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. This, in turn, might throw off the hygiene in the area and give rise to complications, in which instance, products like Balance Activ come to aid. 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.

8 Responses

  1. One year three months ago i took a fall off of the top of my truck(sandblasting engine bay), worrying more for my back as it had suffered a bad fall years prior,i gave no thought to what at the time felt like a slight sprain. My GP(general practitioner)confirmed my suspiscions and i delt with it accordingly. Five months passed and i started noticing a strange occurance,whilst walking i could feel what can only be discribed as a ball of crunchy substance in the middle back area of the arch in my foot. A trip to the podiatrist and i learn a tendon had snapped with my arch fallen. So in past years i have been a very avid downhill skier with early olympic team hopes so i had been pretty rough on my legs and so on but they had always been strong . I am approaching sixty and not as active as i should probably be. I am experiencing deep pain in my right groin area. I cannot affect a response where i feel this pain when i dig deep with my fingers. I feel incapacitated with my girlfriend when we have sex because it pains me to manipulate my right hip / leg to get positioning,but we do enjoy a somewhat enjoyable time,well i know she does but really i have issues. I have a wear ulcer on the bottom of my left big toe which has been diagnosed from having to strong a tendon and he is talking about cutting it!! Is he for real? He seems a bright young doctor and has me in a cam walker now(left foot).
    Right foot is where i snapped a side tendon in the fall and now crunches when i walk. BUT THE PAIN IN MY Deep GROIN AREA is whats driving me crazy. When it seems aggrivated most. 1-Mornings getting out of bed.
    2-Sitting on the john,trying to get my right cheek positioned on the toilet seat. 3- SEX 4- Rolling on to my right side when in bed. 5-Scooting into the driver seat of suv. Well thats a bunch and thank you for lending an eye & thought.
    God Bless
    O yes i was at seatac airport and spoke to a street massage person who had a massage gig. He said ” yep ilaspoas muscle . Is this correct?

    1. Thank you for your detailed post. Once the foot is injured or healing, the hip and inner thigh muscles end up being recruited overtime as full weight bearing cannot be done on your foot. My suggestion is to seek a pelvic physical therapist so she can examine both the hip, groin, pelvic floor and foot to prescribe a good exercise program and apply targeted manual therapies to help you return to function.
      All my Best,

  2. greetings. of all things– you MUST be diligent with a good regimen. Both in physical therapy– moreover– a really significant massage therapist. I’m not talking ‘pleasure massages.’ I’m talking about some deep tissue manipulations– once a week — consistently for at least 4-6 weeks. It’s a $300-$400 bill that is WORTHY of your time. Those stupid muscle spasms, mis-alignment WILL HAUNT you. You MUST have the spasm muscles ‘deprogrammed’ through a, sometimes nauseating, physical massage. I am NOT a massage therapist. I AM a nurse, with my own muscle troubles, and while physical therapy IS helpful– HANDS-ON therapy is critical to healing. Best wishes on your healings. If all else fails, it’s possible that you have an inguinal hernia which would need surgical repair. Get a TRUSTING massage therapist first — not the average person. One who is well versed in anatomy and is strong enough to work through your pain. If you happen to live in SC, there is an Active-Release-Technique Chiropractor who is amazing with muscle manipulation. Dr Renick. And his painfully wonderful massage therapist- Lucy. Best of luck and, whatever you do, COMMIT consistent time to your healing or it will haunt you!

  3. I’ve been able to relieve a ton of pain I have a bit of tensions but the worst issue is the tightness in the oenile region. It feels like when you jump into a cold body of water and everything tightens up. It’s hard having no sexual sensitivity. Is there a specific muscle that causes this?

    1. Hi Max,
      Thank you for your question! Yes the bulbospongiosus which surrounds the base of the penis and the anterior fibers of the pubococcygeus (part of the levator ani muscles) can create this vise-like sensation. Having restricted inner thigh muscles (hip adductors); if you hold tension in your pelvic floor; sit on your coccyx hours at a day – all of these situations can add to your symptoms. Best news is that these muscles can be released and better sexual sensitivity can be returned. If you are in NYC or would like to travel in for a thorough evaluation by one of my staff PT’s we’d be happy to help! Call us at (212) 288-2242.

  4. I habe struggled with pelvic floor pain due to a knot for years and years. Going to physical therapy for a couple of months seemed ro make my tension more severe so I quit going. I have since let go of my 10yr relationship because the pain was too much for me to bear. I have been continuing the exercises but it causes such pain for me. Should I continue to see a physical therapist or can I alleviate it by allowing myself to be free of triggers for the pain (sex.)

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