Fibromyalgia, Pelvic Pain and Pelvic Floor Physical Therapy
I’ve struggled with intermittent, unexplained pelvic pain for many years. As a teenager, my cramps were excruciating. My family doctor thought it was ovarian cysts and gave me a prescription for the birth control pill. From age 15 to 24, the pill seemed to keep my periods in check and the pain at bay. However, around age 24 I started having pain again, even with the pill. The pain came and went at seemingly random times with no correlation to my cycle or any other trigger that I could identify. It was also inconsistent in location – sometimes it would be on the left, sometimes on the right. I also had painful and urgent bowel movements, which I wasn’t sure were related, but they had started around the same time.
Probably the worst symptom of all was how much pain I experienced during orgasm. I felt like someone was stabbing me in the ovary. It happened during intercourse as well as without penetration. It even happened when I would have a sexy dream – the excruciating pain would wake me up. I went back to my family doctor, who thought my symptoms could be caused by endometriosis. She referred me to a reproductive endocrinologist at Johns Hopkins (I am so lucky and grateful to live in Baltimore!) When the specialist examined me, I started to cry because it hurt so much. Afterward, she explained that the only way to confirm endometriosis would be through exploratory surgery, which I didn’t want to do. However, she said there were definitely muscle knots in my vaginal walls that could be causing some of the pain. She diagnosed me with Levator Ani syndrome and suggested that I try pelvic floor physical therapy.
Admittedly, pelvic floor PT was a weird and sometimes uncomfortable experience. Thankfully, the sessions always took place in a private room so at least I only felt weird in front of one person. During the consult, the therapist evaluated my pelvic floor strength, weakness, and tightness via an internal exam. She inserted two fingers into my vagina, then asked me to tighten my pelvic floor muscles. (This is commonly known as Kegel exercises. The muscles you use to stop the flow while urinating are the pelvic floor muscles.) At first, I could only hold the tension for 1 or 2 seconds. During my first visit, the therapist taught me how to strengthen the muscles by doing Kegel exercises a few times each day, trying to increase the duration each time until I could hold tension for 10 seconds. Holding the tension helps to strengthen the muscle and allows it to fully relax afterward.
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During the internal portion of the sessions, the therapist would also apply pressure to areas where there were knots in the muscle. This was rather painful at first but it got better as my muscles started to relax. I would equate the feeling to the pain when a massage therapist digs into a particularly tight spot –it hurts, but it also helps the muscle to let go. She recommended a tool called a dilator that I could use at home to achieve the same effect. (A dilator looks like a sex toy, but it is thinner and made of hard plastic instead of silicone.) She recommended that I use it in the bathtub for easier access, support, comfort, and privacy, and suggested a methodical approach of going around the vaginal wall, stopping at each “number on the clock” and applying pressure to the areas where I felt muscle soreness.
In addition to these exercises, the therapist also had me work on strengthening my core muscles. One of the reasons she suspected that my pelvic floor was so tense was that the muscles had to work extra hard to compensate for my weak core muscles in order to keep my innards in place. She also massaged some of the external muscles in the pelvic area, such as the piriformis, which is deep under the glutes. This was painful, but in a “hurts so good” kind of way.
After a few weeks, my pain decreased considerably and the pain at orgasm disappeared completely. I kept up with my at-home exercises even after I stopped seeing her regularly, and the pain stayed away. It’s been 4 years and I’ve only just now started having some pain again, probably because I’ve gotten out of the habit of doing the exercises and using the dilator. (Note to self — I should probably start again so that I can keep the pain at bay before it gets too bad!)
Overall my experience with pelvic floor PT was very positive. It was awkward at times, but well worth the outcome of reducing my chronic pelvic pain without surgery or medication. I hope this information has been helpful – if you have any questions, feel free to post as comments and I will reply. Thanks again to Julie for inviting me to share!
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Lauren in Baltimore