Saturday, March 26, 2011

Physical Therapy

I recently finished a round of physical therapy & have since had several IC patients ask me about the results, etc. I decided to do a blog post about it to help answer some questions & break down what all was involved. I am only referring to my specific therapy regime, with my specific therapist, and cannot guarantee results or methods. Having said that, I personally believe that each IC patient suffers from PFD- Pelvic Floor Dysfunction, and I believe Physical Therapy to be a huge step in recovering from PFD.

I decided to start with a FAQ, then I'll follow that with a break down of what we did at each session of PT. I hope this helps those looking for answers, and gives anyone reading this a better idea of what living with & treating Interstitial Cystitis/Vulvodynia is like!

Who referred you? I was referred by my gynecologist, after requesting a referral. I wish she had suggested it, but she had actually told me there wasn't more she could do- then I asked her about the referral & she was all for it. (I'm pretty certain I'll be finding a new Gyno soon.)

What was the PT for? It was for my Vulvodynia symptoms, however it had been suggested that it could help my IC pain as well. The official term was simply for "Pelvic Pain", but I was found to have PFD, and Physical Therapy is very effective in many PFD cases.

Was it expensive?
Yes, it was. I'm not going to lie- it cost us almost as much as a month of Elmiron, per month ($400). However, it was WORTH it. (The whole cost vs worth debate can be played out right here- physical therapists have to go through years of training, and to specialize in pelvic issues- more school! So I'm sure that it wasn't easy for my therapist to become one, and such a good one, but I'm glad she did & I'm glad I was able to be referred!)

Did it hurt?
Again, yes, it did. Also not going to lie- but it was "good" pain. The pain from the exercises was just because I wasn't used to them. The internal pain, from pressure point (trigger point) therapy lessened with each time, but a few hours later I usually felt amazingly well- sometimes even pain free.

Was it hard?
Yes. Yes, yes, & yes! But the hardest part so far has been to KEEP IT UP! It takes dedication & hard work- there is nothing easy about physical therapy! It was totally worth it all though!

How long did you have to go?
My circumstances actually created a unique plan that worked just for me. My insurance didn't offer very good coverage, and because I was a determined & dedicated patient, my therapist set up a program that worked very well & specifically for me. I only went once a month, after the first two initial evaluative visits. My total time in PT was 5 months, and only 6 visits. I learned so much & progressed so well, that at my last visit there wasn't much left to cover! For many patients the normal seems to be weekly visits, but you should do what your therapist recommends for your individual needs.

Did it help?
Amazingly well! I wish I had tried/been offered the chance sooner. I would highly encourage anyone considering PT, for IC, VVS, even Endometriosis patients, anyone with pelvic problems, to find a licensed therapist specializing in PFD.

Now, on to the actually therapy & visits...
At the first visit, my initial evaluation, I was asked to fill out a survey that rated pain from every day life. G, my therapist, checked my posture, measured various joints & their movement capacities. She started me on some basic exercises to loosen muscles in the pelvic area. She measured how long I could hold a Kegel (internal muscle contraction of the vagina) and started me on a low grade Kegel exercise to start strengthening & lengthening those muscles. I had started my period that day, so we skipped the internal exam.
At my next appointment we discussed the exercises I'd been doing & several were changed to make them more challenging. We did the internal exam, at which point G discovered how stoic I am & we had a little discussion about pain & expressing the pain. (She doesn't miss much!) After we went through talking about what trigger point therapy was like, she did some on me. Basically, one or two fingers are inserted into the vaginal opening & pressure is applied wherever the painful points are. Thirty to sixty seconds of firm pressure is applied. This HURT. However, immediately after, I didn't feel anything... and about an hour after the appointment, I actually felt great! She explained to my husband how to do it, and went over some relaxing techniques as well.
The relaxing techniques actually worked best during sex. It was a complete "AH HA!" moment- I realized because sex was so painful, I was tensing up terribly- not just internally, but everywhere. It scared Sam a bit, as I kind of zoned out while I started relaxing, but it has helped to keep that in mind each time I start to experience pain.

On my third visit we started biofeedback. Biofeedback for pelvic issues is measured by using a vaginal sensor. It is hooked up to a computer & monitored. The program we used measured my resting tension, and then the strength & length of my Kegels. Using the program really helped me to SEE what a Kegel is doing. It helped from then on to visualize what I saw on the computer screen when I did Kegels as my daily exercises. I even was able to keep the sensor, so I use it from time to time to help remind me of what it felt like to use it.

I'm going to skip the middle sessions because nothing major changed- just "upping" the difficulty of the exercises & lengthening the time of my Kegels. At one point I got majorly frustrated because I couldn't hold them beyond 7 seconds & I was supposed to be working up to 10. So we (G & I) timed my counts & it turned out I was counting one second in the span of about two- so I was actually holding my Kegels for 14 seconds!

The last session ended with me going alone. Sam went to every appointment, but had to work that last day & couldn't make it. It was rough, because I really had felt G become a major player in my health & knew I was going to miss her encouragement. Upon arriving I had to take the pain survey again. My initial survey had yielded me a pain score 0f 91... and my ending session left me with a pain score of a mere 36! Even more exciting was that my worst pain problem- pain from intercourse- went from a 10 (out of 10) to a one!! It is even some times a zero. A ZERO!

One thing that G was amazed by was my husband's ability to not only learn how to do trigger point therapy, but his ability to learn how to feel where those "hot spots" actually are. I no longer have to tell him where the areas of greatest pain are- he can feel them & knows how to manipulate them. It is a wonderful blessing to have this man so devoted to my well-being & so willing to support me in the quest to find a semi-normal life again!

Overall, not only did my VVS pain lower a great deal, but my IC pain was reduced as well, and I realized I was able to stop taking fiber for IBS. The retraining of my muscles even helped eliminate IBS symptoms! I was & continue to be amazed.

Most importantly, I left with all the tools to help myself continue on a path of healing. It was all worth it.

PS~ I mentioned this in my previous post, but in case you missed it- My therapist had me doing exercises from a wonderful book that is about healing pelvic problems. The book is called Heal Pelvic Pain and I highly recommend reading it!! It isn't a replacement for Physical Therapy, but it is a good starting point if you are wanting to try a more holistic approach to healing your painm


  1. I love that you wrote all this out to answer others questions about PT. I am also in PT for PFD, IC and IBS. Its been maybe 6 weeks now and I go twice a week. One thing I was curious about though is I have been told by many different people and doctors, especially my PT, that we are absolutely not supposed to do Kegels. They are to make your muscles tighter and have more strength where as ours are too tight and need to relax. Does that make sense? Im just curious as to why yours had you doing them when I have just heard and read they are bad for us??

  2. This is Naomi (posting under my other account)- Kegels are bad if all you do is tighten, tighten, tighten, but just as important, or maybe even more importantly are the relaxing periods in between- when you deep breath & relax the muscles.

    Kegels should be taught by an actual PT who specializes in PFD, but they definitely have been a huge help! I can even hold my pee for a few extra minutes, if needed- something I could not do before!


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