What is Pelvic Floor Physical Therapy

marigold-2117436_960_720By Amy Stein, DPT and Fiona McMahon, DPT

As physical therapists who specialize in abdomino-pelvic pain disorders, one of the toughest parts of the job is meeting men and women who have suffered with pelvic pain for years, only to be told by their doctors/healthcare providers that there is no help for them. It is not uncommon to meet a patient who has suffered for 5- 10 years without help before finding us. Musculoskeletal causes of abdomino-pelvic pain are treatable conditions and often times we can start to improve a patient’s symptoms within just a few visits. Please read on to see how we can help you with your pain.

What do pelvic floor physical therapists actually do? Why do they do what they do? What can you expect from your first physical therapy visit?

Physical therapists (PTs) are experts in movement and function, which sounds like a pretty broad topic to be an expert in, and it is. After physical therapists graduate PT school (now-a-days at the doctoral level), they find their niche and specialize. You can find PTs working with high-level athletes, children, infants, people who are recovering from injuries, people with neurological conditions, and many other types of clients.

Pelvic floor physical therapists specialize in the muscles, nerves and connective tissues that live between your legs, also known as the pelvic floor. They gain their expertise through a series of post-graduate continuing education classes, certifications, and training. Their training allows them to perform both internal and external pelvic exams, and broadens their knowledge of conditions which affect the pelvic floor. Sometimes, people who specialize in modalities like biofeedback or dilator therapy, advertise themselves as pelvic floor therapists, but don’t have any hands on experience treating the sensitive and often reactive muscles of the pelvic floor. If you are seeking pelvic floor physical therapy, it is important to inquire about the experience and level of training your potential physical therapist has had in this specialty.

What is the pelvic floor and what is pelvic floor dysfunction?

Who needs pelvic floor PT? The pelvis performs many important functions of the body. The muscles, nerves, connective tissues and skeletal structures of the pelvic floor help to keep us continent, aid in sexual performance and function, and assist in core stability.

When some or all of these structures of the pelvic floor are not functioning properly, they can cause a multitude of different symptoms. People who are suffering from bowel, bladder, and or sexual problems, as well as those who are suffering from pain in the pelvis, upper legs, abdomen or buttocks most likely have pelvic floor impairments contributing to their pain.

Issues with the pelvic floor can arise from a multitude of reasons. Infections, previous surgeries, childbirth, postural and lifting problems, and trips and falls can all bring on pelvic floor dysfunction. Pelvic floor pain can persist well after the cause of it has been removed. So it is entirely possible to feel the effects of an old infection, surgery or injury, days to years after it occurred. Anyone who has had long standing abdomino-pelvic pain, or pain that they can’t seem to get rid of after seeking the help of medical doctors or other healthcare providers is a good candidate for a pelvic floor physical therapy evaluation and possible curative treatment.

What is Pelvic Floor Physical therapy?

Physical therapy is a practice of healing that restores function and reduces pain through the use of techniques to improve bony alignment, reduce trigger points, and improve muscle coordination and strength. Pelvic floor physical therapy is a branch of physical therapy and is built upon these same principles.

What sets pelvic floor physical therapists apart is their in depth understanding of the muscles and surrounding structures of the pelvic floor, beyond what was taught in physical therapy graduate school. What that means for a patient who is seeking the help of a pelvic floor physical therapist, is that his or her pelvic floor issues will be examined and treated comprehensively with both internal and external treatment, they will be provided  with lifestyle modifications to help remove any triggers, and receive specific exercises and treatment to help prevent the reoccurrence of pain once he or she has been successfully treated.

What exactly do Pelvic Floor Physical Therapists Do?

The elephant in the room with pelvic floor physical therapy is the internal exam/ treatment. It can seem a little daunting, especially if you have pelvic floor pain, but pelvic floor therapists are trained to be as thorough as possible while minimizing discomfort.

During the internal exam, your physical therapist will place a gloved finger into your vagina or rectum to assess the tone, strength, and irritability of your pelvic floor muscles and tissues. Internal exams and internal treatment are invaluable tools that are taught to pelvic floor physical therapists. It can tell us if there are trigger points (painful spots, with a referral pattern or local); muscle/tissue shortening; nerve irritation and/or bony malalignment that could be causing your pain directly or inhibiting the full function of your pelvic floor muscles. We can also determine if your pelvic floor has good coordination during the exam. A pelvic floor without good coordination, may not open and close appropriately for activities such as going to the bathroom, supporting our pelvis and trunk, sexual activity, and keeping us continent.

It is essential that we, as pelvic floor physical therapists, also include other assessments when we are examining our patients for the very first time. We employ the tried and true physical therapy exam practices to determine if there is an underlying condition elsewhere in your body, such as a strength deficit or alignment issue that could be affecting your pelvic floor. It’s wild to think of it, but something as seemingly unrelated as a flat foot or a hip injury can be enough to set off pelvic and abdominal pain!

Some pelvic floor physical therapists may have the opportunity of getting a lot of time to speak one-on-one with a patient to determine possible causes of his or her symptoms, educate the patient and to guide them to other practitioners who may optimize their physical therapy results if necessary. We truly can find out so much by just listening to what our patients have to say. A fall, or infection can be significant as well as a patient’s feelings and knowledge about their current condition.

Once we determine the cause of our patient’s pelvic floor dysfunction, we design a plan tailored to the patient’s needs. At Beyond Basics, we have a diverse crew of physical therapists who bring their own training and background into each treatment. What is really beautiful about that, is that all teach and help each other grow as practitioners. It will be difficult to go over every single type of treatment in one blog post, but we will review some of the main staples of pelvic floor rehab.

Manual Techniques

As physical therapists, are our hands are amazing gifts and phenomenal diagnostic tools that we can use to assess restrictions, tender points, swelling, muscle guarding, atrophy, nerve irritation and skeletal malalignment. We also use our hands to treat out these problems, provide feedback to the muscles, and facilitate the activation of certain muscle groups. There have been a great number of manual techniques that have evolved over the course of physical therapy’s history. Let’s go over a few.

Myofascial Release

Myofascial release was developed by John Barnes to evaluate and treat the myo-fascia throughout the body. The myofascial system is the connective tissue that coats our muscles, nerves, blood vessels, and bones, and runs throughout our bodies. Any tightness or dysfunction in the myofascial system can affect the aforementioned structures and result in pain and or movement dysfunction. By treating the fascia directly, therapists can improve their patient’s range of motion, reduce pain, and improve a patient’s structure and movement patterns.

Myofascial release is a more gentle technique that can be useful in cases where a patient is already experiencing a great deal of pain. The therapist will hold gentle pressure at the barrier of the tissue (the point where resistance is felt) for a short period of time, usually less than 2 minutes until the therapist feels the tissue release on its own. The therapist does not force the barrier.

Scar Tissue Manipulation

Scars are almost always a fact of life. From surgeries, to accidents, to conditions like endometriosis, or certain STI’s, almost everybody has one. What doesn’t have to be a fact of life are the muscle, nerve and skin restrictions and overactivity that they can cause. By releasing scar tissue in physical therapy, it has been shown that the surrounding restrictions also decrease their resistance and adherence to the deeper tissues and surrounding organs.

Myofascial Trigger Point Release

Discussed extensively in Travel and Simon’s two volume series, trigger points are taut (firm) points in the muscle that have a consistent referral pattern (they transmit pain to the another part of the body). Trigger points are not only important because they cause pain, they also can affect how the muscle works. This is one of the main reasons our therapists at Beyond Basics are fastidious about ensuring all trigger points are released in the abdomen, back, legs and pelvic floor before transitioning to any core stabiltiy or strengthening exercises that can re activate a trigger point.

People with trigger points in their pelvic floor and surrounding areas can experience pain in the rectum, anus, coccyx, sacrum, abdomen, groin and back and can cause bladder, bowel, and sexual dysfunction. When physical therapists find a trigger point they work to eliminate it and lengthen it through a myriad of techniques. Recent literature has found that trigger point release alone can achieve an 83% reduction in symptoms.

Connective Tissue Manipulation

Skin rolling, ie. rolling of the skin over another layer helps to improve the movement of those two layers and reduce the tension and pulling between them. It feels like a scratch or ‘nails’, and in cases where a patient has more restrictions, the sensation may be more amplified.

One of the great benefits to skin rolling is it increases the circulation in the area to which it was applied. Often times, areas that are tight or restricted are receiving reduced blood flow and oxygen. By bringing blood flow to the area, toxins can be cleared and the healing contents of the blood are brought to the injured area. Skin rolling can also restore the mobility of surrounding joints and nerves, which can help to restore normal function. By allowing the skin to move more freely, pelvic congestion, heaviness and aching can be effectively treated.

Neural, Visceral, and Joint Mobilization

Nerves, organs, and joints can lose their natural mobility over time and cause a whole host of symptoms from pain, to loss of range of motion, and poor functioning of the bodily symptoms. Skilled and specialized therapists can use a variety of active techniques (patient assisted) and passive techniques to free up restrictions in these tissues and organs and improve overall function.

Neural mobilization as the name implies, involves the restoration of neural structures back to their normal mobility: to glide and slide. Neural structures that cannot move properly can cause pain that can radiate down an extremity or into the trunk and can give the sensation of burning, zinging, and stabbing. Some orthopedic therapists practice this type of mobilization; common examples include the sciatic nerve in the leg and the ulnar nerve in the arm. Pelvic floor PTs focus on these nerves when they cause issues, but they also pay attention to nerves that innervate the perineum and genital region (bicycle seat area), such as the pudendal, iliohypogastric, obturator, ilioinguinal, genitofemoral and the femoral cutaneous nerves. By allowing these nerves to move freely, symptoms such as vulvovaginal, penile, rectal, clitoral and testicular pain, itching and burning can be greatly improved.

Visceral mobilization restores movement to the viscera or organs. As elucidated earlier in our blog, the viscera can affect a host of things even including how well the abdominal muscles reunite following pregnancy or any abdominal surgery. Visceral mobilization aids in relieving constipation/IBS symptoms, bladder symptoms, digestive issues like reflux, as well as sexual pain. Visceral mobilization can facilitate blood supply to aid in their function, allow organs to do their job by ensuring they have the mobility to move in the way they are required to perform their function, and to allow them to reside in the correct place in their body cavity. Evidence is beginning to emerge to demonstrate how visceral mobilization can even aid in fertility problems.

Joint mobilization is a common and favorite tool of most orthopedic physical therapists. We love it so much because it can have so many different benefits depending on the type of technique used. Maitland describes types of joint mobilization on a scale between 1 and 5. Grade 1 and 2 mobilizations are applied to a joint to help to lessen pain and spasm. These types of mobilizations are typically used when a patient is in a lot of pain and to help break the pain cycle. On a non-painful joint, grade 3, 4, and 5 (grade 5 requires post graduate training) mobilizations can be used to help restore full range of motion. By restoring full range of motion within a restricted joint, it is possible to lessen the burden on that and surrounding joints, thereby alleviating pain and improving function.

Neuro-education of the Pelvic Floor and Surrounding Structures

The muscles of the pelvic floor must work together and in coordination to perform specific tasks. The pelvic floor has to contract, elongate and relax in very precise ways to perform basic functions like urination, defecation, support the pelvis and organs, and sexual function and pleasure. If your pelvic floor muscles and/or nerves fail to do what they are supposed to do at the right time, problems like painful sex, erectile dysfunction, constipation, and incontinence can occur.

Biofeedback is a modality that allows you to learn how to better control your muscles for optimal function. Biofeedback shows you what your muscles are doing in-real time. It is helpful to teach patients to lengthen and relax the pelvic floor for issues like general pelvic pain, painful sexual activity and constipation or to contract the pelvic floor in order to prevent leakage with activities like coughing, laughing, lifting, running or moving heavy objects. However, biofeedback does not demonstrate shortened muscles and tissues; therefore, in certain cases the biofeedback may seem to be within normal limits but yet the patient has 10/10 pain. In these incidences, manual palpation is more appropriate to identify restricted and shortened tissues and muscles, and myofascial trigger points.

HEP: Home Exercise Program


Home exercise programs are essential for each patient. In the case of weakness, a patient will require more pelvic floor, core and functional strengthening and stability exercises. For overactive and pain conditions, the HEP typically consists of relaxation techniques, self-massages (both external and internal), gentle stretching, cardiovascular fitness as tolerated, and eventually pain-free core stability exercises. Both require postural and behavioral modifications and self-care strategies. For more information and detail, check out the book: Heal Pelvic Pain, by Amy Stein or her DVD: Healing Pelvic and Abdominal Pain here.


As you can now see, there is so much out there that can be done for people suffering with pelvic floor dysfunction. This blog is by no means extensive, and there are even more options you and your physical therapist can explore to help manage your pain or other pelvic issues. Pelvic floor dysfunction requires a multidisciplinary approach for most of our patients. Hopefully, this blog helped to paint a picture of what you will experience with a pelvic floor physical therapist. We advise that you seek out an expert and experienced pelvic floor physical therapist in order to help better your life and improve your function.


FitzGerald M, Kotarinos R. Rehabilitation of the short pelvic floor I. Background and patient evaluation.

Padoa A, Rosenbaum T. The Overactive Pelvic Floor. Springer. 2016

Simons DG, Travell JG, Simons LS. Travell and Simons’ Myofascial Pain and Dysfunction: The Trigger Point Manual. Volume 1 Upper Half of Body. 2nd ed. Baltimore, MD: Williams & Wilkins; 1999.

Stein, Amy. Heal Pelvic Pain. McGraw-Hill. 2008

Stein, Amy. Healing Pelvic and Abdominal Pain. Video: www.healingpelvicandabdominalpain.com 2013

Travell, Janet G. and Simons, David G., MYOFASCIAL PAIN AND DYSFUNCTION. THE TRIGGER POINT MANUAL, Volume 2, The Lower Extremities, Williams & Wilkins, Baltimore, 1992.

Valovska A. Pelvic Pain Management. Oxford University Press. 2016

Weiss J. Chronic pelvic pain and myofascial trigger points: manual therapy for interstitial cystitis and the urgency-frequency syndrome. J Urol. 2001; 166(6) 2226-31

May is Pelvic Pain Awareness Month

Mayis PelvicPainAwarenessmonth

Fiona McMahon PT, DPT

May is Pelvic Pain Awareness Month: #PelvicPainAware. This is a big deal to us at Beyond Basics Physical Therapy, where we see it as our mission to spread awareness of pelvic pain and dysfunction to clinicians and patients alike. This month is spearheaded by the International Pelvic Pain Society (IPPS), of which, the founder of Beyond Basics, Amy Stein is the president. Amy took time to sit down with me to describe all of the fantastic things that are planned for this month so I can share them with you.

Before we get started, I want to share a little about IPPS, the organizer of Pelvic Pain Awareness Month. IPPS was founded in 1996. It is a society of healthcare clinicians who treat abdomino-pelvic pain conditions in men, women, and children. Their mission is twofold: “To educate healthcare professionals how to diagnose and manage chronic pelvic pain, thereby changing the lives of patients worldwide.” and “To bring hope to men and women who suffer from chronic pelvic pain by significantly raising public awareness and impacting individual lives.” Pelvic Pain Awareness month, is our opportunity to spread awareness among professionals and public alike in hopes of improving outcomes and demystifying pelvic pain.

Now let’s get started with Amy’s interview!

Fiona: Why did IPPS feel the need to start a pelvic pain awareness month?

  • Amy: I felt like it was needed. As president of IPPS, I wanted to make some changes to awareness, and I felt this was a great opportunity to get the word out and stop patients from having to suffer in silence. I wanted it to be abdomino-pelvic pain awareness month, but the phrase was too long.


Fiona: What activities does IPPS have planned this month to spread awareness of pelvic pain?

  • Amy: We created a pelvic pain awareness page on facebook and continue to tweet about it @intpelvicpain. We are also doing a blog talk radio interview with Lorimer Moseley, PhD, PT from Adelaide, Australia, on blogtalk radio/pelvic messenger on Thursday, May 18th at 7.30pm EST. Lorimer Moseley has written 270 articles and 6 books on pain. If you want to interview someone who is experienced in the study of pain and the brain, he is a good person to be interviewing. May 17th in New York City, we are doing a local fundraising/ networking event in the Green Room on 23rd street from 6:30-8:30pm to create more awareness locally. On may 25th, 9pm EST, 6pm PST we are doing a twitter journal club. An article on sexual health in women affected by cancer  will be featured, as well as one on vulvodynia, and prostatitis . [Click here to access the articles we will be discussing!] Each year we plan to add on more events for May is #PelvicPainAware both locally and internationally. 



Fiona: Why is it so important to build awareness of abdomino-pelvic pain conditions? What was the big driver for IPPS in doing this work?

  • Amy: Bringing awareness of abdomino-pelvic pain conditions is one of the main missions for IPPS, as well as Beyond Basics Physical Therapy and I believe it is a mission of many of other clinics, hospitals, etc, that treat pelvic pain. Again, it is such a common experience of many, many patients who visit us, to have gone to various well-known institutions throughout the country for pelvic pain, to be told it is all in there head and that they just need mental health therapy or a glass of wine. This infuriates me STILL (20 years later!), as well as the patients. Often times it will take just one session with an experienced pelvic health physical therapist or healthcare provider to have hope again. Many of our patients have been to 5 up to 10 physicians/healthcare providers and ended up being misdiagnosed, undiagnosed, or told to go home and relax; or even worse, have more sex or switch partners. Yes, pain is processed in your brain, but there is a physical component with most of these patients.

Fiona: Where would you suggest someone who is starting their journey? What resources would you recommend?

  • Amy: I would suggest to look at International Pelvic Pain Society, International Cystitis Association, IC-network, Endometriosis Association, National Vulvodynia Association, American Physical Therapy Association (APTA) or Herman and Wallace “ Find a provider”, for you to find physical therapists and physicians. Even taking that a step further, when you find a provider, do some research: ask how often your provider sees pelvic pain patients,, how long have they been treating in this area, because that can make a difference. If you go to someone who is not as experienced or is not trained, you might hit a roadblock or plateau in your progress.
  •  I would caution against looking up too much on patient-centered forums; however, here are a lot of great blogs out there that can help give you helpful information. There are some great books out there, like Heal Pelvic Pain, and Pelvic Pain Explained, Sex without Pain, and Pelvic Pain Management.  For providers, I want to add that IPPS is hosting the World Congress on Pelvic and Abdominal Pain in Washington D.C. at the Renaissance Hotel in October 11-15th. We have Lorimer Moseley and Paul Hodges flying in from Australia. They both have done extensive research in pain. This year we are doing 9 clusters on different topics with poster and abstract presentations, as well as a post conference on The Pain Revolution, with Paul Hodges, PhD and Lorimer Moseley, PhD, PT

Fiona: If you had to distill your message for May is Pelvic Pain Awareness month, what would you like the public, people with and without pelvic pain to get from this month?

  • Amy: I would like them to know there are resources and providers out there for abdomino-pelvic pain conditions. But remember to do your homework when deciding who and what is best for you. For providers, there are great resources too, including the International Pelvic Pain Society to help better your practice.

We also want everyone to know we are having a give away in honor of Pelvic Pain Awareness Month! Learn more info below!

For Everyone!

IPPS Facebook Page

Twitter: @IntPelvicPain #pelvicpainaware


Blog Talk Radio/Pelvic Messenger


For Patients!

International Pelvic Pain Society: Find a provider

National Vulvodynia Association: Health Care Provider List

APTA Find a clinician

Herman and Wallace Find a Clinician


Give Away Information

Giveaway open internationally ). Must provide a mailing address within 48 hours of notification of winning, otherwise another winner will be selected at random. Click here for full details,
We have several generous donors lined up for the hour and will be randomly giving away the following items during the event:
1 Copy of Amy Stein’s Book “Heal Pelvic Pain” & DVD Healing Pelvic and Abdominal Pain”  (follow @beyondbasicspt @HealPelvicPain2)  (Open to International)
1 Copy of Heather Jeffcoat’s book “Sex Without Pain: A Self Treatment Guid to the Sex Life You Deserve” (follow @SexWithoutPain @TheLadyPartsPT) (Open to International)
1 Copy of Stephanie Prendergast and Elizabeth Rummer’s book “Pelvic Pain Explained”   (follow @PelvicPainExp @PelvicHealth) (Open to International)
1 Gift Card to Soul Source Dilators (link to soulsource.com)  (follow @SoulSourceTD) (Open to US only)
2 EndoFemm heating/cooling pads by Pelvic Pain Solutions (Open to US only)
2 CAPPS Travel Cushions by Pelvic Pain Solutions by Pelvic Pain Solutions  (follow @EndoFEMM) (Open to US only)
2 Multi-Comfort Therapy Pads by Pelvic Pain Solutions (Open to US only)
Official Rules: This giveaway is open to US only (except where specifically indicated as international above). The following guidelines must be followed to be eligible: Use the #PelvicPainAware hashtag during the twitter party from 6PM PST to 7PM PST to be entered into the random drawing. Must follow @IntPelvicPain @TheLadyPartsPT so we may contact you after the event regarding your winnings. Winners will have 48 hours from the time of notification to provide us with their eligible mailing address, or else a new winner will be randomly selected.
Twitter Party/Journal Club Disclaimer: Tweets during the 1 hour event are not to be taken as medical advice. We recommend following up with your team of providers to gain your most optimal care.


Amy is Live with Integrated Pelvic Health!

Fiona McMahon DPT

amy2016What would you ask a pelvic floor physical therapy expert about exercise, or about the pelvic health as an athlete, if you had the chance? Don’t miss Amy Stein, founder of Beyond Basics Physical Therapy and author of Heal Pelvic Pain answer some commonly asked questions in a webinar hosted by well-renowned Jessica Drummond of Integrated Women’s Health Institute. Jessica is a nutritionist specializing in abdomino-pelvic health and dysfunction.  She will be interviewing Amy on the athlete and pelvic floor dysfunction, treatment paradigms, and practical tips for relieving the under active and the overactive pelvic floor.


Time: Friday, Sept 23, from 12-1pm EST.

Place: www.facebook.com/IntegrativePelvicHealth

Remember this interview can be replayed later if you cannot view it live.



Resources for Pelvic Pain:

Beyond Basics Physical Therapy: http://www.beyondbasicsphysicaltherapy.com/


Heal Pelvic Pain: http://www.healpelvicpain.com/


Integrated Women’s Health Institute: http://integrativewomenshealthinstitute.com/


Link to hear Amy and many other wonderful pelvic health experts speak in December about the female athlete and pelvic floor dysfunction:



Postcard From: Expert Panel

Compiled By Fiona McMahon DPT


Beyond Basics Physical Therapy recently held its first ever Expert Panel and it was a massive success. We invited some of the City’s/Country’s/ World’s leading clinicians in pelvic health/pain and opened the floor up to our guests to ask questions regarding pelvic pain and its treatment.

Let us first introduce you to the guests on our panel. First up is Dr. David Kaufman (DK), urologist and leading expert on interstitial cystitis, a condition affecting the bladder, which can cause severe pain, urinary urgency, retention and frequency. Our next expert speaker is Dr. Dena Harris (DH), a gynecologist and expert in chronic sexual, vulvar, and pelvic pain. Dr. Allyson Shirkhande (ASMD) is a physiatrist specializing in male and female pelvic pain. Dr. Amy Stein (ASPT) is a physical therapist specializing in pelvic floor dysfunction, the author of Heal Pelvic Pain, and founder of Beyond Basics Physical Therapy.

The floor was opened to our guests to ask our expert panel whatever questions they wanted. Here is a brief synopsis of the questions asked and our experts’ answers.

Question: How can a labral tear [a tear in the the covering of the hip joint] effect pelvic pain and vulvodynia?


DH: A labral tear can be related to pelvic floor dysfunction and starting off with a conservative approach is recommended: PT, injections and anti-inflammatory medication if needed. Earlier detection is better and repair of labral tear can help, especially with generalized vulvodynia  (non-provoked). [Non-provoked vulvodynia means that there are vulvar symptoms without a specific irritant. Provoked vulvodynia means that vulvar pain occurs in response to a specific stimulus].

ASPT: Typically we like to see if PT or a more conservative approach can help and in most cases it does! We do a combination of manual [hands-on] work and exercise to take the pressure off of the labrum and to help with proper alignment and body mechanics.

ASMD: There is a relationship with obturator, piriformis and other external rotators of hip and vulvuodynia. Typically we do a course of physical therapy first. We very rarely do surgery right away.

Follow up question: Can you treat it with physical therapy here [Beyond Basics Physical Therapy], if we are already seeing you for another issue?

ASPT: Yes, we are all well trained in treating hip issues, including labral tears. We find that people with premorbid pelvic floor dysfunction present differently than those with just hip pain. Because we have knowledge of the pelvic floor, we can treat your hip without worsening your pelvic floor, which can happen with clinicians who are not well educated in pelvic floor dysfunction. We also treat hip dysfunction with patients that do not have a pelvic floor condition.

Question: I have a lot of pulling in my pelvic floor. I do pilates and yoga and I know the importance of strengthening. I have vulvodynia and neuropathy. I sometimes feel like I’m hurting myself. I sometimes get stabbing pain throughout my leg. I’m tight but not too flexible. What should I do?

DH:  Have you been to physical therapy?

ASPT: It sounds like you have tightness in your pelvic floor muscles and other areas of the body and possibly some nerve irritation.

ASMD: It sounds like you are spasming because you are unstable.

ASPT: We see a lot of foot pain secondary to fascial pulling and nerve irritation. In the brain, [the homunculus: the area that senses what is going on in the body], the feet and the genitals are very close together and the nerves get overflow onto the other nerves. I would tell you to stop Pilates if I saw you and then I think you’d need a very specific type of yoga. I have my patients start from 0 and then slowly work up. I then monitor very careful to detect what is aggravating their symptoms.

Follow up comment: I have neuropathy too.

DH: It may be worth checking it out if you haven’t been to physical therapy in a while. A lot can change [in one’s body over time] and there are constantly advances in medicine and physical therapy.

ASPT: Have you had a nerve block?

Follow up Question: What type of nerve block?

ASMD: That would require an assessment to determine which nerve(s) are irritated. There are a lot of medications to calm it down, injections, medications as well.

DK: I find that if you do things piecemeal it doesn’t work as well. You can do all these individual pieces, but the magic is when you do it all together

Follow up Question: I see a lot of different doctors, it’s so hard to navigate.

DK: That’s why we’re all here, I certainly understand it.

ASPT: A fresh set of eyes may be helpful to see what’s changed in the past five years. I am a huge proponent of home exercise programs and so are the physical therapists here. For your situation I’d have you do more relaxation and breathing exercises. You probably need a lot of soft tissue work and sympathetic nervous system down training.

DH: A lot of doctors are into meditation in ways to desensitize the pain, acupuncture

ASMD: Accupressure as well.

Question: Is there ever a time where it stops? Are you in therapy and the doctor’s office forever? Do you always have to maintain or do a home program?

DH: It depends what’s wrong. Some people get completely better

ASMD: With our physical therapists, we try to instill lifestyle changes. When you’re done with PT you may want to do something like yoga.

DK: You need to find the instigator to find out what’s making the fire that’s making the muscles go nuts. You need to get the fire down. Medicine and physical therapy can help.

Follow Up Question: Say you got a massage and then you feel better, but a few days later your back hurts again, is it like that?

DK: If you haven’t figured out why your back hurt in the first place your back will cramp again.

ASPT: When people are getting ready to be discharged,  I warn them to come back  if they feel their symptoms coming back even the slightest or to increase their home program. Your home program should work for you. It should help to reduce your symptoms and reset the pain cycle. If not, you need to meet with your PT and adjust it accordingly. I have patients that come in for “check ups” but the majority of our patients we do not see again in our office because they get better. We give them the tools to be independent, monitor their symptoms, make adjustments in their daily routine, etc.

Question: What’s the relationship between the gastrointestinal system and vulvodynia?

DH: Sometimes the trigger is gluten, constipation, ulcerative colitis, Crohn’s, IBS [irritable bowel syndrome]. Sometimes the treatment for IBS helps with vulvodynia.

DK: Sometimes a spastic pelvic floor and abdominal wall can cause constipation and IBS-type symptoms.

Follow up Question: What about food?

DK: It’s interesting with people that think they have bladder problems because their symptoms are flared with certain types of food. I look at the bladder it’s fine. Sometimes the food is actually exacerbating pelvic floor muscles.

Question: If you have pelvic floor dysfunction and nothing else, [no other diagnosis], is there anything else that  could cause it?

DK: If you go back in time there is usually something. Like history of infection, a fall on the tailbone or sacrum as a kid.

ASPT: Lots of things, alignment.

Follow up question: What about scoliosis?

All: Definitely.

Follow up question: How often is the cause emotional?

DK: There is always a component of emotion. It’s devastating. I never think emotions cause the problem. Anxiety can make it worse but not the cause.

ASPT: There’s usually trigger like a urinary tract infection but you have to address the emotional component to bring down the activity of the pelvic floor muscles.

There are some great mindfulness/mediation options on iTunes. It’s not for everyone. Sometimes people respond better to yoga.

Q: I have interstitial cystitis which is well managed, however the interstitial cystitis keeps coming back secondary to bacterial vaginosis. I’m  taking meds and suppositories why does it keep coming back?

DH: Ureaplasma, it can cause recurrent pain. There may be some underlying infections that aren’t being detected. You need a really good lab to pick up some of the other types of yeast. There’s certain candidiasis [yeast] that doesn’t respond to typical drugs.

DK: I think it’s great that she’s figuring out what the fire is. Just a little bit of bacteria can send someone to the moon. Sex can move a lot of bacteria to the urethra and set off interstitial cystitis. These are the things I recommend that my patients do:

1.) Pee after sex- a little tinkle after sex isn’t going to cut it. If you pee before sex you don’t have enough urine to really flush out the bacteria from the urethra. It needs to be like a water hose!

2.) Bidet- really wash out the vulva- you really need to irrigate it with water before sex: put it on strong. Get a moveable shower head, spread apart the lips of the vulva to get it really clean.

Q: What percentage of you patients are male?

DK: There is a whole category of men that no one thinks of as pelvic floor dysfunction. It actually is the most common diagnosis in my office. It’s common knowledge that pelvic floor dysfunction can come from untreated prostatitis. 95% of prostatitis is nonbacterial, and the cause, pelvic floor myalgia/spasm.

Celebrate Good Times

By Riva Preil

Wednesday night, the Beyond Basics team celebrated a monumental occasion- the release of Amy Stein’s new patient self-care  DVD entitled Healing Pelvic and Abdominal Pain!  In this new 2 hour home program for patients and guide for practitioners, Amy provides an explanation of pelvic and abdominal pain as well as self-care strategies (including massages and stretches).

The DVD is appropriate for patients with vulvodynia, endometriosis, non-bacterial prostatitis, pudendal neuralgia, pelvic pain, coccyx pain, interstitial cystitis, and bladder and or bowel dysfunction. The video provides information for men, women and children.

Amy also educates viewers on the proper performance of pelvic floor relaxation techniques, including diaphragmatic breathing, stretching, and dilator usage.  Bonus material includes behavioral modification suggestions.

The DVD is available for purchase at: http://www.healingpelvicandabdominalpain.com ($49.95, free shipping).  It is included as a bonus for all out of town patients.

The release of this amazing DVD is an exciting opportunity for us to SHARE KNOWLEDGE about pelvic floor health. Too many individuals suffer in silence, and many are not aware their pelvic floor muscles may be the root of their symptoms and/or pain.  Heck, many people don’t even know what their pelvic floor IS to begin with!  Thanks to Amy and her new innovative DVD (as well as her book, Heal Pelvic Pain), the word is spreading and information is more accessible than ever before. That is truly reason to celebrate, and celebrate we did…in grand style!  A special thank you to Karen, Alexa, Yarissa, and Arianna for planning such a fabulous launch party!

Photo by Elyssa Goodman


The Pelvic Wizard Meets Oz

By Riva Preil

Mark your calendars and your Tivo, because Beyond Basics’ very own Amy Stein will be featured the Dr. Oz Show this coming Tuesday (4:00 PM, on Fox 5)!  After the eye opening article in Prevention last month, pelvic floor dysfunction has been on more people’s minds…including the researchers at the Dr. Oz Show.

The researchers were impressed by the article, and they contacted Amy to learn more about pelvic pain.  Amy educated them through phone calls and emails, and she shared her book and new DVD with them. They realized that Amy had a lot to offer, and wanted her to share her knowledge with the general public. She was invited to be interviewed for the show.   


On Tuesday, April 29, the episode that was filmed on April 22 will be aired.  Amy says the experience was like a whirlwind.  After being chauffeured to the station courtesy of a car service, Amy went straight to get her hair and makeup done.  Shortly thereafter, Amy was brought onto the set where she met with Dr. Oz. Dr. Oz opened the conversation with a great presentation regarding the size of the pelvic floor, and he polled the audience by asking, “Do you think the pelvic floor is the size of a A. Nutbowl? B. Cereal bowl? C. Salad bowl?”  Almost everyone was surprised by the answer…as you will probably be when you watch the show on Tuesday!  He also did a fun, interactive presentation of the pelvic floor which included muscles, nerves, and organs.

Amy was allotted a very brief time to discuss symptoms and causes of pelvic pain, and was also given the opportunity to show one of the many stretches that are typically prescribed as part of the home program.  She was able to add additional information on Dr. Oz’s website, that will be posted after the show.

According to Amy, “It was quite an experience and a step in the right direction towards educating the public about pelvic pain. I was thrilled to have the opportunity to discuss this important topic with such a large audience, but I still feel like there is a long way to go.  Getting the word out there is tremendously valuable. My endorphins rush at the thought of Dr. Oz presenting on pelvic pain, even if just for a few minutes!”  May this be the beginning of a lengthy, important, and long overdue conversation with the medical community.

Amy is in Prevention Magazine this month!

We’re excited to share that Amy and her pelvic health expertise are featured in none other than Prevention Magazine this month! The article, written by Sari Harrar, is titled ” The Pain Down There” and appears beginning on page 104 of Prevention’s April issue. It features insightful advice and information for those suffering from pelvic pain. Check it out below!

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