Pelvic Floor Therapy: Day 1

B&W photo of a person with long dark hair wrapped up in a sheet and hiding their face; white text: "Pelvic Floor Therapy: Day 1" and "Chronic Sex"

Earlier this year, I made an urgent appointment with my primary care doctor. She’s also an OB/GYN, which I love. I had a spot of seborrheic keratoses on my pubis that alarmed me. I didn’t know what it was before the appointment but, in prepping for my boudoir shoot, I found this giant mole-thing.

It was kinda scary.

While I was there, though, I also brought up something I’ve been dealing with for a few months. I will wake up with pain in my pelvic region. At times, it can be throbbing, stabbing, or spasmodic. I’ll usually need to pee, but have a hard time easing up muscles to let myself pee. Afterward, the pain is still so bad that I have to get in the fetal position and shove a pillow in my abdomen.

After an invasive and dysphoria-causing transvaginal ultrasound, everything was found to be normal. Two weeks later, I reached back out to my primary care doctor to see if pelvic therapy might help. So now, in addition to spine physical therapy for a bulging disc, I get to do pelvic floor therapy.


First appointment

Today was my first visit with my pelvic floor therapist. She is a little older and incredibly kind. I will admit, though, that I was a little nervous about the appointment.

Not only was I dealing with anxiety around having someone manipulate my vagina, but I also wound up dealing with some bowel incontinence earlier in the day.

a view of Kirsten's legs while she's on the toilet; her black boxer briefs from Tomboyx are visiable, as is a blue Ikea rug and while/beige tiles

Apparently, I’m not allowed to eat pineapple and drink juice anymore, says my GI tract.

I was worried about how this might affect things. Would we be able to do as much? Or, the more concerning question for me, was I going to just let loose everywhere?

Thankfully, I did not!

The first part of the appointment was spent talking about these spasms – when they happen, what might bring them on, etc. I mentioned my puzzling neurological stuff in addition to some rough abuse stuff I’ve been through.

It wasn’t exactly the easiest way to start a doctor-patient relationship.

Next, though, she pulled out a pelvis model and we talked through anatomy around the pelvic floor muscles.

pelvis model; the hip bones are visible along with the muscles that create the vaginal outside and the uterus poking out the top

Aside from the uterus popping out the top there, this is how a female pelvis looks. The hip bones are seen here in white with muscles in red. If you look closely, you can make out the urethra and vagina, too. One thing I always struggled to visualize was the different layers of muscles. This model comes apart so you can see the pelvic floor muscles both on the outside and inside.

The exam

It was really helpful to have a model to talk about the anatomy, but also for her to demonstrate what she was going to do with the exam.

The exam itself wasn’t horrible. I’m used to seeing my primary care doctor (who is also an OB/GYN) though, where I don’t have to make eye contact. That part got a little funky.

For those of you who haven’t had this type of therapy, the first thing is to switch from shorts to a hospital gown and lay on an exam table with a sheet over yourself. Next, the therapist feels around the outside of your pelvis – really, the outside of the labia and where it connects with your legs.

The exam moves to the inside, with the therapist using their fingers to check the muscles out. During different stages, they might ask you to clench or bulge/push out. This helps them to test the strength of your muscles.

My initial concern was that I might have loose muscles, but it’s the opposite! One thing we noticed quickly was that the left side of my pelvic floor was very tight. We then found the same at the bottom of my pelvic floor.

This isn’t super surprising. I tend to be tense in general. My left side is also the worst with every single health issue I have.

The treatment

For now, the first thing to do is start an at-home exercise. I mean, this is PT after all!

The one we decided to focus on for now is the submax:

This exercise is fitting for patients with pelvic floor tension or elevated baseline at rest. Begin at rest, contract your pelvic floor muscles gently, 70-80% effort. Hold the contraction for 5 seconds, then relax and release all tension for 5-10 seconds.

I am supposed to be mindful of my pelvic muscles, too. It’s easy to hold tension in pelvic muscles. Stress – ya know, like from begging Congress to not kill you – just makes that worse. Dealing with weakness in muscles can make them get tense trying to do their job, too.

There are some exercises that can help with pelvic floor tension as well. Right now, we’re avoiding those since I’ve got this bulging disc, but we will build up to them.

I’ll be seeing my pelvic floor therapist weekly before moving to biweekly. I’ll be documenting how things go here, too, because we need more resources on all this.

Have you ever tried pelvic floor therapy? What did you think?

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