Physical Therapy in the Management of Pelvic Floor Muscles Hypertonia in a Woman with Hereditary Spastic Paraplegia

Background. Pelvic floor (PF) hypertonic disorders are a group of conditions that present with muscular hypertonia or spasticity, resulting in a diminished capacity to isolate, contract, and relax the PF. Their presentation includes voiding and sexual dysfunctions, pelvic pain, and constipation. Various factors are associated, such as complicated vaginal birth, muscular injury, scar tissue formation, and neuropathies.Study Design. The case of a single patient will be presented, together with the management strategies employed.Case Description. A woman with hereditary spastic paraparesis and a history of muscle spasticity and urinary and fecal complaints since childhood. She presented to this institution seeking treatment for pelvic pain, pain during intercourse, constipation, and micturition problems. A physical therapy protocol was developed, with the trial of several treatment modalities.Outcome. After some failed attempts, perineal and pelvic floor stretching proved to be very efficacious therapies for this patient’s complaint, leading to improved pain during intercourse, constipation, pelvic pain, and urinary stream.Discussion. PF spasticity can lead to severe disability and interfere with daily basic functions, such as micturition and evacuation. Physical therapy plays an essential role in the management of these patients and can lead to significant improvement in quality of life.

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Pelvic Pain and Floor Dysfunction

10.1093/med/9780199350940.003.0024 ◽

2018 ◽

Author(s):

Danielle Sarno ◽

Farah Hameed

Keyword(s):

Physical Therapy ◽

Pelvic Floor ◽

Pelvic Pain ◽

Multidisciplinary Approach ◽

Rehabilitation Program ◽

Painful Bladder ◽

Integral Role ◽

Comprehensive Rehabilitation ◽

Irritable Bowel ◽

Tract Infections

Chronic pelvic pain is defined as persistent pain perceived in structures related to the anatomic pelvis (lower abdomen below the umbilicus) of either women or men for greater than 6 months. The etiology may be related to gynecologic, urologic, gastrointestinal, musculoskeletal, and neurologic causes. Pelvic pain and floor dysfunction often are associated with a musculoskeletal disorder related to the pelvic girdle, spine, or hip. Myofascial pelvic pain may be related to other diagnoses, such as depression, irritable bowel syndrome, endometriosis, constipation, painful bladder syndrome, and chronic urinary tract infections. A thorough history and clinical examination, including an internal pelvic floor musculoskeletal examination, can help identify the underlying etiology. A multidisciplinary approach to management is essential. Pelvic floor physical therapy plays an integral role. Other treatments, such as medications, complementary therapies, and injections, may be used in conjunction with physical therapy to facilitate a comprehensive rehabilitation program and manage symptoms.

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Re: Prevalence of Myofascial Chronic Pelvic Pain and the Effectiveness of Pelvic Floor Physical Therapy

The Journal of Urology ◽

10.1016/j.juro.2015.06.065 ◽

2015 ◽

Vol 194 (3) ◽

pp. 730-730

Author(s):

Alan J. Wein

Keyword(s):

Physical Therapy ◽

Pelvic Floor ◽

Pelvic Pain ◽

Chronic Pelvic Pain ◽

Pelvic Floor Physical Therapy

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PD39-07 PELVIC FLOOR PHYSICAL THERAPY SIGNIFICANTLY IMPROVES PAIN AND VOIDING SYMPTOMS IN WOMEN WITH PELVIC PAIN

The Journal of Urology ◽

10.1016/j.juro.2017.02.1734 ◽

2017 ◽

Vol 197 (4S) ◽

Author(s):

Natalie Gaines ◽

Jacob Henrichsen ◽

Laura Nguyen ◽

Larry T. Sirls ◽

Jason Gilleran ◽

...

Keyword(s):

Physical Therapy ◽

Pelvic Floor ◽

Pelvic Pain ◽

Pelvic Floor Physical Therapy ◽

Voiding Symptoms

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Using Physical Therapy as an Adjunct for Women with Chronic Pelvic Pain and Pelvic Floor Myalgia

Journal of Minimally Invasive Gynecology ◽

10.1016/j.jmig.2018.09.631 ◽

2018 ◽

Vol 25 (7) ◽

pp. S214

Author(s):

S. Song ◽

R. Everist ◽

R. Deans ◽

E. Nesbitt-Hawes ◽

T. Hallam ◽

...

Keyword(s):

Physical Therapy ◽

Pelvic Floor ◽

Pelvic Pain ◽

Chronic Pelvic Pain ◽

Pelvic Floor Myalgia

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Characteristics of Patients Seeking Outpatient Rehabilitation for Pelvic-Floor Dysfunction

Physical Therapy ◽

10.2522/ptj.20110264 ◽

2012 ◽

Vol 92 (9) ◽

pp. 1160-1174 ◽

Cited By ~ 10

Author(s):

Ying-Chih Wang ◽

Dennis L. Hart ◽

Jerome E. Mioduski

Keyword(s):

Physical Therapy ◽

Pelvic Floor ◽

Pelvic Pain ◽

Pelvic Floor Dysfunction ◽

Secondary Analysis ◽

Outpatient Rehabilitation ◽

Therapy Services ◽

Bowel Disorders ◽

Prospective Longitudinal ◽

Physical Therapy Services

BackgroundPelvic-floor dysfunction (PFD) affects a substantial proportion of individuals, especially women.ObjectiveThe purposes of this study were: (1) to describe the characteristics of individuals with disorders associated with PFD who were seeking outpatient physical therapy services and (2) to identify the prevalence of specific pelvic-floor disorders in the group.DesignThis was a prospective, longitudinal, cohort study of 2,452 patients (mean age=50 years, SD=16, range=18–91) being treated in 109 outpatient physical therapy clinics in 26 states (United States) for their PFD.MethodsThis study examined patient demographic variables and summarized patient self-reported responses to questions related to urinary and bowel functioning at admission prior to receiving the therapy for their PFD disorders.ResultsPatients primarily were female (92%), were under 65 years of age (39%: 18 to <45 years; 39%: 45 to <65 years; 21%: 65 years or older), and had chronic symptoms (74%). Overall, 67% of the patients reported that they had urinary problems, 27% reported bowel problems, and 39% had pelvic pain. Among those who had urinary or bowel disorders, 32% and 54% reported leakage and constipation, respectively, as their only problem. Among patients who had pelvic pain, most (56%) reported that the pain was in the abdominal area. Combinations of urinary, bowel, or pelvic-floor pain disorders occurred in 31% of the patients.LimitationsBecause this study was a secondary analysis of data collected prospectively, the researchers were not in control of the data collection procedure. Missing data were common.ConclusionsData suggested most patients with PFD receiving outpatient physical therapy services were female, younger than 65 years, and had disorders lasting for more than 90 days. Combinations of urinary, bowel, or pelvic-floor pain disorders were not uncommon.

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Pelvic Physical Therapy for Chronic Pain and Dysfunction Following Laparoscopic Excision of Endometriosis: Case Report

Internet Journal of Allied Health Sciences and Practice ◽

10.46743/1540-580x/2019.1684 ◽

2019 ◽

Author(s):

Jennifer Hunt

Keyword(s):

Case Report ◽

Physical Therapy ◽

Pelvic Floor ◽

Pelvic Pain ◽

Muscle Tone ◽

Short Form ◽

Relaxation Techniques ◽

Program Outcomes ◽

Laparoscopic Excision ◽

Patient Reported

Background: Pelvic pain and abnormal pelvic floor muscle (PFM) tension frequently are present in individuals with endometriosis and often persist even after surgical excision of the endometriosis lesions. Physical therapists are educated in improving muscle tone and function for individuals who have sustained injury, have had surgery, or have required rehabilitation for various pelvic health conditions. More scientific evidence is needed to support the benefits of physical therapy (PT) interventions for individuals with a history of endometriosis. Case Description: The 50-year old female patient presented in this case report underwent laparoscopic excision of endometriosis, yet she continued to experience discomfort in her left lower abdomen and vaginal area after surgery. Within a four month period, the patient participated in ten sessions of pelvic physical therapy that included manual therapy, instruction in relaxation techniques, and a home program. Outcomes: At the time of her discharge from physical therapy, the patient reported a reduction in symptoms on the Pelvic Floor Impact Questionnaire - Short Form 7 (PFIQ-7) and was able to resume activities that she had not previously tolerated because of abdominal and pelvic pain. Discussion: Identifying effective interventions for patients that have received surgical management is important. Pelvic physical therapy may help individuals avoid surgery and eliminate or reduce the use of medications. Because of the positive outcomes of this case report, it is recommended that when endometriosis is suspected or diagnosed, a pelvic physical therapy evaluation should be considered. Further research is needed to assess physical therapy as part of the standard of care for women with suspected or diagnosed endometriosis.

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