By Dr. Heather Rader, PT, DPT, PRPC, BCB-PMD
Pelvic Physical Therapist and Medical Board Member of the Cauda Equina Foundation
Just like in medicine, physical therapy has different specialties. A pelvic physical therapist has extra training to treat the muscles in the perineum and pelvic floor region of the body. These muscles give you bowel and bladder control and assist in sexual functions. Using exercise prescription, manual therapy, and modalities such as electrical stimulation and biofeedback, pelvic P.T.’s treat problems such as incontinence, constipation, painful sex, and sitting pain.
If your CES gives you any of the following symptoms, then a pelvic health physical therapist should be a part of your healthcare team.
• Urinary urgency – a strong, sudden urge to urinate, often with very little urine output
• Urinary frequency – going too often – more than 8 times a day, or less than every 2 hours
• Nocturia – waking up 2 times or more a night to urinate
• Decreased awareness of bladder fullness
• Effortful urination – straining to start or maintain the urine flow
• Feeling the bladder is incompletely emptied after going
• Stress Urinary incontinence – leakage with a cough or sneeze, while lifting things, or when exercising
• Urge Urinary incontinence – leakage during an urge to go or not making it in time
• Overactive Bladder – a bladder syndrome that includes urgency, frequency, nocturia, and/or incontinence
• Pain in the lower abdomen as the bladder gets full
• Pain in the urethra as urine comes out
• Self-catheterization support
• Constipation – slow transit type with BM’s occurring 2 times a week or less
• Constipation – outlet obstruction due to overactive pelvic floor muscles or prolapse
• Fecal urgency – strong, sudden urges to have a BM
• Fecal frequency – routinely going 4 times or more a day
• Fecal incontinence – from fecal smearing on undergarments to loss of entire bowel contents
• Effortful BM’s – excessive straining to go or taking longer than 5-10 minutes to complete a BM
• Painful BM’s – abdominal or pelvic pain as the bowels fill up or pain during a BM
Sexual or Reproductive Health
• Pain during sex at the vaginal opening or deep in the pelvis
• Pain during sex in the scrotum or penis during erection or ejaculation
• Changes in orgasm – unable to achieve, takes a long time, or lowered intensity
• Dysmenorrhea – extremely painful menstruation
• Abdominopelvic pain syndromes like endometriosis
• Vulvar and vaginal pain syndromes
• Prostate related pain syndromes
Where can I find a pelvic PT?
Here are some national locator links. You can also do a Google search in your local area by using some of the following keywords and combinations: Pelvic Floor, Pelvic Health, Pelvic Physical Therapist near me.
Regardless of how long you have had symptoms, a pelvic physical therapist can still help you minimize bowel and bladder symptoms and help reduce your pelvic pain. Talk to your doctor about it. Reach out to the therapist directly. Most states do not require a doctor’s order to get started with treatment. Don’t assume you are stuck with the symptoms of CES – Find a Pelvic PT today!