Ladies, have you heard of pelvic floor therapy?  Did you know that our muscles “down there” can get too tight, just like the muscles in our back, neck, and shoulders?  We don’t hesitate to get a deep tissue massage to make us feel better when our backs hurt, but when was the last time you released the tension in your pelvic floor? 

Many women carry their stress in their pelvic floor and then don’t connect the dots when when they experience urinary incontinence, urinary urgency, lower back pain, chronic constipation, pain with tampon use, pain during intercourse, or many other symptoms.  Read on to see how Laura (name changed for privacy) went through numerous tests, procedures, and antibiotics to treat her sudden bladder pain and burning sensations.  It was only when she was referred to a pelvic floor physical therapist that she found the root cause – and the healing solution.

– – – – – – – – – – – – – – – – – – – – – – – – –

Heather:  Thanks so much Laura for agreeing to share your experience.  I know your story involves many intimate details that are sometimes difficult for people to talk about, but please know that many women will benefit from your courage in sharing this. Can you please first let us know what symptoms you were experiencing that led you to know that something was wrong?

Laura:  Sure.  It started with the sudden onset of a burning sensation in the pelvic area.  It felt like there was constant pressure on my bladder and that made me feel like I had to pee all the time.  The pressure and burning sensations were extremely painful and the pain kept me up at night.  I had to sleep with a heating pad between my legs.  During the day I still went to work but was in constant pain.  I remember getting up to present at an important board meeting and having to hold back my tears because the pain was so bad. 

Heather:  In addition to the excruciating pain, you must have felt scared about what might be causing this.

Laura:  Well, at first I assumed it was a UTI infection.  I had only had two UTI’s in my life and I remember the burning pain.  Though I did think it was a bit odd that this time it didn’t burn when I urinated.  It burned all the times that I wasn’t urinating (24/7). 

Heather:  What was the first medical treatment you were given for this condition?

Laura:  I was busy on a client engagement and didn’t have time to see a doctor, so I called the Teledoc service offered by my company.  I told them my symptoms and a doctor prescribed me an antibiotic, assuming this was a UTI infection.  After a few days the pain felt a little better so I assumed that was a correct diagnosis.  But the day after I completed the round of antibiotics the pain came back again. 

I called my ob/gyn and she had me come in for a urine test to confirm the UTI diagnosis.  It came back negative but they sent it away for a longer test thinking the culture might turn positive in a few days.  She sent me home with a prescription for a different antibiotic just in case.  After I took the first dose of that antibiotic I got a terrible headache and decided not to finish the pills.  The longer test came back negative anyway.

When I saw my ob/gyn, she also did a vaginal ultrasound to follow up on a cyst they found a few months earlier at my annual exam just in case that was causing the trouble.  That checked out fine, and the pap smear done at that earlier exam was also clear so I wasn’t worried about ovarian or cervical cancer.  But I started feeling scared that this was a rare form of cancer or something serious.  The pain was constant and nothing seemed to be helping.

Heather:  It’s not only scary but also very frustrating when no one has answers as to why you’re experiencing such pain.  Did your ob/gyn have any other recommendations?

Laura:  She referred me to a urologist to check for kidney stones.  The urologist said it might still be a UTI and wanted to take a urine sample directly from the bladder to prevent any contamination the sample might incur from doing a regular pee test.  So she inserted a catheter into the bladder to obtain a clean sample.  While we waited for the results, she prescribed vaginal valium.  It’s just like a normal valium pill that you take orally, but this time you insert it into the vagina.  The goal is to try to relax the muscles in the pelvic floor in an attempt to get some pain relief.  She also prescribed a medicine to numb the bladder to try to control the pain.  Unfortunately neither prescription took any of the pain away. 

The urologist ordered a CT scan to check for kidney stones and that was negative.  Also, the urine sample from the bladder came back negative for a UTI.

Heather:  At this point you had gone through numerous tests and several prescriptions with no relief from the pain and no diagnosis.  How much time had passed since your initial symptoms?

Laura:  The pain started in early June and by this time it was around mid-July.

Heather:  I love this next part of your story because you really took matters into your own hands.  Can you explain what you did next?

Laura:  Since I wasn’t getting anywhere with the tests and doctor visits, I decided to get a journal to keep track of my daily symptoms.  I began to notice that my symptoms were worse on the days when I did strength training.  It wouldn’t necessarily hurt during the strength training, but rather toward the end of the day.  I also noticed that the pain wasn’t as bad during the week in July when I want on vacation with my family.  The pain was still there 24/7, but it wasn’t as intense that week.  Also, I was not doing my normal weight training during vacation. 

I shared these observations with my ob/gyn and this led her to believe that the cause might be more muscular.  She referred me to a pelvic floor physical therapist.  It took me a few weeks to get in, but finally toward the end of July I had my first visit with Dr. Kristi Rosipal at the Rosipal Institute for Pelvic Therapy Solutions.

At my first visit, Dr. Rosipal did a manual physical therapy session on the pelvic floor by inserting her fingers inside me and pushing on various muscles.  Some of the muscles toward the back were painful, but when she pushed on one particular muscle near the urethra I knew she had found it.  It caused the exact same pain I had been feeling all those weeks.  Dr. Rosipal said she was fairly certain that she had found the cause of my pain because my pelvic floor muscles were extremely tight.  She recommended a therapy protocol involving eight sessions to manually loosen the pelvic floor muscles. During these sessions she would work on the pressure points until they finally released.  In between sessions she gave me stretches to do each day to stretch those same muscles. 

Heather:  What was your pain level after leaving your first session with Dr. Rosipal?

Laura:  Though the session itself was quite painful at times, I left the session feeling so much better and just knew that this was the answer.  The first two to three therapy sessions were painful, but I left feeling better each time and the overall pain was reduced greatly. All of my pain was completely gone after the 3rd session though I completed the entire 8-session protocol. 

Heather: It has been about eight months since you completed the pelvic floor therapy.  Did the pain ever return?

Laura: During the therapy, Dr. Rosipal advised me not to do ab work again because engaging the abs automatically engages that tight muscle near the urethra that was my pain problem.  After several months with no pain, I decided to ease my way back into ab work thinking I was in the clear.  Well, I should have listened to Dr. Rosipal!  The evening after I did my first ab workout, I felt the same pain starting to come back again.  I immediately booked a pelvic floor physical therapy session and the pain never returned, but I have now resigned to strengthen my core through general fitness rather than through dedicated ab work. 

Heather:  Did Dr. Rosipal indicate that your original abdominal training may have been the cause of the initial tightness in the pelvic floor to begin with? 

Laura:  She thinks it was a “perfect storm” that led to that initial problem.  I had been doing the same intense strength training program for 2 1/2 years prior to having any issues.  But at the time the pain began, I had recently begun a new ab workout program.  At that same time, I had completed many cross country and international flights in a one month period, so that meant lots of time sitting down and not stretching.  Also, work was really busy during that time.  Thus, the perfect storm.

Also, I had noticed that sex was painful for approximately six months prior to experiencing that initial painful episode that led me to seek help.  I guess that was an indication that my pelvic floor was tight even back then.  After a few therapy sessions, the pain during sex went away as well.

Heather:  Many women have sadly experienced sexual trauma in their lives and I would imagine doing manual therapy in that area could be emotionally challenging for some.  Do you have any thoughts on that?

Laura:  I can understand where women who have experienced trauma in that area might experience heightened emotions about seeking this type of therapy.  For me personally, I thankfully didn’t have any issues with it.  The pain was so bad that I would have done anything to make it better.  But I’m certainly sensitive to others with more trauma and emotional pain associated with that area of the body.  Most of the therapists who do this work are women, so that may help a bit.

Heather:  Have you made any lifestyle changes as a result of your experience with pelvic floor therapy?

Laura:  I pay better attention to my body now, especially during strength training.  The program I had been on for years involved heavy weights and slow reps.  Apparently this was a terrible recipe for the pelvic floor tightness.  For several months post-therapy I had to lighten the weights and do faster reps.  I’m about 80% back to my weight levels prior to this incident and I’m actively listening to my body now.  By paying more attention, I can tell quickly if something is beginning to aggravate me and I can then adjust accordingly.  Also, I now stretch every day!  That is so important.

Heather:  I’m so appreciative that you’re sharing your story because I believe this will help many other women.  Is there anything else you’d like to share?

Laura:  The physical therapists also work on women with the opposite problem – when the muscles are too loose.  In addition, I understand that sometimes the pain from a tight pelvic floor is so bad for some people that their ob/gyn accompanies them to the PT appointment in order to inject lidocaine into the pressure points. I’m thankful that my pain wasn’t at those levels. 

With as common as pelvic floor issues are in women, I’m surprised I had never heard of any of this before.  That’s the main reason I’m coming forward with my story now.  Women need to know this is out there.