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Rehabilitation of the short pelvic floor. I: Background and patient evaluation

Abstract

Pelvic floor physical therapists have traditionally focused on rehabilitation of the weak pelvic floor of normal length. With the recognition that many urogynecologic symptoms arise from the presence of a short, painful pelvic floor, the role of the physical therapist is expanding. Clinically, the pelvic floor musculature is found to be short, tender, and therefore weak. There are associated trigger points and characteristic extrapelvic connective tissue abnormalities. We report the characteristic patterns of myofascial and connective tissue abnormalities in 49 patients presenting with this syndrome.

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Fig. 1A, B.
Fig. 2.
Fig. 3a, b.

Abbreviations

PFM:

Pelvic floor muscles

TP:

Trigger point

IC:

Interstitial cystitis

LUT:

Lower urinary tract

UTI:

Urinary tract infection

SPF:

Short pelvic floor

CT:

Connective tissue

OI:

Obturator internus

References

  1. Kegel AH (1948) Progressive resistance exercise in the functional restoration of the perineal muscles. Am J Obstet Gynecol 56:238–249

    Google Scholar 

  2. Bo K, Hagen RH, Kvarstein B, Jorgensen J, Larsen S (1990) Pelvic floor muscle exercise for the treatment of female stress urinary incontinence: III. Effects of two different degrees of pelvic floor muscle exercises. Neurourol Urodyn 9:489–502

    Google Scholar 

  3. Bo K, Talseth T, Holme I (1999) Single blind, randomized controlled trial of pelvic floor exercises, electrical stimulation, vaginal cones, and no treatment in management of genuine stress incontinence in women. Br Med J 318:487–493

    CAS  Google Scholar 

  4. Burns PA, Pranikoff K, Nochajski T, Desotelle P, Harwood K (1990) Treatment of stress urinary incontinence with pelvic floor exercises and biofeedback. J Am Geriatr Soc 38:341–344

    CAS  PubMed  Google Scholar 

  5. Lagro-Janssen TLM, Debruyne FMJ, Smits AJA, VanWeel C (1991) Controlled trial of pelvic exercises in the treatment of urinary stress incontinence in general practice. Br J Gen Pract 41:445–449

    CAS  PubMed  Google Scholar 

  6. Enck P (1993) Biofeedback training in disordered defecation: A critical review. Dig Dis Sci 38:1953–1960

    CAS  PubMed  Google Scholar 

  7. Heymen S, Jones KR, Ringel Y, Scarlett Y, Whitehead W (2001) Biofeedback treatment of fecal incontinence. A critical review. Dis Colon Rectum 44:728–736

    CAS  PubMed  Google Scholar 

  8. Weiss JM (2001) Pelvic floor myofascial trigger points: Manual therapy for interstitial cystitis and the urgency-frequency syndrome. J Urol 166:2226–2231

    CAS  PubMed  Google Scholar 

  9. Butrick CW (2000) Discordant urination and defecation as symptoms of pelvic floor dysfunction. In: Butrick CW, ed. Pelvic pain. Diagnosis and management. Philadelphia, Lippincott Williams & Wilkins,

  10. Salvati EP (1987) The levator syndrome and its variant. Gastroenterol Clin North Am 16:71-77

    CAS  PubMed  Google Scholar 

  11. Travell J, Simons D (1983) The trigger point manual. Vol. 1. Baltimore, Williams & Wilkins

  12. Zermann D-H, Ishigooka M, Doggweiler R, Schmidt RA (1999) Neurourological insights into the etiology of genitourinary pain in men. J Urol 161:903–908

    CAS  PubMed  Google Scholar 

  13. Glazer HI (2000) Dysesthetic vulvodynia. Long term follow up after treatment with surface electromyography-assisted pelvic floor muscle rehabilitation. J Reprod Med 45:798–802

    CAS  PubMed  Google Scholar 

  14. McKay E, Kaufman RH, Doctor U, Berkova Z, Glazer H, Redko V (2001) Treating vulvar vestibulitis with electromyographic biofeedback of pelvic floor musculature. J Reprod Med 46:337–342

    CAS  PubMed  Google Scholar 

  15. Lilius HG, Oravisto KJ, Valtonen EJ (1973) Origin of pain in interstitial cystitis. Scand J Urol Nephrol 7:150–152

    CAS  PubMed  Google Scholar 

  16. Wesselman U, Burnett AL, Heinberg LJ (1997). The urogenital and rectal pain syndromes. Pain 73:269–294

    Article  PubMed  Google Scholar 

  17. Ling FW, Slocumb JC (1993) User of trigger point injections in chronic pelvic pain. Obstet Gynecol Clin North Am 20:809–815

    CAS  PubMed  Google Scholar 

  18. Jasmin L, Janni G, Manz HJ, Rabkin SD (1996) Activation of CNS circuits producing a neurogenic cystitis: Evidence for centrally induced peripheral inflammation. J Neurosci 1996;18:10016–10029

    Google Scholar 

  19. Doggweiler R, Jasmin L, Schmidt RA (1998) Neurogenically mediated cystitis in rats: An animal model. J Urol 160:1551–1556

    CAS  PubMed  Google Scholar 

  20. Wesselman U, Lai J (1997) Mechanisms of referred visceral pain: uterine inflammation in the adult virgin rat results in neurogenic plasma extravasation in the skin. Pain 73:309–317

    Article  PubMed  Google Scholar 

  21. Dicke E, Schliack H, Wolf A (1978) A manual of reflexive therapy of the connective tissue. Sidney S. Simon, Scarsdale, NY

  22. The Interpreter (1963) An endocrine interpretation of Chapman's reflexes. American Academy of Osteopathy

  23. Head H (1983) On disturbances of sensation with especial reference to the pain of visceral disease. Brain 16:1–133

    Google Scholar 

  24. Kinder MV, Bastiaanssen EHC, Janknegt RA, Marani E (1995) Neuronal circuitry of the lower urinary tract; central and peripheral neuronal control of the micturition cycle. Anat Embryol 192:195–209

    CAS  PubMed  Google Scholar 

  25. Yalla SV, Resnick NM (1997) Initiation of voiding in humans: The nature and temporal relationship of urethral sphincter responses. J Urol 157:590–595

    CAS  PubMed  Google Scholar 

  26. Hemborg B, Moritz M, Lowing H (1985) Intra-abdominal pressure and trunk acitivity during lifting. Scand J Rehab Med 17:25–38

    CAS  Google Scholar 

  27. Sapsford RR, Hodges PW, Richardson CA, Cooper DH, Markwell SJ, Jull GA (2001) Co-activation of the abdominal and pelvic floor muscles during voluntary exercises. Neurourol Urodyn 20:31–42

    Article  CAS  PubMed  Google Scholar 

  28. McMahon SB, Lewin GR, Wall PD (1993) Central hyperexcitability triggered by noxious inputs. Curr Opin Neurobiol 3:602–610

    CAS  PubMed  Google Scholar 

  29. Butler D (1971) Mobilization of the nervous system. Melbourne, Churchill Livingstone

  30. Mense S, Simons DG (2000) Muscle pain. Understanding its nature, diagnosis and treatment. Philadelphia, Lippincott Williams & Wilkins

  31. Travell J, Simons D (1992) The trigger point manual. Vol. 2. Baltimore, Williams & Wilkins

  32. Bo K, Kvarstein B, Hagen RH, Larsen S (1990) Pelvic floor muscle exercise for the treatment of female stress urinary inctontinence: II. Validity of vaginal pressure measurements of pelvic floor muscle strength and the necessity of supplementary methods for control of correct contraction. Neurourol Urodyn 9:479–487

    Google Scholar 

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Acknowledgement

Illustrations by Dr. M.J.T. FitzGerald.

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Correspondence to M. P. FitzGerald.

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FitzGerald, M.P., Kotarinos, R. Rehabilitation of the short pelvic floor. I: Background and patient evaluation. Int Urogynecol J 14, 261–268 (2003). https://doi.org/10.1007/s00192-003-1049-0

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  • DOI: https://doi.org/10.1007/s00192-003-1049-0

Keywords

  • Pain
  • Pelvic floor
  • Physical therapy
  • Rehabilitation