Connective Tissue Disorders And Pelvic Floor Muscle Dysfunction: Is There A Connection? Part I

Beyond Basics

Connective tissue disorders (CTD) cause dysfunction in the structures that support, bind, and protect the organs of the body, such as bone, fascia, cartilage, muscle and skin. There are over 200 identified CTDs with the majority of the disorders affecting women more than men. Some CTDs are heritable, such as with Elhers-Danlos Syndrome, Marfan Syndrome and Osteogenesis Imperfecta, although in most cases the cause is unknown. Here at Beyond Basics Physical Therapy, we have noticed that several patients not only report issues involving bowel, bladder, or sexual dysfunction, but also have a history of systemic issues including fatigue, general joint pain, Raynaud’s phenomenon or dryness. These complaints have led us to look into the possible relationship between pelvic floor muscle dysfunction (PFMD) and connective tissue disorders, specifically Ehlers-Danlos syndrome and Sjögren’s syndrome.

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Ehlers-Danlos Syndrome (EDS) is a genetic CTD resulting from defective synthesis of collagen. Collagen is a foundational matrix in the body which forms skin, bone, blood vessels, organ capsules and other body structures. There are several subtypes of the syndrome, each affecting a different type of collagen and therefore presenting with different symptoms. Hypermobility-type EDS is the most common subtype and presents with general joint hypermobility, chronic subluxation, skin elasticity, easy bruising and chronic joint pain.Classical-type EDS also presents with general hypermobility and skin extensibility but has increased skin involvement, such as tissue fragility and atrophic scarring over bony prominences. The relationship between EDS and PFMD has been explored in several studies and a correlation between dyspareunia (painful intercourse), stress urinary incontinence, pelvic organ prolapse and EDS have been identified, with the trend toward increased symptoms with classical-type EDS.

EDS

Pelvic Floor Disorders and Treatment

— Beyond Basics PT | Pelvic Floor Therapy NYC.

Frequently Asked Questions

What is pelvic floor dysfunction and why does it happen?

Pelvic floor dysfunction is extremely common and occurs when the muscles, tissues, or nerves of the pelvic floor are weakened, tightened, or injured by trauma, chronic strain, or overuse. Pelvic floor disorders can result from traumatic injury such as a fall, from sporting activity, surgery, or childbirth. They can also happen from more chronic issues, such as infection or chronic inflammation such as endometriosis. Pelvic floor disorders can be a consequence of poor alignment or posture, overuse, or improper movement. The pelvic floor muscles surround the urethra, rectum, vagina and prostate; therefore, if there is a dysfunction in these muscles it can result in urinary, bowel, or sexual dysfunction in people of all ages.

Who should I see to get a proper diagnosis?

Many healthcare providers don’t assess – or don’t know how to assess – the pelvic floor muscles and nerves, so it’s important to get a proper diagnosis from a practitioner who specializes in pelvic floor dysfunction and pelvic pain. Too often patients tell us that they’ve been to 10 different doctors and healthcare providers and their symptoms have not improved, or have worsened. Find a specialist right away and get on the path to healing as quickly as possible.

Why do healthcare providers miss (or misdiagnose) pelvic floor dysfunction?

Long story short, the medical practice is divided into areas of the body: Urology. Orthopedics. Gynecology. But the body itself doesn’t have walls; every system interacts with everything else. Sometimes providers are so laser-focused on what they treat that they miss the whole picture.

As more and more research emphasizes the importance of physical therapy as part of a complete treatment regimen, more and more physicians are learning how to recognize and treat pelvic floor disorder. In the meantime, if you’re not getting relief from your current treatment, make an appointment with a pelvic floor specialist to learn more.

How does pelvic floor dysfunction affect sex?

Pelvic floor muscles have a huge impact on sex. Muscles that are shortened or tight and are unable to elongate will not allow for good blood flow into the genitals. This can result in pain, weaker erections, diminished sensation, inability to orgasm, and even decreased lubrication. Pelvic floor PT can help with these issues by enhancing blood flow and improving muscle function.

How can pelvic floor dysfunction cause bloating?

Pelvic floor dysfunction, a condition characterized by the inability to correctly relax and coordinate pelvic floor muscles, can significantly contribute to bloating due to its impact on gastrointestinal functions. When these muscles are not functioning properly, it can impact the ease of emptying and make it difficult for your body to pass stool and gas through the intestines. This obstruction leads to an accumulation of waste and gas in the gastrointestinal tract, causing bloating and abdominal discomfort.

Is it true there’s internal massage?

There can be. We do perform internal soft tissue mobilization of the pelvic muscles that are inside your pelvis and are accessible only through the vagina or rectum. We never do internal treatment without your consent and understanding.

What makes someone a pelvic floor PT vs a regular PT?

All pelvic PTs get additional training in pelvic floor internal treatment through continuing education and at our clinic.

We pride ourselves on the level of training we provide, not just at the beginning but throughout the time our therapists spend at Beyond Basics. We know that learning is a life-long process. We also provide additional training in physiology of the GI system and urinary system as well as sexual health and function and nutritional training. Most PT programs and schools do not provide the depth and breadth of knowledge that we provide all our PTs at Beyond Basics.

What are the first steps I should take if I suspect I have endometriosis?

If you suspect you have endometriosis, it’s important to schedule an appointment with a healthcare provider who specializes in endometriosis. They can help you determine the next steps, which often includes imaging tests, symptom management strategies, and a referral to a pelvic floor physical therapist.

How can pelvic floor physical therapy help with endometriosis symptoms?

Pelvic floor physical therapy can significantly alleviate symptoms of endometriosis by targeting the musculoskeletal system, which can help reduce abdominal-pelvic pain, bladder and bowel urgency, frequency, retention, incomplete emptying, and sexual pain. By addressing these areas, pelvic floor therapy can improve the quality of life for those affected by endometriosis.

How often should I attend pelvic floor physical therapy sessions?

The frequency of pelvic floor physical therapy sessions varies based on the severity of your symptoms and your individual treatment plan. Typically, patients might start with weekly sessions and gradually reduce frequency as they progress.

What can I expect during a pelvic floor physical therapy session?

During a pelvic floor physical therapy session, you can expect a thorough assessment of your pelvic floor muscles, a discussion of your symptoms, and personalized exercises to help relieve pain and improve function. Your physical therapist might also use techniques such as manual therapy, biofeedback, and relaxation exercises.

Are there any at-home exercises I can do to complement my pelvic floor physical therapy?

Yes, your physical therapist will likely recommend specific at-home exercises tailored to your needs. These might include stretches, relaxation techniques, and strengthening exercises to support your pelvic floor health.

How long does it take to see improvements from pelvic floor physical therapy?

The timeline for seeing improvements varies among individuals. Some patients might notice relief after a few sessions, while others may take several months to experience significant changes. Consistency with physical therapy and at-home exercises is key to achieving the best results.

How do I know if my pelvic floor muscles are contributing to my endometriosis pain?

A pelvic floor physical therapist can assess your pelvic floor muscles to determine if they are contributing to your pain. Symptoms such as pelvic pain, painful intercourse, urinary issues, and bowel dysfunction can indicate pelvic floor muscle involvement.

Can pelvic floor physical therapy replace surgery for endometriosis?

While pelvic floor physical therapy is highly beneficial for managing symptoms, it does not replace the need for surgical intervention in cases where excision surgery is required to remove endometrial tissue. However, in many cases, physical therapy can significantly reduce symptoms so that individuals might no longer need surgery.

Is pelvic floor physical therapy covered by insurance?

At Beyond Basics, we are out of network with most insurance providers. This allows us to offer better care, including full-hour, one-on-one sessions without passing you off to aides. We create a treatment plan based on your specific needs rather than the limitations set by insurance plans, and we focus on functional goals that truly improve your life.

We accept out-of-network plans from Cigna, United Healthcare, Aetna, and Oxford. Our internal billing staff will work with you to submit claims on your behalf and walk you through your options. You can also make convenient monthly payments with various finance options through Care Credit, offering special interest-free financing of 6, 12, or 18 months, as well as discounted package rates.

If you have any questions about insurance coverage or financing, call our billing office at 212.354.2622, text us at 212.354.2622, or email [email protected].

Should I get an assessment before doing Kegels?

Yes, it is important to get a proper assessment from a pelvic floor physical therapist before starting Kegels, especially if you’re experiencing symptoms such as pelvic pain, urinary issues, or discomfort. Not everyone benefits from Kegels, and doing them incorrectly or unnecessarily can lead to further issues. A personalized assessment will help determine the appropriate exercises based on your specific condition.

Why might Kegels not be beneficial for everyone?

Kegels are often recommended to strengthen the pelvic floor muscles. However, they’re not a one-size-fits-all solution and might not be suitable or beneficial for everyone. Some people have overactive or hypertonic pelvic floor muscles, and Kegels can exacerbate their symptoms. A personalized assessment is crucial to determine the right treatment approach.

What are some signs that Kegels might not be the right exercise for me?

If you experience more pain, discomfort, or pressure in your pelvic region after doing Kegels, it’s a red flag. It’s important to consult with a pelvic floor physical therapist to find the right exercises for your condition.

What alternatives to Kegels might be recommended by a pelvic floor physical therapist?

A pelvic floor physical therapist might recommend several alternatives to Kegels depending on the individual’s specific condition and needs. Alternatives to Kegels might include relaxation techniques, breathing exercises, postural correction, and manual therapy.

How can a pelvic floor physical therapist help me?

Our pelvic floor physical therapists can provide a thorough assessment of your pelvic floor muscles and tailor a treatment plan specific to your needs. They use various techniques to address pain, and dysfunction, helping you achieve better pelvic health and overall well-being.

Get help now from a pelvic floor therapist.