Did you know that May is Pelvic Pain Awareness Month? Pelvic pain can be described as pain along the lower abdomen, pelvis, or perineum (the area between the rectum and the scrotum or vagina). According to the International Pelvic Pain Society, nearly 25 million people in the U.S. experience pelvic pain secondary to conditions such as endometriosis, irritable bowel syndrome, myofascial pelvic pain, among others. 

Pelvic pain often requires a multimodal approach to treatment. Symptoms can be contributed by a variety of factors, including the following:

• Overactivity and tightness of muscles at the pelvic floor, hips, and low back
• Weakness of muscles at the pelvic floor, hips, and low back
• Pregnancy and childbirth
• Hypermobility of joints
• Pressure on nerves at the lumbar spine or in the pelvis
• Scar tissue post-abdominal or pelvic surgery (e.g. c-section, sling procedure, prostatectomy)
• Pelvic organ prolapse

Although pelvic pain is common in individuals with vulvas, it is important to note that all individuals have a pelvic floor and those with a penis can also experience pelvic pain symptoms. No matter the external anatomy, anyone can experience the following signs or symptoms consistent with pelvic pain: 

• Pain or difficulty with daily activities such as sitting and walking
• Stiffness and/or pain in the hips, low back, and tailbone
• Pain with sexual activity
• Urinary frequency, urgency, incontinence, or pain during urination
• Constipation, pain, and/or straining with bowel movements
• Pain with insertion of tampons, sexual penetration, and/or with pelvic exams
• Pain before, during, or after ejaculation

If any of these symptoms are familiar, you may want to consider discussing them with your healthcare provider. Physical therapy can be helpful in addressing pelvic pain, as well as in improving mobility, strength, and function for daily activities. A pelvic physical therapy evaluation will include a review of your medical history and a physical exam to try to identify the causes/contributors of your pelvic pain. A pelvic PT can also help to identify any specialists that you might benefit from seeing to address your symptoms with a multidisciplinary approach. 

MOTI Physiotherapy offers pelvic physical therapy services for all patients. If you experience pelvic pain and would like help in navigating treatment, we are happy to help you with your healing journey!

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Pain with penetration can be a symptom of pelvic floor hypertonicity or having pelvic floor muscles that have too much tension. When your pelvic floor muscles have too much tension you might experience these other symptoms as well:

-Pain with penetrative sex (during or after)

-Pain or inability to use tampons or menstrual cups

-Urinary urge and frequency

-“Shy” bladder or having to strain to urinate

-Constipation or straining with bowel movements

-Pain with bowel movements or urination

-Painful orgasm or difficulty reaching orgasm

-Tailbone pain

-Clitoral or penile pain

-Perineal or anal pain

-Hip pain

How do I know if I have a hypertonic pelvic floor?

A hypertonic pelvic floor can be identified with an exam by a Pelvic Floor Therapist. Your therapist can determine if pelvic floor muscle tone is normal or abnormally high. For more information regarding what to expect on your first visit with a pelvic floor therapist, check out this article.

How can Pelvic Floor Therapy help a hypertonic pelvic floor?

A pelvic floor therapist will help facilitate the lengthening of your pelvic floor muscles. Treatments with a pelvic floor therapist can include:

-Manual therapy (external, intravaginal, or intrarectal, depending on patient needs)

-Patient training to use vaginal dilators

-Biofeedback

-Home exercises including stretching and coordination exercises

What about other treatments?

Medical management of hypertonic pelvic floor muscles can include pharmaceuticals or procedures such as trigger point injection or botox. These options will have to be discussed with your doctor. 

How do I schedule with a Pelvic Floor Therapist?

Consult with your doctor to see if you are a good candidate for pelvic floor therapy and to get a referral for pelvic floor therapy. The pelvic floor therapy team at MOTI have undergone additional training to be able to perform pelvic floor examination and treatment and are ready to help you on your healing journey!

Exercises to Try Today

The following exercises are helpful to relax your pelvic floor, give them a try today.

Diaphragmatic Breathing

The diaphragm and pelvic floor are both soft domes of muscle in the abdomen that move together when you breathe. Diaphragmatic breathing can help restore rhythm between the two and balance tension in your abdomen. Start in a seated position or lying down on your back. Place one hand on your chest and one hand on your stomach. As you inhale, allow the pelvis, belly, and lungs to expand and fill with air. Both hands should rise and fall at the same time. As you exhale, you’ll feel the air gently leave the body, without any strain. Repeat for 5-10 minutes.

SINGLE KNEE TO CHEST

Begin laying on your back. Bring one knee to your chest, cradling the knee with the arm/hand. Hold the stretch for 30-90 seconds. Breathe. Repeat on the other side.

MODIFIED HAPPY BABY

Laying on your back, hug both knees to the chest, using your hands or a stretching strap/towel behind the thighs. Hold the stretch for 30-90 seconds while performing your diaphragmatic breath.

CAT COW

Start on all fours, exhale as your round the spine like an angry cat. As you inhale, come into a back extension, allowing the belly to sink towards the mat and eyes towards the sky. Move slowly with controlled movement. Perform 5-10 reps. 

CHILD’S POSE WITH SIDE STRETCHING     

From all fours, stretch the glutes towards the heels, walking fingertips forward. Hold the stretch for 30-60 seconds while perform deep breaths. Walk the fingertips toward the right side of the mat, until you feel a side stretch on the left. Hold for 30-60 seconds. Repeat on the other side. 

SUPPORTED SQUAT STRETCH

Come into wide leg squat onto a low stool, a stack of sturdy books or yoga blocks. Focus on dropping the pelvic floor and perform diaphragmatic breathing. Hold for 30-90 seconds. 

The post Pain with Sex or Tampons? How Pelvic Floor Therapy May Help You and Five Exercises You Can Try Today appeared first on MOTI Physiotherapy.

So you were recently diagnosed with pelvic floor dysfunction, but what does that mean? Let’s talk about what the pelvic floor is, what it does, and what happens when it is not working correctly. 

What does your pelvic floor do? 

Your pelvic floor is a group of muscles that runs from your pubic bone to your tailbone and acts as a muscular sling. It is responsible for the 3 S’s: Support, Sphincter, and Sexual Function. The pelvic floor acts as support because it works in conjunction with your abdominal muscles and diaphragm to provide stability to your pelvis and support your internal organs. Your pelvic floor also surrounds your urethra and anus and is responsible for sphincter function. Lastly, your pelvic floor plays an intimate role in your ability to have pleasurable intercourse, reach orgasm, and, for men, maintain an erection.  

What is pelvic floor dysfunction? 

Pelvic floor dysfunction is an umbrella term for any issue that may cause the pelvic floor to not function properly. Usually, pelvic floor dysfunction falls into two categories: tension or weakness. 

What happens if your pelvic floor is too tight? 

Tension occurs when the pelvic floor muscles and surrounding musculature are too tight and have trouble relaxing. Risk factors include frequent yeast and urinary tract infections, endometriosis, interstitial cystitis, nerve entrapments, constipation, urge urinary incontinence, abdominal surgeries, and fibromyalgia. Symptoms can include pain around your abdomen, vaginal opening, inner thighs, rectum, back, and buttocks. You may notice that it is uncomfortable to urinate, insert a tampon, have intercourse, or have a gynecological exam.  Orgasms can be painful because your muscles are tight and stay contracted after climax. 

Pelvic floor tension can also cause urinary and bowel issues. Muscular tension around your anus can cause constipation because it is hard for stool to pass through the sphincter. Similarly, if the muscles that surround your urethra are tight, you may experience urinary hesitancy and have difficulty starting the flow of urine. Another common urinary symptom of pelvic floor tension is frequency. You may find that you have the sensation to urinate every 30 minutes to an hour or wake up multiple times a night to pee.   

What happens if your pelvic floor is too weak? 

Pelvic floor weakness occurs when your pelvic floor lacks the strength and endurance to perform its regular function. Risk factors include older age, pregnancy and childbirth, abdominal surgery, obesity, and activities that involve high impact or heavy lifting.  

Like pelvic floor tension, pelvic floor weakness can also cause urinary and bowel issues. Because the muscles that hold back urine are weak, you may have stress incontinence and notice leaking during activities such as lifting, jumping, or sneezing. After you urinate, you may also notice slight dribbling because your pelvic floor muscles that surround your urethra do not close it completely.  

A weak pelvic floor can also cause issues with support of your pelvis and torso. You may experience a sensation of heaviness or falling out around your vaginal opening that can be a symptom of pelvic organ prolapse. Additionally, pelvic floor weakness can also contribute to a separation of your abdominal muscles called diastasis recti.  

What can you do if you think you have pelvic floor dysfunction? 

See a women’s health physical therapist! An evaluation with a trained women’s health physical therapist can help you determine the type of pelvic floor dysfunction you have and begin to work towards correcting those issues.  

– Dr. Fei Zang, PT, DPT

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