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The pelvic floor is made up of the bony pelvis (hip bones) together with different layers of muscles, fascia, and ligaments. The pelvic floor acts like a hammock to support the pelvic organs including the uterus, bladder, and rectum. If the muscles become overactive, strained or uncoordinated, they may cause pain in the pelvis. This pain may lead the muscles to not contract, relax, or work together.
Symptoms related to PFD may include pain of the lower abdomen and pelvic region, a sensation of vaginal heaviness or pressure, pain with vaginal penetration, and low back pain that cannot be explained by other reasons. PFD can also impact bladder and bowel function. Bladder symptoms may include urinary urgency and frequency, feeling of incomplete emptying, intermittent urinary stream or the need to strain, and urinary incontinence (leakage). Bowel symptoms may include constipation, pain with bowel movements, frequent bowel movements and fecal incontinence (leakage of stool.) Symptoms of PFD tend to develop slowly and worsen over time.
Main causes of PFD
While the cause of PFD is not always known contributing factors may include pregnancy, vaginal delivery, pelvic trauma, pelvic surgery and obesity. PFD is also frequently found alongside pelvic diseases such as endometriosis, bladder pain syndrome, irritable bowel syndrome and vulvar pain. PFD may also arise due to repeated straining (such as with bowel movements) leading to poor coordination of the pelvic floor muscles. The pelvic floor muscles may also be involved in compensating for other musculoskeletal conditions, such as low back or hip pain.
Diagnosis of PFD is typically performed by a trained pelvic health physical therapist or medical provider. It begins with a complete initial evaluation including patient history, symptom review, and a physical examination. A combination of musculoskeletal, gynecologic, and neurological assessments may be conducted to determine the extent of muscle dysfunction and associated conditions.
Physical Therapy is performed by a physical therapist who has been specifically trained in pelvic health. The physical therapist will perform a complete initial evaluation and, together with the patient, will establish goals and develop an individualized treatment plan. The treatment plan may include patient education, manual therapy, therapeutic exercise, postural training, breathing exercises, neuromuscular reeducation (teaching how to improve pelvic floor muscle control including relaxation, contraction, and coordination), biofeedback, and home exercise program. Modalities such as cold laser, interferential current, electrical stimulation, ultrasound, heat, and ice may also be used.
Medications in the form of muscle relaxants or nerve pain medicines can be given to relax the pelvic muscles, desensitize the nervous system, and help the patient tolerate physical therapy.
Trigger point injections are injections placed directly in the dysfunctional muscles to control pain, treat inflammation, and reduce spasm. Injections may include a numbing agent, a steroid, or even botulinum toxin.
PFD often requires a combination of treatments in addition to physical therapy. In patients with chronic pain, other interventions such as stress control, lifestyle modification, cognitive behavioral therapy (CBT), relationship therapy, meditation, yoga, and acupuncture may be used to reduce pain and improve function.
Pelvic floor physical therapy (PFPT) focuses on strengthening pelvic floor muscles to address incontinence, pelvic pain, and prolapse. It includes exercises to improve strength, flexibility, and coordination. PFPT is non-invasive and effective for pelvic floor dysfunction, especially for those avoiding surgery. A therapist will create a personalized plan, including manual therapy, biofeedback, and muscle retraining. PFPT often provides significant relief before considering surgery.
Non-Invasive Pelvic Floor Treatment
Emsella is an FDA-cleared treatment that uses high-intensity focused electromagnetic energy to stimulate deep pelvic floor muscle contractions. Each session is equivalent to doing thousands of Kegel exercises in just 30 minutes. It's an effective, non-invasive solution for stress urinary incontinence (SUI), helping to restore muscle strength and improve bladder control. Many women experience improvement after a series of treatments, with no downtime and comfortable, fully clothed sessions.
Non-Surgical Radiofrequency Treatment
EMFEMME 360 is an FDA-cleared, non-invasive treatment that uses radiofrequency to deliver gentle heat to the vaginal and pelvic tissues. This process promotes collagen remodelling, enhances circulation, and supports tissue tone, improving both pelvic floor strength and overall vaginal health. EMFEMME 360 is ideal for women looking to address pelvic discomfort and urinary control without surgery or downtime.Sir for Emsella and Emfemme-360 I have created these two content let me know
Pelvic floor injections are a minimally invasive treatment for pelvic pain, urinary incontinence, and muscle dysfunction, offering targeted relief.
Trigger point injections target tight pelvic floor muscles that contribute to pelvic and bladder pain. A local anesthetic or corticosteroid is injected to relax muscle knots, reduce inflammation, and relieve pressure. This treatment is ideal for patients with chronic pelvic discomfort that hasn't improved with physical therapy or medication.
Botox injections help reduce bladder and pelvic pain by relaxing overactive pelvic muscles. This FDA-cleared treatment improves muscle function, relieves spasms, and eases pressure linked to bladder issues. Results typically last several months, offering sustained symptom relief without the need for invasive procedures or extended recovery time.
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