Q&A: Post-Op Pelvic Pain, Kegels for Erectile Dysfunction, Scar Tissue and More

In Pelvic Floor Physical Therapy by Stephanie Prendergast and Elizabeth RummerLeave a Comment

As the blog grows, we continue to get important questions from our readers. In this blog post, we’re going to tackle a handful of the recent questions that have come our way. If you have a question of your own, please take the opportunity to post it in the “comments” section of this blog.

Pelvic Floor Relaxation: Beyond the Drop

Dear Liz,

Do you have any tips for ways to lengthen the pelvic floor beyond the “pelvic floor drop?”


Beyond the Drop

Dear Beyond the Drop,

If you’re looking for additional ways to relax your pelvic floor beyond pelvic floor drops, try I diaphragmatic breathing. Diaphragmatic breathing is taking deep breaths that make your belly go up and down, not just your chest. This kind of breathing can help relax your pelvic floor muscles.

Plus, if you don’t have any nerve-like symptoms, such as burning, shooting, or stabbing pain in your pelvic floor region, you could also try getting into a deep squat when you do your diaphragmatic breathing. However, if you do have nerve-like symptoms, I don’t recommend this position because it stretches the pudendal nerve, which in turn can cause irritation to this nerve.

All my best,


Post-hysterectomy Pelvic Floor Pain

Dear Stephanie,

I am two weeks post-op after a hysterectomy. I have begun to get discouraged because I still can’t be on my feet for more than ten minutes without feeling immense pressure on my pelvic floor muscles. Even when I lay down, they still ache and feel worn out. 

Is it normal for my pelvic floor to feel this way after surgery?



Hysterectomy Post-Op

Dear Hysterectomy Post-Op,

Your situation—post-surgical pelvic pain—is one we see quite frequently in our practice, so I was very glad to get your question, and hope I can shed light on this issue here.

Unfortunately, in today’s day and age of rushed medicine, most physicians do not have the time they need to fully inform patients about what to expect after surgery, therefore, many patients are often scared and confused by symptoms that may be totally normal.

The normal healing process from surgery may be causing your symptoms. However, it is very important to be brutally honest with your doctor in this situation. My hope is that in return she will explain her thoughts about your symptoms and give you a full run down of what to expect from the healing process of your surgery.

But I also believe it would be wise for her to refer you to a pelvic floor PT. And your doctor is the best judge of how soon you should visit a pelvic floor PT post-surgery.

It’s always helpful to get checked out by a pelvic floor PT after a procedure like this. If you think about it, rehab after ankle surgery, just to use one example, is mandatory. The pelvic floor is much more complicated than our ankles! A pelvic floor PT can work with your doctor to assess exactly what is going on with your pelvic floor post-surgery. She or he will be able to tell you if the muscles are in spasm, if there are any trigger points that need release, or whether the procedure caused scar tissue to form within your pelvic floor. (To learn more about post surgical scar tissue, take a look at this great post Melinda wrote.)

All the best,



Are Kegels a Cure for Erectile Dysfunction?

Dear Liz,

Some folks in the men’s health arena suggest that kegeling can enable men to retain harder and longer lasting erections, or have suggested it as cure for erectile dysfunction. What are your thoughts on this matter?


Curious About Kegels

Dear Curious About Kegels,

It is fairly uncommon for men to need to do kegels because there aren’t too many reasons for a man’s pelvic floor muscles to become weak. Weak pelvic floor muscles are the only reason one would need to do kegels. However, one example of a situation where a man would find the necessity to engage in a pelvic floor strengthening program, i.e. do kegels, would be after a prostatectomy.

There is no research to support kegels for better erections or orgasms. In fact, if a man were to do kegels when they are not necessary, he runs the risk of making his pelvic floor muscles too tight, which can actually negatively affect the muscles ability to contract optimally. This could negatively impact erections and orgasms.

All the best,



Can Faulty Mechanics Cause Scar Tissue Formation?

Dear Melinda,

A recent MRI I had showed scar tissue in various areas of my pelvic floor. However, the strange thing is that I have never had any surgeries involving my pelvic floor, just two vaginal births 25 years ago. I’ve been told this could be due to a mechanical issue.

I am experiencing pelvic pain, and my PT believes that the scar tissue is the culprit. Is it true that this scar tissue could be the result of mechanical issues?



Scar Tissue

Dear Scar Tissue,

Thanks for sharing your story. Your question brings up a great point.

Mechanical stresses to the body can indeed create micro injuries to the tissues, which the body will heal by making new tissue. Examples of mechanical stresses can include having one leg that is shorter than the other, faulty posture, or scoliosis. However, sometimes your body is overzealous and makes too much of this tissue, and the tissue remodel causes symptoms that are similar to those that arise with scar tissue from a surgery. These symptoms include limiting blood flow or entrapping nerves. So, the answer is that yes, mechanical issues that impact the pelvic floor can indeed create what is for all intents and purposes scar tissue, which can result in all of the problems that I mention in my previous blog about scar tissue, which you can read here.

All my best,


Getting an Education on Central Sensitization

Dear Stephanie and Liz,

Recently I have been diagnosed as having “central sensitization” in addition to my pelvic pain. Do you know of any good resources on central sensitization and pelvic pain?



Central Sensitization Education

Dear Central Sensitization Education,

For specific reading about pelvic pain and central sensitization, I recommend that you check out two great articles from the American Physical Therapy Association’s Section on Women’s Health titled: “The Puzzle of Pelvic Pain: A Rehabilitation Framework for Balancing Tissue Dysfunction and Central Sensitization: A Review of  Evaluation and Treatment Considerations (Parts One and Two).”

In addition, the web site, www.bodyinmind.org, has great general info about central sensitization.

All the best,


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