We’ve long passed those days when we believed that IC was an incurable bladder disease. Today, we consider IC/BPS a pelvic pain syndrome that can involve structures beyond the bladder, often the pelvic floor muscles. Dysfunctional pelvic floor muscles can trigger all of the symptoms we normally associate with the bladder, including frequency, urgency, pressure and/or pain. If your IC symptoms began after having a baby, a car accident, a fall, a history of athletics or sexual abuse, pelvic floor dysfunction could be driving your symptoms.
Tens of thousands of IC patients are now referred to physical therapy but some walk away too soon. Why? Because the initial examination hurt. They incorrectly assumed that every visit would be painful. Let’s take a closer look at why that first visit can be a bit uncomfortable and why experiencing some pain is actually a good thing!
During your first visit with a physical therapist, you will have a pelvic floor assessment. Their goal is to evaluate your pelvis and related muscles. They will look at your legs, back, hips and abdomen looking for patterns of muscle tension. They’ll have you walk down a hallway to see if your muscles are functioning normally. They’ll measure your legs to see if one is longer than the other.
And, of course, they will do either a vaginal exam (women) or a rectal exam (men) to gently touch your muscles internally. This is the moment where pelvic floor dysfunction is usually identified. Using a finger, they will gently touch muscles throughout your pelvis. If they trigger your bladder pain by touching a muscle internally, this is a tremendous victory. It means that they’ve found the source of your pain and with that knowledge they can now focus on creating an individualized treatment plan that can help. Ideally, at the end of that first examination, you’ll also have the name of muscles that are hurting so that you can do your own research.
The actual pelvic floor physical therapy begins at your next appointment. Physical therapists usually go quite slowly as they gently work those muscles to relieve tension. In some cases, they might not start with any internal work. They may start first by teaching you how to relax your leg, back and belly muscles. Your job is to tell them how it feels. If it hurts, speak out. Ask them to be more gentle and/or use a lighter touch. Your voice and feedback is critical.
Trigger points (tight bundles of muscles) can be challenging. What do you do when you have a muscle knot on your back? You usually ask someone to press on it to release it. You might also have trigger points in your pelvic floor that need some releasing. Your physical therapist will work on those with their fingers or perhaps with dry needling or trigger point injections. Yes, those can be uncomfortable at first but as they release, you should feel much better. The last thing you want to do is leave a tight trigger point alone. Your goal is to get good blood flow into those tissues.
There are also some patients who, because they were victims of sexual abuse, cannot contemplate internal examination and/or pelvic floor work. Please do not carry any shame if you feel this way. This is a normal response that many survivors struggle with. Explain your fears to your physical therapist. While internal work is ideal and the most effective, they don’t have to start with an internal examination. They can start externally first and teach you how to relax any dysfunctional muscles they find. Their job is to make you comfortable, to be compassionate, to build your confidence.
Pelvic floor rehabilitation takes patience, time, dedication and courage. You and your physical therapist must work together. Your job is to guide the therapist during your appointments to tell them what you feel. But you’ll also be doing quite a bit of work at home too. And, in the end, muscles can respond beautifully and rapidly to muscle work. Don’t let the fear of pain stop you. Be courageous! Try it out!