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Pelvic HealtH
services

Commonly Treated Diagnosis

Pain

  • Coccyx pain

  • Vulvar pain

  • Vulvar vestibulitis

  • Chronic nerve pain

  • Post-hernia repair

  • Perineal pain

  • Pudendal neuralgia

  • Dyspareuria

  • Vaginismus

  • Sacroiliac pain

  • Groin pain

  • Genital pain

  • Pain with penetration

  • Nocturia: Increases fall risk; Increases fracture and mortality risk; Behavioral treatment plus bladder-relaxant therapy is better than drug therapy alone.

 

Bladder

  • Urinary incontinence (stress, urge, or mixed)

  • Urinary urgency and frequency

  • Painful bladder syndrome/interstitial cystitis

  • Detrusor instability (overactive bladder)

  • Urinary hesitancy/delay

  • Incomplete emptying/retention

  • Urethral pain

 

Interstitial Cystitis/Painful Bladder Syndrome

  • American Urological Association (AUA) updated guidelines list Pelvic Therapy as "second line" treatment following education, behavioral modifications, and stress management

  • Pelvic Therapy components can include manual therapy and avoiding pelvic muscle strengthening

Sexual dysfunction

  • Pain with orgasm

  • Difficulty achieving orgasm

  • Inability to tolerate penetration

Wellness programs:

  • self-care for postpartum mothers

  • advanced age pregnancy

  • body back post-partum

  • self-care for pregnant patients

  • preparing for pregnancy

Other diagnoses:

  • organ prolapse

  • diastasis recti treatment and prevention

Our practice offers pelvic health as well as pre-post prostatectomy care. Christy Watson, OTR/L, PRPC, CMHIMP, Meghan Bush, COTA/L, and Kathi Bushway, COTA/L have received specialized training in the area of women's and men's pelvic health.

 

Christy is the first Occupational Therapist to hold the Pelvic Rehabilitation Practitioner Certification in the state of Mississippi.

 

Providers who specialize in pelvic rehabilitation are Occupational Therapists and Physical Therapists. These therapists have received post-graduate training specifically for this specialty. Pelvic rehab providers are neuromusculoskeletal experts who aim to identify patients with pelvic dysfunction who are limited in daily function.

During the history taking, the focus is on finding functional deficits and figuring out the patient's habits and goals.

  • Medically screen for needed referral to physician

  • Integrated models of care point out the value of knowing patient motivators, fears, belief systems

  • Examination and evaluation

  • Strength testing general or specific to pelvic floor

  • Pelvic floor muscle assessment of coordination, endurance, resting state of muscles

  • May include biofeedback, e-stim, therapeutic ultrasound, or cold laser therapy

  • Often includes an internal vaginal exam

  • Education in behavioral training such as bladder and bowel habits, muscle retraining, modalities (heat, cold, electrotherapies)

  • Home program, self-care

  • Therapeutic exercise

  • Manual therapy

  • Internal releases

 

Pain and the Brain

 

Women with chronic pelvic pain and/or endometriosis demonstrate changes in brain areas involving pain perception . Rehab approaches are increasingly following biopsychosocial models and instructing patients in behavioral modification practices to overcome chronic pain patterns.

 

"Non-relaxing Pelvic Floor" from Mayo Clinic Proceedings:

 

It causes impaired defecation, urination, and sexual function.

 

Authors suggest early referral for pelvic therapy is a "cornerstone of management"

 

Look for cluster of symptoms: voiding dysfunction, constipation, dyspareunia, low back pain, pelvic pain

 

How to Refer to Pelvic Rehabilitation

  • Find a local clinic who offers pelvic rehabilitation

  • Provide a referral and/or script that states "Occupational Therapy evaluate and treat"

  • (In some clinics, it may be that their pelvic floor therapist is a Physical Therapist.)

  • Emphasize the value of pelvic rehab to the patient

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