Pelvic Floor Dysfunction

The muscles and connective tissues that make up your pelvic floor 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.

Dysfunction Of The Pelvic Floor

Signs that your pelvic floor may not be doing its job often begin with bladder and bowel leakage, urinary hesitancy or urgency, 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:

Pain in the genital area
Pain in the perineum
Rectal pain
Pain in the pelvis
Urine leakage during exercise
Leakage when coughing, sneezing or laughing
Difficulty emptying your bladder or bowel
Prolapsed uterus or organs
Urine leakage during intercourse
Low back or hip pain

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:

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

Diagnosis Of Pelvic Floor Dysfunction

Diagnosis begins with a medical history and physical exam of the pelvic floor, low back, hips and pelvis. Gait analysis may be performed as well. Your clinician will ask for detailed information about pregnancies and childbirth, and any difficulties or abnormalities you experienced associated with childbearing.

At NYDNRehab, we use high resolution dynamic real-time ultrasound to visualize the structures of the pelvic floor during activity. Since pelvic floor pain and dysfunction is closely related to the low back and hips, we perform diagnostic and functional sonography to rule in or rule out hip and low back issues.

During a diagnostic ultrasound session, both patient and clinician can view the muscles of the pelvis and abdominal wall in motion, to assess for muscular deficits, excessive force production (pressure) and trigger points.

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

HOW WE DIFFER FROM CONVENTIONAL PELVIC FLOOR PHYSICAL THERAPY:

Most traditional approaches fail to get at the root cause of dysfunction and correct it. Instead what we see is an excessive amount of internal, intravaginal, intrarectal myofascial work, which we believe is not really addressing the root cause of these problems, but merely providing temporary symptomatic relief. Although this work may be necessary in some cases, unlike most pelvic pain physical therapy clinics we do not place great emphasis on it.

We believe that the cause of these trigger points within the pelvis, as well as the cause of pudendal nerve compression is due to:

Dysregulation of the forces within the intra-abdominal and intrapelvic cavities, and the inability of the motor system to cope and coordinate postural and spinal stabilization, breathing, sexual and excretory functions.
Hip muscle dysfunction caused by excessive sitting and deficient gait (walking) mechanics
Poor postural and lifestyle habits
Stress, emotional issues and poor coping strategies

WHAT SETS OUR TREATMENT APART?

We are experts in diagnostic and functional ultrasonography. These two methods enable us to examine the structure and function of the:

Pelvic floor
Low back
Abdominal wall and hips
Pudendal nerve

We have the only available system in NYC to perform state-of-the-art 3D gait analysis.

Our physical therapy is based on a meticulous clinical exam and diagnostic and functional ultrasonography, not on symptoms alone. We use Dynamic Neuromuscular Stabilization (DNS) and restoration of postural breathing mechanics to restore pelvic balance and stability.

Pelvic floor problems often stem from abnormal walking gait. Ours is one of the few clinics providing gait-specific physical therapy for pelvic floor dysfunction.

We use highly effective ultrasound-guided dry needling on muscles of the pelvic floor, abdomen and hips.

We perform ultrasound guided pudendal nerve blocks when necessary.

We provide pelvic floor visceral manipulation.

We use extracorporeal shockwave therapy (ESWT) for intrapelvic trigger points, which is more effective than manual release.

We use a highly effective combination of guided imaging and intrapelvic device biofeedback to release and strengthen the pelvic floor muscles.

Treatment options for pelvic floor dysfunction

Our goal is to restore optimal pelvic floor function, so you can enjoy an improved quality of life.

Physical therapy and rehab can be time consuming,

and a faulty diagnosis can make treatment a total waste of time.

Failure to accurately diagnose a condition in its early stages can lead
to chronic problems and sometimes devastating results.

Diagnostic musculoskeletal sonography (MSUS) provides the perfect tool for the rehab practitioner. Yet many doctors and physical therapists have no experience with MSUS, are unaware of its advantages, and have no idea how to use it as a diagnostic tool.

Below is a prime example of how ultrasound can take the guesswork out of diagnosis.

Learn more

Accurate Diagnosis Is the ONLY way to

Successful Treatment

A bad physical therapy experience is one of the primary causes of unnecessary surgery.

At NYDNR, we believe in medical innovation

ACL Robotech

С.A.R.E.N.

Kineo

Alter G

Proteus shoulder arm recovery

Zebris

We have equipped our clinic with the latest research-grade technology to arrive at objective and accurate diagnoses, and to objectively measure our patients’ progress.