvic floor therapy at Fishermen’s Community Hospital Therapy Center in Big Pine Key.

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