Physical therapy: A key component of pelvic pain treatment

Physical therapy plays a vital role in the treatment of women’s pelvic pain.

Once a patient’s underlying medical issues have been addressed, that’s when a physical therapist’s job begins. We provide pelvic floor physical therapy to reduce pain, improve muscle strength and function, and restore quality of life. As physical therapists, we help women build bridges back to the lives they knew before they began experiencing pelvic pain.

Treatment and education

Many people don’t realize that pelvic pain problems can be treated by physical therapy. In some cases, pelvic floor physical therapy treats the main condition causing a woman’s pain. In other cases, it treats a related issue that is contributing to her pain.  

In addition to manual therapy, exercise and other physical modalities or treatments, another important component of what we do is education. We educate patients on topics like bowel, bladder and sexual function, as well as on the topic of pain itself. We talk about how pain is created by the brain, how it differs when it lasts for a long time — the pain-spasm-pain cycle — and how fear can be linked to pain. The goal is to “retrain” the brain through education and physical modalities.

An in-depth evaluation

When new patients come to us, the first thing we do is learn everything we can about their pain and its history. Perhaps they had surgery recently, but their pain actually started 10 years ago. We go back to the very beginning, when and where the pain first started, and what it affected. We ask about bowel and bladder function, sexual function, daily activities, and work. We delve into the impact the pain is having on all aspects of their lives.

Next we perform a musculoskeletal exam to evaluate movement. If indicated, we also do an internal pelvic floor muscle exam to evaluate muscle function. Are muscles underactive and not doing their job? Or, as is more often the case with pelvic pain, are they overactive? If these muscles have been “turned on” but haven’t been properly turned off, it can result in painful spasms.

We look at the whole picture, including the individual pelvic floor muscles, whether the spine and hips are contributing to the pain, and any behavioral causes of pelvic pain, such as chronic constipation due to diet or lack of exercise or mobility. Examining all these different factors allows us to determine where physical therapy can have the greatest impact — and we start there, decreasing pain, improving muscle action, and ultimately helping women get back to functioning effectively and living the lives they once knew.

Sarah Ammons, PT, DPT, OCS, FAAOMPT is an orthopedic and women’s health physical therapist at Texas Children’s Pavilion for Women. She specializes in acute and chronic orthopedic conditions, pelvic floor dysfunction, lower extremity problems, and dance medicine.