Pelvic floor physical therapy

Chronic pelvic pain is an umbrella category of dysfunctions of the pelvic region associated with long-term discomfort, and includes diagnoses such as dyspareunia, vaginismus, vulvodynia or vestibulodynia, endometriosis, interstitial cystitis, chronic nonbacterial prostatitis, chronic proctalgia, piriformis syndrome, hip dysfunction, and pudendal neuralgia. Around 1 in 4 women and between 2% to 10% of men experience chronic pelvic pain, making CPP of high clinical relevance. Just as chronic pain is conceptualized elsewhere in the body, CPP is considered to have many underlying and interconnected causes, and therefore treatment is often interdisciplinary.[2] PFPT is considered to be a key element in the treatment of CPP, working to reduce pain or enhance function by normalizing pelvic floor muscle tone and endurance.[1]

Many disorders which cause chronic pelvic pain (CPP), such as dyspareunia and vaginismus, are associated with discomfort during intercourse. As a result, the treatment of CPP with pelvic floor physical therapy is often related to the treatment of sexual dysfunction.[2] Pelvic floor physical therapy has also been shown to be effective in the treatment of erectile dysfunction (ED), providing a treatment avenue with less risk of complication than commonly prescribed medications or surgical interventions. Multiple randomized controlled trials have seen a range from modest to significant success with pelvic floor physical therapy treatments for ED. Research has also shown success in treating premature ejaculation with pelvic floor physical therapy, although the underlying reasons for this success are unknown. It is possible that PFPT is helpful in addressing disorders such as ED and premature ejaculation simply because it enhances awareness and control over individual muscles or muscle groups in the pelvic region.[3]

Large, systematic reviews have shown that stress urinary incontinence (SUI) can be treated with high success using PFPT. The treatment of overactive bladder syndrome, a more complex disorder characterized by a larger range of symptoms, as well as fecal incontinence with PFPT has shown more modest success. A pelvic floor physiotherapist will advise on simple exercises focused on the pelvic floor muscles and core muscles which help to strengthen those muscles and for improving bladder control. For patients who have urinary incontinence along with some other health condition, such as interstitial cystitis or scarring of pelvic muscles after delivery, a physiotherapist will introduce a customized treatment plan to solve bladder problems, as well as offer relief from the pain and discomfort associated with the disease.[4] There are also many benefits associated with pelvic floor physical therapy specifically in postpartum women including increasing muscle strength and endurance on top of decreasing the rate of urinary incontinence.[5] More research is needed to determine the best treatments within PFPT and/or interdisciplinary approaches to treatments for these disorders. Higher than average pelvic floor physical tone is thought to be a component of constipation, anismus, and irritable bowel syndrome (IBS). In addition, research shows that it is more beneficial for women to train for longer periods of time (>12 weeks or ≥ 24 sessions) with shorter sessions (10–45 minutes). Those who accumulate a greater number of shorter sessions achieve a greater decrease in urine loss than those who participate in smaller number of longer sessions.[6] Because these disorders can be of unknown origin or may be caused by multiple lifestyles, genetic, and physical factors, PFPT may only be effective for some individuals with these conditions or may be most effective as part of a larger treatment plan.[3]