Pain can emerge because of lifestyle factors and underlying medical problems. Sitting all day can affect the nerves in your saddle, which may translate into a burning pain in your vulva, explains Rhonda K. Kotarinos, DPT, a specialist in pelvic floor dysfunction in the Chicago area. The discomfort of chronic vaginal infections or holding urine all day long can also lead someone to “walk around with their pelvic floor clinched to their ears. It can make your pelvic floor very angry,” she says.
“I would recommend that people call the facility and maybe schedule the first appointment and see how you feel about it. I also think patient support groups tend to have closed Facebook groups and they can recommend people in certain geographical areas. I know people call [our practice] a lot and we try and get them paired up with somebody we trust in their area,” Prendergast says.
Look in a mirror if lying down doesn't work. If you are a guy, the lying on your back method for locating your pelvic floor muscles may not work. An alternative is for you to stand in front of a mirror naked. Look at your body as you attempt to flex your pelvic floor muscles. If you are contracting the muscles correctly, you should be able to see your penis and scrotum lift up. When you relax your pelvic floor, you should see these parts drift back down.[4]
During the internal exam, your physical therapist will place a gloved finger into your vagina or rectum to assess the tone, strength, and irritability of your pelvic floor muscles and tissues. Internal exams and internal treatment are invaluable tools that are taught to pelvic floor physical therapists. It can tell us if there are trigger points (painful spots, with a referral pattern or local); muscle/tissue shortening; nerve irritation and/or bony malalignment that could be causing your pain directly or inhibiting the full function of your pelvic floor muscles. We can also determine if your pelvic floor has good coordination during the exam. A pelvic floor without good coordination, may not open and close appropriately for activities such as going to the bathroom, supporting our pelvis and trunk, sexual activity, and keeping us continent.
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.
Do some "dead bug crunches." Start lying on your back, with your knees bent and your feet at knee level. Strength your arms straight up toward the ceiling. Take a deep breath, tighten your pelvic floor muscles, and extend your right arm and left leg in opposite directions. Release back to the position your started in, and repeat on the right side.[12]
Perform bridges. Kegels are not the only way to strengthen your pelvic floor. There are numerous exercises you can do, and a great one is bridges. Start by laying on your back with your knees bent, keeping your feet about a fist distance apart. Then flex your lower abdominal muscles and lift your hips off the ground slightly. Your buttocks should barely be off of the floor and you should keep your inner core muscles flexed. Hold for 3 seconds and slowly return your hips to the ground.[10]
Myofascial release was developed by John Barnes to evaluate and treat the myo-fascia throughout the body. The myofascial system is the connective tissue that coats our muscles, nerves, blood vessels, and bones, and runs throughout our bodies. Any tightness or dysfunction in the myofascial system can affect the aforementioned structures and result in pain and or movement dysfunction. By treating the fascia directly, therapists can improve their patient’s range of motion, reduce pain, and improve a patient’s structure and movement patterns.
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.
Hip bridges: Engage your abdominals and pelvic floor before you start to bridge up, then bring the hipbones up to the sky. Then hollow out even more and really engage the pelvic floor. Then slowly lower your back to the mat, starting with your upper back, middle back, then lower back. Once you reach the mat, you can release your pelvic floor, and then re-engage as you do this move again.
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