Wednesday, July 1, 2009

Pelvic Floor Physical Therapy

Lots of people stumble onto this blog while searching google for pelvic pain and physical therapy, things like that.  And one particular commenter was about to go in for some pelvic floor physical therapy and felt scared so I thought it might be useful to do a post about what to expect when you encounter the unknown world of pelvic floor physical therapy.  

Many women (some men too) go to pelvic floor physical therapists for bladder and bowel disorders like incontinence, painful intercourse, pelvic pain, IBS, etc.  When I started, I was very skeptical that this sort of thing could relieve pain.  I'm still not sure!  But for me, I do know that whatever my problem is, my muscles and ligaments have tightened and shortened beyond belief (both internally and externally) over the last few months due to pain and a PT is the only person that's able to help with that. 

Before I went in for my first PT session my Dad had been telling me how useful PT exercises were for him when he hurt his back - so I was expecting some exercises and stretches and off I'd go.  I was naive.  I didn't even know this type of PT existed so boy was I surprised when I ended up on the table with a hospital gown on and a non-MD getting more friendly with me than my OB-GYN.  What happened to my pants?   Where are the stretches like my Dad said? 

If you find the right PT, these women seem to have more knowledge about your anatomy (that they'll share with you) than you will find with any other Doctor you're working with.  The key is finding the right person - I think this is even more critical than with a doctor.  Do not give up if you see a couple of people and don't like them or don't like whatever technique they're using.  Keep looking.  And from what one of them said to me, something like: "we all get the basic training but then we all specialize in certain things so X you saw last week may have training in that but I have some training in Y."  That was very interesting to me.  So do not give up if you do not like the first few people you see.  These places are very used to their clients requesting certain people, refusing others. Don't feel bad about doing that.  You're getting treatment for sensitive areas, you're the boss! 

I pursued PT for a few sessions and saw 2 different people, I didn't particularly hit it off with them and I didn't feel like they were helping me.  I didn't leave the sessions feeling better or worse.  Just the same.  Which isn't a good thing.  So I gave up for about 2 months.  Fortunately, I decided to give it another try and I'm really glad I did because I made an appointment with someone new who so far has been a great match for me.  That's why I'm now a believer that PT is worth giving a good shot with the right person.  Now, will it help me cure my pain? Who knows.  Will it help resolve these muscle problems I have because of the pain and the scar tissue I have because of my surgery? It should definitely do that and I'll be happy with that result.  All that muscle tightness isn't something I feel until I'm on the table and someone gently tries to massage any muscle from below my chest to my ankles basically -- I never knew I had it until I went to PT so it could be playing into your problem...or resulting from your problem...

The first session is typically much longer - maybe an hour and a half - and will probably be your least favorite.  It's a full evaluation (looking at your spine, walk, hold up a knee, vaginal).  For me it wasn't particularly painful but I suppose it could be depending on your problem.  The modesty factor is the only uncomfortable part which you'll quickly get over soon as all of the PTs I have encountered have been quick to put you at ease. And I have found PTs are better than most OB-GYNs about making sure you are covered up even when they are doing an internal exam or internal work.  I have found PTs to take things slowly, explain what they are doing if you ask (while they're working on a particular muscle) and you can have a running dialogue during the session if you want to - I try to get info out of them while they're working! They'll tell you what they're doing before they do anything that may cause you any pain - I would imagine this is the case particularly if you are there for issues related to pain with intercourse.  

After that, my PT currently treats in 45 minute sessions.  The only pain I experience is when she is working on really tight muscles.  But when they do internal myofascial release (working on tight muscles inside) I really don't feel it.  They are also very gentle - so find the right place, the right person and give it a try.  It is worth it if you can help regain a part of your life back that has been taken away from you.

Please feel free to post any questions or contact me.


29 comments:

  1. Thank you so much for your post. I have been struggling seeing different PT's and I have yet to find the right one. You just gave me hope to not stop looking. : )

    Best,

    Pamela in Pelvic Pain
    pamm725@yahoo.com

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  2. WOW!!! you are just amazing and I can't thank you enough for taking the time to try to be helpful and so informative about the whole PT thing. Lots of my questions were answered and that was really nice of you to try to help all of us. Best of luck to you in your search for answers. I have the feeling that you will be successful.

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  4. Great insight from a patient! I'm a pelvic floor PT and I totally agree that not all PT's (even those who specialize in Women's Health/Pelvic Floor) are the same. It is very important to find the right match. I have treated patients who have seen 6 physicians and 2 other PT's and were so frustrated by the time they reached me. I found many things that were never addressed by the last 8 people and completely made a difference. So, don't give up!! It's also important to remember that the best results when dealing with pelvic pain is to tackle all aspects of it at the same time- using appropriate meds or topical cream, doing PT, and a home program. Best wishes to all of you.

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  5. Thank you. I am in the midst of frustration; ready to give up. This all seems 'new agey' to me! I feel like a failure right now. After 2 wks, no improvement...it is all humiliating to me. Just another thing with getting older.

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  6. I had a severe pelvic floor injury, a full hyperextension of my pelvic floor. I have massive amounts of scar tissue and trigger points which are very painful. I lived with that pain for 9 years until I found a Pelvic floor PT that treats men and women. It has been a long, slow process but I can honestly stay I am 40% better than I was a year ago. Because of the extent of my injury and subsequent injuries I have been told by my urologist and my PT that this process may take several years. The pain has manifested in several areas including acute testicular pain for which I am treated at a pain clinic. I also have a female urologist (they listen-men don't) who has been giving me trigger point pelvic floor injections and Theile massage. Its not pleasant but after the second treatment I had 21 pain free days. That a first in almost ten years. No pain meds, no up all night, no testicular pain. I had another series of injections in January and had 25 pain free days. In March I will have the genitofemoral nerves burned off and pelvic trigger point injections the same week and we are hoping for as much as two months relief with no pain. If you are suffering from pelvic floor pain, whether a man or a woman, there is help for you. Just keep trying people until you find someone you can work with. There is a way out of this.

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  7. I'm only 18, I have never had a baby. No problems besides the occasional severe tightening of the muscle, which does hurt. My obgyn suggested PT, but the idea of internal therapy makes me very uncomfortable. Does all therapy include internal work, or is it possible to feel better with out taking my clothes off?

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  8. I have Endo and had a lap. hysterectomy and double hernia repair in Dec. 08. Since my surgery, I have extreme pain. I am 100% positive it's adhesions from the surgery. It feels like my bladder is adhered to my colon. Long story short, my doc. doesn't want to go back in because of the risk of developing more adhesions. The catch 22 right. So, I've been reading a lot about pelvic floor physical therapy. Is there a good website or resource that could help me find a doctor in the Houston area that could treat me? Do you recommend any other alternative treatments. I am getting desperate for an alternative method to reduce the pain. Any thoughts would help.

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  9. The Chronic Pelvic Pain Treatment will be successfully done through the proper usage of the modern equipment, devices and the medications. Basically, women whose average age group ranges from 26 -30 years are under the onset of the CPP. They suffer from pelvic inflammatory disease or infection which attacks the uterus section. CPP is very common physical discomfiture to females.

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  10. Thanks for this post. I was just referred, by a urologist, to a pelvic floor physical therapist. Although my urologist told me what to expect, it helps to read about it from someone who's been there. I have my first PT on July 1 and I'm looking forward to getting relief of my symptoms.

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  11. My pain started right after giving birth to my beautiful baby girl. It was very painful. I haven't been able to walk, stand, or sit for long periods of time. After attempting a 15 minute walk I begin to feel as though I'm giving birth to a heavy bowling. Walking hurts so bad that I have go right home. I have seen to different pt. The first one was amazing but due to job cuts we were not able to afford seeing her anymore. The second didn't even do half of what the first pt did. She expected me to do it all alone at home. Yeah right I have a two yr old at home and trust me her terrible you'd twos are tough. I sometimes felt as though she was not willing to do her job. Meaning everything in her power to help. I need help badly. It saddens me to see my daughter and not being able to take her for a nice walk, our play with her at the playground (her favorite), I can't even run around with like a mother should. Someone please throw some help my way. my family would deeply appreciate. Thanks for reading my experience.

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  12. I have had burning pelvic and abdominal pain for the last two months. I've never had any kind of surgery. I think it might be due to weightlifting from bad form. I'm doing internal myofascial release for the pelvic floor. I don't know if its working or not yet, but i will continue going. I am one of the unfortunate men to have been afflicted with mysterious pelvic pain. I hope one day to be pain free.

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  13. I was just referred to pelvic floor PT and thought it was just like for my back until reading this info tonight. I don't mean to sound nieve but exactly what does everyone mean by internal work & closer than your OB/GYN has ever been. Where are they putting what? I'm more afraid now than I was before I started reading this info. I have a Urodynamic test next week. I just found out they are going to insert a sensor into my bum and a cathater into my bladder. I have huge anxiety issues and I think I am going to just hide under my bed and try to ignore my painful bladder and very wet undies.

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  14. I am also a pelvic floor physical therapist. To answer the questions posted on 11/1/11...

    "Internal work" means internal vaginal or rectal work. It's like a gentle trigger point release. We use a finger and are very gentle and only do what you give us consent to do. It is usually much less uncomfortable than you expect it to be.

    The pelvic floor therapy is much gentler than your urodynamic testing.

    If you have anxiety issues, it's important to ask your therapist a lot of questions. The more you understand, the less anxious you will be.

    And...if this is any consolation...if your issue is incontinence, it is very likely that most of your treatments will be focused on strengthening and less "internal work".

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  15. please go to wakeupwell.org web videos then give me a call at 708 488 8887 "DOC" Mike

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  16. I FINALLY FOUND A PLACE THAT LISTENED AND UNDERSTOOD HOW DESPERATE I HAD BECOME. I've had pelvic pain for years with no hope in sight, I was referred to yet another treatment facility. However, when I arrived this place was different from the rest, "Sartin Physical Therapy" between Nicole and Julie they are angels!! I have began to see my future in a whole other light!!

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    1. Thank you for sharing! I have heard of Sarton therapy. How are you doing with their therapy?

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    2. Between the both of them I have had amazing progress, of course it's nothing that happens overnight but I am hopeful. They gave me a new perspective and helped me take control of my mind and body. There's nothing like feeling that you've lost yourself and your mind. I'm on the road to a successful recovery!

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    3. You are indeed very lucky to have found Julie Sarton. She is a dedicated, highly intelligent AND compassionate practitioner and she made a huge difference in my lire. I'm happy for you (and a little jealous, because I moved to northern CA and can't see Julie any more)!

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  17. This is a very informative blog and I'd like to add my 2 cents. I've had unrelenting pain in my coccyx area for 5 years. It was most painful when sitting but walking there was no pain. I've had numerous steroid injections and a spinal cord stimulator placed, none of which helped much at all. I am seen by a Boston pain clinic and they recently referred me to SRH for pelvic floor PT. I've been going for about 6 months and didn't think I was getting much relief but all of a sudden the therapist put her finger right on my pain and now that she has worked with that particular knotted muscle, I feel so much better. I've actually been sitting without wiggling for 4 days and I am ecstatic. So I just want to encourage anyone thinking of trying this therapy, give it a chance. I never would have believed anyone could help me. after such a long time and seeing all the top doctors in Boston.

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  18. starting PT monday and very nervous. My doctor told me this is all very normal for my age (27) but that does not ease my nerves very much. does anyone have any suggestions to ease my nerves? if so please let me know.

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    1. Hi there! It's been some time since you put your post online (I only just found this blog) but I hope that you have benefitted from pelvic floor PT exercises and treatment. I have had issues for years (I'm now postmenopausal and the absence of estrogen is a BUMMER!) and was referred to a PT specializing in pelvic floor pain about 10 years ago. She helped me so much--I hope your experience is similar and I wish you good luck.

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  19. Hi
    Is there any man that has been diagnosed with Levator Ani Syndrome. If so, please contact this fellow sufferer at syjaffe@comcast.net

    Thank you...

    Stan

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  20. I'm very excited to start pelvic floor PT this Wednesday. I'm in the LA area and am diagnosed with an entrapped iliohypogastric nerve as a result of a DNC after miscarriage last spring. Does anyone else have this diagnosis and if so have you found relief with PT? I would really like to try for another pregnancy, but am very worried that pregnancy will be super painful with this nerve problem. I would really like some positive news! Thanks!

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  21. Hi, I was reading your blog and this is very late.. but in case someone finds this helpful..

    Pelvic pain and tightness can start VERY early, you could be taking a dance class at age 10 and be told to "hold in" your muscles, and you learn to do this over and over... until stress or an injury makes it worse. It can extend to your tail bone area, thighs (burning) and buttocks.
    I had pelvic PT and it greatly helped me. They can also give you a script for vaginal inserts of valium/baclofen etc and those help with spasms.

    I would also add, if you have fallen etc. it is very important to have an MRI done. I was diagnosed, eventually, with a spinal cord issue. I probably had 15+ docs miss it, even with an MRI, but it's worth having an expert look at the actual film, not just the reports. I ended up having neurosurgery and preventing a lot of damage to my bladder and legs (although I was not able to prevent 100% of it)

    To recap- pelvic pain + urinary problems+ severe back pain = possible spinal cord issue.

    Best of luck!

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  22. I am going to Physical Therapist Assistant School and I am doing my last Clinical and I am working with a PT who does Pelvic Floor Therapy for Women and Men. As a women I have IC and have Pelvic Pain and so I began looking for ways to relieve my personal pain, when I ran across a book called Relieving Pelvic Pain by a PT in New York. I am glad to be able to learn how to help others through PT with all the problem that can occur in the pelvic area. Good Luck to you all and I hope you will give PT a try, because I see it work for many men and women.

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