FAQs: Part 2

4. I have (X) and was told it is not curable. Am I ever going to get better?

The goal of physical therapy is not to cure your disease, but instead to make you feel better. Often times diagnoses like interstitial cystitis and pudendal neuralgia sound and feel hopeless, and pelvic floor physical therapy is not going to treat your disease process. However, when we have a chronic condition that creates pain, our bodies respond to that pain in a number of ways, many of which are productive, and many of which are not.

Physical therapy may not be able to rid you of IC, but it may be able to help manage your symptoms to help you return back to exercise, work or having sex comfortably. The goal of physical therapy is to help you get back to the life you want to be living, not necessarily get rid of the condition. Our goal is to help you figure out how to manage your symptoms or your flares, how to prevent flares from happening in the future, and better manage them to make them less severe and shorter lasting if and when they happen. Our goal is to help you understand your body and your pain so that when you feel your symptoms, you feel empowered to manage them rather than a helpless victim of your condition.

A chronic condition does not need to mean chronic suffering. Pelvic floor physical therapy can help ease your suffering and improve your ability to participate in activities that matter to you as an employee, friend, partner and parent. This can help you feel and live better, even if your diagnosis doesn’t change.

5. I’ve already tried kegels, what else is there?

My answer to this question comes in the form of two additional questions:

  1. Are kegels right for you or your diagnosis?
  2. Are you doing kegels correctly?

Kegels are a big part of pelvic floor PT, but not for every patient or every diagnosis. Furthermore, even if kegels are right for you, research tells us that roughly 50% of people do them incorrectly.

Let’s elaborate on the first question. Kegels, or pelvic floor contractions, are a strengthening exercise. Strengthening is great, if you are weak. However there are plenty of diagnoses and symptoms that don’t necessarily need strengthening. For instance if you are experiencing pain with intercourse due to tension in your pelvic floor, contracting those tight muscles repeatedly may not be the right way to go. The same holds true for many pain diagnoses. If tension in your muscles is causing your pain, strengthening needs to be done carefully and intentionally so as not to increase that tension, and thus that pain.

Now, the second question. Are you doing them correctly? Like I said earlier, research has shed light on just how in touch we are with our pelvic floor. Upon examination, I have seen people do all sorts of things while trying to squeeze their pelvic floor muscles. I have seen people bear down, which is the exact opposite of what you want to do. I have seen people squeeze their glutes, legs and fists. It’s a hard muscle to coordinate, and sometimes it takes a bit more guidance than telling yourself simply to squeeze.

So if you’ve tried Kegels and are wondering what else is out there that can help, my answer is many things. Pelvic floor physical therapists can help guide you through relaxation exercises, stretches, habit modifications, strengthening of the correct muscles, the correct way, and a number of other options to address your pain.

6. What do you think about vaginal weights?

They are rarely necessary. That’s how I feel about vaginal weights. More often than not, when I see patients who have pelvic floor weakness, their muscles are barely strong enough to support the weight of their body during normal day to day activities. If your hand was so weak that you couldn’t type on your computer, you wouldn’t walk around holding a dumbbell.

Typically, strengthening the pelvic floor muscles against the weight of your body or while doing other activities like squatting, lunging, bending and jumping, is enough. This progression takes a minimum of 6 weeks, but could take longer depending on the rate of your progress. The cases where vaginal weights make more sense to me are for high intensity athletes who have gone through an entire strengthening progression, have returned to their sport in some modified fashion, but continue to have symptoms during or after a difficult workout. In this case, vaginal weights may be a helpful tool.

7. Why did you get into this field?

Honestly, this is probably my #1 FAQ. I got into this field rather accidentally. I started my PT career with an interest in outpatient sports rehab and absolutely nothing else. Then I learned that pelvic floor PT existed, and I was not interested at all. Then I learned more about it and met a PT’s practicing in the pelvic world, and I started realizing just how impactful this field can be.

What I love about physical therapy is how well we get to know our patients, and how personal our program creation becomes for them. People suffering with pelvic pain and pelvic floor dysfunction often feel trapped and alone, and pelvic floor physical therapists get to help guide them back to feeling like themselves. That’s what I love about it.

Plus, to quote my colleague Christina McGee, “I like talking about pee, poop and sex.”

Feel free to leave questions or comments below or email me at becky@sullivanphysicaltherapy.com.

-Rebecca Maidansky, PT, DPT

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