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Pelvic floor dysfunction significantly impacts the quality of life in up to 1 in 4 women. Problems range from stress incontinence to inadequate core stability and chronic back pain. Unfortunately, many chiropractors have a limited skillset for this ubiquitous problem.

ChiroUp’s newest protocol summarizes the current best-practice management for this condition, including expert advice from more than a dozen providers who treat and teach pelvic floor dysfunction. 

Want the down and dirty? 

Check out this one-minute video synopsis of the docs sharing what they know about pelvic floor problems.

Want more? 

Check out our top ten clinical pearls from our newest protocol:

1. The Problem

Dysfunction can arise when the pelvic floor’s muscular hammock is excessively stretched, damaged, or otherwise weakened- leading to stiff and distensile fibers that cannot generate power and sustained contraction. (15) Conversely, pelvic floor muscles can become hypertonic and overactive, causing rapid fatigue. (15)

2. Risks

Vaginal childbirth is the primary risk factor for pelvic floor dysfunction. More than 90% of women demonstrate some form of pelvic floor injury following vaginal childbirth. (24) 

3. Symptoms

Pelvic floor dysfunction presents as a complex clinical picture with a spectrum of potential symptoms, including pain, urinary urgency or incontinence, fecal urgency or incontinence, sexual dysfunction, and pelvic organ prolapse. (2,14,34) While females account for 95% of pelvic floor presentations, males are not immune and can experience symptoms including chronic pain, prostatitis, and sexual dysfunction. (16,19,20)

4. Assessment

Like any other muscle dysfunction syndrome, management hinges on identifying hypotonicity vs. hypertonicity as the primary culprit.

Manual therapists should carefully consider whether they are the best-suited clinician for the hands-on assessment. Before embarking on any palpatory evaluation of the pelvic floor, examiners must weigh many factors, including your scope of practice, training, informed consent, patient expectations, gender preferences, and liability issues. (A specialty-trained pelvic floor physical therapist is the most common type of practitioner to perform an internal pelvic floor evaluation.) (82)

5. Management

Patients with weak or hypotonic vaginal and anal muscles may benefit from Kegel-type exercises. In contrast, those with hypertonicity might be better served by techniques like manual therapy, scar tissue manipulation, modalities (ultrasound, e-stim, ESWT), massage, dilators, breathing re-training, cognitive behavioral therapy, and meditation. (42,44)  

6. Kegels

In cases of pelvic muscle weakness, Kegel exercises may be appropriate. Proper instruction and exercise monitoring are essential, as most women with pelvic floor dysfunction have an inaccurate self-perception of pelvic floor muscle contraction. (61) Many patients will often incorrectly bear down, performing a Valsalva maneuver instead of a Kegel. Monitoring devices or internal self-assessment by the patient can confirm a proper lift and squeeze technique.

Kegel – Short Hold

7. Alternatives

One of the quandaries for prescribing Kegel exercises is that a hands-on pelvic exam is a prerequisite; however, very few practitioners are qualified and willing to provide that service. Fortunately, core and eccentric pelvic floor training exercises are alternatives to Kegel exercises that may benefit patients with either hypertonicity or hypotonicity. 

Examples include:

* The following new exercise videos are subscriber-only benefits.

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8. Rehab Benefits

Pelvic floor muscle training performed for three months can lead to significant quality of life improvements. (62) Women who perform pelvic floor muscle training are five times more likely to report resolution of urinary incontinence. (58) 

9. Aerobic Exercise

Concurrent general aerobic training may enhance outcomes for pelvic floor rehab. (55,64) Regular aerobic exercise may also help maintain improvements achieved through pelvic muscle training. (42) Incorporating Pilates and yoga may be useful adjuncts. (65) 

10. Patient Education

Patient education is a crucial component of recovery. (26) Considerations include:

    • Providing a potent rationale and motivation for home exercise. 
    • Teaching controlled fluid intake and timed urination skills, although some patients may not respond to bladder training. (36) The natural tendency to avoid fluids can lead to dehydration and subsequent muscle dysfunction. 
    • Patients must understand the importance of diet, including limiting caffeine, alcohol, artificial sweeteners, and inflammatory or gas-producing foods. (66) 
    • Most importantly, providers must provide an environment of support, empathy, and compassion so that patients are comfortable discussing their concerns.

    Want to put this information into action?

    Subscribers can visit the condition reference library to review the entire new protocol, including all assessments, treatments, and exercises. Plus, subscribers can relay the essential exercises and ADL’s to their patients with a couple of clicks.

    References
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    8. Continence Foundation of Australia. 2018. Pelvic Floor Muscles in Men. Accessed 3/12/2021 from: Link

    10 . Foundation Physiotherapy. 2018. 5 Basic Functions of your Pelvic Floor. Accessed 03/12/2021 from: Link

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