Pelvic Floor Dysfunction

The muscles and connective tissues that make up the floor of your pelvis form a hammock that spans from your tailbone to your pubic bone, creating a wall of separation between your perineal region and your pelvic bowl. The pelvic floor provides support for your intestines, bladder and uterus, and its muscles govern bladder, bowel and sexual function. The muscles also facilitate childbirth as the fetus descends, causing the baby to rotate as it enters the birth canal.

Dysfunction of the Pelvic Floor

Signs that your pelvic floor may not be doing its job often begin with bladder and bowel leakage or constipation. High-impact sports like gymnastics, basketball and running create downward pressure on the pelvic floor muscles, putting athletes in those sports at risk for dysfunction. Pregnancy and childbirth may also lead to pelvic pain and dysfunction.

Prevalent symptoms include:

  • Urine leakage during exercise
  • Leakage when coughing, sneezing or laughing
  • Difficulty emptying your bladder and/or bowels
  • Sudden loss of bowel control
  • Gassiness
  • Prolapsed uterus or organs
  • Pain in the pelvis
  • Urine leakage during intercourse

Chronic Pelvic Pain (CPP)

Pain that persists for six months or longer is categorized as chronic, and CPP can seriously interfere with normal daily activities. CPP is common in women, accounting for about 10% of all visits to the gynecologist. It is also a relatively common urologic complaint among men under age 50.

Causes of Pelvic Floor Dysfunction

A number of anatomical changes can lead to pelvic floor dysfunction. Tight or weakened muscles, joint impairment in the low back or pelvis or sensitive painful tissues may be contributing factors.
Other causes include:
  • Infections
  • Postural issues affecting the pelvis and low back
  • Trauma
  • High-impact physical activities
  • Surgery
  • Obesity
  • Sedentary lifestyle
  • Pregnancy and childbirth
Subcategories of pelvic floor dysfunction include:
  • Bladder disorders
  • Bowel disorders
  • Sexual dysfunction
  • Post surgical issues
Subcategories of pelvic floor dysfunction

Diagnosis of Pelvic Floor Dysfunction

Diagnosis begins with a medical history and physical exam of the pelvic floor. Your clinician will ask for detailed information about pregnancies and childbirth, and any difficulties or abnormalities you experienced associated with childbearing. They will also ask for details about surgical procedures in the pelvic region. Bowel patterns, nutrition, physical activity and lifestyle habits may hold clues that can help your provider make an accurate diagnosis.
At NYDNRehab, we use dynamic real-time ultrasound to visualize the structures of the pelvic floor. During a diagnostic ultrasound session, both patient and clinician can view the muscles of the pelvis in motion to assess for abnormalities.
With real-time ultrasound imaging, we are able to diagnose and treat a number of conditions, including:
  • Low back pain
  • Chronic pelvic pain
  • Hip and groin pain
  • Postpartum issues
  • Urinary incontinence
  • Post-surgical issues

Treatment Options for Pelvic Floor Dysfunction

Traditional treatment mostly centers on pain management and coping strategies. Traditional interventions often include:
  • hormone therapy
  • pain medications
  • physical therapy
  • surgery
Most traditional approaches fail to get at the root cause of dysfunction and correct it. However, pelvic dysfunction can be safely and effectively treated without drugs or surgery.
Treatment options for pelvic floor dysfunction
At NYDNRehab, we used cutting edge technologies and innovative therapies to diagnose and treat your condition. Our unique corrective approach sets us apart from other clinics and medical practitioners whose primary focus is pain management.

Pelvic floor Physical Therapy

  • Biofeedback
  • Neuromuscular reeducation
  • Manual therapy
  • Myofascial release
  • ESWT (extracorporeal shock wave therapy
  • Muscle strengthening, stretching and relaxation
  • Postural retraining
  • Gait retraining
Our goal is to restore optimal pelvic floor function, so you can enjoy an improved quality of life.
130 West 42 Street Suite 1055, New York NY 10036
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In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)

image

Complete tear of rectus femoris
with large hematoma (blood)

image

Separation of muscle ends due to tear elicited
on dynamic sonography examination

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