Pelvic Floor Therapist’s Guide: How to Treat Pelvic Pain
How do I know where to start?
When looking for relief from pelvic pain, you may question whether to discuss your concerns or symptoms with your primary care physician, your gynecologist, or perhaps your PT or OT you have been going to for another injury you have been dealing with. Oftentimes, people get tired of sharing their story because they have been dealing with medical gaslighting for so long and have found no one to take them seriously or validate their concerns. Most people are surprised to find out that you can go straight to a pelvic floor therapist for relief. A pelvic floor therapist is a physical therapist (PT) or occupational therapist (OT) that specializes specifically in pelvic health. In other words, they are not seeing clients with shoulder or ankle injuries and then seeing some clients with pelvic related concerns on the side here and there. Pelvic floor therapists at Bloom Pelvic Therapy spend their entire day solely working with clients with pelvic floor conditions.
In an evaluation at Bloom Pelvic Therapy, you will spend at least 1 hour with your pelvic floor therapist to share your story and finally be heard. Clear answers start with having the opportunity to share details of your concern in a safe and comfortable setting where you are not rushed or dismissed. After discussing with your pelvic therapist and sharing additional medical history, your pelvic therapist may complete an internal muscle assessment of your pelvic floor, as well as assess whole body movement to better understand the cause of your concerns.
As the root cause of your symptoms are better understood and communicated with you, you will create an action plan for your care with your pelvic floor therapist. This will guide your upcoming sessions and ensure the goals that are most important to you are of utmost priority and are met. Your pelvic floor therapist is also skilled in helping you navigate any upcoming primary or gynecology appointments to ensure you have optimal support and medical management as needed.
What is an internal pelvic floor muscle assessment, and do I have to do one?
An internal pelvic floor muscle assessment is never required, although it is a great first step to gathering information about how the pelvic floor is working and how it contributes to your concerns. The internal muscle assessment is completely different from a typical gynecologic or rectal exam. The internal assessment should not be painful. There is no speculum, no stirrups, no paper gowns. One lubricated gloved finger is inserted into the vagina or rectum. This allows the therapist to assess for movement of the muscle, strength, or any tension. During the assessment the pelvic floor physical or occupational therapist may ask you to cough, laugh, or lead you through some breathing. This helps us to assess the coordination of the pelvic floor.
The internal muscle assessment is very helpful to getting to the root cause, but never required. We can certainly get a very good understanding of what is going on with the pelvic floor based on your symptoms and history, along with what needs to be corrected to get rid of your pelvic floor concerns. At times, clients will defer their internal assessment for a session or two until they feel comfortable. This is perfectly fine- we want you to be comfortable!
Your pelvic therapist will also assess whole body movement to better understand the cause of your concerns. They may complete a movement screen as indicated and even observe you as you demonstrate how you complete some daily tasks or even your preferred exercise. This is essential in getting a full picture of your body mechanics. Sometimes this is completed at the first follow up session or two, depending on how much is covered during the first visit (evaluation) alone.
What do pelvic therapy appointments look like for someone with pelvic pain?
After an evaluation, treatment sessions at Bloom Pelvic Therapy are one-on-one with your pelvic floor therapist within a private and comfortable room. We individualize each session for each unique person, looking at the whole body, and targeting their goals specifically. Some of our clients come to us with very specific goals, such as being able to have enjoyable sex with their partner again. Some clients come with very general thoughts or even just trusting a recommendation from a friend. We hear things like, “I have always had pain with gyno visits and thought maybe this could help.” Our sessions are all focused on getting you back to doing the things you love without fear or worry. With that in mind, two clients experiencing pain with sex may partake in treatment sessions that look entirely different depending on their specific goals and root cause of their concerns.
Generally, each session begins with asking about the time since your last pelvic floor therapy appointment, how things are going, and any hang ups. From there, we get into the treatment techniques for that session. This may include hands-on manual techniques externally, such as myofascial release, or internally. Internal manual therapy techniques are performed either vaginally or rectally (depending upon which muscles are affected) often to decrease tension in pelvic floor muscles or fascial restriction. Outside of manual therapy, there are also movement-based strategies you will go through with your pelvic therapist. This may look like stretching, breathwork, and mindfulness. This could also look more like your workout or simulations of the way you do daily tasks. It all depends on you and what interventions your body needs. Each session concludes with making sure you feel great, understanding where you are at with your progress, and what you could be doing at home between the sessions. You will leave each visit with increased understanding and actionable items to progress you in reaching your goals!
Most clients are delighted to find that there are things they can do to help push their progress forward when at home or during their current workout regimen. By partnering with you during your journey towards healing pelvic pain, we are not the “fixers.” After all, you are not broken! We emphasize client education and empowering you with tools and strategies to employ between sessions for optimal results while getting you that much closer to meeting your goals.
Do dilators help vaginal pain with sex?
Short answer… Sometimes! Long answer is that it depends on the reason or cause behind your pain. Your pelvic floor therapist will help you to understand if dilators (sometimes referred to as vaginal trainers) would be an appropriate tool for you specifically. This will depend on if your concerns are related to anticipatory muscle spasms, overactivity of your pelvic floor, scar tissue, and other factors. They will also help you determine exactly how to use the dilators as well as if it would be more advantageous for you to use a pelvic wand instead. The recommendation and method for using either device is dependent upon you, your symptoms, and your stage in your journey. This is not a one-sized-fits-all approach.
We frequently see clients that have tried dilators at home before coming to pelvic therapy and have found that they did not see much improvement with them. Most often, this is because they inserted the dilator, left it in for a certain number of minutes, and then took it out, periodically progressing to the next size but still finding discomfort with each. Not only should a dilator program include more than that to target the cause of concern, but it is also important the other aspects of pelvic therapy are being addressed simultaneously, such as pelvic mobility, muscular strength and balance, and cognitive factors if warranted. When appropriate, we guide our clients on exactly how to use each dilator to target the specific muscles that are causing them trouble and progress them through to the dilator size indicated for them in a systematic manner based on their individual progress.
Is there any hope for me to have pain-free sex?
YES! There is hope for you to have not only pain-free sex, but pleasurable sex. While the emphasis at first may be decreasing the amount of pain, duration of pain, etc., it is often the goal to help our clients get to a place where they actually look forward to intimacy—whatever that may look like to them. Especially for people that have been dealing with pain with sex for years, it can be difficult to trust that relief is possible. For our clients that have a more recent onset of pain with sex, they are often frustrated trying to figure out what suddenly went awry. Is it hormones? Is it a new medication? Is it pelvic floor? Is it from that pesky yeast infection that keeps returning? Is it partner size? The list goes on. Rather than playing the guessing game, we encourage you to find a place where you can get real answers and find relief.
What’s the deal with lube?
We recommend everyone at every age and stage to have a good, clean lubricant on hand. Somewhere along the line, there became a stigma associated with using a lubricant. This should not be the case. While lube certainly will not be addressing the underlying issue you may have at hand, it can be a great first step to decreasing pain or discomfort even by a smidge. Of course, we are not dismissing your concerns by saying, “Have you tried lube?” because we know that story all too well. We do, however, want to ensure that this is a tool in your toolbox. If you are already using a lubricant, we recommend checking that it is a clean lubricant without lots of additives, scents, hot/cold elements, etc., as all of this can be irritating to the delicate vulvar and vaginal tissues. Lubricants we recommend include:
-Slippery Stuff
Connect with a pelvic floor therapist to discuss your unique story for individualized recommendations and a treatment plan specific to your concerns. Pelvic pain does not have to be your forever. While healing may not occur overnight, it is indeed possible with the right support team!
For more information on pelvic health, related concerns, and other helpful tips we wrote a large blog “The Complete Guide to Everything to Know about Your Pelvic Floor Health and Pelvic Floor Therapy”