Common conditions and diagnoses that affect the pelvic floor muscles and pelvic health include the following issues.

Abdominal Pain

Abdominal pain can be caused by many different things. Physical therapy can lessen this pain if it is from:

• Constipation
• Scar tissue or connective tissue adhesions from gynecologic or abdominal surgeries, such as cesarean deliveries (C-sections)
• Endometriosis
• Pelvic floor dysfunction or pelvic floor trigger points which can contribute to pain to the abdomen
• Peripheral nerve entrapment

Cancer Rehabilitation

Some people may experience persistent pain or soft tissue changes after surgery or radiation therapy for cancer in their genital or pelvic region. This can impact daily functions, such as activity tolerance, bowel and bladder control, or sexual function. Physical therapy can reduce pain and restore functions by:

• Improving tight muscle or scar tissue mobility
• Desensitizing painful areas
• Helping with better neuromuscular control

C-section Rehabilitation

Sometimes this is a procedure that patients choose, but sometimes it is unplanned. Having a C-section is a major surgery, and patients often do not have enough time or support to recover while undertaking all of the new demands of parenthood. It is important to make sure that the abdominal wall properly recovers, scar tissue is managed, and safe body mechanics are taught for daily movements and childcare tasks. C-section rehabilitation helps reduce pain and supports good long-term outcomes.

Coccygodynia (Coccyx or Tailbone Pain)

This can be a debilitating condition of persistent pain in your tailbone region, which can impact sitting, defecation and sexual activity. Tightness or spasm of pelvic floor muscles and the gluteus maximus muscle or joint dysfunction can contribute to this type of pain. Physical therapy can identify the causes of this pain and provide relief by offering treatments, such as soft tissue release, stretching, posture education or joint movement.

Constipation

The pelvic floor muscles need to be able to relax enough for stool to pass. Sometimes, tightness or pain of the pelvic floor or poor coordination with relaxing these muscles can lead to difficulty passing stool. It can also lead to feeling like you still need to use the bathroom. Constipation can also be impacted by soft tissue restrictions in the abdominal and pelvic region, poor posture when sitting on the toilet, or impaired breathing mechanics. Physical therapy can help address these issues.

Diastasis Recti (Abdominal Separation)

Diastasis recti occurs when the rectus abdominis muscles on the right and left sides of the abdominal wall separate. This is typically a result of a thinning of the connective tissue band (called the linea alba) that normally joins these muscles together.

The linea alba is an important structure that typically allows the abdominal wall muscles to be used properly and for your spine and pelvis to be stable. Diastasis recti is common during pregnancy; as pregnancy progresses, the linea alba stretches and thins, allowing the abdominal wall to make room for the growing baby.

Depending on how much separation happens, diastasis recti can lead to poor stabilization of the spine and pelvis. This can cause abdominal or lower back pain during or after pregnancy. It can also lead to “doming” or “coning” in the middle of your abdomen; it can look like a football shape is protruding from your belly. This can indicate that your body cannot properly stabilize your abdomen and the increased pressures that occur with movements, such as getting in and out of bed.

Physical therapy can promote better use of your abdominal muscles, teach proper body mechanics for daily activities and childcare tasks, and facilitate better spine and pelvic stability.

Dyspareunia (Pain With Vaginal Penetration, Including Intercourse, Tampon Use or Gynecologic Exam)

Some people may experience pain with attempts at vaginal penetration. This can occur during sexual intercourse, tampon use or a gynecologic exam. Pain can be caused by many different factors, including:

• Pelvic floor muscles that are too tight or in spasm
• Sensitive scar tissue in the perineal (between your anus and outer genitals) region
• Vaginal dryness during a period of decreased estrogen levels, such as during menopause or while breastfeeding
• Certain dermatological conditions of the vulvar area, such as lichen sclerosis

Physical therapy can help identify and treat parts of dyspareunia. Treatment may include manual release techniques for tightened muscles, mobilizing tight perineal scar tissue, hip or pelvic stretches, relaxation and breathing exercises, desensitization of painful perineal scars, or vaginal dilators for gentle stretching.

Endometriosis

Endometriosis is a disease process where tissue inside the uterus grows where it should not. This endometrial tissue can grow on the ovaries, bowels or walls of the pelvic cavity. In some cases, the tissue implants in the ovaries or fallopian tubes, which can cause infertility. This misplaced tissue responds to the hormonal changes of menstrual cycles. It builds up, breaks down and bleeds but the blood has nowhere to go. This causes healthy tissue around the endometrial tissue to become inflamed or swollen. It can also cause scar tissue, long-term pain and heavy periods.

While physical therapy cannot cure endometriosis, it can help to treat tissues affected by endometriosis. Treatment may include manual release techniques for connective tissue, scar tissue and muscles tension, hip and pelvic stretches, relaxation exercises and mindfulness techniques to reduce parts of the long-term pain associated with endometriosis.

Fecal Incontinence

This is involuntary leakage of stool, which can be loose or solid. It may happen with a strong urge or with no feeling at all. This can be due to muscle weakness around the anal opening or muscles that are too tight to work correctly. People can also experience fecal incontinence if they try to make a bowel movement but cannot completely empty their bowels.

Treatment may include manual techniques to restore normal mobility of the muscles and soft tissue, strengthening exercises, biofeedback to encourage better muscle coordination, or balloon retraining to normalize the feeling of the nerves that communicate with the brain to control bowel function.

Interstitial Cystitis (Painful Bladder Syndrome)

This is a long-term issue typically characterized by frequent bladder pain and/or pressure. It can also have symptoms like urinary tract infection (UTI) symptoms, such as:

• Pelvic pain
• Pain with urination
• Urgency or frequency of urination
• Difficulty emptying the bladder

Physical therapy can address these symptoms by focusing on relaxing the pelvic floor muscles and other nearby muscles, identifying unhealthy habits that can worsen symptoms, and teaching you strategies that can help lessen urinary urgency and frequency.

Low Back Pain

One of the most common complaints that prompt people to seek physical therapy, low back pain is also common during pregnancy. Many changes during pregnancy can lead to posture changes, including:

• A smaller range of motion in the hips and spine
• Tightness of the muscles attached to the spine and pelvis
• Different walking patterns
• Decreased core stability

Physical therapy can help to improve these changes to reduce any pain and make it easier to move.

Pelvic Girdle Pain, Sacroiliac Joint Pain or Pubic Symphysis Pain

Another common complaint related to pregnancy is pelvic girdle pain. It can be in the front or back of your pelvis and involve either the pubic symphysis joint, sacroiliac joints or both. Pain of the pelvic girdle can make simple movements harder. Pelvic joints can become less stable due to weak supporting muscles, weight changes, altered movement patterns, and increased muscle tension that places unnecessary strain on these joints.

Physical therapy can help correct muscle imbalances contributing to this type of pain. Treatment may include:

• Manual therapy techniques to move pelvic bones or decrease soft tissue restrictions
• Exercises to strengthen muscles or increase core stability
• Use of support garments or belts
• Education on how to perform daily activities safely and with less pain

Pelvic Organ Prolapse

When the organs of the pelvis (bladder, uterus and rectum) drop or press into the vaginal canal or outside of the vaginal opening, it is called pelvic organ prolapse. Weak or damaged muscles and tissues that support these organs can cause prolapse. It can cause discomfort in the vaginal area or a sense of heaviness or pressure; pain can sometimes go into the low back. Prolapse can interfere with your ability to urinate or defecate normally.

Physical therapy can help strengthen and control your pelvic floor muscles for better support of your pelvic organs. Treatment will also include education about how to prevent prolapse from worsening, as well as considerations for breathing and body mechanics for activities that require physical movements.

Perineal Lacerations and Scar Management

Some people may experience tearing of the perineal region or undergo a surgical incision to increase the vaginal opening (episiotomy) during childbirth. Tearing can range from mild to severe and scars that develop are important to address during the healing process. Scars from childbirth can cause persistent pain or sensitivity in the perineal region or a feeling of tightness at the vaginal opening or the area between the vagina and anus. These symptoms can be painful and make it difficult to engage in sexual activity. They can also limit you from making movements that stretch the tissues in this area. Severe tears can also lead to poor control of bowel movements.

Physical therapy will focus on improving the mobility of the scar and tissues around the scar, desensitizing the area and restoring your pelvic floor’s normal function.

Sciatica

This is a common term to describe pain that often starts in the low back or buttocks region and travels down the leg. Sciatica can also have other sensory symptoms including numbness or tingling. Sciatica is a common during pregnancy. It can be cause by muscles in the low back or buttocks region that are too tight. The muscles can put more pressure on the sciatic nerve which causes pain. These muscles may become too tight because of:

• Changes in movement or walking patterns that are common in pregnancy
• Weak hip muscles
• Instability of your spine or pelvis

Physical therapy can decrease pain by helping correct these changes or imbalances.

Sexual Dysfunction

Sexual dysfunction is a complex condition that may include physical, medical, hormonal and/or emotional aspects that interfere with intercourse or other sexual activity. Many of these aspects are influenced by connective tissue and the pelvic muscles around it, leading to dysfunction and pain.

Physical therapy can help treat parts of sexual dysfunction and its symptoms. Therapy can address soft tissue restrictions and emphasize relaxation techniques to improve mobility of the pelvic floor muscles for better blood flow and sexual function.

Stress and Urge Urinary Incontinence

Urinary incontinence is the involuntary leakage of urine and there are different types. Stress incontinence happens with movements (such as coughing, laughing or sneezing) when pressure in the abdominal cavity increases and the pelvic floor muscles cannot provide the proper closure around the urethra to stop leakage.

Urge incontinence is leakage that occurs when someone has a strong urge to urinate and cannot control that urge. They may experience leakage of urine on the way to the bathroom of just a few drops or their whole bladder may empty. This is influenced by behavioral habits, what we eat or drink, and if there is too much tension in the pelvic floor muscles preventing them from relaxing enough.

You may also experience mixed incontinence, which is both stress and urge incontinence. Physical therapy can be helpful for both types of incontinence; it is an excellent first-line option for conservative care.

Thoracic Pain or Rib Pain

Pain in the thoracic area, or upper and mid regions of the back, is common during and after pregnancy. Pain and stiffness in this area can be caused by:

• A reduced range of motion of your spine
• Posture changes
• Impaired breathing pattern
• Decrease mobility due to a growing baby

Some people may also experience rib pain during pregnancy. If it is not addressed, rib pain can persist after pregnancy and be worsened by the demands of parenthood. Lifting, carrying and holding a new baby and/or car seat can put even more stress on an area of the body that may already be weak due to poor posture habits.

Physical therapy can improve your mobility and reduce pain in this area by emphasizing:

• Proper posture
• Teaching correct body mechanics with normal daily activities including childcare tasks
• Restoring normal joint mobility in the spine
• Facilitating good breathing patterns
• Providing soft tissue mobilization to muscles and connective tissue that may be too tight

Urinary Frequency

Normal urinary frequency during hours of being awake is every two to four hours, or about five to seven times per day. Sometimes, you may have to urinate so often that it becomes disruptive to daily activities. Urinating more often than every one and a half hours per day can sometimes be attributed to too much tension in the pelvic floor.

The increased tension can lead to an greater sense of urinary urgency, and it can also prevent you from fully emptying your bladder each time you try to urinate, making you feel like you need to take more frequent bathroom trips. Other factors than can contribute to increased urinary frequency include consuming foods, beverages or medications that irritate your bladder.

Your physical therapist can teach you how to normalize your urinary frequency, as well as offer manual treatment techniques to relax the pelvic floor muscles.

Urinary Urgency

Urinary urgency is a sudden and compelling urge to urinate. It can happen along with urge incontinence and urinary frequency. With urinary urgency, the urge to urinate cannot be suppressed and is only relieved with urination. If you cannot urinate immediately when you feel the urge, the strong sense of urgency can cause significant discomfort.

Physical exams often reveal tightened pelvic floor muscles and tissues around the pelvic floor. Physical therapy can address these soft tissue restrictions and emphasize ways to relax and suppress the urination urge to decrease the urgency.

Vaginismus (A Type of Dyspareunia Caused by Involuntary Muscle Tightening)

Vaginismus is when your pelvic floor muscles involuntarily tighten or spasm during attempts at vaginal penetration. This can include trying to insert a tampon, undergoing a gynecologic exam, or during sexual intercourse. Vaginismus is often accompanied by pain and can happen even if you want to engage in sexual intercourse.

Physical therapy can be significantly beneficial in relaxing the pelvic floor through gentle stretching, education about breathing and relaxation techniques, teaching proper coordination of the muscles, and dilator use.

Vulvodynia and Vestibulitis

Vulvodynia and vestibulitis refer to pain in the vulvar area. This pain can be constant or caused by something. Both can make it hard to sit for long periods, sexual activity, or wearing tight clothing. Pelvic floor muscles often become tightened and dysfunctional with long-term pain.

Physical therapy can help your pelvic floor muscles relax and aid in the desensitization of the vulvar area. A physical therapist can teach you about avoiding things that irritate this part of your body and changing your activities to decrease pain.