Pelvic Floor Therapies

Pelvic floor therapies first came to the attention of the mainstream IC community in the mid 1990's. Upon therapy, some IC patients reported dramatic reductions in symptoms. Dr. Jerome Weiss (UCSF Medical School), a recent guest speaker on the IC Network, is one physician who actively assesses muscle tone and then may use direct manual manipulation and/or biofeedback to assist the patient in restoring muscle tone and health. Dr. Weiss offered a fascinating insight into pelvic floor functioning and therapies. Read the chat transcript here.

For IC patients, the health of the pelvic floor muscles merit a second glance particularly if they haven't been active for a period of time due to pain or frequency. Just the inactivity of an IC patient in a flare could lead to poor muscle tone. Signs of muscle weakness may be: (1) an uncomfortable feeling of pressure or heaviness, (2) leaking of urine when coughing, laughing, running or doing exercise, (3) bulding of the bladder into the vagina (cystoscele), (4) bulging of the rectum into the vagina (rectocele) and (5) the dropping of the uterus into the vagina. Therefore, a proactive approach to maintaining pelvic floor health can be a vital tool in an IC patient treatment arsenal and can prevent future bladder problems (i.e. stress incontinence, leakage) from developing.

If you are interested in learning more about your pelvic floor, your first goal is to obtain a pelvic floor assessment by a physician or physical therapist who is familiar with the latest in pelvic floor theories. Generally, the examination is done both externally and internally. The therapist may do an examination of the abdominal and perineal muscles to locate tender muscle areas. For women, a vaginal exam will allow the therapist to palpate the various internal pelvic floor muscles. Men will have their pelvic floor assessed through a simple rectal exam.

If your care provider finds that you have muscle problems, there are three common approaches to pelvic floor treatment: (1) myofascial release, (2) biofeedback and (3) kegel exercises.

• Myofascial release is used to directly massage and reduce any myofascial trigger points (muscle knots) found. It may take several (many) sessions of physical therapy to reduce the tension in those muscle areas. In some cases, doctors may inject a local anesthetic directly into the muscle knot to relieve and reduce pain. Remember, muscle knots are tender. This therapy may be initially uncomfortable. Heat or ice may help reduce symptoms. If they are uncomfortable, talk with your care provider about how you can reduce your symptoms.

• Biofeedback involves the use of a small machine and a wand, gently inserted in the vagina. It measures muscle tone and offers a pitched, audible sound to help patients relax the proper muscle areas. This can eventually be done at home, after proper training.

• Kegels are simple exercises that help strengthen the perineal muscles. These are the muscles around the vagina and urinary opening. Kegels are simple, easy to do several times a day. The US NIDDK offers several excellent resources for patients who wish to learn more about kegel exercises. Read their resources here!

The ICN has had several guest presenters who have discussed and/or advocated pelvic floor therapies, including:

• Joan Delgado, Physical Therapist
• Jerome Weiss, MD - Pacific Center for Pelvic Pain
• B.J. Czarapeta, RN - Urology Wellness Center
• Joanne Yount - Executive Director, Vulvar Pain Foundation

• NIDDK Guide to Pelvic Floor Therapies
• The International Society for Pelvic Pain
• Springer LINK: International Urogynecology Journal
• Pelvic-Floor Exercises After Childbirth & METs and Monitoring Exercise Intensit
• Biofeedback Pelvic Floor Therapy
• Pelvic Floor Assessment
• Experts: Midwife: Postpartum Care: Cystocele and pelvic floor tone
• Vulvodynia.Com - Dr. Howard Glazer