Background: Many women experience debilitating symptoms of voiding dysfunction and pelvic pain, leading to limitations in daily living. Physical therapist interventions for voiding dysfunction and pelvic pain are noninvasive, multimodal, and patient-specific. This study reviews the efficacy of physical therapy interventions in treating symptoms of voiding dysfunction and pelvic pain.
Study Design: This is a retrospective chart review of 5 female patients referred from urogynecology to Women's Health Physical Therapy. Indications for referral included urinary retention, chronic pelvic pain, recurrent urinary tract infections, and levator ani spasm. Interventions included bladder training, pelvic floor relaxation, biofeedback, manual therapy, vaginal scar massage, and instructions for internal self-massage.
Case Description: Mean age was 52 years (range, 20-80). Mean duration of symptoms at the onset of therapy was 13 years (range, 2-25). Each patient was evaluated and treated on an individual basis by using a wide range of physical therapist interventions. Outcome measures of change in pain and functional limitation scores were measured.
Outcomes: On a scale of 0 to 10, with 10 being the greatest pain, initial mean pain score was 5.3, and the mean at completion of therapy was 1.3. Functional limitation described by patients (range from 0%, no limitation, to 100%, complete limitation) improved from a mean of 75% to 40%. Three patients required self-catheterization at the onset of therapy; at discharge, 2 no longer required catheterization, and the third reduced from 12 to 3 times daily. The mean number of visits for the 5 patients was 7 (range, 3-15), with treatment duration ranging from 10 to 16 weeks.
Discussion: Voiding dysfunction and pelvic pain symptoms appear to improve in women who adhere to a comprehensive physical therapy plan of care. By combining direct intervention during Women's Health Physical Therapy visits with a regular home exercise program, women in this case review were able to make gains toward symptom resolution.
Duke University Medical Center, Durham, North Carolina.
The study received approval from the Duke University Health System Institutional Review Board for clinical investigations.