By: Fiona McMahon, DPT
Hey Ladies!!! In the next installment of our Pelvic Health 101 course, we are hosting a ladies’ session to allow for a safe and non-threatening place to discuss many issues that can affect the health of your pelvic floor. This class one of Stephanie Stamas’s (the founder of PH101’s ) favorites and is definitely not to be missed. Hear more about it in her video below! Join us at 7pm on October 30th . Please register at pelvichealth101.eventbrite.com
On October 23rd at 7pm we will be hosting our “Men’s Only Seminar”. Join us as we discuss how pelvic floor dysfunction affects the male pelvic floor. Learn how your sex life can be improved by pelvic floor treatment, how to regain function after prostatectomy, and how to rid yourself of the pain of prostatitis, and avoid antibiotics for the most common type of prostatitis. This seminar is not to be missed!
For more reading on male pelvic health topics, check out:
Sex should feel good… really, really good. But when it doesn’t, you may start to wonder, what’s wrong with me? Am I broken? Am I a prude? Am I frigid? Painful sex isn’t something we talk about. No one would look at you twice if were complaining of pain in your elbow, but in your genitals is a different story.
On October 16th at 7pm, we at Beyond Basics are breaking down those taboos and having an educational seminar, followed by an optional question and answer session at the end. We will discuss the many causes of sexual pain and how physical therapy can help. The event will be hosted by one of our expert therapists, Stephanie Stamas. Stephanie will give a detailed seminar about pelvic health and take time to clear up some common misconceptions many people have concerning their bodies and sexual function.
Gluten free, soy free, low FODMAP. It’s amazing how many diets there are out there that really can provide people with symptom relief. If you are suffering with chronic pain you may be confused on where to start, or what is right for you. You also may have tried out a bunch of different ways of eating, not seen results and have gotten really frustrated. If this is the case for you, I highly encourage you to come to our next pelvic health seminar on October 9th at 7pm, “Does my diet really matter”.
This seminar will be hosted by a special guest speaker, nutritionist Jessica Drummond. Jessica Drummond is a former pelvic floor physical therapist who now specializes in nutrition for those suffering with pelvic floor dysfunction. This seminar was a hit last year and is a great starting point for those considering adding nutrition as part of their healing journey.
“Vaginismus”, it sounds like a dirty word if you have never heard it before, but for the many, many women who experience this painful and frustrating disorder, it is an important diagnosis to understand, recognize and treat in order to improve quality of life.
Vagnismus occurs when the muscles of the vagina clench or spasm, making penetration by a partner, toy, tampon, or speculum impossible and painful. These spasms occur independently of the person’s desire to have sex. As you could imagine, this condition can be be extremely frustrating and can interfere with an individual’s sex life and health. Vaginismus can also occur in anticipation of pain, which is reinforced by unsuccessful attempts at penetration. Other gynecological, muscular, and gastrointestinal disorders can perpetuate the pain and spasm feedback loop.
Treatment for vaginismus must be holistic and may incorporate treatment for any medical or systemic causes of pain, counselling to reduce stress and fear associated with penetration, and physical therapy to help “teach” the muscles of the pelvic floor to relax and lengthen in order to accommodate penetration. It takes a skilled clinician to recognize all the components contributing to vaginismus and to make referrals to other members of the healthcare team as necessary.
The medical approach for vaginismus may be two pronged in order to relieve this condition. First, your doctor or nurse practitioner may prescribe a medicine to help treat the specific symptom of pain with penetration. Your healthcare provider (HCP) may also identify a medical cause to pain with penetration. By treating the cause, your HCP can help to break the pain and spasm cycle of vaginismus. Some medical conditions that can contribute to vaginismus include, endometriosis, intersitial cystitits, skin conditions such as lichen planus, simplex, or sclerosis, or hormone imbalances affecting the vulvar skin.
Sometimes, getting referred to therapy, when you have a problem like vaginismus can seem insulting, like someone is telling you “it’s all in your head”. It’s not. In a study conducted by Van der Velde in 2001, pelvic floor muscle response was found in both women with pelvic pain and without in response to a threatening movie. You can imagine how this could affect a woman who has had a history of painful penetration. Therapy can go a long way towards lessening the fear around penetration and allowing your body to relax in sexual situations.
Vaginismus isn’t all in anyone’s head. It is a very real physical response to anticipated pain. Vaginismus often affects one’s partner as well. She or he may develop fear of hurting you and may be afraid to have sex. Sex therapists can work with individuals and couples to help facilitate a non threatening return to sex.
Physical therapy is a mainstay of treatment for vaginismus, and in simple cases may be all that is required. Vaginismus is all about overactive muscles and there is so much we can do for muscles as physical therapists.
Treatment for vaginismus is all about taking one’s time and making the patient as comfortable as possible with every aspect of treatment. Rushing to perform an internal pelvic exam is not in anyone’s interest as it may facilitate increased guarding and spasm. That being said we can work to lessen the strain on the pelvic floor muscles by releasing the surrounding tissues and fascia of the abdomen and legs. We can also use external biofeedback, which is a way for you to see in real time, whether or not you are tightening your pelvic floor so you can gain more control over it.
When you are ready, the therapist will do an internal exam, where she will place a gloved finger into the vagina to assess whether or not there is trigger points ( highly irritable tight bands of tissue) or spasm within the muscle. When trigger points or spasm are present in the muscle she will work to release the muscles so that they can better stretch to accommodate an object penetrated into the vaginal canal, as well as reduce pain with penetration in hope of breaking the pain and spasm cycle.
Another great part of physical therapy in treating vaginismus is the home exercise plan your therapist will prescribe. Dilators are commonly used tool for treating vaginismus both at home and in the clinic. Dilators are cylinder shaped wands that are inserted into the vaginal canal. They come in many different sizes. The smallest size is usually smaller than a tampon. Usually a therapist and patient will work their way up from the smallest to “goal” size. Goal size is decided by the patient and corresponds to the patient’s desired functional goal, whether that is accommodating a speculum, tampon, toy, or partner’s penis. Dilators can do a number of things for someone with vaginismus. First they allow for a gentle stretching of the vaginal canal both at home and at therapy. Dilator use at home can really help to speed up a course of therapy. Secondarily, dilators can allow the patient confidence in a private place devoid of a partner’s expectations which can then be transferred to sexual relations with the patient’s partner.
Your therapist may also suggest stretching and strengthening exercises to help take pressure off of the pelvic floor, because the pelvic floor may be tight if it is working too hard to stabilize the bones and organs of the abdomen .
Sex doesn’t have to be painful and even with the worst cases of vaginismus, there is help. The physical therapists at Beyond Basics are specially trained to recognize vaginismus and identify the its specific causes in each individual case. If you are affected by this condition, please consider visiting us for an evaluation. Also check out the film “Tightly Wound” which is a personal account of living with and treating vaginismus.
Harish T, Muliyala K, Murthy P. Successful management of vaginismus: An eclectic approach. Indian J Psychiatry. 2011;53(2): 154-155
Van der Velde J, Laan E, Everaerd W. Vaginismus, a component of a general defensive reaction. An investigation of pelvic floor muscle activity during exposure to emotion- inducing film excerpts in women with and without vaginismus. Int Urogynecol J Pelvic Floor Dysfunct. 2001; 12 (5) 328-31
On September 18th, at 7pm we will be kicking off our fall semester of pelvic health education class, we call Pelvic Health 101 (PH101). In our first class we will be introducing you to the pelvic floor muscles, where they are, what they do, and how they relate to the health and function of your bowel, bladder, and sexual functioning. We will also be covering how things such as alignment, posture, muscle tone and nerves can affect your symptoms. This course is a great starting point to help you understand your pelvic floor and pelvic floor symptoms.
Wait! Marie Kondo has you throwing out your favorite jeans because the joyless saggy bottoms that your tushy cannot manage to fill out? We are seeing an epidemic flat butt among mamas, plumbers, barre fanatics, and office workers—all with strangely similar symptoms—pelvic floor dysfunction, low back and sacroiliac pain, and a tucked under pelvis. In this blog we will explore why the position of the pelvis, the maker of flat butts and the maker of less flat booties, is important and how to more easily move out of this position for benefit beyond your behind.
Besides needing a new wardrobe, why should I care about my flat bum?
The flat bum or preference towards posterior pelvic tilting shrinks the distance between the front and back of pelvic outlet which changes pelvic floor muscle tension. The body needs access to the full range of the pelvis and pelvic floor muscles. Over time, this position could cause excessive pelvic floor activity to compensate for the loss of resting tension. Think of the pelvic floor muscles simplified as a rubber band between two points, the pubic bone and tailbone. When the distance between the two points decreases, the rubber band loses its stability from resting tension. Changes in pelvic position alters stability from the pelvic floor muscles. This posterior pelvic tilt position also decreases the accessibility for hip extension and therefore the upper glute muscles get sleepy. As the top of the pelvis moves back, the sacroiliac joint in the low back opens and decreases its bony stability. Translated into everyday life, the flat butt position increases the potential for incontinence, pelvic floor muscle tension, sacroiliac pain, and decreased efficiency in movement.
The Flat Bottom. Only in the eye of the beholder?
The disagreement of the “neutral pelvis” or zero-point causes confusion when describing pelvic tilt—anterior pelvic tilt, posterior pelvic tilt, and neutral pelvis. Some argue that the neutral pelvis is when the ASIS’s (front hip bones) are level to the PSIS (back butt dimples). Others say that the pelvis is neutral when ASIS’s are in the same plane as the pubic bone. Or for those with X-ray vision, pelvic tilt is the vector of the sacral angle at S2 in relation to the vertical axis. But often, neutral pelvic position is subjective to the observer and relative to other parts of the body—namely the spine/rib cage and thigh bone. Clinically, this “neutral pelvis” is hard to find because 1) pelvis’ are shaped very differently, 2) left and right pelvis on the same person can also be quite different, 3) feeling these bony landmarks have been shown to be remarkably unreliable, 4) the neutral pelvis should be on top of vertical thigh bones. See how the eyes can be tricked confusing spinal curve focusing on pelvic tilt without also including rib position.
The inability to move in and out of posterior pelvic tilt and anterior pelvic tilt decreases efficiency and possibly results in pain and instability. Anterior pelvic tilt is when the front part of the pelvis moves forward/down. Posterior pelvic tilt is when the front part of the pelvis moves back/up. A neutral pelvis on top of vertical femurs and happy rib cage should correlate with better muscle performance.
Do I have a flat butt?
Aside from the saggy jeans, the flat butts of the world have a few other correlations.
1. The Tailfeather Test: Stand comfortably and squeeze the gluts.
a. Neutral pelvis: Thigh bones rotate.
b. Posterior tilt-ing pelvis: The butt will further tuck under and mainly access the lower glutes.
c. Anterior tilt-ing pelvis: The pelvic floor muscles will do most of the work.
2. You bear weight more in the heels
3. Back of your rib cage is behind your pelvis
4. Your Thigh bones are angled so that your pelvis is front of your knees
5. Your lower belly pooch
6. You Sit with pressure more on the sacrum/tailbone vs. sit bone
7. You have Overactive and possibly overworking pelvic floor muscles—the front to back pelvic distance decreases with your posterior tilted pelvis and loses the resting tension from length. As described earlier, this is similar to tensile strength of a slightly stretched rubber band vs. rubber band without pull/tension. Therefore, your pelvic floor muscles have to work harder to keep some type of tension for purposes like continence, stability, etc. The inability for the pelvic floor muscles to work optimally can lead to incontinence, pain, and constipation.
9. You have Breathing and abdominal pressure problems
10. You have Sacroiliac joint pain. As the pelvis tips back, the sacrum moves away from the ilium decreasing the bony stability. The hip muscles have to work harder, but as felt in the Tailfeather Test, the glut muscles aren’t in a good place to work.
Is there a better fix than butt implants?
Bodies have and love variability for posterior, anterior and “neutral” pelvic positioning. The brain likes positions where muscles and nerves work with ease and stability—life shouldn’t be so difficult—but it needs the chance to choose and learn it. Folks working with bodies have traditionally “corrected” spinal curves by changing pelvic position. From what has already been discussed, spinal and pelvic position can be altered many different ways—from the changing weight-bearing area in the feet, to position of ribs and range of breath, and even head angles with visual and vestibular input. Consider these hacks into pelvic stability until the brain learns how to access this stability in many situations and positions.
1. Standing. Bring your chin down to your neck and keep looking down until you see the front of your ankles. You’ve just untucked your pelvis and brought your ribs over your pelvis. This one is courtesy of my colleague, Stephanie Stamas. Or check in to feel where the weight is going through your feet. The front to middle of the foot is a good place to start and then do the Tailfeather Test. You might have to toggle other parts of the body because of how the body will compensate in the chain.
2. Sitting. Get your hips as far back as possible. Or put a pillow in the back of the chair so that your hips can find the pillow and you are sitting on top of your sit bones. Then, relax the trunk into the seat back/pillow. Again, you’ve untucked your pelvis and brought your ribs over the pelvis.
3. Better squats/lunges/burpees/stairs/ab work. You can do 5 sets of 20 squats, but still no junk? Take care to see if your pelvis is tucking under in the movement. If so, use an inhale to keep the pelvic floor lengthening as your hips bend in movement. Later, the movement should be dissociated with breath pattern (as long as you are breathing.)
4. See a physical therapist. Often times, the habits of pelvic tucking are a little more complicated because it is a protective and compensatory mechanism for stability. A physical therapist can help with seeing the bigger picture and how different parts of the body relate to each other. They can also help facilitate better movement through manual therapy and specialized movement.