Question from Kate, a mother of two boys, ages 5 and 7:
“I have pelvic pain due to a non-relaxing pelvic floor. I cannot even sit down without pain. I am already doing pelvic physical therapy and have had multiple therapies (see below). What can yoga do to help me find relief?”
Note: Kate is also a physical therapist, a big plus for her. Otherwise, she may have not recognized the dysfunction as a diagnosis, or a real condition that is abnormal. Many women do not know pelvic physical therapy is an option. Fortunately, as a therapist, Kate was able to recognize the problem immediately and seek help.
Here is how you can recognize the signs of pelvic pain, and what
you can do about it:
pain (myalgia) can have many signs and symptoms. If you have pelvic myalgia or
non-relaxing pelvic floor, you may experience the following:
- Pressure on the
pudendal and obturator nerves, which makes stretching, walking, sitting,
bending, or anything that puts tension on these nerves in the pelvic floor area
- Groin pain
- Difficulty with
emptying the bowel or bladder or a feeling of incomplete emptying
- Bloating or
constipation (bowel symptoms)
- Urinating frequently,
hesitation during urination, painful urination, and/or urge incontinence
- Dyspareunia or
insertional pain with intercourse or after
- Pelvic pain unrelated
nonrelaxing pelvic floor dysfunction are associated with voiding dysfunction,
anorectal dysfunction, sexual dysfunction, and pain.” – Mayo Clinic Proceedings
current treatment, since she recognized it and sought out physical therapy as
soon as possible, gives her the best chance for recovery. Early referral to
physical therapy is recommended by the Mayo Clinic Proceedings (2012). I take this
a step further and am a strong advocate of physical therapy becoming a standard
of care for every new mother.
There are also conservative treatment(s) for pelvic myalgia. Note
that conventional medicine such as trigger point or steroid injections, drugs,
or surgery can be included as options; however, drugs and surgery should be
considered a last resort because of the many side effects and limited long-term
gains associated with them.
Conservative treatment options include:
Physical Therapy &
Pelvic Physical Therapy?
A physical therapist (PT) can identify any low back or
sacroiliac issues that could be contributing to orthopaedic problems that would
influence pelvic pain. A women’s health PT can also perform internal and
external exams of the pelvic floor area, diagnose pelvic pain, and treat it
with a range of options. PT can include biofeedback through electrical
stimulation or monitoring, relaxation techniques, exercise and balance of the
pelvic floor and surrounding musculature, biomechanical analysis, dry needling,
Talk therapy can
assist with types of biofeedback and even hypnotherapy to help release and relax
the areas creating pain. Therapy can also include addressing or identifying
past trauma or abuse that can often be associated with pelvic pain.
Prolotherapy is a
series of injections designed to assist in stabilization of connective tissue, also
known as regenerative injection therapy. It’s mechanism or effectiveness is
currently undecided, but proponents of the therapy say it can strengthen
weakened connective tissue and help alleviate pain. Several trials have shown
benefits of prolotherapy outstrip, and are safer than, steroid injections. In
Kate’s case, she was receiving injections into the sacral area to assist with
stability and pain-relief that is perhaps contributing to her pelvic pain.
There are many options
to pursue to find relief from pelvic pain using holistic techniques supported
by science, including meditation for better hormonal regulation and cortisol
regulation, which directly affect the body’s stress (and pain response). For
example, my primary modality for treating women’s health issues is yoga.?Yoga
offers a method for integrating medicine, physical therapy, and psychology into
a single treatment session, which can be both a time and money saver. The
techniques I use as a women’s health physical therapist are based around
medical therapeutic yoga, but there are many other conservative (non-surgical
and non-drug) interventions which can be incredibly beneficial and necessary.
Part 2, we will address what questions you should ask your health care provider
to get the care you need, which can include yoga.