May is Pelvic Pain Awareness Month (#PelvicPainAware), supported by the International Pelvic Pain Society (www.pelvicpain.org). As physical therapists who specialize in abdomino-pelvic pain disorders, one of the toughest parts of the job is meeting men and women who have suffered with pelvic pain for years, only to be told by their doctors/healthcare providers that there is no help for them. It is not uncommon to meet a patient who has suffered for 5- 10 years without help before finding us. Musculoskeletal causes of abdomino-pelvic pain are treatable conditions and often times we can start to improve a patient’s symptoms within just a few visits. We are promoting Pelvic Pain Awareness Month because it is our mission to ensure that people know that help exists so they can start living richer and fuller lives. In honor of Pelvic Pain Awareness Month we want to take some time to explain what we do and how it can help with the symptoms of pelvic pain. Please read on to see how we can help you with your pain.
Some pelvic floor physical therapists may have the opportunity of getting a lot of time to speak one-on-one with a patient to determine possible causes of his or her symptoms, educate the patient and to guide them to other practitioners who may optimize their physical therapy results if necessary. We truly can find out so much by just listening to what our patients have to say. A fall, or infection can be significant as well as a patient’s feelings and knowledge about their current condition.
Kelly is a certified Personal Trainer with NASM, a Yoga Alliance Registered Yoga Teacher, and has her B.S. in Kinesiology from San Diego State University. She is co-owner of Roaming Yogi Adventures, a yoga and adventure-based retreat. She believes that having fun and well-rounded exercise is the key to maximizing strength, flexibility, and mental health.
It takes time, effort and practice to become good at these exercises. It is best do these exercises for at least three months to start with. You should start to see benefits after a few weeks. However, it often takes two to five months for most improvement to occur. After this time you may be cured of stress incontinence. If you are not sure that you are doing the correct exercises, ask a doctor, physiotherapist or continence advisor for advice.

In some cases, vaginal weighted cones or biofeedback might help. To use a vaginal cone, you insert it into your vagina and use pelvic muscle contractions to hold it in place during your daily activities. During a biofeedback session, your doctor or other health care provider inserts a pressure sensor into your vagina or rectum. As you relax and contract your pelvic floor muscles, a monitor will measure and display your pelvic floor activity.

Discussed extensively in Travel and Simon’s two volume series, trigger points are taut (firm) points in the muscle that have a consistent referral pattern (they transmit pain to the another part of the body). Trigger points are not only important because they cause pain, they also can affect how the muscle works. This is one of the main reasons our therapists at Beyond Basics are fastidious about ensuring all trigger points are released in the abdomen, back, legs and pelvic floor before transitioning to any core stabiltiy or strengthening exercises that can re activate a trigger point.

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.

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.
Strengthening weak pelvic floor muscles often helps a person gain better bowel and bladder control. A physical therapist can help you be sure you are doing a Kegel correctly and prescribe a home program to meet your individual needs. Diet modifications can also reduce urinary and fecal incontinence. Bladder re-training can decrease urinary frequency and help you regain control of your bladder.
When some or all of these structures of the pelvic floor are not functioning properly, they can cause a multitude of different symptoms. People who are suffering from bowel, bladder, and or sexual problems, as well as those who are suffering from pain in the pelvis, upper legs, abdomen or buttocks most likely have pelvic floor impairments contributing to their pain.
Myofascial release is a more gentle technique that can be useful in cases where a patient is already experiencing a great deal of pain. The therapist will hold gentle pressure at the barrier of the tissue (the point where resistance is felt) for a short period of time, usually less than 2 minutes until the therapist feels the tissue release on its own. The therapist does not force the barrier.

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.
“I intentionally try and distract you during treatment, so that you don’t focus too much on the pain of the treatment. Furthermore, talking during our sessions continues to build rapport which is so important — it builds trust, makes you feel more comfortable, and also makes it more likely that you will return for your follow-up visits so that you will get better,” she says.
Pelvic floor exercises are specific movements that engage and strengthen your pelvic floor muscles, which can weaken due to factors such as childbirth, aging, menopause, obesity, chronic coughing, or heavy lifting. Most pelvic floor exercises don’t require specific equipment. These exercises typically rely on your body’s weight to initiate the stretch and engage the muscles. Pelvic floor exercises can increase bladder control, reduce the probability of pelvic organ prolapse, and increase sexual pleasure.
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