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25500 Point Lookout Rd., First Floor
Leonardtown, MD 20650
MedStar St. Mary’s offers pelvic rehabilitation services for both women and men. Our therapists work with patients to develop individualized treatment plans to address pelvic floor dysfunctions, which can be caused by overactive or underactive muscles in the pelvic floor. Common conditions include urinary incontinence, pelvic pain, or bowel problems, such as fecal incontinence or constipation. We are also trained to assist with recovery for post-surgical patients, like those who have undergone prostatectomy.
Treating Pelvic Pain and Continence Issues
MedStar St. Mary’s offers a non-operative treatment approach for patients with pelvic pain and continence issues. Individualized pelvic health physical therapy programs are developed utilizing numerous treatment techniques. Each patient undergoes a comprehensive evaluation of his/her history, current problem, and pelvic floor musculature. Based on the findings, an individualized pelvic rehabilitation program is designed to meet your specific needs.
This condition is a prevalent problem that affects people of all ages and usually results from increased pelvic floor tension due to trauma in and around the pelvis, organs, abdomen, and back and also dysfunctional use patterns, diseases, or surgery. Symptoms include pain in the following regions: low back, vagina, rectum, abdomen, coccyx, and posterior thigh.
The most common types of pelvic pain syndromes are:
- Coccydynia: This condition is often a result of a fall or injury affecting the coccyx or sacroiliac joint. It can also be a result of muscle imbalances in the pelvic region. Symptoms include pain in the coccyx while sitting and pain while transitioning from sit to stand.
- Dyspareunia: This can be caused by a prolapse, pelvic floor muscle tightness, scar adhesions or decreased lubrication. Symptoms may include pain during sexual intercourse.
- Interstitial Cystitis: The cause of this condition is unknown. Potential causes include chronic infection, unknown neurologic disorder, and ulcerations of the bladder and autoimmune disease. Symptoms may include bladder and abdominal pain, frequent voiding, sleep deprivation, dyspareunia and often corresponds with vulvar pain.
- Vulvodynia: Contributing factors to this condition include: infections, dermatological conditions, chemical reactions and vulvar trauma or surgery. Symptoms may include severe pain, burning and stinging in the vulvar region. Usually the patient is unable to wear tight clothing or use tampons secondary to increased pain in vulvar/vestibular region.
Physical Therapy Treatments
Therapy to treat pelvic pain may include:
- Dietary considerations, including bladder irritants
- Vestibular irritants
- Hot packs and cold packs can also be used depending on the patient’s condition. Heat can ease interstitial cystitis pain while cold may help vulvodynia patients. Once again, the therapist will work closely with the patient for the best treatment option.
- Ultrasound is a deep heating modality which, in combination with manual therapy techniques, can decrease muscle and pain tension in their perineal, inner thigh, buttocks and low back region.
Bladder and bowel incontinence is a prevalent problem that affects men and women of all ages and levels of health. Incontinence is a symptom, not a disease. It is often a result of weakness or nerve damage of the muscles of the pelvic floor from childbirth, prostatectomy, low estrogen levels during or after menopause, urinary tract infection, or some medications.
Types of Urinary Incontinence
The most common types of urinary incontinence are:
- Stress incontinence: Urine leaks out during exercise, while laughing, lifting, coughing/sneezing, or during any activity that suddenly increases abdominal pressure, thereby placing pressure on the bladder. This is common after pregnancy, pelvic surgery, and during menopause. Studies have demonstrated that approximately one in three people who have stress incontinence are unable to correctly contract their pelvic floor muscles.
- Urge incontinence: There is a sudden uncontrollable urge to void and the individual is often unable to make it to the bathroom in time. Urge incontinence is often associated with urinary tract infections, certain medications, stress, spinal cord injuries, multiple sclerosis, and neurological diseases.
- Mixed incontinence: This is a combination of stress and urge incontinence. Left untreated, urinary incontinence can get worse. However, it is estimated that a large percentage of urinary incontinence can be greatly reduced or cured using conservative measures.
Bowel Dysfunctions include:
- Constipation: This condition can occur due to pelvic floor muscle spasms resulting in the inability to have normal bowel movements. Spasms can be caused by surgery, injury, fissures, or hemorrhoids. Constipation can be treated using methods to relax pelvic floor muscles.
- Fecal incontinence: Inability to control pelvic floor muscles can result in fecal incontinence. This can be a result of childbirth or anorectal surgery. This can be treated in similar ways as urinary incontinence.
Pelvic Rehabilitation for incontinence may include:
- Pelvic floor muscle exercises, in which the patient contracts and relaxes specific pelvic muscles.
- Bladder retraining and behavior modification which teaches the patient to resist the initial urge to urinate. Using diaries for self-monitoring, habit training, and voiding schedules can help the patient with urge incontinence.