The 1st Appointment
So I was a little nervous going into the 1st appointment after all I knew it would involve an internal pelvic floor examination. But for me enough was enough it was time to get a professional diagnosis of the health of my pelvic floor.
It seemed like most of the other clients at the pelvic floor therapists were women but I was told by my physiotherapist that they are seeing more and more men lately (apparently male pelvic floor physio's are one in a million because of the fact that they practice on each other during their training which may make it quite awkward for a man, well that's my thinking anyway). The first thing we went through was a series of questions to determine whether tightness/pain was my issue or whether it was incontinence and a weak pelvic floor.
Some of the questions I was asked were.
- Do I experience any pain or discomfort, when and where?
- Sexual Orientation
- Any history of sexual abuse ( unfortunately very common for people with pelvic floor disorders)
- Ease of bowel movements
- Any leakage either urine or from the anal
- Do I experience any other pain be it backs, hips, neck
She also showed me a very disturbing image of different types of poo :P and asked me to tell her which ones I experience on a daily basis , I felt like I was choosing items off a very unappetizing menu
a necessary discussion of bowel movements
My physiotherapist then walked me through the basics of pelvic floor anatomy with the help of a pelvic floor anatomy model.
She discussed the fact that the pelvic floor muscles resemble a muscular bowl with the job of holding all internal organs in their correct positions. She showed me on the model the deeper layers of the pelvic floor such as the levator ani which can often hold painful trigger points which can be healed through massage or relaxation exercises.
Pelvic Floor Internal Examination
We then moved onto the pelvic floor examination (just what I was dreading :P ). My physiotherapist had my lie on my back with my knee's bent and did a quick external examination to check for pain or muscle tightness around the perineum (between the anus and testicles) , around the thighs and buttock area. For me I felt no pain what so ever but she did notice that I had very tight abductors and hips. (very common for people with office jobs or sitting for long peroids of time)
We then moved to the internal examination , I positioned myself on my side with my knees drawn up towards my chest so that the anal canal is more easily accessible. The physio was very gentle and I did not feel any pain or discomfort during the examination which had me worried because my number one goal of visiting the physio was to find the trigger points that I knew must be the cause of my pelvic floor issues.
The physio continued to lightly press on different muscle fibers of the pelvic floor and FINALLY I felt what I would describe as a slight twinge of pain which was most definitely a trigger point. Something that I had never been able to find when performing internal massage by myself. The Physio then lightly pressed down on the trigger point while she instructed me to do semi contractions of the pelvic floor and I did feel almost instant relief. ( Can't tell you how happy I was that I now had proof I had trigger points in my pelvic floor :) ).
After a couple more minutes or internal massage , I was given a pelvic floor exercise routine which looked like this
3 SETS
10 x Pelvic Floor Squeezes
Procedure
1. Breath in2. Breath out and contract the pelvic Floor
3. Breath in and maintain the pelvic floor contraction
4. Breath Out and release the pelvic floor
5. Breath in and out without contracting , on the exhale try and relax pelvic floor further
This procedure was also recommended for constipation to train my body to know the difference between a contracted and relaxed pelvic floor. I know you may think that prescribing pelvic floor exercises can be counter productive for people with pelvic pain and tightness but its really about training yourself to relax by first feeling what a contraction feels like. You will eventually reach a higher level of pelvic floor relaxation.
Also price wise the first consultation was not cheap, just under $200
for a 1 hour appointment. My health insurance did pay a little but I
wouldn't be scheduling appointments too often I am going to get the most
out of it and heal myself hopefully :)
So that's about it for the 1st appointment, feel free to ask me questions and I will create another post for appointment 2 with the progress I have made (which I have by the way :) ) Also on a side note I was given a diagram on proper defecation posture which involved placing a short stool under my feet to put me into a squat position to straighten out the anal canal and allow for easier bowel movements.
Similar to the squatty potty , which I have ordered recently :) can't wait for it to arrive
Dear mark, my name is jiya.I am 27 years old.I live in Karachi, Pakistan. I am suffering from chronically tight pelvic floor muscles, incomplete defecation, difficulty evacuation, and if I don't take fiber rich diet I get constipated. My left psoas muscles are lot tighter than my right psoas. And I do have found trigger points in my left psoas muscles and lower back with the help of your previous post, in which you have given insight on these deep hidden painful trigger points.when I breathe my left psoas muscle pains and it stretches and pulls awkwardly and this stretch goes down to my left leg. I feel great discomfort. But many many thanks to you that now I can find these trigger points too and I am massaging them and getting relief.
ReplyDeleteMy muscles are very tight around perinium.you have mentioned about performing pelvic floor squeeze exercise. My question to you is that will this exercise benefit me in treating incomplete defecation? This exercise somewhat looks like kegels and I very afraid of kegels because it does more harm than good to people like us suffering with pelvic floor dysfunction due to tight pelvic floor muscles.
I would be very grateful to you if you could spare time to respond to my query. Keen to hear from you.
Hi Zeeshan Ali , thanks for the comment
ReplyDeletei'm glad you found some relief by massaging the psoas trigger points and surrounding areas. Do you experience pelvic pain or pain when you perform a kegel/contraction? if you do then it is best not to perform these exercises and focus more on relaxation.
the exercise will help with incomplete defication but you will need to be very patient , while on the toilet you can breath in and perform and contraction then relax and breath out to try and train your mind into knowing the difference between tight and relaxed.
You do sound quite tight compared to myself i would recommend a moderate 20 minute walk on a treadmill to restore blood flow , or perhaps a bath. Otherwise the wall split stretch can be great for tight muscles on my previous post -> http://painfulpelvic.blogspot.com.au/2014/02/Stretches-Pelvic-Floor.html
Hello Mark,
ReplyDeleteI suffer from a similar problem and I am desperate for a solution. Is there anyway I can talk to you. I am based in USA. I am happy to call on phone or skype etc. Incase you want not to share your personal contact details, I can provide my details. I can be reached at vicksarin@gmail.com