Physical Therapy and the Treatment of Chronic Pelvic Pain: A Comparison of Pelvic Floor Exercises and Manual Therapy

Academic Advisor: James “Bone” Dexter, PT, MABackground/Purpose: Chronic pelvic pain (CPP) is defined as nonmenstrual pelvic pain occurring for an average of two weeks per month for at least 6 months duration and may be accompanied by symptoms such as urinary urgency or dyspareunia. The prevalence of CPP reaches 15-20% in the general female population and accounts for up to 10% of gynecological visits resulting in $2.8 billion annual expense. The purpose of this study is to determine whether pelvic floor muscle exercise or manual therapy is more effective in treating chronic pelvic pain. Case Description/Methods: Patient is a 52 year-old gravida 1 para 1 female presenting to physical therapy with chronic pelvic pain, dyspareunia, and urinary urgency. A search of the literature was performed to compare the efficacy of pelvic floor muscle exercises and manual therapy in the treatment of chronic pelvic pain and associated symptoms. A critical appraisal of the resulting articles was executed and several evidence-based interventions were integrated into the patient’s plan of care. Findings/Conclusions: While there are few studies with high levels of evidence investigating the use of manual therapy in the treatment of chronic pelvic pain, myofascial release and trigger point therapy are two manual techniques that have been used to successfully treat chronic pelvic pain and urinary urgency. As a patient’s painful symptoms decrease, it is important for patients to maintain normal movement and function. Increasing strength of the pelvic floor muscles and obtaining a correct contraction are important in maintaining stabilization and appropriate support of the pelvic viscera after myofascial restrictions and trigger points are addressed