Physical therapy management of pelvi/perineal and perianal pain syndromes

Pelvic floor physical therapy is considered to be effective in the management of functional urogenital and anorectal disorders. A functioning pelvic floor is integral to increases in intra-abdominal pressure, provides rectal support during defecation, has an inhibitory effect on bladder activity, helps support pelvic organs, and assists in lumbopelvic stability. Coordinated release of the sphincters within a supporting extensible levator ani allows complete and effortless emptying. A major feature of pelvi/perineal and perianal pain syndromes commonly encountered by multidisciplinary clinicians is pelvic floor imbalance and incoordination. Precise pelvic floor and abdominal muscle coactivity, based on research, is used clinically. Motor and cognitive learning which can alter peripheral and central pain mechanisms and produce physical changes in the CNS, viscera, smooth and musculoskeletal tissues is the basis of physical therapy in pelvic floor and pelvic organ pain management.