Pelvic Floor Rehabilitation

Pelvic Floor

The pelvic floor consists of nerves, muscles, and connective tissue that span the area underneath the pelvis. The pelvic floor supports the bladder, uterus, and rectum; as well as sphincter, sexual, stability, and lymphatic functions.

When the pelvic floor is weakened due to a pathology or injury an individual can experience pain, bowel, bladder, and/or sexual dysfunction.

Pelvic Prolapse

Pelvic floor prolapse refers to a condition in which organs such as the bladder, uterus, or rectum drops or descends into the vaginal wall.

Many different factors can cause a pelvic prolapse to occur. Some of the more common causes included:

  • Child birth/vaginal delivery
  • Increased abdominal pressure
  • COPD – chronic obstructive pulmonary disease
  • Constipation or prolonged straining when having a bowel movement
  • Heavy, prolonged lifting
  • Menopause
  • History of pelvic surgery

 

Depending on the type of prolapse, one can experience a variety of symptoms. Common symptoms of a pelvic prolapse include:

  • A feeling of a bulge or protrusion from the vaginal region
  • Poor or prolonged urinary stream
  • Feeling of incomplete emptying of the bladder after urination
  • Having to reposition self when urinating to start or complete urination
  • Stress urinary incontinence or the loss of urine with physical exertion
  • Urinary retention or lack of the ability to urinate
  • Having to reposition when having a bowel movement
  • Having difficulties evacuating the rectum
  • Requiring the use of fingers as a splint to defecate

 

Physicians label prolapses by indicating which organ is prolapsing or descending into the vaginal wall and by the stage of the descent. Stages of prolapse range from 0 (no prolapse) to 4 (complete eversion of the organ).

 

Cystocele:  Bladder is descending into vaginal wall

Common symptoms include:

  • A  feeling of a bulge or protrusion from the vaginal wall
  • Poor or prolonged urinary stream
  • Feeling of incomplete emptying when urinating
  • Positional changes to start or complete emptying when urinating
  • Stress urinary incontinence
  • Urinary retention

 

Urethrocele:  Urethra is descending into the vaginal wall

Common symptoms include:

  • Pelvic or vaginal pressure
  • Difficulty evacuating the rectum and emptying the bladder
  • Lower back pain/discomfort which increases as the day progresses
  • Lower back pain/discomfort that increases with prolonged standing and is relieved by lying down

 

Urethrocystocele:  Both the bladder and urethra are descending into the vaginal wall

Common symptoms include:

  • A  feeling of a bulge or protrusion from the vaginal wall
  • Poor or prolonged urinary stream
  • Feeling of incomplete emptying when urinating
  • Positional changes to start or complete emptying when urinating
  • Stress urinary incontinence
  • Urinary retention

 

Rectocele:  Rectum is descending into the vaginal wall  

Common symptoms include:

  • Pelvic or vaginal pressure
  • Difficulty evacuating the rectum and emptying the bladder
  • Lower back pain/discomfort which increases as the day progresses
  • Lower back pain/discomfort that increases with prolonged standing and is relieved by lying down

 

Rectal prolapse:  Rectum is descending into the vaginal wall

Common symptoms include:

  • Pelvic or vaginal pressure
  • Difficulty evacuating the rectum and emptying the bladder
  • Lower back pain/discomfort which increases as the day progresses
  • Lower back pain/discomfort that increases with prolonged standing and is relieved by lying down

 

Enterocele:  Small intestine is descending into the vaginal wall

Common symptoms include:

  • Pelvic or vaginal pressure
  • Difficulty emptying the rectum and bladder
  • Lower back pain/discomfort which worsens as the day progresses
  • Increased pain/discomfort with prolonged standing which is relieved by lying down

 

Vaginal vault prolapse:   Upper portion of the vagina is descending into the vaginal wall

Common symptoms include:

  • Pelvic or vaginal pressure
  • Difficulty evacuating the rectum and emptying the bladder
  • Lower back pain/discomfort which increases as the day progresses
  • Lower back pain/discomfort that increases with prolonged standing and is relieved by lying down

 

If an individual is diagnosed with a prolapse a physician may recommend a pessary, physical therapy, or in some cases surgery.

Physical therapy is considered conservative management and is often preferred by both physicians and patients as a method of treatment for individuals who have a pelvic prolapse. A physical therapist can address symptoms such as pain, urinary incontinence, and/or urinary urgency. A trained physical therapist in pelvic floor rehab is recommended to treat patients who have pelvic floor dysfunction such as prolapse.

Physical therapy includes the following:

Evaluation:

  • Musculoskeletal evaluation, which includes assessment of an individual’s function, posture, manual muscle test, and  joint mobility
  • A pelvic floor assessment, which includes both a manual muscle test of the pelvic floor muscles and prolapse examination

 

Treatment can consist of the following:

  • Patient education on pelvic floor anatomy, bladder and bowel health, and ADL training
  • Trunk, abdominal, pelvic floor, and lower extremity strengthening
  • Neuromuscular re-education to improve functional use of pelvic floor in daily activities that causes symptoms
  • Instruction on home exercise program
  • Biofeedback