Issues with the pelvic floor can arise from a multitude of reasons. Infections, previous surgeries, childbirth, postural and lifting problems, and trips and falls can all bring on pelvic floor dysfunction. Pelvic floor pain can persist well after the cause of it has been removed. So it is entirely possible to feel the effects of an old infection, surgery or injury, days to years after they occur. Anyone who has had long standing abdomino-pelvic pain, or pain that they can’t seem to get rid of after seeking the help of medical doctors or other healthcare providers is a good candidate for a pelvic floor physical therapy evaluation and possible curative treatment.
Biofeedback. This is a technique to help you make sure that you exercise the correct muscles. For this, a physiotherapist or continence advisor inserts a small device into your vagina when you are doing the exercises. When you squeeze the right muscles, the device makes a noise (or some other signal such as a display on a computer screen) to let you know that you are squeezing the correct muscles.
Kegels: American gynecologist Arnold Kegel created this seminal pelvic floor exercise. To do a Kegel, contract your muscles that stop the flow of urine, hold for five seconds, then release for five seconds. Repeat this exercise 10–15 times, up to three times per day. Avoid doing Kegel exercises when urinating since stopping the flow midstream can cause some urine to remain in your bladder, putting you at a higher risk of urinary tract infections (UTIs).
The type of exercises are exactly the same as above. If you are not used to doing pelvic floor exercises then perhaps do the exercises as often as described above for the first three months or so. This will strengthen up the pelvic floor muscles. Thereafter, a five-minute spell of exercises once or twice a day should keep the muscles strong and toned up which may help to prevent incontinence from developing in later life.
But while “vaginal massage” is a general, nonspecific term, it may be used to treat the musculoskeletal system of the pelvic floor, notes Dr. Huang. Sometimes this may be internally through the vagina or anus, though the target isn’t the vagina itself, but rather the muscles. “Some muscles, like hip rotator and pelvic floor muscles, are better accessed internally,” she says. (Imbalances in other muscles like those found in the abdominal wall or hip girdle are best treated from the outside.)
If that’s part of your treatment protocol as determined by your therapist, she may use one finger to stretch and mobilize the pelvic floor muscles, explains Tadros. While it may seem like some patients would balk at this, “I find that patients are so desperate for help, they’re more than okay with having it done. We don’t use a speculum or stirrups. This isn’t invasive, it’s designed to keep someone as comfortable as possible,” she adds.
If you’re dealing with pelvic pain, Kotarinos recommends researching the International Pelvic Pain Society or the American Physical Therapy Association to find a qualified pelvic floor physical therapist. (You can also see your PCP for a referral.) Dr. Huang also suggests focusing on your health holistically, with things like stress management, regular exercise, and a well-balanced diet. “We want to educate and empower women to be in control,” she says.
Nerves, organs, and joints can lose their natural mobility over time and cause a whole host of symptoms from pain, to loss of range of motion, and poor functioning of the bodily symptoms. Skilled and specialized therapists can use a variety of active techniques (patient assisted) and passive techniques to free up restrictions in these tissues and organs and improve overall function.
The term “vaginal massage” may not be legit—practitioners don’t like to use it—but the treatment is. In fact, it’s part of a well-rounded therapy regimen for pelvic floor physical therapy. Certified specialists in this field can help women who are dealing with pain during sex—something 75% of women experience at some point in life, according to research.
Tabletop splits: Tabletop splits engage your core, hips, inner thigh muscles, and pelvic floor. To do a tabletop split, lie down on your back in a comfortable position on the floor, and bring your knees up in the air, so your thighs are perpendicular to the ground. Slowly spread your knees until your legs are as far apart as they can comfortably go, then slowly bring your knees back together. Repeat 10–15 times, up to three times per day.