Content Warning: This article extensively discusses multiple forms of trauma, including mental, physical, and sexual abuse.

An abuse survivor refers to an individual who has experienced some form of trauma, such as physical, emotional, or sexual abuse. Any form of abuse can have significant physical and psychological effects on a person that can be either short or long-term.

One major result of abuse that often doesn’t get much attention is the impact on pelvic health.

Read through this article to learn about the connection between abuse and pelvic health, as well as how physical therapy can play a major role in managing symptoms resulting from abuse.

Pelvic Health

Pelvic health is just as important as any other aspect of bodily health. It impacts daily life for every individual, after all! The pelvis contains a group of muscles called the pelvic floor, which allows for urination, defecation, sexual function, and sexual appreciation.

When the pelvic floor is not in good health, it cannot perform these functions properly. This can happen when the muscles are too weak, too tight, inflexible, or uncoordinated—also known as pelvic floor dysfunction. 

Additionally, the pelvic floor has other jobs that can be impacted by dysfunction.

These jobs include supporting pelvic organs, contributing to the body’s stability, and coordinating with other areas of the body like the core, lower back, or hips.

Due to its unique connection to so many areas, the pelvic floor helps support a wide range of daily movements and physical activities.

Pelvic floor dysfunction can involve a very wide variety of symptoms, and many of these symptoms present themselves in some form of bladder, bowel, or sexual dysfunction.

Some examples of symptoms that can be experienced with pelvic floor dysfunction include:

• Chronic pelvic pain
• Dyspareunia (pain before, during, or after sex)
• Vaginismus (pain with insertion, such as menstrual products, examination tools, or sexual activity)
• Urinary or fecal incontinence
• Incomplete bladder emptying
• Urinary urgency
• Constipation 
• Genital pain
• Erectile dysfunction
• Pelvic organ prolapse
• Painful bowel movements or urination
• Pain in the abdominals, hips, or lower back
• And more

Unfortunately, pelvic floor dysfunction can also worsen gastrointestinal or gynecological disorders such as IBS, IBD, endometriosis.

Pelvic Floor Health and Abuse

Pelvic floor dysfunction has many different causes. However, any form of pelvic floor dysfunction can originate from or be worsened by experiences of abuse.

It is important to note that “abuse” does not strictly refer to physical abuse. Any form of abuse—physical, psychological, or sexual—can impact pelvic health.

The body and mind are more connected than people realize. Emotional well-being affects physical health, and vice versa.

In fact, other pelvic symptoms related to abuse and trauma can include sensitivity to touch, lowered bodily awareness, or a disconnection from the pelvic area. These are often due to the psychological effects of trauma.

These psychological effects create stress, anxiety, and fear surrounding the body and experiences involving the body, including but not limited to sexual activity, the use of menstruation products, or physical examinations.

Regardless of the type, abuse can leave an individual with lasting effects that can impact their pelvic floor health and other aspects of physical and mental health. This can include things like:

• PTSD
• Depression
• Anxiety
• Physical damage or injury
• Heightened stress or an overactive nervous system
• Fear of sexual intimacy

Due to these factors and their lasting effects, pelvic floor dysfunction can become a long-term struggle.

It is very important to seek treatment for pelvic floor dysfunction, as it can worsen with time and does not usually resolve on its own.

Hive Pelvic Floor Therapy

While seeking treatment for pelvic floor dysfunction can seem intimidating, especially for those who have experienced abuse, it is very important not to ignore your symptoms.

Rest assured that at Hive Therapy and Wellness, your comfort is our priority. Our providers do their best to provide compassionate, trauma-informed care that puts you in control.

When receiving treatment or an examination at Hive, your provider will always request consent beforehand and educate you on the entire process. You always have the right to refuse services or even stop services midway if need be.

Your comfort is what matters most, and so our providers will always work with your needs, even if that means working around certain treatments. We want you to feel heard, safe, and supported throughout your entire health journey!

Our providers understand that talking about your abuse experience can be difficult.

While talking with others can often help individuals who have experienced abuse, we’ll never push you to share more than you are comfortable with.

Understanding that abuse can have significant effects on pelvic health is important, but you are not obligated to share anything you are uncomfortable with.

Additionally, our physical therapists are always ready to collaborate with other providers as needed, including mental health professionals, urologists, gynecologists, and more in order to best meet your unique needs.

In other words, they are ready to be a part of your support team—remember, you are not alone!

Start Healing with Hive

Abuse is often mistakenly thought to be strictly physical, but as mentioned before, that is definitely not the case.

There are unfortunately many situations and types of abuse that can affect a person’s pelvic health. Some abuse survivors may not even realize just how much their experiences can impact their pelvic health.

Therefore, we’ve decided to list many different examples of abuse that can impact pelvic health, so that those who are uncertain on whether their experience could be a contributor to their pelvic dysfunction can hopefully find clarity.

Sexual Assault / Abuse 

Individuals who have experienced sexual abuse or assault, whether in childhood or adulthood, are likely to experience significant effects on their pelvic health.

The most common result is tightened pelvic floor muscles, which can cause chronic pelvic pain, painful intercourse, vaginismus, and urinary dysfunction.

The emotional aspects of this form of abuse can greatly affect an individual’s relationship with intimacy, creating fear or anxiety that leads to involuntary guarding of the pelvic floor.

Sexual violence can unfortunately occur in many different places and situations. This can include survivors of trafficking, exploitation, or sexual violence in war or training in armed forces.

In other words, any form of sexual abuse is harmful, and its effect on pelvic floor health shouldn’t be disregarded.

Physical / Domestic Abuse

Physical forms of abuse can create injury and damage to the pelvic or abdominal region, which can affect structures of the pelvic floor and harm function.

These structures can include muscles, organs, connective tissue, and nerves. Direct damage to these structures causes pain and dysfunction that may contribute to long-term conditions.

Physical violence can also create scarring and emotional trauma that can exacerbate pelvic floor tension, as well as cause psychological effects like depression or anxiety.

Medical Abuse or Trauma

The medical system cannot be excluded as a source of abuse. Non-consensual invasive procedures, medical negligence, forced medical interventions, and other traumatic experiences can significantly impact pelvic health.

These types of experiences can create emotional trauma and well as physical injuries or scarring, all of which can lead to pelvic floor dysfunction.

Obstetric (childbirth-related) violence is one form of medical abuse that can significantly affect pelvic health. This form of abuse includes anything from verbal abuse to procedures performed without consent.

Obstetric violence can happen during labor or delivery, and can create worsened perineal tearing, trauma from episiotomy, and even pelvic organ prolapse.

Psychological or Emotional

As mentioned before, physical abuse is not the only form of abuse. Psychological and emotional abuse can significantly impact an individual’s health, including pelvic health.

This form of abuse can create chronic stress and anxiety, as well as other psychological effects like depression.

All of these factors can create tight muscles and an overactive nervous system, which can lead to pain and pelvic floor dysfunction.

Religious or Cultural Trauma

Lastly, religious and cultural beliefs can cause both physical and psychological harm to individuals, which can impact pelvic health.

In many cases, religious or cultural practices can create sexual shame and emotional distress that leads to anxiety, fear, and other negative feelings related to pelvic health or sexual health.

Some examples include cultural practices, forced social cohesion, forced marriages, and ritualistic abuse.

These kinds of experiences can vary greatly, but can lead to severe pelvic floor dysfunction, sexual dysfunction, sexual trauma, emotional trauma, and even damage to the pelvis or surrounding areas.

Ultimately, any form of abuse or violence can cause pelvic floor dysfunction, scarring, physical trauma, and psychological impacts that can affect an individual’s daily health for years to come.

A multidimensional treatment approach can help reduce pain and other symptoms, allowing survivors to live with better health and an improved quality of life.

In the next section, we’ll discuss how pelvic floor physical therapy can play a very important supportive role for abuse survivors.

The pelvic floor physical therapists at Hive Therapy and Wellness provide trauma-informed care for survivors of abuse.

Our physical therapists can support survivors by addressing pelvic floor dysfunction and other musculoskeletal symptoms through curated treatments, while collaborating with other professionals who focus on the emotional and psychological effects of abuse.

Although physical therapy does not directly address the psychological aspects of abuse, the physical therapists at Hive work hard to create a safe and supportive environment for our patients.

We hope that Hive can become a pillar of support for patients as they regain control of their health!

As mentioned earlier, you are in control of treatment. Our providers will always request consent before performing treatment or examination, and even after previously giving consent, you have the ability to revoke it.

Hive’s providers want you to feel comfortable and safe, so rest assured that you’ll have control of each and every visit! Your boundaries will always be respected, and your concerns will always be heard.

Now, let’s take a closer look at the role physical therapy plays in supporting abuse survivors…

Benefits of Pelvic Floor Physical Therapy

First and foremost, pelvic floor therapy has a ton of benefits to offer. Improving your pelvic health can reduce pain and restore your pelvic floor function—which in turn, relieves a variety of unideal symptoms.

With a strong, healthy, flexible, and coordinated pelvic floor, you’ll have less urinary problems, better bowel function, and more control over your sexual health. You’ll have less pain, and you’ll be able to better manage chronic conditions like IBS or endometriosis.

Addressing pelvic health is a great way to restore a healthy relationship with your body.

Your physical therapist will create a safe space where you can learn about your pelvic floor and how it contributes to sexual health or general health. Education helps clear fear of the unknown, allowing you to gain better bodily awareness and confidence.

With treatment in the clinic and consistent at-home care, you’ll be able to live with less pain, better function, and a better overall quality of life! With that being said, let’s talk about the actual treatment process next.

Examination and Assessments

Before coming into your appointment, you will be asked to fill out intake forms, which your provider will review before you come in.

At Hive Therapy and Wellness, your intake form will ask if you have experienced any form of abuse, or if you have ever had an unwanted sexual experience.

This helps your provider better understand the level of care you may need, even if you do not wish to discuss your experience further during treatment.

The actual treatment process typically begins with an evaluation. The evaluation allows a provider to review any relevant medical histories (past injuries or surgeries), as well as discuss your symptoms and your trauma history, if you are comfortable with doing so.

In addition to an evaluation, your provider will perform an examination with your consent. Examinations can be either internal and external, and allow your provider to assess things such as:

• Muscle tone
• Range of motion
• Sensitivity
• Trigger points

External examination typically focuses on the pelvis, hips, lower back, and abdominals. External exams can even include things like posture, breathing patterns, and spinal alignment.

Internal examination looks to assess the pelvic floor muscles, and can be done via the vagina or rectum. Internal assessments typically only involve palpation (touching and feeling) from your provider’s gloved hands, and don’t usually require any tools.

This type of examination can provide important information, such as the location of your pain, the condition of your muscles (their tension, bulk, length), and the level of control you have over these muscles.

Again, you have the right to refuse examination. Even if you provide consent, don’t be afraid to let your provider know what you are or aren’t comfortable with during examination.

Pelvic Floor Therapy Treatments

Once your physical therapist has a better understanding of your health and pelvic floor condition, they’ll formulate a treatment plan that is curated to your unique needs.

This treatment plan can involve a wide variety of treatments, all of which are designed to restore your function and reduce your pain. Some examples of pelvic floor treatments used at Hive can include the following:

Pain Management and Manual Therapy

Tight, overactive pelvic floor muscles and other factors can create significant and even chronic pain. Your physical therapist can provide a variety of pain-relieving treatments, a major one being manual therapy.

Manual therapy is a physical technique that manipulates muscles, nerves, ligaments, and tendons to gently mobilize them and reduce tension.

Manual therapy improves blood flow and addresses painful trigger points, helping to relieve pain and reduce stiffness. This can be useful for those with scars from past injuries or surgeries, which can contribute to restricted mobility in the pelvic region.

Manual therapy can be performed in a variety of ways. It may be done externally using your provider’s hands or other tools to areas such as the pelvis, abdominals, lower back, or hips.

Techniques like cupping, tissue scraping, or dry needling are great for these areas. Internally, your provider can utilize pelvic wands to target tight pelvic floor muscles.

Releasing tension and improving mobility doesn’t just reduce pain, but it also improves overall function. Manual therapy can even help address hypersensitivity or fear of touch through slow, gradual exposure.

Pelvic Floor Training

In order to properly address tight or weak pelvic floor muscles, you must gain control over them. Your pelvic floor muscles are able to voluntarily and involuntarily contract and relax.

However, some individuals may be unable to control these movements, leading to problems such as overactivity and tightness.

Therefore, your physical therapist will lead you through exercises and treatments to improve your coordination and control over these muscles.

This can involve treatments like neuromuscular re-education and biofeedback, which allow you to relearn and practice contraction and relaxation of your pelvic floor.

These treatments can allow you to receive feedback on your pelvic floor movements in real time, so that you can better understand those movements mentally, too!

While you regain control over your pelvic floor, your physical therapist will teach you other ways to relax or strengthen your pelvic floor. This can include breathing exercises, pelvic floor exercises, and other specialized activities.

Additionally, they’ll teach you important behavioral modifications that will reduce strain on the pelvic floor. This may involve things like:

• Posture corrections
• Toileting techniques
• Proper lifting form
• And more!

Dilator Therapy

For many survivors of abuse, dilator therapy may be an extremely beneficial form of treatment. Dilator therapy is a form of treatment involving tools called dilators, which come in many different sizes (length and width) and materials.

These tools allow individuals to gradually and gently stretch the tissues of either the vagina or rectum at their own pace.

This therapy is beneficial for many as it can help with a variety of struggles and concerns, such as the following:

• Vaginismus
• Hypersensitivity
• Vaginal stenosis
• Painful penetration (such as with sex, exams, menstruation products or sexual aids)
• And more

Dilator therapy may seem simple, but it is possible to go about it improperly. With the guidance and instruction of a pelvic floor physical therapist, you can better understand how to go about the process safely and effectively.

This can include aspects such as how long to dilate, when to dilate, how often to dilate, which size or material is suitable for your needs, which lubricants are best to use, and even how to set goals properly.

Long-Term Maintenance

Pelvic health is something that can change with many factors: hormones, age, medication, pregnancy, and much more.

In order to help you maintain good pelvic health long-term, your physical therapist will provide you with the education, tools, and resources needed to prevent future dysfunction.

This can include at-home exercises plans, stress management strategies, and even suggestions for supporting sexual health (positions, lubricants, and more).

Your provider can suggest tools such as pelvic wands or dilator sets for you to use at home, and can teach you self-massage techniques to reduce tension and manage pelvic pain.

For some individuals, revisiting your pelvic floor therapist periodically may be necessary to maintain good pelvic health or to reach certain health goals.

This is totally normal; as mentioned before, many things can impact pelvic health over the course of your life.

Regular visits can be especially useful for those managing chronic conditions, which are long-term and can impact pelvic health significantly for many years.

As you can see from the examples above, there are many ways that a pelvic floor physical therapist can provide support and treat symptoms for an abuse survivor—many of which we didn’t discuss in detail here.

The providers at Hive Therapy and Wellness work hard to provide compassionate trauma-informed care to those who are recovering from their experiences, and hope to support a better quality of life through comprehensive treatment plans.

This comprehensive care plan can include a variety of treatment methods, including any of the following:

• Neuromuscular re-education 
• Manual therapy
• Exercise prescription 
• Dry needling 
• Cupping 
• Tissue scraping 
• Behavioral modifications 
• Therapeutic activities 
• Electrical muscle stimulation
• Spinal manipulation 
• Therapeutic modalities 
• Biofeedback