New Explanation for Women's Pelvic Pain?

Some women, even younger women, feel like their lives revolve around their bladder.

They find themselves searching for a public restroom even though they went to the bathroom 20 minutes ago. Some of these women may also have nebulous pelvic pain, low back pain, bowel problems, or pain during intercourse.

Most will cope with their symptoms, despite the impact on their quality of life. And others will seek help from a variety of doctors, often trying pain medications and antibiotics that don't provide any relief.

Some doctors and physical therapists have begun to diagnosis women with these symptoms with pelvic floor dysfunction, concluding that their symptoms are due to problems with the muscles of the pelvic floor.

Because not all health professionals recognize pelvic floor dysfunction as a condition, it is a somewhat controversial diagnosis.

As a result, awareness of pelvic floor dysfunction among health professionals and patients is low.

But Dr. Elizabeth Kavaler, a urologist in private practice in New York City, and Amy Stein, a physical therapist with Sports Physical Therapy of New York, are hoping to raise its profile.

Although relative little research has been done in this area, physical therapy may be helpful in treating many pelvic floor dysfunction symptoms. Kavaler and Stein are planning a study that will examine how well physical therapy eases the symptoms of pelvic floor dysfunction.

Below, they discuss pelvic floor dysfunction diagnosis and treatment.

What is pelvic floor dysfunction? Stein: Pelvic floor dysfunction is any kind of impairment in the pelvic floor area, which is part of the core of the body. The pelvic floor includes the muscles that surround the rectal area and genital area. The pelvic floor helps to support the internal organs and helps with the function of urination and defecation.

Kavaler: Pelvic floor dysfunction is not a very widely understood or necessarily accepted concept, but to those of us do accept it as a diagnosis, it is a muscular problem that involves spasming of the pelvic floor muscles.

What are the symptoms of pelvic floor dysfunction? Stein: Common symptoms are urinary symptoms, such as urinary frequency and urgency, pelvic pain, low back pain and irritable bowel syndrome. I've found that some people have just one symptom, and other people have combinations of symptoms. Additionally, there are many different sub-classifications of pelvic floor dysfunction. Vulvodynia, for example, is defined as pain in the vulvar area and may also include chronic stinging, irritation, painful intercourse and burning.

Kavaler: Often pelvic floor dysfunction patients will present, at least to me, with urinary problems. So they may have a lot of frequency and urgency, but they have a normal exam and no evidence of infection in their urine. If I do studies on them, I find that their bladders work very well. But when they empty their bladders, the bladder doesn't empty very efficiently. It's slow and there is a lot of stopping and starting. That's because the muscles that are around the urethra are in spasm and are not relaxing enough to allow the bladder to empty.

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