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Chronic Pain and sexuality: How Eva Margot Kant, LCSW-R helps people navigate these issues

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(Image courtesy of Eva Margo Kant, LCSW-R)

The National Institute of Health (NIH) defines chronic pain as pain lasting more than 3 months and it affects more than 100 million Americans today.  As a pelvic floor physical therapist, I help patients with both acute and chronic pain, more specifically pelvic pain, on a daily basis. Due to the private nature of pelvic floor issues, sexual dysfunction, or bowel and bladder complaints it can be difficult for patients to feel comfortable talking about their symptoms.

The famous quote, “no man is an island,” rings true for healthcare providers who treat chronic pain as multiple specialists working together is more effective than one. I recently met with Eva Margot Kant, LCSW-R  with 12+ years of experience helping people deepen their self-esteem, navigate life’s transitions, and address fears and questions about chronic illness/pain which includes topics of sexuality and sensuality. Eva taught me some great perspectives on how she helps people heal their emotional/sexual wounds and how they can be a source of chronic pain.

Eva runs workshops about sex and disability, sex and aging and trains medical students how to talk about sex with their patients. Her goal is to help people “unpack their feelings” that are attached to physical pain and anxiety. Anxiety increases the output of the limbic system, the emotional flight or fight, and memory areas of our brain which results in pain.

Eva believes that “understanding how the body works is the key to understanding you”.  Her job is to help people understand what their sexuality is to them and to own how they view and understand it.  Eva believes that “the body always remembers.” She likened the reflexive blink of an eye that’s about to be poked to the feeling a woman with sexual pain feels if her partner demonstrates affection. The woman may fear that any show of affection may lead to sex which is painful for her, so she avoids this.

Eva’s goal is to help patients learn if some physical reflexive tightening may be due to thoughts involving shame, guilt, or embarrassment.  She helps clients decide when to disclose to a new partner about their chronic condition. She stressed the importance of self-care with their partner and to feel emotionally safe. People who have chronic pain/illness may go thru life as if they are “holding their breath.” Often times Eva finds that partners want to help, they just don’t know how. Demystifying chronic pain/illness allows partners to be supportive and an active participant in healing.

Eva’s upcoming book and course work, called “The Holy Trilogy of Sex (c),” guides patients and their partners in sensuality, sexuality, and intimacy; none of which are possible without communication, sensation, and connection. She encourages partners to engage in body mapping: offering each other a “menu” of intimate ideas that can promote togetherness without causing more pain.

As a Pelvic Physical Therapist, I invite my patient’s partner to a session to observe, learn, and understand what my patient is experiencing and teach the partner ways they can help. I work on the physical aspect of pain with my manual, movement and exercise therapies while Eva addresses on the mental and emotional aspects of chronic pain which leads to a more efficient outcome.

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EMH Team; Jennifer Jurewicz, Tova Laufer & Charissa Morrisroe with Eva Margot Kant, LCSW-R

If you have chronic pelvic pain consider receiving both physical and talk therapy to get your life back on track.  Consider visiting us at EMH Physical Therapy and Eva Margot Kant, LCSW-R if you are in the NYC area. Your pelvic floor with thank you!

Resources:
http://evamkantlcsw.com/
http://www.ninds.nih.gov/disorders/chronic_pain/chronic_pain.htm

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PelviCorFit™ by EMH Physical Therapy Grand Opening

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Have you been working out for years, but neglecting a crucial muscle group??

At EMH Physical Therapy we recently launched our brand new PelviCoreFit™ program designed to whip your pelvic floor muscles into shape. Proper firing of pelvic floor muscles is not only essential for pelvic health but is also a key factor in overall core strength and fitness.

Visualize this:

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The pelvic floor muscles form a sling that transmit forces from the ground up and from your head down. If pelvic floor muscles are weak and unaccustomed to firing during exercise, you could be promoting a faulty movement pattern in the chain. Neglecting the Pelvic floor muscles can potentially lead to more serious conditions such as chronic hip, back or pelvic pain, urinary or fecal incontinence, GI and bowel disorders, and erectile or sexual dysfunction. At EMH Physical Therapy we will help you identify and strengthen the pelvic muscles during your general workouts to help prevent future dysfunction!

Additionally, did you know that the pelvic floor muscles play a fundamental role in breathing through connections to the diaphragm?  Think about doing cardio, executing a heavy lift, or performing a Vinyasa flow with a sub optimal breathing pattern. Strengthening the pelvic floor muscles can improve breathing which will help to optimize your workout efficiency.

Come try out our discounted  PelviCoreFit™ program, learn about proper activation of the pelvic floor muscles and bring your workouts to the next level!

We offer 2 options:

“PelviCorFit™ #1” – One fifty minute session with a DPT + Fitness Guru that includes 15 minute pelvic floor/core education followed by a 30 minute PelviCorFit™ workout, then Q&A. Regular price is $200. New Client price is $50

“PelviCorFit™ Pack” – Three (3) fifty minute sessions with your DPT + Fitness Guru. The first session is similar to the description above. The 2 follow up sessions include 45 minute PelviCorFit™ workouts plus instruction on how to implement pelvic floor awareness into your fitness program. Regular price is $500 for 3 sessions. New Client price is $130

To register call 212-288-2242

or

email info@emhphysicaltherapy.com

For more information click here

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Pelvic PT highly rated in new IC Guidelines

The American Urological Association (AUA) released a new update to their 2011 Guideline on the Diagnosis and Treatment of Interstitial Cystitis/Bladder Pain Syndrome (IC/BPS). The original guidelines included research studies up through 2009. This new revision includes research studies through 2013. Read the amended guidelines here!

“Although the science relevant to IC/BPS is continually improving and evolving, it is still a challenging and complicated condition to diagnose and treat,” said Philip Hanno, MD, who chaired the multi-disciplinary Panel that developed and updated the Guideline. “…this Guideline is fully aligned to the latest science and provides physicians with a relevant blueprint to treating patients.”

Developed as a treatment guide and planning tool, the 2011 guidelines introduced a six step treatment plan. Newly diagnosed patients generally begin with strategies outlined in Step One and then, if those strategies do not bring symptom relief, are advised to try Step Two treatments and so forth. The treatments are classified within the steps based upon their risk of adverse events and/or if the treatment is reversible. Surgery, for example, would never be used as a first line intervention because it is irreversible and could cause very serious complications. Rather, surgery is listed as a Step Six treatment and would only be considered after the patient has tried and failed the therapies listed in Step One Through Step Five.

Two Key Changes

Comprehensive Physical Therapy Encouraged

In Step Two, Pelvic Physical Therapy was suggested for patients who present with pelvic floor tenderness with the highest review possible, Grade A. It states:

Appropriate manual physical therapy techniques (e.g., maneuvers that resolve pelvic, abdominal and/or hip muscular trigger points, lengthen muscle contractures, and release painful scars and other connective tissue restrictions), if appropriately-trained clinicians are available, should be offered to patients who present with pelvic floor tenderness. Pelvic floor strengthening exercises (e.g., Kegel exercises) should be avoided. Standard (Evidence Strength Grade A).

Botox Therapy Rating Improved!

Botox A was reclassified from Step Five to Step Four. New research emerged which showed that using BotoxA at a lower dosage, (from 200u to 100u) substantially reduced the risk of a troublesome complication, the need for self-catheterization. If a Botox treatment silences the nerves which control urination, a patient may be forced to self- catheterize until the effect wears off, often for months. One criteria for the use of Botox is the ability of a patient to self-catheterize if necessary. If a patient is unable to do so, this therapy is not recommended. The guidelines state:

Intradetrusor botulinum toxin A (BTX-A) may be administered if other treatments have not provided adequate symptom control and quality of life or if the clinician and patient agree that symptoms require this approach. Patients must be willing to accept the possibility that post-treatment intermittent self- catheterization may be necessary. Option (Evidence Strength- C)

Learn more about IC Treatments, including all treatment options in the AUA Guidelines here!

Pelvic Pain App developed by Evelyn Hecht, PT

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“She inspires us to not accept the status quo, to strive for wonderful things and not just acceptable things. There’s a lot of good nuggets of wisdom and interesting ways of looking at the profession. Some Apps are fun but the best are more about life”-  Dr Joe Simon

 

I felt this quote was the best to describe my thoughts about this interview. Dr Evelyn Hecht has been treating patients with Pelvic Floor Dysfunction (PFD) longer than there has been a doctorate program at my alma mater. But innovation is not the key to riches. Evelyn saw a need in the marketplace and decided unlike many in our industry not to wait for someone else to do it .

Lately i have consulted with more and more physicians and surgeons on their legacy or exit strategy. Evelyn is no where near the end , matter of fact , she is on the cusp of a new road in healthcare. Apps are a highway of free traffic from possible clients from around the world. Evelyn has just made it easier for the vast population to accept her as the expert in the field.

Pelvic floor therapy is a growth factor for practices across the country. This new specialization is growing with a medical network from physicians, physios & psychologists.

INTRODUCING, PELVIC TRACK a new app to help PATIENTS and practitioners to work together. The challenges associated with communication with the therapist dealing with pelvic floor therapy. Again , it was not looking for a better mousetrap but to create one that doesn’t exist from the need of her patients and her therapists.

The motivation for our new grad and younger (not age but career wise)  listeners. Evelyn has made strides and conquered the niche market. Marketing pelvic floor therapy through facebook, through her blog and now through her App is something i would ask all my listeners to take a deeper look at.

I hope you find the takeaways that I did.

For more info or to read the article directly click  HERE

To purchase or for more info on Pelvic Track App click HERE

Pregnancy achieved following manual pelvic physical therapy for Mechanical Infertility

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Sumer Samhoury, MSPT

Manual Physical Therapy can help some women with Mechanical Infertility achieve  pregnancy.   To understand what Mechanical Infertility is and how manual pelvic physical therapy helps, let’s first review the steps to becoming pregnant.

Mechanics of pregnancy

To achieve pregnancy, the process of ovulation and fertilization within healthy, mobile, and supported reproductive organs (ovaries, fallopian tube and uterus) without presence of adhesions & scar tissue has to occur. The steps to pregnancy are

 

  • The woman’s body releases an egg from one of her ovaries (ovulation)
  • The egg is grasped by the “fingers” of the fimbria, located at the ends of the fallopian tubes.
  • The egg travels through the open, non blocked fallopian tube toward the uterus (womb)
  • The man’s sperm joins with the egg (fertilization)
  • The fertilized egg attaches to the inside of the uterus (implantation)

Mechanical Infertility

Mechanical Infertility (MI) is defined as the inability to become pregnant due to intra pelvic and abdominal adhesions on/around or within the reproductive organs. MI affects approximately 2.5 million ( 40%) of the 6 million infertile women in the United States who have not conceived after 1 year of unprotected sexual intercourse.

Adhesions around the ovary can prevent the release of the egg (ovum) from the ovary. Adhesions can squeeze the fallopian tube (s)like a used tube of toothpaste, so the egg cannot travel to the uterus to hook up with the sperm.    Adhesions can pull the uterus out of a centered, midline position which makes implantation of the fertilized egg difficult. Adhesions within the uterus could increase uterine spasms which can result in miscarriage.

What are Adhesions?

An adhesion is a sheet or band of scar tissue that binds two parts of tissue or organs together.   Normally, with no scar tissue present, organs are slippery and they glide against each other. Adhesions can look like thin sheets similar to  plastic food wrap or they can be thick fibrous bands,  like ropes.  These bands of scar tissue can wrap around your internal reproductive organs squeezing them too tight or pull the organs out of their normal centered alignment which prevents their  optimal  function during pregnancy.

Cause of Adhesions

Adhesions naturally develop when the body’s healing/repair mechanisms respond to any tissue disturbance, such as surgery, infection, trauma, or radiation.  Our body naturally cleans a damaged area, which is followed up by the laying down of collagen fibers to replace the damaged tissue.  The replaced new collagen is haphazard, fibers get bunched up  and cross-links form. As healing time continues, cross links may grow into microadhesions, then adhesions and may eventually thicken into scars  When a woman has pelvic or abdominal surgery,  such as a C-section or other gynecological surgeries,  the only visible scar is on the outside where the incisions may have been made, but  tissue also heals on the inside,  resulting in internal scarring.

The formation of internal pelvic adhesions is known to accompany any inflammatory process, whether it be internal trauma and bleeding (ruptured ovarian cysts or ruptured appendix), Endometriosis, or sexually transmitted infections such as Chlamydia, Gonorrhea, pelvic inflammatory disease (PID).  Pelvic spasms, bowel obstructions and chronic abdominal/pelvic pain can also lead to adhesions.

The most common cause of adhesions within the uterus is due to previous uterine surgeries such as D&Cs either for abortions, miscarriages, or excessive bleeding. In addition, adhesions may be related to child birth when there are uterine infections or bleeding associated from childbirth, or if a Cesarean Section is performed.

What is Manual Pelvic Physical Therapy?

Manual pelvic physical therapy is a gentle hands on approach, no surgery, no drugs, to improve motion, decrease restriction and improve organ function. Manual therapy techniques for Mechanical Infertility can include:

  1. Myofascial Release to decrease restricted muscles and fascia (the web-like covering that surrounds all organs, muscles and nerves of the body)
  2. Visceral Mobilization to improve organ mobility and function
  3. Pelvic lymphatic drainage to reduce pelvic congestion

Myofascial Release is a safe and effective hands-on technique that applies gentle sustaining pressure to the restricted connective tissue to eliminate pain and restore motion. The slow sustained, gentle pressure allows fascia to elongate.

Visceral mobilization technique is a gentle hands on technique to release tight ligaments and connective tissue which surrounds and supports the internal organs. Just as a therapist would mobilize the shoulder for someone who has lost motion  tight  ligaments that support the organs also need to be treated.

The lymphatic system helps our body detoxify, drain stagnant fluids, regenerate tissues, filter out toxins and maintains a healthy immune system. Pelvic lymph drainage helps to re-circulate body fluids, stimulates the immune system and promotes relaxation and balance in the autonomic nervous system.

Pregnancy Achieved

In 2012, Doctor Mary Ellen Kramp, DPT published her infertility case study in the Journal of American Osteopathic Association demonstrating that 6 out of 10 women diagnosed with mechanical infertility conceived and delivered their healthy babies at full term following  manual pelvic physical therapy. These women were found to have mechanical infertility due to lymphatic congestion, sacral dysfunction and restrictions in uterine mobility and were treated with a group of manual therapies Dr Kramp described as above and  termed  “The Infertility Protocol”.

At EMH Physical Therapy, we received training to treat Mechanical Infertility and can offer this service to women to  help them achieve pregnancy.

 

Pelvic physical therapy is an effective non invasive treatment for Pelvic Organ Prolapse vs “high risk” transvaginal mesh surgery

The FDA recently deemed use of transvaginal mesh surgery to be “high risk” to repair pelvic organ prolapse.  See news link below:

http://www.philly.com/philly/health/womenshealth/HealthDay687309_20140429_FDA_Moves_Female_Incontinence_Device_to__High_Risk__Status.html

Pelvic physical therapy is a more effective and non invasive option.

In a 2014 study of 800 women with pelvic floor dysfunction (which includes pelvic organ prolapse) by University of Missouri, researchers found that ” incontinence, constipation, and/or pain improve by 80% with pelvic physical therapy”. Research shows that pelvic physical therapy plus a prescribed home exercise program works better than just engaging in one option.

Pelvic physical therapy teaches patients with pelvic organ prolapse how to build up the “floor” or muscular base of the pelvis. The pelvic floor muscles provide the main support for all pelvic organs. Kegels alone are not the only treatment option. If there is tension in the pelvic floor muscles, they need to to be released via manual therapies or risk further dysfunction. Sitting posture and good voiding habits are addressed, exercises are prescribed and body awareness improved.

EMH Physical Therapy has been providing successful pelvic physical therapy for 18 years in NYC. We have helped thousands of women return to better function. Call us today to get your prescription for pelvic health.

Women’s Pelvic Health

Women's Pelvic Health

 

 

Check out this link ( link) to see Evelyn’s interview on physical therapy for women’s pelvic health in the Los Angeles Times. The app, Pelvic Track, is now available on the Apple store.

 

 

Tips for regaining firm abs and pelvic floor for all Moms

As a licensed physical therapist specializing in pelvic floor and core dysfunction, I treat women who experience pelvic pain, sexual pain, leaking, constipation, urinary urgency, have restricted C-section/episiotomy scars and  weak pelvic and core muscles, months or years after delivering their children (Vaginal or C-Section).

If all moms consulted a physical therapist soon after giving birth, this is what I would teach:

1)   To prevent leaking urine or feces, or future prolapses of the bladder or rectum, do pelvic floor strengthening exercises (if there is no pelvic pain). Many women do not know how to recruit these small muscles surrounding the vaginal and anal region.  Some either hold their breath, or tighten their inner thighs, gluteal and abdominal muscles when doing the pelvic floor muscle contraction.  A licensed PT can guide on how to recruit these muscles without substitution via our manual and biofeedback therapies.

Pelvic Floor Strength Exercise: Contract the pelvic floor muscles (squeeze the anal and vaginal regions) for up to 10 full seconds (one – one thousand, two -one-thousand, etc). Then, more importantly, relax,  completely let go of the contraction, softening for up to 20 seconds. If 10 second contraction and 20 second relaxation is too much, start with 5 seconds contraction and 10 second relaxation. Do this exercise 10 times, once in the morning and once at the end of the day. They can be performed in lying, sitting even standing (once you are good at the exercise).

2) To reduce pelvic pain, breathe and relax your pelvic floor muscles.  Slow deep breathing, produces a calming effect on your muscles, heart, and brain activity. It also gently massages the abdominal contents. If you have pelvic/lower back/hip/groin or abdominal pain, consult with your doctor first and then see a pelvic physical therapist for our targeted therapies and exercises to reduce pain and regain function.

Diaphragmatic Breath Exercise:  Inhale for 5 seconds, hold the inhale for 5 seconds, exhale for 5 seconds. Repeat 2 times, twice a day or as needed.  During your inhalation, allow your stomach to expand or balloon to allow the diaphragm to descend which  fills the lungs with oxygen. As the stomach expands, think letting the pelvic floor muscles widen, soften (no pushing outward!).  As you exhale, allow the stomach to contract and see if you can keep your pelvic floor muscles relaxed.

3) To reduce your belly post baby, reduce the DR or “diastasis rectus”, which is the separation of the two long rectus abdominal muscles as the baby grew in utero, you can wear a compression garment and strengthen your lower abdominal muscles.  The abdominal binders and/or compression shorts that support the pelvic floor can be worn daily during and after delivery to prevent further widening of the DR.

Core Exercise: Breathe in. Breathe out and think of zipping up a tight pair of jeans.  There should be no major movement of your spine, just the lower abdominal region moving “up and in” as it tightens. Hold this for 5 seconds. Breath in as you release.  Breathe out as you tighten and hold.  Repeat 10 times. Do this 5 times throughout the day.  A physical therapist can help with your DR by modifying the exercise. This can be done during pregnancy to minimize the DR and keep a strong core.

4) To prevent binding of fascia, abdominal restrictions and  pain, mobilize your C-section scar.

Scar Tissue Massage: Gently press your fingers against the scar and pull the scar in a upward direction and hold the end range for a minute. Then move downwards, to the R, and L sides, holding the end range of each direction for a minute, until you feel less burning, less tension. Eventually you can try to pick up the scar up in-between your thumb and fingers to lift the scar away from your body, affording more stretch.  For perineal scars, your physical therapist can perform manual therapies and guide you in self perineal stretches and use of a dilator to help increase the flexibility of the scar.

5) To return to pain free intercourse, if painful due to episiotomy scar, your physical therapist can perform intravaginal manual therapy, scar mobilization and teach you how to gradually and painlessly stretch your vaginal area with dilators.

Along with postural exercises, instruction on how to lift, carry and feed baby, your physical therapist can help you regain your body, prepare for another child and most importantly, prevent the pain and other issues that so many of our mothers took for granted as a “normal part of having babies”.

 

 

 

 

Painfree sexual intercourse during Menopause: Helpful tips by a Pelvic Floor PT

Physical therapists have helped women in menopause return to painfree, satisfying sexual intercourse. These women could experience pain with intercourse, even after rehydrating their vaginal tissues under the guidance of their GYN, due to pelvic floor muscle tension.   The pelvic floor is a group of muscles located at the bottom of the pelvis  surrounding the vaginal canal.  Intercourse requires that the muscles be flexible to be able to receive the penis and strong enough to contract to provide more intense orgasms.    All healthy muscles have a normal length during rest.  Unhealthy muscles have knots/fascial restrictions so they are stuck in tight position during rest.  So with a tight pelvic floor, the penis cannot enter and women can experience pain.

How to gain a healthy pelvic floor?  Treatment by a physical therapist trained in pelvic floor dysfunctions is optimum as we provide you with tailored manual expertise and guidance to heal.  Here are some helpful tips:

1)      STRETCH HIP/GLUTEAL MUSCLES Stretch the large muscles of your hip, and buttock region as they can actively refer pain into the pelvis and cause the pelvic floor muscles to overwork or be strained.  By actively stretching the hip flexors, hip external rotators, inner thigh (adductors), groin and hamstrings,  the pelvic floor is released and can function optimally.  Hold each static stretch for 30 seconds, done twice,  2x’s times a day.

2)      VISUALIZE A RELAXED PELVIC FLOOR   Chronically tight pelvic floor muscles need many reminders to relax throughout the day.   Every time you look at the watch or your mobile phone, ask yourself, “Where is my pelvic floor?”   Think about the area softening, melting, widening. Use any visualization that is calming to you, send a healing color to your pelvis to bring awareness and “let go”.

3)      BREATHE  Diaphagramatic breathing helps to relax the abdominal and pelvic regions.   Lie on your back, pillow under your knees. Place your hands on your stomach, bent elbows resting by your sides.  Inhale slowly through your nose for a count of 5 seconds.  During your inhalation, allow your stomach expand into your hands. Visualize your pelvic floor muscles widening as well.   With each inhalation,  imagine or visualize the pelvic floor muscles expanding in all directions, front, back , left , right.  Slowly exhale for 5 seconds. Repeat 5 times. Do once in morning and at night.

4)      NEUTRAL PELVIS Set up your computer/reading/art work space to fit your body versus your body having to adjust to the environment.  The chair should be at a comfortable height so your feet are supported either on the floor or a raised footrest.  “Good posture” is when a neutral spine in maintained.  When sitting, your weight should be on center of your pelvic bowl, your lower back resting against a lumbar cushion. The lumbar cushion gently pushes your lower back forward to maintain it’s natural curve.  You should not slump back to sit on your coccyx bone, nor too far forward on your pubic bone and no sitting on one side/hip for hours at a time.      Here is where a PT can really help you gain knowledge and best position of your body.

5)      SELF STRETCHING INTRAVAGINALLY  This is a technique where you can stretch the intravaginal tissues by inserting a clean left thumb intravaginally up to the level of the first thumb joint. Gently press or sweep your thumb along the right vaginal walls providing a deep stretch.  Do a few sweeps from the midline towards bottom of the right vaginal wall.  You can hold a few areas that feel tight or uncomfortable.   Then insert the right thumb intravaginally and sweep or apply pressure points along the left side of the vaginal wall.  Repeat a few times each side. Do once a day.

6)      DILATORS Dilators are also used to help women prepare for intercourse and to apply pressure to tight spots within the vaginal walls to stretch. Your PT can guide you on how to use them.

7)      PELVIC FLOOR STRENGTH   Once your pelvic floor muscles are lengthened, a basic pelvic floor strengthening program can begin. Your physical therapist can teach you how to best recruit these muscles without co contraction of the hip adductors, hip extensors, and breath holding.  A basic pelvic floor strength exercise can be done by holding a contraction for 10 full seconds, resting/relaxing for 20 seconds. Repeat this 10x’s.   Then do 10 quick contractions and quick relaxations, repeated 10x’s to stimulate the fast twitch fibers of the pelvic floor which are innervated during orgasm

8)      SQUAT Squatting exercise helps to lengthen the pelvic floor and increases the strength of your hip and buttocks muscles.  When performing either a quarter, half or full squat in good alignment, this provides great balance of the pelvis and pelvic floor muscle function.

9)      AN ORGASM A DAY… Yes, an orgasm a day keeps all the pelvic muscles happy and healthy

Release Pelvic Pain in 2-3 months with Pelvic Floor Physical Therapy

Many evidence based studies prove that pelvic floor physical therapy is an effective treatment approach for men and women suffering from pelvic pain caused by tight muscles and restricted tissues.  The pelvic floor muscles, namely the levator ani, coccygeus and obturator internus can develop adhesions, tension or trigger points which restrict movement and cause pain.  Trigger points are palpable spasms/knots within muscle tissue and can occur in pelvic floor muscles.  Trigger points can lead to adhesions of fascia/connective tissue of the abdomen, groin, pelvic floor and even restrict the viscera (colon, uterus, bladder, prostate gland) within the pelvic bowl.

The pudendal nerves and its branches, traveling from the sacrum (back of the pelvis) and running all through the pelvic floor region innervates the vaginal/penile and rectal areas. The nerves can become squeezed as it travels through tight muscles and fascia, which then decreases optimum pelvic floor function and increases pain.

The pelvic floor muscles are located INSIDE our bodies, in women the muscles are approximately 1-2 inches up from the vaginal/rectal region and in men, the muscles are approximately 1-2 inches up from the base of the penis/rectal region.

The pelvic floor muscles are key for four functions of the body:

1) lower back/core stabilization; 2)  normal urinary function; 3) good bowel function; 4) satisfying sexual function.

As a core stabilizer, the pelvic floor works with 3 other core muscles, the Transversus Abdominus (deepest stomach muscle), Multifidus- (deep low back extensor muscle), and deep fibers of the Iliopsoas (hip flexor muscle). These 4 muscles work together to keep our core strong, flexible and prevents lower back pain. If one of the 4 core stabilizer muscles becomes weak or injured, then the other 3 muscles have to work harder to compensate. Over time this puts great strain on the whole core, which leads to back pain/stiffness/weakness.

The pelvic floor muscles are directly involved with three bodily functions, urinary, bowel and sexual.

For functional urination, the pelvic floor muscles surround the urethral opening and should relax when you are voiding and maintain closure or tension when you are not voiding.   If the muscles are in spasm, urinary symptoms such as leaking,  or feeling a strong urge to void, or having to go to the bathroom multiple times a day (called urinary frequency) and/or being awoken at night to void more than once (called nocturia), can occur.   Women using public restrooms should not “hover” over the toilet, as this sustained half squat creates tension in the pelvis and does not allow full relaxation of the sphincters around the urethra to allow full urination. Best to use the protective toilet seat covers and sit comfortably.

For normal bowel movements, the pelvic floor muscles should be able to open and widen to allow the full passage of stool. When not having a BM, the pelvic floor maintains tension at the rectal opening to prevent leakage.  If the pelvic floor is weak, leakage can occur.  If the pelvic floor is tight, constipation resulting in sitting too long at the toilet, straining to defecate can occur. Toileting should take no longer than 5 minutes following the urge to void.  Even though you may not feel completely empty, it’s better to stand and leave the bathroom  versus continue to sit and strain. Constant straining can result in hemorrhoids and/or the development of a rectocele, which further impedes good function.

For satisfying sexual function, the toned and flexible pelvic floor allows for more intense orgasms in men and women.  A fully relaxed pelvic floor helps women experience pain free intercourse with their male partners.  Many patients who are experiencing sexual pain may experience difficulty with partner relationships or even avoid them due feeling of shame or inadequacy.

Pelvic pain due to restricted muscles can be released and return to normal function, no matter how long a person has been experiencing symptoms.

Physical therapists trained and mentored in pelvic floor work can:

  • apply targeted manual therapies to rid muscles of trigger points
  • utilize biofeedback therapy to help patients learn how to either downtrain (relax) their pelvic floor or to uptrain (strengthen) the pelvic floor
  • perform visceral mobilization to improve the mobility of organs lying within the pelvic bowl
  • mobilize and teach a patient self-connective tissue (skin rolling) techniques to abolish tight skin and fascia of the inner thighs and abdomen
  • teach patients gentle stretching techniques with foam rollers, tennis balls, knobbles, Theracane,  S –wands and dilators
  • educate in exercises for a strong core
  • teach diaphragmatic breathing and visualization to help lower tension of the pelvis and to increase oxygenation to the body and decreased stress
  • guidance in cardiovascular exercise to pump more oxygen and nutrients to the tissues
  • teach proper bladder and bowel techniques and habits

Most people start to feel better after 2 months of consistent, twice a week therapy which incorporates many of the above techniques. Some reach goals sooner; others may take up to 3 months.  By attending regular pelvic floor physical therapy and performing all the home exercises, faulty pattern are reversed and many people are pain free within 2-3 months.