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Pelvic Floor Disorders




Physical Therapy

All women's health patients have individualized programs customized to maximize success.  Treatments begin with a thorough evaluation of the pelvic floor muscles.  Alignment of the ilium and sacroiliac joints are evaluated as they can be a factor in the development of pelvic floor muscle dysfunction.  Assessment of the abdomen and pelvis for restrictions caused by scar and myofascial tension around the uterus and ovaries are also part of the evaluation.

Some of the specific interventions used to treat pelvic floor disorders include:

Hands-On Therapy

This form of therapy is typically recommended for pelvic pain, dyspareunia, and vaginismus.  In these conditions, the pelvic floor muscles are often tender and shortened by spasticity.  Treatment often requires internal and external techniques.  Manual (hands on) therapy aims to reverse the myofascial tension and release the trigger points.  Some pelvic pain patients tend to have abdominal myofascial restrictions either from an old scar or just myofascial tightness around their uterus, ovaries and intestines. Manual therapy is used to release all fascial restrictions.  Most patients with vaginismus need to work on soft tissue lengthening around the vaginal opening through manual physical therapy techniques.  They are instructed on the proper use of vaginal dilators, which they are also directed to use at home for at least ten minutes per day. Some of these patients also have soft tissue tightness along the deeper pelvic (levator ani) muscles, which need additional manual treatment.  During treatments, patients are asked to do diaphragmatic breathing to relax as trigger points are released by manipulation (putting pressure on spot until it relaxes). Treatments are concluded with a series of pelvic floor exercises to help bring blood flow to the pelvic floor and help strengthen these muscles, which tend to be weak due to soft tissue shortening. 


This form of therapy utilizes a digital device with visual feedback on a small screen as a teaching tool to help patients learn Kegel exercises (pelvic floor muscle exercises useful in the treatment of urinary and fecal incontinence) and to relax their pelvic muscles.  It also provides information on the strength, tension, and the patient’s ability to voluntarily contract her muscles.  External electrodes are placed on the body or probes are inserted in the vagina or rectum to determine how tight or relaxed the pelvic floor muscles are and a visual display of the results is projected on the computer screen.  All urinary and fecal incontinence patients need to strengthen the pelvic floor muscles. Some patients need to focus on the slow twitch (endurance) muscles while others must focus on the fast twitch (power) muscles. The biofeedback machine is also useful in teaching patients how to relax the pelvic floor muscles.  

Electrical Stimulation

E-Stim is used for both neuromuscular re-education of the pelvic floor and to help reduce over stimulation of the bladder.  A small probe is placed inside the vagina or rectum and the pelvic muscles are stimulated directly, causing the muscles to contract and relax.  External electrodes may also be used to relieve pain and spasm.  With these techniques, patients learn to more effectively recruit the pelvic floor muscles during the exercises.  This form of therapy is useful to treat pelvic pain, spasms, as well as urinary and fecal incontinence.  These E-Stim units can be used at home to continue a therapy program. 


About our Physical Therapist

Cassand Crispo Palmer MPT, is a board certified Physical Therapist working at Sibley Memorial Hospital in the outpatient PT department. She completed her master’s degree in physical therapy in May 2000 at the University of Maryland at Baltimore where she focused her studies in orthopedics. Shortly after graduating from PT school, Cassand gained interest in women's health and began taking continuing education courses specific to women's health issues. Over the past seven years, she has become a women's health specialist and helped develop a women's health program at Sibley Hospital. 
Cassand has been treating women with a variety of pelvic floor dysfunctions including:
  • pelvic pain
  • interstitial cystitis
  • dyspareunia (pain with intercourse), 
  • vaginismus (involuntary muscular closure of the vagina)
  • urinary incontinence 
  • pelvic organ prolapse 
  • fecal incontinence

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