Visceral Manipulation For Bladder and Pelvic Pain
My urogynecologist set me up with a new pelvic floor therapist recently. This one is supposed to help with my bladder pain, or interstitial cystitis. My doc said it's clear I have pelvic floor tightness along with specific trigger points, or sensitive spots in my muscle tissue.
And he thinks these problems are affecting my nerves, bladder, and other pelvic organs.
There's a lot of evidence that people with endometriosis have myofascial dysfunction, meaning our muscles spasm and hurt. And we often have trigger points in our abdomen, including the pelvis. One study describes them as "hard, palpable, discrete, localized nodules within taut bands of skeletal muscle that are painful on compression." Muscle tension can cause a ripple effect of pain throughout the body.1,2
I already knew I had all these issues. But no one had ever tried to directly address them through PT manipulation. I was definitely on board with this new therapy.
Read on for more details.
What is visceral manipulation?
It's a kind of gentle massage that's supposed to help your internal organs flow freely. My physical therapist talked a lot about fascia. That's connective tissue that "holds every organ, blood vessel, bone, nerve fiber, and muscle in place," according to Johns Hopkins Medicine.3
Fascia is supposed to be smooth and flexible. Surgery or chronic muscle tension can cause it to stick together. That's when you can get adhesions. Those cause knots in your muscles, which are the trigger points. Adhesions can also squeeze and twist nearby structures.3
It's kind of hard to prove that pain is caused by fascia and not something else. But that definitely sounds like something that could be going on with me.
What was my first visit like?
She knew I was there for bladder issues. But she also wanted to know about my endo symptoms. She asked about my sex life and other pelvic pain issues — the nerves in your lower spine and pelvis are all connected, she told me.
Here are some of the questions she asked:
- Do you have more sex pain with deep penetration or insertion?
- Have you experienced sexual trauma?
- Does your back or tailbone hurt when you sit for long periods of time?
- Do you get pain when you stand for a while?
- How often do you have lower back pain?
Then she gave me a visual and physical exam. Here are some of the things she did:
- Checked for scoliosis, or a sideways curve in the spine
- Looked at my hip alignment
- Tested the muscle strength in each of my legs
- Gave me a vaginal exam to check for muscle tightness and trigger points
- Checked how my bladder and uterus "sit" in my pelvis
She told me the following: My lower skeletal structure isn't aligned quite right. My right leg is weaker than my left. My fascia and muscles aren't relaxed around my lumbar spine — the ones that connect to the pelvis. And I have way more muscle tension up and down the right side of my body, when compared to the left.
While these aren't great things to hear, I felt validated by her assessment. There was a sense of relief; if she could see a problem, we could come up with a plan to fix it!
(I can't tell you how many chronic illness warriors I've talked to who actually feel better knowing something is actually wrong. So, if you hope your doctor will find a problem, know you're not alone.)
What did it feel like?
The internal pelvic exam didn't feel great. But the visceral massage was pretty relaxing. At my first visit, she lightly pressed along my spine and the outside of my organs, including the ones in my pelvis. She said she was smoothing out the fascia and "getting things to lay right."
Occasionally, I got passing chills and nausea when she'd "release" something. I asked her why I felt sick. She said it's probably because the nervous system reacts when tissue, organs or nerves are messed with. I should also note that I have a history of inappropriate vasovagal responses. That's when your blood pressure drops from things like shots or needle pricks.
I didn't have any negative side effects at the second visit. It was completely calming, and I wish it would've lasted longer.
I also learned that my bladder should "teeter-totter." She said there's teeter but barely any totter. I'm not exactly sure what that means, but her overall point was that it doesn't move freely like it should.
She also said my right side — the location of the trigger point that sent me to PT in the first place — is a bit of a mess. Of course she didn't use those words. But she said she couldn't even feel my organs in one spot because there's "something in the way." She said it feels like scar tissue, but it's hard to say.
We'll keep working on it, she told me.
Do I feel better yet?
I had to wait a couple months between my first and session second session, which isn't ideal for quick progress. But I have slightly less bladder urgency. Usually, I feel like I have to pee constantly before my period starts. And I didn't really feel like I needed to run to the bathroom a lot these past two cycles.
And I've definitely had less pain with sex. But pelvic floor PT has always done wonders for my sex life.
I have five more sessions coming up. I'll keep you updated on how it's going!
Has anyone ever said the following to you about your endometriosis?