Background:
Ankyloglossia is a congenital condition of the tongue in which the lingual frenulum is shortened, causing restrictions in the mobility of the tongue. Improper tongue mechanics have an impact on breathing, and impairments can cause a strain on the diaphragm, muscles of the head and neck, as well as the pelvic floor via the connective tissue and fascia. Evidence is largely lacking for the impact ankyloglossia has on pelvic floor function and pain.
Case Description:
The patient is a 31-year-old woman who reported primary dyspareunia, with significant exacerbation of symptoms postpartum. Six months after the physical therapy initial evaluation she was diagnosed with ankyloglossia, with the frenotomy performed 1 month later.
Outcomes:
The connective tissue restrictions, muscular restrictions, and myofascial trigger points were addressed via manual therapy. Her planned home exercise program was focused on down-training and breathing. She was initially improving at a slower rate than patients with similar symptoms and history. The first time she attempted intercourse following the frenotomy, she noticed a marked difference in her dyspareunia symptoms and her ability to relax her pelvic floor voluntarily.
Discussion:
The impact ankyloglossia had on the patient's pelvic floor was missed and her slow progress was attributed solely to other factors. Asking the proper patient history questions and understanding the potential impact that ankyloglossia can have on pelvic floor function can help physical therapists identify an easily missed underlying contributor for pelvic pain.