Do you suffer from lower back pain? If so, you’re not alone as about 80 percent of all Americans deal with it during some point in their lives. There are many reasons for lower back pain. One of the most commonly overlooked causes is PFD or pelvic floor disorders. Here’s how lower back pain may be caused by problems with the pelvic floor, along with how physical therapy can be an effective treatment.
Definitions of Lower Back Pain and Pelvic Floor Disorders
First, let’s clarify what we mean by lower back pain and pelvic floor disorders.
- Lower back pain (LBP) pertains to pain that’s localized in the lumbar spine or pain in the lower back that’s between the legs and the ribs. LBP may or may not involve symptoms to the distal extremities.
- The pelvic floor is the term that refers to the group of muscles in the pelvic area. These muscles that make up the pelvic floor serve as type of hammock or sling for the organs in the pelvic area and have the job of protecting vulnerable bodily functions, such as bladder and bowel control, mobility and sexuality. Problems with the pelvic floor can also be an underlying cause for lower back pain.
- Pelvic floor disorders are the result of pelvic floor muscles failing to contract properly, which can lead to problems, such as pelvic organ prolapses, urinary and/or fecal incontinence, besides other issues.
- According to studies, it’s been found that people with lower back pain also suffer from a substantial amount of pelvic floor conditions compared to those without any lower back pain.
Symptoms Suggesting Lower Back Pain Is Caused by Pelvic Floor Problems
If you have lower back pain, it may be caused by PFD when you have symptoms, such as:
- Needing to urinate more frequently than normal—Consider that normal urination should occur about every two to four hours or six to eight times per day.
- Difficulty getting to the toilet on time
- Urinary leakage linked with an unexpected strong urge to urinate as well as leaking urine when you laugh, cough, sneeze or exercise
- Chronic constipation or other bowel issues
- Lower abdominal pain
The first step is getting a comprehensive medical and pelvic floor exam by a trained pelvic floor physical therapist. Then, after a professional diagnosis of PFD has been done, you have several options:
- The first line of defense is physical therapy and creating a critical pathway supported by research. If standard orthopedic physical therapy doesn’t fix your issue, the missing link to your problems can often be the pelvic floor.
- Pharmacotherapy may be used for addressing incontinence problems. This involves taking drugs that are formulated for increasing urethral closure pressure and targeting the urethra’s smooth and striated muscles. Although corticosteroid shots or pain meds may help in relieving symptoms, they don’t solve the root issues of either LBP or PFD.
- Surgery is typically the last resort but may be recommended if you’re a female with LBP and PFD who hasn’t found relief from physical therapy or other types of noninvasive treatments.
- Some of the surgical options include the implantation of a spinal cord stimulator, artificial urinary sphincter, pubovaginal sling procedures and mid-urethral sling procedures.
How Physical Therapy Can Help
Even though drugs and surgical procedures can resolve some pelvic issues, there are numerous studies showing that, for many people, the answer is a combination of physical therapy and home exercises. Various exercises are used by physical therapists for treating LBP/PFD, but they all share a common goal, which is regaining neuromuscular control of the pelvic floor. Usually, physical therapists start their clients out with diaphragmatic breathing and then progress to exercises, including tonic activation, muscle strengthening, functional expiratory patterns and impact activities.
Physical therapists also use lumbar stabilization exercises designed for stabilizing the lower back. These exercises, which are done in a neutral, pain-free position, teach patients how to strengthen their backs, while increasing flexibility.
Once you’ve fixed your pelvic floor problems, you want to ensure they don’t return. A few important aftercare guidelines include:
- Maintaining a healthy body weight—If you’re overweight, you need to lose weight by eating healthy foods and staying physically active. Consider how excess abdominal body fat around the abdominal organs can create more pressure on the pelvic floor.
- Continue doing safe, pelvic floor fitness exercises as recommended by your physical therapist.
- Don’t strain when constipated as this increases the odds of prolapse. Furthermore, consume foods that encourage well-formed, soft stools.
- Control coughing because forceful coughing can lead to pelvic floor prolapse. Coughing causes a downward force from the abdominal muscles that puts pressure on the pelvic floor. Forceful coughing can be even more of a threat when a pelvic floor is weak and isn’t strong enough to resist the force involved with coughing.
People Who Are More Likely to Have LBP and PFD
- You are most at risk for LBP and PFD if you are a middle-aged or older woman. In fact, more than one out of every four women, besides one out of three women over age 65, deal with PFD.
- If you’re pregnant or have had a vaginal delivery, you’re more prone to develop PFD. If you’ve had more than one vaginal delivery you’re even more susceptible.
- Being overweight or obese is another factor.
- If you smoke, you’re more at risk than people who do not smoke.
- If you struggle with incontinence or have lumbopelvic pain, you’re more likely to suffer.
- Do you exercise regularly? If not, you stand a greater chance of developing pelvic floor conditions.
- Stress and depression can cause problems with LBP and PFD.
- Having a job involving a lot of bending, twisting and heavy lifting can also lead to issues in the pelvic area.
Other Considerations and Warnings
- It’s critical you get physical therapy from a highly trained and qualified physical therapist and not attempt exercises on your own.
- Having pelvic floor muscles that are too tight doesn’t mean they’re stronger although it may seem like a positive thing.
- If you have a tight pelvic floor, you need specific exercises. To determine whether your pelvic floor is too loose or too tight, see your doctor.
- Kegels are exercises that are only intended for a weak pelvic floor and can do more harm than good when they’re used for a tight pelvic floor.
- Since the pelvic floor isn’t visible, often pelvic floor issues are not diagnosed for a long period of time. But this doesn’t mean you can’t get help from physical therapy.
Questions? To learn more about the benefits of physical therapy for pelvic floor issues, please contact us.