After more than 20 shots and two surgeries, I’d given up hope that I’d ever find relief. Suffering from endometriosis, I came to terms with the idea that pelvic pain was now a part of the norm for me.
That was until my doctor introduced me to pelvic physical therapy.
I know what you’re thinking: it doesn’t sound like a real thing. I was thinking that too.
I associated physical therapy with sports injuries or rehabilitation after a surgery, and that was about it.
My doctor brought up pelvic physical therapy and referred me to a pelvic physical therapist at Novant Health Rehabilitation Center.
During my eight appointments, I learned that pelvic physical therapy can help a lot of conditions.
What is pelvic physical therapy?
Pelvic physical therapy focuses on the pelvic floor, muscles that support the bladder and bowel, and the uterus in women. These muscles make up the bottom of what we commonly refer to as the "core." Healthy pelvic floor muscles relax to allow urine and feces to pass. When pelvic floor muscles become too relaxed, it can lead to leakage; muscles that are too tight can lead to pelvic pain, or pain during sexual intercourse.
Pelvic physical therapy is an individualized process that focuses on strengthening or stretching movements, or a combination of both, depending on the conditioning that the pelvic floor muscles need. A first visit to a pelvic physical therapist always involves an exam to assess the beginning state of the muscles and plan a course of treatment.
It's not just for women
I’ve seen the countless adult diaper commercials and heard women joke about peeing when they laugh. Apparently, urinary leakage is something to just accept these days. It shouldn’t be.
Pelvic physical therapy can help with many conditions, including urinary urgency or frequency, bowel conditions, chronic pelvic pain and painful intercourse, as well as help patients before and after some surgeries.
Sandy LaComa, a physical therapist and pelvic rehab specialist with more than 20 years of experience, works with women and men of all ages.
"Pelvic rehab isn't just for older women or people of a certain age. My practice is a mix of men and women," LaComa said. "Some therapists specialize in working with children who have bowl or bladder issues that continue beyond potty training. Teens and young adults may develop pelvic pain, too. We also see people before surgeries like a prostate removal to train men how to coordinate their muscles (or Kegel), something they've never had to think about before. In fact, pre-hab has been shown to be more beneficial than treating someone after a surgery."
Pregnant women can also get help both during and after pregnancy. "Prenatal and postpartum care can help prevent chronic problems from developing," LaComa added.
Pelvic physical therapists work with patients to develop a treatment plan. The ultimate goal, LaComa said, is to help them manage their condition on their own.
How it helped me
In my case, and often with patients suffering from chronic pelvic pain, the weekly sessions last 45-60 minutes. When people are in pain, as I was, their body is constantly in a fight-or-flight response. I jokingly call it the “permanent Kegel," when the pelvic floor muscles are contracted. This constant state of tension can lead to chronic pelvic discomfort or what is referred to as pelvic floor dysfunction, a state where the muscles are weak or injured.
To alleviate the constant tension associated with pelvic pain, pelvic and occupational therapists coax the body out of that fight-or-flight mode through various massages, exercises and stretches. These include deep breathing, because breathing is essential for optimal pelvic floor muscle function, and yoga-type stretches like a deep squat. For women, pelvic floor physical therapy may also include intravaginal massage to directly reach the muscles of the pelvic floor.
Like with most physical therapy, my therapist walked me through some “homework" exercises, simple moves and stretches I could do at home.
Thankfully, I found relief before I had any other major issues. And I went from skeptic to believer after five years of chronic pain came to a halt.
It’s all about the process
Patients don’t need a referral to see a pelvic physical therapist. And many insurances cover the sessions, but be sure to ask upfront.
Treatment is usually just a few visits, though LaComa said chronic conditions may require more visits.
"The goal is to find or fix the underlying cause of the problem," she said. "This can help relieve pain or leakage, and ultimately, we teach people how to manage it on their own."
If you think this might improve your quality of life, have a conversation with your doctor about pelvic physical therapy as a potential solution.