Step Two – Physical Therapy and IC

treatments-ptPelvic floor physical therapy is now recognized and classified as a Step Two treatment option in the AUA Guidelines for the treatment of IC/BPS.  Why? Pelvic floor dysfunction (tight, painful muscles) is common in patients struggling with pelvic pain. Our muscles naturally protect or guard from injury by tightening. However, when the tension is prolonged, painful trigger points and muscle dysfunction occurs. Because the pelvic floor muscles support the organs in the pelvis, if they are unusually tight it can be difficult to empty the bladder or bowels. Similarly, for some patients, sexual penetration can also be quite difficult and painful (aka vaginismus).

The AUA suggests:

Appropriate manual physical therapy techniques (e.g., maneuvers that resolve pelvic, abdominal and/or hip muscular trigger points, lengthen muscle contractures, and release painful scars and other connective tissue restrictions), if appropriately-trained clinicians are available, should be offered to patients who present with pelvic floor tenderness. Pelvic floor strengthening exercises (e.g., Kegel exercises) should be avoided. Standard (Evidence Strength Grade A).

How do I know if I have pelvic floor dysfunction?

Most IC patients have some degree of pelvic floor tension. It is usually assessed via a simple pelvic floor assessment. A medical care provider (i.e. urologist, ob-gyn or physical therapist) will assess the health and status of the muscles in the hips, abdomen, and upper legs. A gentle internal exam will occur, vaginally for women or rectally for men, during which the provider touches specific muscle groups to determine if they are dysfunctional. Tight pelvic floor muscles are often described as tight piano strings. If present, physical therapy should be utilized. Learn more in the ICN PFD Information Center

What does a physical therapist do?

While many patients would prefer to use an easy medication, they must understand that muscle dysfunction requires muscle work. PFD physical therapy is generally “hands on” with a physical therapist manipulating your body, both externally and internally, appropriately. Because the pelvic floor muscles are often quite tender and sensitive, physical therapy is generally done slowly over time. If substantial pain and discomfort occurs during or after therapy, that is a sign that the physical therapist is being too aggressive. Ask them to be more gentle.

A physical therapist will also provide a variety of stretches and exercises designed to relax, lengthen and loosen tight pelvic floor muscles at home. These must be performed daily to retrain those muscles to their normal, relaxed state. In other words, going to a physical therapist once a week is simply not enough. Pelvic floor rehabilitation requires daily commitment by the patient to work with the muscles to restore proper functionality.

Are Kegel Exercises Enough?

Absolutely not. Kegel exercises NOT recommended for patients struggling with PFD because they tighten muscles. Rather, PFD patients must focus on relaxing, loosening and lengthening the muscles.

How to find a physical therapist to treat pelvic floor dysfunction?

What if I have no insurance or can’t afford pelvic floor physical therapy?

You are certainly not alone and the good news is that there are books, CD’s and DVD’s that can help. One strategy that some patients use is to visit a physical therapist once for an assessment and suggested exercise which they they do at home, daily. They then visit the PT once or twice a year for additional suggestions and evaluation of their progress. Pilates and/or Hatha Yoga can also maintain pelvic muscle health provided they are done in an appropriate manner.