By Stephanie Prendergast, MPT, Cofounder, PHRC West Los Angeles
A while back we asked you for your questions about having a hypertonic pelvic floor. This week we answer all your questions and then some!
Q- Hi! I have really tight pelvic floor muscles and pain during sex and I was wondering if you might be able to suggest any pelvic relaxation exercises please? Thank you!!
A- Please check out our Pelvic Floor Relaxation Exercises on YouTube.
Q-I have a hypertonic pelvic floor & saw someone comment “the hip pain” on your post. Mine is terrible! Could you share the resource you were referring to with me please?
A- Hip pain is common in people with pelvic floor disorders for several reasons. Here are a few: the obturator internus muscle is an external rotator of the hip and can be a source of hip pain. A separate reason, but one that can coexist with OI dysfunction, is that the pelvic floor muscles are part of our core. If they are tight they may not be supporting us as they should and injuries in the neighboring joint can result. Many studies are now linking the pelvic floor to low back and pelvic girdle pain, including this wonderful study.
Q-Hi, just seen your post about endometriosis. Out of interest can endometriosis symptoms get better over time with no treatment? I had terrible period pains, all in the lower back as a teenager but in my 20’s particularly after starting the contraceptive pill the pains decreased in severity. I was told as a teenager that it might be endo, never got a proper diagnosis though.
A- Generally dysmenorrhea (painful periods) can be a symptom of endometriosis. Typically the disease does not improve without treatment. It is important to note that oral contraceptives do not TREAT endometriosis but may reduce the symptom of dysmenorrhea while you are taking them. Currently the only way to diagnose endometriosis is through a biopsy during surgery. However, people often start other treatments for overlapping symptoms while they are trying to decide if surgery is a choice for them. In addition to endometriosis excision specialists we suggest working with a pelvic floor physical therapist, a GI doctor and integrative health providers if SIBO and/or H.Pylori are present, a psychologist as the symptoms of endometriosis can take a toll on our mental health, and a pain management physician also can offer help with the symptoms.
Q-I’m surprised anal pain isn’t mentioned. Is it related to hypertonic pelvic floor? Or not…?
A- Anal pain can be a symptom of pelvic floor dysfunction. Anal pain can also come from hemorrhoids or fissures, which can also be associated with pelvic floor dysfunction. Anal pain can also be a sign of pudendal neuralgia.
Q-Does Botox procedures hinder chances of getting pregnant?
A- To my knowledge there are no studies suggesting botox hinders chances of getting pregnant.
Q-I am curious to learn more about hip pain. I have a hip that gives me more trouble than the other and also a feeling of a really tight nerve on the inside of that leg, in the hip/groin as well.
A- If you have not yet seen a pelvic floor PT this may be a good place to start! Pelvic floor PTs use soft tissue techniques, internally and externally, that may not be used by orthopedic PTs. The soft tissue structures (pelvic floor and girdle muscles, tissues, and nerves) can cause as much trouble as the joint itself.
Q- Does that include piriformis, obturator internus, SI Joint pain?
A-The piriformis and OI muscles are part of the pelvic floor and are usually painful if the Levator Ani muscles are painful too. These muscles are also commonly associated with SI joint pain. The good news is pelvic floor physical therapy can help with all of it!
Q-After an internal work at a pfpt session my lower back and my tailbone start killing me. My pt hasn’t really acknowledged it. What can I do? She said today when starting the internal exam that it wasn’t super tight. I’m worse at night. But even if I’m not super tight I’m still in pain.
A- Unfortunately flares can happen, and when they do they should not last more than a few days. We have a blog that discusses what to do when in a flare. Remember to listen to your body as you work through it, as not everyone responds the same way when handling a flare. It may also be helpful to get a second opinion with a different pelvic floor PT.
Q- Can this lead to vaginismus? Or is this the cause of vaginismus?
A- Pelvic floor hypertonus is a common impairment in women with vaginismus, which basically just means ‘pelvic floor tightness’. We have a handful of blogs about vaginismus if you would like to read more.
Didn’t see your question answered? Have follow up questions to this blog? Drop them in the comments and we would be happy to answer them!
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Are you unable to come see us in person? We offer virtual physical therapy appointments too!
Due to COVID-19, we understand people may prefer to utilize our services from their homes. We also understand that many people do not have access to pelvic floor physical therapy and we are here to help! The Pelvic Health and Rehabilitation Center is a multi-city company of highly trained and specialized pelvic floor physical therapists committed to helping people optimize their pelvic health and eliminate pelvic pain and dysfunction. We are here for you and ready to help, whether it is in-person or online.
Virtual sessions are available with PHRC pelvic floor physical therapists via our video platform, Zoom, or via phone. For more information and to schedule, please visit our digital healthcare page.
In addition to virtual consultation with our physical therapists, we also offer integrative health services with Jandra Mueller, DPT, MS. Jandra is a pelvic floor physical therapist who also has her Master’s degree in Integrative Health and Nutrition. She offers services such as hormone testing via the DUTCH test, comprehensive stool testing for gastrointestinal health concerns, and integrative health coaching and meal planning. For more information about her services and to schedule, please visit our Integrative Health website page.
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FAQ
What are pelvic floor muscles?
The pelvic floor muscles are a group of muscles that run from the coccyx to the pubic bone. They are part of the core, helping to support our entire body as well as providing support for the bowel, bladder and uterus. These muscles help us maintain bowel and bladder control and are involved in sexual pleasure and orgasm. The technical name of the pelvic floor muscles is the Levator Ani muscle group. The pudendal nerve, the levator ani nerve, and branches from the S2 – S4 nerve roots innervate the pelvic floor muscles. They are under voluntary and autonomic control, which is a unique feature only they possess compared to other muscle groups.
What is pelvic floor physical therapy?
Pelvic floor physical therapy is a specialized area of physical therapy. Currently, physical therapists need advanced post-graduate education to be able to help people with pelvic floor dysfunction because pelvic floor disorders are not yet being taught in standard physical therapy curricula. The Pelvic Health and Rehabilitation Center provides extensive training for our staff because we recognize the limitations of physical therapy education in this unique area.
What happens at pelvic floor therapy?
During an evaluation for pelvic floor dysfunction the physical therapist will take a detailed history. Following the history the physical therapist will leave the room to allow the patient to change and drape themselves. The physical therapist will return to the room and using gloved hands will perform an external and internal manual assessment of the pelvic floor and girdle muscles. The physical therapist will once again leave the room and allow the patient to dress. Following the manual examination there may also be an examination of strength, motor control, and overall biomechanics and neuromuscular control. The physical therapist will then communicate the findings to the patient and together with their patient they establish an assessment, short term and long term goals and a treatment plan. Typically people with pelvic floor dysfunction are seen one time per week for one hour for varying amounts of time based on the severity and chronicity of the disease. A home exercise program will be established and the physical therapist will help coordinate other providers on the treatment team. Typically patients are seen for 3 months to a year.
What is pudendal neuralgia and how is it treated?
Pudendal Neuralgia is a clinical diagnosis that means pain in the sensory distribution of the pudendal nerve. The pudendal nerve is a mixed nerve that exits the S2 – S4 sacral nerve roots, we have a right and left pudendal nerve and each side has three main trunks: the dorsal branch, the perineal branch, and the inferior rectal branch. The branches supply sensation to the clitoris/penis, labia/scrotum, perineum, anus, the distal ⅓ of the urethra and rectum, and the vulva and vestibule. The nerve branches also control the pelvic floor muscles. The pudendal nerve follows a tortuous path through the pelvic floor and girdle, leaving it vulnerable to compression and tension injuries at various points along its path.
Pudendal Neuralgia occurs when the nerve is unable to slide, glide and move normally and as a result, people experience pain in some or all of the above-mentioned areas. Pelvic floor physical therapy plays a crucial role in identifying the mechanical impairments that are affecting the nerve. The physical therapy treatment plan is designed to restore normal neural function. Patients with pudendal neuralgia require pelvic floor physical therapy and may also benefit from medical management that includes pharmaceuticals and procedures such as pudendal nerve blocks or botox injections.
What is interstitial cystitis and how is it treated?
Interstitial Cystitis is a clinical diagnosis characterized by irritative bladder symptoms such as urinary urgency, frequency, and hesitancy in the absence of infection. Research has shown the majority of patients who meet the clinical definition have pelvic floor dysfunction and myalgia. Therefore, the American Urologic Association recommends pelvic floor physical therapy as first-line treatment for Interstitial Cystitis. Patients will benefit from pelvic floor physical therapy and may also benefit from pharmacologic management or medical procedures such as bladder instillations.
Who is the Pelvic Health and Rehabilitation Team?
The Pelvic Health and Rehabilitation Center was founded by Elizabeth Akincilar and Stephanie Prendergast in 2006, they have been treating people with pelvic floor disorders since 2001. They were trained and mentored by a medical doctor and quickly became experts in treating pelvic floor disorders. They began creating courses and sharing their knowledge around the world. They expanded to 11 locations in the United States and developed a residency style training program for their employees with ongoing weekly mentoring. The physical therapists who work at PHRC have undergone more training than the majority of pelvic floor physical therapists and as a result offer efficient and high quality care.
How many years of experience do we have?
Stephanie and Liz have 24 years of experience and help each and every team member become an expert in the field through their training and mentoring program.
Why PHRC versus anyone else?
PHRC is unique because of the specific focus on pelvic floor disorders and the leadership at our company. We are constantly lecturing, teaching, and staying ahead of the curve with our connections to medical experts and emerging experts. As a result, we are able to efficiently and effectively help our patients restore their pelvic health.
Do we treat men for pelvic floor therapy?
The Pelvic Health and Rehabilitation Center is unique in that the Cofounders have always treated people of all genders and therefore have trained the team members and staff the same way. Many pelvic floor physical therapists focus solely on people with vulvas, this is not the case here.
Do I need pelvic floor therapy forever?
The majority of people with pelvic floor dysfunction will undergo pelvic floor physical therapy for a set amount of time based on their goals. Every 6 -8 weeks goals will be re-established based on the physical improvements and remaining physical impairments. Most patients will achieve their goals in 3 – 6 months. If there are complicating medical or untreated comorbidities some patients will be in therapy longer.