Physical therapy management of pelvi/perineal and perianal pain syndromes

Abstract

Pelvic floor physical therapy is considered to be effective in the management of functional urogenital and anorectal disorders. A functioning pelvic floor is integral to increases in intra-abdominal pressure, provides rectal support during defecation, has an inhibitory effect on bladder activity, helps support pelvic organs, and assists in lumbopelvic stability. Coordinated release of the sphincters within a supporting extensible levator ani allows complete and effortless emptying. A major feature of pelvi/perineal and perianal pain syndromes commonly encountered by multidisciplinary clinicians is pelvic floor imbalance and incoordination. Precise pelvic floor and abdominal muscle coactivity, based on research, is used clinically. Motor and cognitive learning which can alter peripheral and central pain mechanisms and produce physical changes in the CNS, viscera, smooth and musculoskeletal tissues is the basis of physical therapy in pelvic floor and pelvic organ pain management.

Urinary incontinence in very young and mostly nulliparous women with a history of regular organised high-impact trampoline training: occurrence and risk factors

“…Defecation requires rectal support by the PFM, and obstructed defecation is said to be the result of low tonic activity in the PFM and perineal descent [28]. Hence, constipation might be another sign of dysfunctional PFM.…”

Anorectal and perineal pain: new pathophysiological hypothesis

“…The functional re-education of the abdominal, dorsal and gluteal muscles seems to affect the stability of the vertebral column and so physical therapy may result in pain relief [18].…”

Quality of Life as Medicine: Interventions that Induce Salutogenesis. A Review of the Literature

“…Most often QOL-improving therapy has been used for chronic pain problems, like vulvar vestibulitis syndrome (N = 35, 71-79% improved) (Schultz et al 1996;Bergeron et al 2002), suprapubic pain (Lukban et al 2001), urinary frequency (N = 42, 82% improved) (Lukban et al 2001;Weiss 2001), pelvic, perianal and perineal pain (N = 179, 87% good to very good response) (Markwell 2001). Recently infertility has also been successfully helped (Wurn et al 2008).…”