Since a long time,
I have wanted to go through Pelvic Floor therapy. My instincts say that my IC
is related to Pelvic Floor Dysfunction or (PFD). I met a pain doctor in Mumbai
who also felt the same. However the problem is in India we do not have any skilled
pelvic floor therapist yet.
Many people with
interstitial cystitis (IC) have problems with the group of muscles in the lower
pelvic area and develop a condition called pelvic floor dysfunction (PFD). If
you have IC and a poor urine stream, feel the need to push or bear down to
urinate, and have painful intercourse, you may have PFD. Treating PFD may
be very helpful in reducing symptoms and
pain for some IC patients—most patients see improvement after
several weeks of therapy.
WHAT IS THE PELVIC FLOOR?
The “pelvic floor”
refers to a group of muscles that attach to the front, back, and sides of the
pelvic bone and sacrum (the large fused bone at the bottom of your spine, just
above the tailbone). Like a sling or hammock, these muscles support the organs
in the pelvis, including the bladder, uterus or prostate, and rectum. They also
wrap around your urethra, rectum, and vagina (in women).
Coordinated
contracting and relaxing of these muscles controls bowel and bladder
functions—the pelvic floor must relax to allow for urination, bowel movements,
and, in women, sexual intercourse.
WHAT IS PELVIC FLOOR DYSFUNCTION?
PFD is usually
related to the presence of too much tension (or high-tone), the opposite
of the too-relaxed state (or low-tone) that contributes to incontinence.
However, sometimes IC patients with PFD can have a combination of muscles that
are too tense and too relaxed.
In patients who
have IC or other pelvic pain conditions, these muscles may be tight or in
spasm, have a combination of tightness and weakness, or have pain-triggering
spots or knots called “trigger points.”
WHAT ARE THE SYMPTOMS OF PFD?
Many of the
urinary, bowel, or sexual symptoms
IC patients experience can be signs of PFD, including:
Urinary
urgency, frequency, or hesitancy, stopping and starting, painful urination, or
incomplete emptying
Constipation,
straining, pain with bowel movements
Unexplained
pain in your low back, pelvic region, genital area, or rectum
Pain
during or after intercourse or orgasm
Uncoordinated
muscle contractions causing the pelvic floor muscles to spasm
HOW IS PFD DIAGNOSED?
Physicians or physical
therapist (PT) who is specially trained in treating PFD diagnose the
condition during a physical examination. However there is lack of IC specific
PTs in India.
PT ‘s diagnose using
external and internal “hands-on” or manual techniques to evaluate the function
of the pelvic floor muscles, they can assess your ability to contract and relax
these muscles.
Bones and muscles
of your lower back, hips, and sacroiliac joint can stress your pelvic floor
muscles. Your doctor or PT will first check externally and internally for
problems such as muscle spasms, muscle knots, and weakness or sacroiliac
misalignment (where your sacrum and upper hipbones meet).
If an internal
examination is too uncomfortable for you, they may use externally placed
electrodes, placed on the perineum (area between the vagina and rectum in
women/testicles and rectum in men) and/or sacrum (a triangular bone at the base
of your spine) to measure whether you are able to effectively contract and
relax your pelvic floor muscles.
Another way to
measure pelvic floor contractions is with a perineometer, a small, tampon-like
sensing device placed into the vagina or rectum.
HOW IS PFD TREATED?
Physical therapist
(PT) should be specially trained in the techniques that help IC and pelvic pain
patients.
Physical therapy to
treat these problems can go a long way toward easing pain and bladder symptoms.
The physical therapy techniques that help relax and lengthen tight muscles and
release trigger points are different from the ones that help incontinence
patients, who mainly need to strengthen the pelvic floor through Kegel
exercises. IC patients DO NOT DO KEGEL.
Kegel exercises, frequently used to treat incontinence, may make both IC and
PFD symptoms worsen.
The goal of PFD
therapy for IC patients is to relax these muscles and avoid stressing them.
Treatment usually combines self-care, medicines, physical therapy, and home exercise.
Self-Care—Avoid pushing or straining when urinating and treat constipation.
Relaxing the muscles in the pelvic floor area overall is important. Using
methods such as warm baths at least twice a day is helpful.
Medicines—Low doses of muscle relaxants may be helpful. Maintaining good posture to keep pressure off your
bladder and pelvic organs and using stretching or other techniques such as yoga
to avoid tightening and spasms in the other pelvic muscles, also help PFD
therapy to succeed.
Physical therapy—a physical therapist specially trained in
pelvic floor rehabilitation may take the following steps to help
you obtain relief from your PFD:
External and internal
evaluation of pelvis
External and
internal manual therapy
Application of
various devices to help relax your pelvic floor
Training in home
exercise and therapy.
The book HealingPelvic Pain by Amy Stein is very useful to start with basic exercises on Pelvic Floor. There
are also Youtube videos to help us. Yoga also helps.
If you are having too much trouble then just try the following position. It should ease your problem a bit.
Few other postures are as follows:
Image Courtesy: Google
Resource: ICA
