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  • Writer's pictureLila Abbate, PT, DPT, MS, OCS, WCS

3 Things I’ve Learned as a Pelvic PT

As with any specialized medical profession, pelvic floor physical therapists treat a lot of people with similar stories and symptoms. As both an educator and a clinical mentor, I’ve learned so much about the treatment of the pelvic girdle and pelvic muscle dysfunction. Therefore, I compiled this list of three themes, that fall outside the musculoskeletal category, but are pertinent for patient well-being.

1. People with pelvic floor dysfunction suffer far too long.

During a patient’s first visit, we conduct an evaluation that includes answering questions about symptoms and medical history. I can’t tell you how many times I’ve asked patients how long they’ve been experiencing symptoms and gotten answers upwards of six months to over a decade. Help is available, but most people aren’t even aware that pelvic physiotherapy is a viable option.

One recent study about the barriers to pelvic treatment reports that only 27% of participants were even familiar with pelvic floor muscle treatment and 87% believed that urinary incontinence was a normal part of being pregnant. [1] And it’s not just women. Only 20% of men experiencing urinary incontinence talk to their doctors about it because they feel embarrassed to bring up the topic. Of those who do, an even smaller fraction see a pelvic specialist as many primary care physicians lack intensive training on the pelvic floor and any available conservative treatments. [6] The result? Patients suffering in silence, unaware that the problems they’re having are both common and treatable.

Many people with pelvic floor dysfunction symptoms simply endure them. People may use over the counter products that mask, but don’t heal the underlying issues. If they do eventually find their way to a Pelvic Floor Physical Therapy, it may be months or even years after their symptoms first begin.

2. Pelvic floor dysfunction leaves patients feeling isolated.

Symptoms of pelvic floor dysfunction go beyond the physical body. Research shows that depression, feelings of isolation, and painful intercourse all go hand in hand for women who experience pain during sex. [2] This same study went a step further and found loneliness to be the catalyst for further depressive symptoms, which leads to more loneliness, creating a spiral of negative emotions and mental health symptoms that all stem from a pelvic floor muscle condition. [2]

Other pelvic floor disorders like incontinence, difficulty emptying the bladder, and pelvic organ prolapse are conditions known to decrease quality of life and increase the development of anxiety and/or depression. [3] If treatment for these diagnoses are prolonged, the issue potentially grows larger and more challenging to treat as both the physical discomfort and toll on mental health compound.

If you exhibit symptoms, it is never too late to seek out a pelvic floor physical therapist or ask your doctor to refer you to one.

3. Pelvic Physical Therapy heals more than just the body.

We know that pelvic floor muscle dysfunction decreases quality of life, physically and mentally. We also see patients who’ve been treated for various cancers like cervical, prostate, and anal. Having cancer in such an intimate part of the body brings up a lot of emotional turmoil in many patients. This makes me think of a quote by actress Marcia Cross who underwent treatment for anal cancer.

"I know there are people who are ashamed. You have cancer! You have to then also feel ashamed? Like you did something bad, you know, because it took up residence in your anus? I mean, come on, really. There's enough on your plate.”

For many patients, the shame feels real, especially when their bodily and sexual function is affected by the cancer and/or surgical treatments of it. Some studies show that developing mental health issues during cancer treatments can affect the outcomes of the treatments. [4]

For example, young men are at high risk for developing depression as a result of pelvic cancers and treatments; therefore, more effort needs to be put toward educating them about the efficacy of pelvic floor physical therapy with issues like erectile, urinary, and bowel dysfunction. [4, 5]

Perhaps if more patients knew about pelvic rehabilitation, they could have a more positive outlook on the road ahead.

The pelvic floor deserves to be treated and given the proper attention like any other part of the body. We wouldn’t walk around with a broken arm or sprained ankle without seeking medical attention, so no one should accept pelvic floor dysfunction as normal or avoid getting the help needed to improve their quality of life. We understand how delicate these issues are to our patients; and by establishing a treatment plan tailored to your body ( from diet to exercise to breathing to posture) we help provide the tools to our patients to promote healing. The sooner you seek treatment, the sooner your pelvic floor, confidence, and relationships will return to their healthiest.

  1. Bayat, Masoumeh MD∗; Eshraghi, Narjes†; Naeiji, Zahra MD‡; Fathi, Marzieh MD Evaluation of Awareness, Adherence, and Barriers of Pelvic Floor Muscle Training in Pregnant Women: A Cross-sectional Study, Female Pelvic Medicine & Reconstructive Surgery: January 2021 - Volume 27 - Issue 1 - p e122-e126 doi: 10.1097/SPV.0000000000000852

  2. Stout, M.E., Meints, S.M. & Hirsh, A.T. Loneliness Mediates the Relationship Between Pain During Intercourse and Depressive Symptoms Among Young Women. Arch Sex Behav 47, 1687–1696 (2018).

  3. Vrijens, D., Berghmans, B., Nieman, F., van Os, J., van Koeveringe, G., & Leue, C. (2017). Prevalence of anxiety and depressive symptoms and their association with pelvic floor dysfunctions-a cross sectional cohort study at a pelvic care centre. Neurourology and Urodynamics, 36(7), 1816–1823.

  4. Ilie, G., White, J., Mason, R., Rendon, R., Bailly, G., Lawen, J., Bowes, D., Patil, N., Wilke, D., MacDonald, C., Rutledge, R., & Bell, D. (2020). Current mental distress among men with a history of radical prostatectomy and related adverse correlates. American Journal of Men's Health, 14(5), 155798832095753.

  5. Chan, K.Y.C., Suen, M., Coulson, S. et al. Efficacy of pelvic floor rehabilitation for bowel dysfunction after anterior resection for colorectal cancer: a systematic review. Support Care Cancer 29, 1795–1809 (2021).

  6. THE OPPORTUNITY TO IMPROVE PATIENT CARE: Pelvic Floor services in 2021 and beyond. (n.d.). SEIZING THE OPPORTUNITY TO IMPROVE PATIENT CARE: Pelvic Floor services in 2021 and beyond.

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