Below is a sample of articles that can be accessed as a Medallion Member of the
International Association of Healthcare Practitioners. See IAHP.com for details.
Gynecologic Visceral Manipulation
An Evolutionary Treatment Approach for Pelvic Dysfunction
By Gail Wetzler, PT, CVMI, BI-D, EDO
The urogenital system can be one of the most stressed areas in the body due to lumbosacral dysfunctions,
intestinal problems, emotional holding, pregnancy, delivery and menses. In order for homeostasis to occur
within the pelvis, the pelvic pressure system must be balanced. In weight bearing postures, gravitational
pressures on the organs should go toward the bony hard frame. Any malalignment of anatomical structures
can have a dramatic effect on physiology (Schamberger 2002). The pelvic organs need room to expand,
displace and rotate with pressure changes promoted by digestion and elimination. For women, conditions
like digestive disorders, infections, trauma, childbirth or menses can increase pressures temporarily. Certain
conditions like chronic illness, medications, adhesions or surgical intervention can increase pressure for a
longer period of time causing visceral dysfunction.
Organs within the pelvic cavity are meant to move! If not, urogenital dysfunction may promote symptoms
of pain, constipation, urinary frequency, levator ani spasm, cystitis, dysmenorrhea or irritable bowel
syndrome. This normal organ motion stimulates specialized cells that secrete fluid for sliding surfaces
between our organs. Normal organ motion also seems to send a pattern of stimulus to the brain which it
recognizes and uses as a part of a communication system between the brain and other systems (Wetzler ,
Amen et al 2006). Organs are also meant to be stable! If not, pelvic floor weaknesses, organ prolapse,
bladder/ bowel incontinence or ligament laxiety may occur.
Prolonged urogenital dysfunction can develop into chronic pelvic pain. Chronic pelvic pain diminishes the
quality of life for one in four women (Zondervan 1999). It is the second most common gynecological
complaint and accounts for 20% of consultations and up to 52% of diagnostic laparoscopy (Ghaly 2000). For
many women, despite enduring multiple procedures, there will be no definitive diagnosis. Often symptom
relief is the treatment goal, rather than resolution. The Centers for Disease Control’s 2005 report reveals that
64% of chronic pelvic pain women suffered early childhood physical, sexual and/or emotional abuse. Long
term depression or anxiety, a facilitated sympathetic nervous system and alterations in the hypothalamicpituitary-adrenal axis may also contribute to chronic pelvic pain (Bremner 2003).
When women come for professional help with pelvic dysfunction we are thankful for the knowledge and
skills of Visceral Manipulation. Adding this approach to a treatment plan has helped resolve many recalcitrant
chronic pelvic dysfunctions. (Barral 1993)
Indications for Visceral Treatment
Low Back Pain – Often a result from urogenital restriction, history of falls on the coccyx, forcep or
suction delivery, chronic uteral deviations in position or visceral afferent somatic
dysfunction
Adhesions – History of surgery, infection, trauma, childbirth or abortions
Stability Problems – Prolapse, muscle weakness and ligament laxiety, hormonal
Dysparunia – Painful intercourse
Anorgasmia – Loss of orgasm, loss of libido
Circulatory Problems – Reflex vascular spasm, irritable bowel syndrome, lymph or chronic illnesses
Dysmenorrhea and Pelvic Pain – Poor biomechanics of the organs, fluid congestion, diet or nutrition,
nerve impingment, hormonal….. multiple
Infertility – Parietal peritoneum, fluid restrictions, cervix or tube dysfunctions, endometriosis, organ
deviations and endocrine imbalances.
Bladder Dysfunction – Incontinence, frequent infections, inflammation, detrusor muscle instability,
interstitial cystitis, urethral syndrome, removal of an associated organ and collapse of the
supporting structures.
Evaluating for pelvic dysfunction requires Listening to the tissues. With the myriad of possibilities that can
promote pelvic dysfunction, allowing the body to speak, letting the tissues guide us to the most important
dysfunction for this person, is KEY to problem solving. Treatment of the primary restriction site with Visceral
Manipulation will recreate, harmonize and increase proprioceptive communication in the body to enhance its
internal mechanism for better health (Barral 2003). Remember, the pelvis is the center of all forces in the
body. Its job is to transfer any load for coordination of Function. When restoring pelvic function with the
visceral concept, the cranial, thoracic and abdominal cavities must be considered in your treatment plan as
this allows for the importance of the anatomical fascial connection and the internal pressure system
relationship. The specificity of Visceral Manipulation will help our patients far beyond just symptom relief, it
will help us find and treat a compensation pattern that correlates with resolution!