Chronic Pelvic Pain (CPP) is defined as continuous or intermittent pelvic pain that persists for at least 6 months and is severe enough to affect daily functioning and relationships. In the US alone, CPP accounts for more than 80,000 hysterectomies and 1/3 of all laparoscopies per year, often without an objective diagnosis or cure. A study of more than 5,000 women in the US found that approximately 1 in 7 are affected by CPP and estimated direct medical costs for out-patient visits for CPP at over 880 million/year. Some of the diagnoses associated with CPP are endometriosis, irritable bowel syndrome andconstipation. Musculoskeletal conditions such as fibromyalgia, pelvic or coccyxgeal trauma or fractures, abdominal or perineal scar adhesions (occurring from C-sections or episiotomies), and piriformis syndrome are all possible contributors to CPP. Pelvic floor muscle imbalances have been linked to unresolved back pain such as sacroiliac joint and lumbar spine dysfunction. CPP can result from or contribute to imbalances of the pelvic floor musculature causing urinary and fecal incontinence and organ prolapse. The pelvic floor muscles are a band of muscles stretching from the pubic bone and tailbone. They connect directly into the bones comprising the hips, pelvis, sacrum and coccyx. They have ligamentous attachments to the above structures as well as an extensive connective tissue system that interfaces with the entire abdominopelvic cavity. These muscles surround the vagina, urethra and rectum. They support the pelvic organs and close off the urethra and rectum to maintain continence. In 1996, the US Department of Health and Human Services reported that 15 million Americans experience incontinence, 11 million of them were women. It is now estimated that more than 25 million people are affected. One in four women ages 30 to 59 have experienced an episode of urinary incontinence. 16.4 billion dollars are spent each year on incontinence-related care, 1.1 billion dollars are spent annually on disposable products for incontinent adults. Stress incontinence is a sudden leakage of urine that occurs with activity, such as, coughing, laughing or jumping. Pregnancy and childbirth are the most common causes of stress incontinence in pre-menopausal women. In pregnancy, stress incontinence can result from the actual weight of the baby causing the pelvic floor to sag, or hormonal changes. Hormones in pregnant women are known to relax the body's connective tissue, that of the pelvic floor included. The combination of the relaxed connective tissue and the baby's weight on the lax tissues can result in enough trauma or weakness to cause incontinence. In a 1996 study published in the British Journal of Obstetric and Gynecology, 34 had C-sections, which indicates that the pregnancy, not the deliver, made a difference in the risk of these women developing incontinence. There are many other studies documenting the incidence of incontinence with pregnancy. What they all have in common are the findings that there is a high percentage of women experiencing the onset of stress incontinence during pregnancy, remaining incontinent after delivery and becoming more symptomatic with subsequent pregnancies. Unfortunately, most women don't talk about this problem and go untreated for years. It has been noted that women will tolerate incontinence on average 4-9 years before they tell their doctors. Physical therapists have the ability to treat these conditions due to their knowledge of anatomy, musculoskeletal disorders, biomechanics, optimal posture and strength training. Physical therapists trained in manual therapy techniques, specifically Myofascial Release, can directly treat the pelvic floor muscles with specialized hands on techniques. Myofascial Release in the Treatment of CPP Myofascial Release (MFR) has been a tremendous help to women (and men) suffering from CPP and incontinence. MFR techniques specific to the pelvis are helpful in decreasing the restrictions that lead to incontinence and CPP. The Myofascial system surrounds and interpenetrates every organ, nerve, blood vessel and duct within the pelvic floor. Trauma, inflammation, surgical scars and childbirth very commonly tighten the myofascial system around these delicate and pain sensitive structures. Tightness and restrictions within the myofascial system can cause or contribute to many women's health issues including, but not limited to, pelvic floor pain and dysfunction, incontinence, vulvadynia, coccydynia, pelvic adhesions from endometriosis and surgical scars, painful episiotomy scars, interstitial cystitis and pregnancy related back pain and sciatica. Conservative techniques that make up the core of treatment for incontinence and pelvic pain include biofeedback, education, passive modalities, manual therapy techniques and MFR. However, our experience shows that MFR will directly treat the cause of the problem for long lasting elimination of symptoms. The US Department of Health and Human Services recommends that conservative treatment be the standard of care for incontinence. Current statistics show that approximately 80 of those affected by urinary incontinence can be improved or cured with non-surgical treatment. The therapists at Hands On Physical Therapy are highly trained in MFR techniques with advanced training treating CPP and incontinence. In many cases, direct Myofascial release of the pelvic floor muscles is needed to more effectively release the restrictions that are causing CPP and incontinence. Patients also learn valuable self treatment techniques to assist in their own recovery. Women and men with CPP and incontinence are encouraged to contact the therapists at Hands On Physical Therapy with questions at 512-310-1928.
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