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 often involves structures outside the bladder, such as the pelvic floor muscles. Who knew that tight pelvic floor muscles could trigger bladder pain and discomfort but, believe it or not, they often do. If your IC symptoms began after having a baby, a car accident, a fall, a history of athletics or sexual abuse, you could easily have pelvic floor dysfunction driving your pain and bladder symptoms.
Injured muscles are weakened and then, because they are struggling to hold your organs in place, they overcompensate by becoming quite tight. Or, sometimes, muscles tighten in a guarding reflex as a result of pain. These tight muscles then cause a ripple effect throughout the pelvis because they don’t allow blood to circulate easily. The bladder and other tissues then struggle to get the oxygen and nutrition they need to be healthy. For these patients, the therapeutic priority is to restore blood flow by relaxing muscles. Tens of thousands of patients are now referred to physical therapists but, unfortunately, some patients walk away too soon. Why? Because the initial examination hurt.
During your first visit with a physical therapist, their goal is to evaluate your pelvis and related muscles. They will look at your legs, back, hips and core. 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 which, of course, can put strain on one side of your pelvis. And, of course, they will do either a vaginal exam (women) or a rectal exam (men) to gently touch your muscles internally. It is at this moment where the sensation of pain is critical and a good thing.
If they can touch or push a muscle in your pelvis and trigger your bladder pain that 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 a gentle treatment plan to help. ” Ideally, at the end of that first examination, you’ll have the name of muscles that are hurting and a treatment plan.
The actual pelvic floor physical therapy done afterwards is usually gentle. Physical therapists usually go quite slowly as they gently work those muscles to relieve tension. Your job is to say “OW! That hurts so that they will back off and be more gentle. 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.
Trigger points (tight bundles of muscles) can be challenging though. What do you do when you have a muscle knot on your back? You usually ask someone to press on it to release it. It’s a hurt so bad hurts so good feeling, right? You might also have trigger points in your pelvic floor that need some releasing. They might work on those with their fingers or perhaps with dry needling or trigger point injections. 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 and trigger points will make those challenging.
There are also some patients who, because they were victims of sexual abuse or because of recent surgery, can not contemplate internal pelvic floor work. After my hysterectomy last year, I had so much vaginal pain that I simply wouldn’t let anyone touch me down there for almost eight months. But that might have been a mistake. I struggled with vaginal and rectal pain for months after surgery. When I finally went back to the surgeon to ask why I was hurting, he discovered that I was having involuntary levator ani muscle spasms. His treatment recommendation? Pelvic floor physical therapy. Of course, I was wary. The incision at the top of my vagina was very, very sensitive. Just three gentle sessions of PT stopped the spasms and improved my pain dramatically. I can’t imagine how I would be today if I hadn’t had the courage to try it. I also have to wonder if I could have saved myself a few months of pain if I had been willing to go in earlier.
Pelvic floor work 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!