Often the source of pelvic pain and dyspareunia is as simple as tight pelvic floor muscles.
You may be surprised to learn that Kegel exercises (contractions of the pelvic floor) can actually be detrimental to your pelvic health. This is particularly true in cases where you have increased tone to your pelvic floor muscles (imagine a tight knot in the muscles of your back or a leg cramp that wakes you up at night).
Simple issues with pelvic, spine or hip injury that lead to alignment problems can cause pelvic pain. In these cases, using integrated manual therapy may bring relief.
If you've been told you have recurrent bladder infections, interstitial cystitis (chronic bladder pain and voiding symptoms), vulvodynia (chronic vulvar pain) or vaginismus (painful cramping of the vagina with attempts to insert a penis or tampon), it may actually be a hypertonic pelvic floor – which is a treatable condition.
Hypertonic pelvic floor is often by cured by using skilled physical therapy to release tight and knotted pelvic floor muscles. The therapist uses manual techniques to release trigger points and tight vaginal muscles with a very high success rate.
In the majority of cases, accompanying issues with urinary incontinence, frequency/urgency, slow urinary stream and constipation are significantly improved. Pain during sex, as well as pain with tampon placement, are also resolved in many women and girls.
When you come to us with pelvic pain, we’ll start with a careful anatomical evaluation which includes urine cultures and a pelvic ultrasound to make sure there are no issues with reproductive organs.
Cystoscopy (minor office procedure that is about one minute in length) may be utilized in select cases where bladder issues are possibly present.
You will be asked to complete a urinary diary and we’ll take a thorough urinary, sexual and bowel history.
We’ll perform a complete pelvic exam to look for anything that could explain the pain, such as a vaginal mass, prolapse (hernia of organs around the vagina like bladder/rectum) or tight/tender pelvic floor muscles.
Your treatment plan will address potential causes of your pelvic pain, and begin with conservative therapy.
If anatomical issues with the bladder and reproductive system are ruled out, we will begin with pelvic floor physical therapy (PT) as an initial treatment. It is noninvasive and has proven quite successful in the cure or improvement of pelvic pain.
Pelvic floor PT may also resolve associated functional issues with bladder pain or burning, urinary incontinence, difficulty with bladder emptying, frequency of urination and even constipation.
Should PT not improve or resolve the pain, we can use Botox injections to relax pelvic floor muscles. We have extensive experience and success using this technique.
It is important to note that if you have an inflammatory condition such as interstitial cystitis (IC) or endometriosis, your symptoms will not resolve with PT alone. We’ll use medications directed at IC or other inflammatory disorders, dietary irritant reduction and bladder instillation therapy as indicated.
Our philosophy is to first use rehabilitative and curative treatment options. If those don’t bring relief, then we’ll develop a care plan tailored to your specific needs.