By Shannon Pacella, DPT, PHRC Lexington
If you’ve been a patient of mine, you probably remember me talking about the mind-body connection. This is especially important when it comes to pelvic pain and pelvic floor dysfunction. The pelvic floor muscles are innervated by the pudendal nerve which contains both motor and autonomic nerve fibers. Most other skeletal muscles (like your hamstrings, quads, glutes, etc.) are innervated by nerves that only contain motor fibers, not autonomic. Because of this special physiology, the pelvic floor muscles will respond to training in mindfulness, and this should be incorporated into the treatment of pelvic pain.
The word mindfulness gets thrown around quite a bit, and you may often hear it connected to meditation. But do you really know what mindfulness is all about? Hopefully by the end of this post, you’ll have a better understanding!
Mindfulness is a process of regulating attention in order to bring a quality of non elaborative awareness to current experience and a quality of relating to one’s experience within an orientation of curiosity, openness, and acceptance.
Let me break this down for you. There are two components of mindfulness:
- First component:
- Involves the self-regulation of attention so that it is maintained on immediate experience, allowing for increased recognition of mental events in the present moment.
- Second component:
- Involves adopting a particular orientation toward one’s experiences in the present moment, characterized by curiosity, openness, and acceptance.
Mindfulness is a form of mental training used to reduce cognitive vulnerability to reactive modes of mind that might otherwise heighten stress and emotional distress, while meditation is a tool/technique used to enable mindfulness.
Training in meditation can be used to cultivate the capacity to evoke and apply mindfulness to enhance emotional well-being and mental health.
Here’s a quick ‘how to meditate’ guide*:
- First, try to find a comfortable position, this may be laying down, sitting, standing, or even walking.
- Attempt to maintain attention on a particular focus, most commonly it is on your own breathing.
- Whenever your attention wanders from the breath to inevitable thoughts and feelings that arise, you simply take note of them and then let them go, as your attention is returned to your breath.
- Do not try to suppress your thoughts or feelings, they are welcome, however, do not dwell on them. Allow them to come, but then allow them to go as you focus on your breathing.
- This process is repeated each time that your attention wanders away from your breath.
*There are many ways to meditate, but most varieties are similar in their basic procedures and goals.
There is an emphasis on simply taking notice of whatever your mind happens to wander to and accepting each object (any stimulus: thoughts, feelings, sounds, etc.) without making judgements or elaborating on its implications, additional meanings, or need for action.
It is encouraged to use this same general approach outside of formal meditation practice by bringing awareness back to the here-and-now during the course of the day, using the breath as an anchor, whenever attention has become focused on streams of thoughts, worries, or ruminations. By going through the procedure of meditation, it will lead to a state of mindfulness.
In a state of mindfulness, thoughts and feelings are observed as events in the mind, without over-identifying with them and without reacting to them in an automatic, habitual pattern of reactivity. This state of self-observation is thought to introduce a “space” between one’s perception and response.
Mindfulness is thought to enable one to respond to situations more reflectively (instead of reflexively). When you respond reflexively, you are not giving yourself time to think about how you are responding to the situation; you may say something or do something that you did not truly want to say/do. By being mindful and allowing yourself to respond reflectively, you are able to create a space where you can react thoughtfully.
Mindfulness can be described as a kind of non elaborative, non judgemental, present-centered awareness in which each thought, feeling, or sensation that arises in the attentional field is acknowledged and accepted as it is.
Did you know that mindfulness based stress reduction (MBSR) is a treatment program originally developed for the management of chronic pain? If you like to learn more about the connection between mindfulness and chronic pain, check out this previous post: Mindfulness Meditation: Is it actually effective for treating chronic pain?
I hope this has inspired you to try and be more mindful throughout the day, and I urge those with pelvic pain to incorporate mindfulness into your daily routine.
Here’s a quick and simple guided meditation to give you a place to start!
References:
- Bishop SR, Lau M, Shapiro S, et al. Mindfulness: a proposed operational definition. Clinical Psychology: Science and Practice. 2006;11(3):230-241. doi:10.1093/clipsy.bph077
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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. The cost for this service is $85.00 per 30 minutes. 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.
PHRC is also offering individualized movement sessions, hosted by Karah Charette, DPT. Karah is a pelvic floor physical therapist at the Berkeley and San Francisco locations. She is certified in classical mat and reformer Pilates, as well as a registered 200 hour Ashtanga Vinyasa yoga teacher. There are 30 min and 60 min sessions options where you can: (1) Consult on what type of Pilates or yoga class would be appropriate to participate in (2) Review ways to modify poses to fit your individual needs and (3) Create a synthesis of your home exercise program into a movement flow. To schedule a 1-on-1 appointment call us at (510) 922-9836
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.
Comments
This is so important and needs to be a tool that we can use for everyday life!
I’ve been living with pelvic pain for over 10 years now, and read about mindfulness and journaling from the beginning of my search for relief. I recommend Dr. John Sarno’s books, too.
Thank you for all the good you are doing through this website ❣️
This is the best despot mindfulness I’ve come across!! Thank you!
I Loved how relaxing this is such a great way to center yourself I do meditation with music or with relaxing ocean waves for music are my favorites but wow new tool pretty simple but what a highly relaxing way to not concentrate on the problem or pain so much it really did help wonders thank you so much!!! I know I can use this in many situations ?
Meditation and being mindful are powerful tools to have in your toolbox; especially when dealing with chronic pain. Have you checked out our other blogs on the topic of mindfulness/meditation? If you have not, you might get some more out of those reads as well!
This is important to rehabilitate an alcoholic or drug addict physically and mentally for long term recovery from addiction. Willpower plays an important role in rehabilitation and a doctor can develop willpower inpatient with counseling. Yes, counseling plays a significant role in addiction recovery because during counseling a counselor tries to make patients believe that they can easily say “No” to alcohol this is not tough for anyone to control their mind. I am also running a rehabilitation center in Boston very we focus more on counseling and the success rate here is very high.
Hello, We believe that taking care of your mental health is a key factor in the recovery process. Physical health is important as well, but mental blocks can sometimes hinder the recovery process. Thank you for your comment!
Wow What an appealing content have you written! I’m really impressed by your words. Waiting for more and more such content.
Thank you for your comment! We are so happy to hear you are enjoying it.
Great article Shannon! I just read a great one by Kim Buonomo who did my initial evaluation appointment. I miss coming but I’m due to get my first vaccine next week. Hope to see you soon for treatment.
Annette- We are happy to hear you enjoyed the article! We also offer virtual sessions, if you ever need to be seen before you are ready to come in to one of our physical locations!