Pelvic Floor Dysfunction

Marathon has a staff of experienced and innovative physical therapists skilled in the treatment of pelvic floor dysfunction. We are committed to advancing knowledge and practice in the area of pelvic floor dysfunction through in-house dialogue, collaboration with physicians and other providers in the area of pelvic medicine and rehabilitation and educational partnerships with several university physical therapy programs. As a teaching facility, we are involved in the training of physical therapy students and medical providers through guest speaking engagements and clinical internships.

Marathon Physical Therapy and Sports Medicine is a proud partner with graduate physical therapy programs across New England and the US in providing high quality clinical education for female physical therapy students.  We are especially committed to providing clinical education in the area of women’s health and pelvic floor dysfunction (WH/PFD).  This is a rapidly growing practice area, so much so that there is often a substantial wait to commence physical therapy at a practice specializing in WH/PFD, and there are very few clinical sites to provide education to interested students.  We want to see a change in both of these trends, and this serves as the basis for our commitment for providing clinical education in WH/PFD.  We hope that you will help us support these educational experiences and allow for students to observe and participate in the course of care as appropriate.  If you have any questions or concerns, please discuss these openly with your physical therapist.

Marathon provides a vast range of services for pelvic floor dysfunction and women’s health, including treatment and management of the following:

Pelvic floor dysfunction is a general term use to describe the presence of dysfunction in the muscles, joints, nerves, and connective tissues of the pelvis. The pelvic floor itself consists of a group of muscles that exist inside of the bony pelvis (Put your hands on your hips. The pelvic floor muscles are inside of the bones and between your hands.). These muscles are generally considered to have 3 primary functions: supportive, sphincteric, and sexual.

• Supportive: The pelvic floor muscles and their associated connective tissue (fascia) work together with the deep abdominals, deep lower back muscles, and the diaphragm to support the weight of the pelvic organs and structures (bladder, vagina, rectum, cervix) and to resist increases in intra-abdominal pressure, which occurs with coughing, changing positions, and lifting.
• Sphincteric: The pelvic floor muscles work to compress the urethra and contract at the anal opening to assist in maintaining continence of urine, feces, and gas. Depending on the situation, this occurs both intentionally and automatically.
• Sexual: The pelvic floor muscles and tissues experience a marked increase in blood flow during sexual arousal and the muscles contract throughout the sexual experience, particularly with orgasm. Further, the tissues that make up the perineum and vaginal wall are required to be flexible and to allow pain-free deformation of the tissues during sexual activity.

In addition, the pelvic floor muscles and tissues help maintain equilibrium between bladder filling, the sensation of urge, and the control one feels as the urge develops. Pelvic floor dysfunction, ie. dysfunction of the muscles, nerve supply, and connective tissues to the pelvic floor, can result in one having problems in any or all of these areas. Pelvic floor physical therapists are skilled in the thorough evaluation of the pelvic floor and associated structures and will design a treatment plan that addresses any dysfunctions in a way that leads to improved function and quality of life. Further, the physical therapists at Marathon firmly believe in the interconnectedness of pelvic floor dysfunction with respiratory function, the lumbar spine, pelvic joints, and hips and will evaluate and treat this as needed, in order to provide a comprehensive and efficacious plan of care.

Glossary:

Cystocele: Relaxation of the supportive tissues of the bladder causing it to descend and protrude into the anterior vaginal wall

Enterocele: Relaxation of the supportive tissues of the small intestine causing it to descend and protrude into the posterior/superior vaginal wall

Functional Urinary Incontinence: The involuntary loss of urine prior to one’s being able to toilet, secondary to limitations in movement, cognition, or communication.  Most common amongst elderly patients with arthritis, parkinson’s, or Alzheimers disease.

Nocturnal enuresis: Involuntary loss of urine during sleep

Overflow Urinary Incontinence: Involuntary loss of urine associated with overdistention of the bladder (ICS definition). It may or may not be associated with a detrusor contraction. There tends to be continuous leakage both day and night.

Post-micturition loss: Loss of small amount of urine after voiding appears to be complete

Rectocele: Relaxation of the supportive tissues of the rectum so that it protrudes into the posterior vaginal wall

Retention: >100mL urine remaining in bladder after voiding

Straining: Use of raised intra-abdominal pressure (IAP) to expel urine

SUI, Genuine stress incontinence (GUSI): involuntary loss of urine occurring in the absence of a detrusor contraction, when the intravesical pressure exceeds the maximal urethral pressure (ICS definition).  This results in a small volume fluid loss, frequently a spot, and occurs at the same time as an increased IAP.

Urinary Hesitancy: Slow start to voiding

Urinary Urge Incontinence: Leakage or gushing of urine that follows a sudden, strong urge.

Urinary Urgency: A very strong urge to void

Uterine (uterovaginal) prolapsed: Cervix and/or uterus prolapsed into the vagina