The Pelvic Floor Matters
I will never forget the first female pelvic pain patient I had. She was a beautiful young woman who had undergone a complete hysterectomy, including ovaries, due to endometriosis. She was still in pain.
I had been treating women with incontinence (leaky bladders) for some time due to a forward-thinking gynecologist who recommended that my business partner and I start seeing “pelvic floor patients". I took a class, bought some EMG equipment, and started teaching women to “Kegel”. All was going well, I sold women vaginal sensors for $60, explained to my patient how to put the sensor in. and stepped out of the room. They did as instructed and then put their clothes back on. I connected the sensor to a computer, gave them verbal instructions and we watched a graph depicting their muscle contractions go up and down with each Kegel. Easy breezy. In my mind, I was really only doing pelvic floor therapy part time because I was really a Pediatric Physical Therapist, just filling time.
Then, my patients started telling me other symptoms...
- “My bladder hurts”
- “I can’t have sex without pain”
- “I have to pee all the time”
- “I have seen 6 doctors and they tell me nothing is wrong”
Wow, who was listening to these women? I took some more continuing education classes and learned how to assess the muscles internally. Picture a bunch of women in a hotel conference room, going “waist down”, covering up with a sheet, and laying on the table that we were just taking notes on and learning how to do pelvic exams. Yup – that was us back in 1994. I still thought that I would not really have to do “internals” very often, only if I absolutely had to.
A patient with pelvic pain
Then, my beautiful sweet, and desperate young patient came in. She had pain, she was post-complete hysterectomy and oophorectomy, she had seen 6 doctors, and then our forward-thinking gynecologist sent her to me. After several visits working with her “externally”, I realized I would need to use my newfound skills and do an internal exam. I asked her to go waist down, covered her up, and put a nice warm hot pack on her privates. I stepped out of the room to let the hot pack do its magic (and review my notes from my course). I went back in and during my very gentle exam that involved palpating her pelvic floor muscles, I reached a tender point. I pushed just a little more and she said “that is my ovary pain” and started crying. She had no ovaries. It was referred pain from her pelvic floor muscles.
Wow. I never looked back. Pelvic floor physical therapy has been my passion ever since this young woman and I discovered that her “ovary” pain was really coming from her pelvic floor muscles. We could work with that... and we did. She and I learned together how to work through muscle spasm with gentle massage, pelvic floor muscle relaxation, and some of the many other techniques that pelvic floor PTs use to help women with pelvic pain. She had less pain and could resume sexual activity with her partner.
Thankfully, my skills have advanced over the years and I am able to offer my patients much more than I was able to offer my first pain patient. I hope that this story tells you a little about me, but more importantly about the fact that pelvic pain can come from many sources. What may be perceived as “ovary pain" may actually be the pelvic floor muscles. The muscles inside may contribute to your pain. They matter. So do your nerves, and hips, and adhesions, and movement patterns. Pelvic physical therapists look at all of these things that may contribute to your pain and help our patients learn ways to manage pain proactively.
Has intimacy with your partner been affected because of endometriosis symptoms?