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Hey y’all,
I recently evaluated a pt with a wide range of complaints, the most unusual of which were perineal pain and LBP with urination or orgasm. I am trying to figure out where pelvic floor issues may play into some of his other complaints. However, I do not have a large selection of pelvic floor special questions in my brain at this point. What are some questions you ask clinically to determine whether or not there is pelvic floor involvement?
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Hey Tyler,
I’m going to post the article I used in my case discussion again, because I found it very helpful for male pelvic floor special questions and differential diagnosis. Some questions I would ask: Any bowel issues? Specifically in the AM? Pain with ejaculation or after? Any NT? (thinking about the article Eric posted on peripheral nerve entrapment at the hip and keeping that on your differential list). Also, any testicular referral? (thinking about myofascial imbalances and their pull on the pubic symphysis and the inguinal ligament).
Keep us posted!!
EDIT: I’ll post the article when I get home because Valley Health’s system wont let me upload the attachment. But its the first article I posted on my OMPTS case discussion for Weekend 5.
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Yeah that’s understandable. Let me know if the article is helpful or if you have any other questions. I wrote up my guy with pelvic floor pain for an abstract submission for CSM, so I have a few other resources available if you need them.
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Tyler – you should post the specifics of the case to better organize the reasoning components more for you upon re evaluation, treatment direction/progression; and to frame this discussion of specific questions better as well.
Thanks
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Heres that article Tyler.
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Hey Tyler!
All of those questions Katie listed are great for determining if this is a pelvic floor case. To take it a step further, if it is pelvic floor I think on of the main objectives is to determine if their pelvic floor is hyper or hypo active. This is particularly important in determine treatment and exercises to give. Some special questions may be asking if he has the feeling of his pelvic floor dropping or if it feels like it is taught. Does anyone remember other ways to determine the difference? Do you have a hypothesis for what end of the spectrum your patient is? If so, what are some manual treatments/ HEP you gave him day 1?-
Jen, I agree on differentiating between hypo- and hyper-active. It is essential to determine the difference because exercises for hypoactivity (kegels/TA activation) are going to make hyperactivity worse. Good exercises for hyperactivity are diaphragmatic breathing and correcting any regional myofascial tightness. The article I attached does a good job of laying out the patient demographics for men with hypo vs hyperactivity. Other special questions with b/b sx are differentiating between leaking urine vs straining to urinate and if there is sx with referral during straining/bearing down.
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