Seeing a Pelvic Floor Physiotherapist - The 1st Appointment & Experiences

Hello all its been a while since my last post , I finally had a chance to see a pelvic floor therapist / specialist / physiotherapist so I thought I would share my experiences to see if it would be something that may benefit others. After all to be honest it wasn't exactly cheap and if I can spread some free information and help others that would be great :)

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 in
2. 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

Anterior Pelvic Tilt and Pelvic Floor Dysfunction - Breathing Exercise

Anterior pelvic tilt or hyper lordosis is very common for people suffering pelvic floor dysfunction.

There are many exercises you can do to correct anterior pelvic tilt and bring the pelvic bowl into a more neutral position but there can be some restrictions that can prevent you from getting the full benefit from these exercises.

Common exercises such as hamstring curls , Glute Bridges and reverse crunches are prescribed to reverse anterior pelvic tilt. These exercises work great when you have the ability to peform lumbar flexion.

For people who have been in a state of anterior pelvic tilt for many years the lower lumbar muscles can be so tight that they physically cannot perform lumbar flexion.

For those with tight lower back muscles, lumbar flexion doesn't always occur and you will see a stiff straight back instead of a slight bend.

1. Crocodile Breathing Exercise

The crocodile breathing exercise is very useful for stretching the lower lumbar muscles and is especially useful for those with shortness of breath and those who find that they cannot take a full deep breath. (shallow breathing)

Lie on your stomach with your head wresting on your hands to maintain a neutral spine.  Take deep abdominal belly breaths and feel the air stretch your lower back and obliques.

                                             image: achievefitnessboston

Important -> For those with anterior pelvic tilt make sure that you dig your ASIS (hip bones) and pubic bone into the ground to avoid arching your back while performing this exercise, Dig your hip bones into the ground but also make sure you are not tensing your pelvic floor or anus muscles.

Not feeling the stretch?

If you have an extermely tight lumbar spine you may need some extra help to feel the stretch. The easiest way to do this is to lay over a foam roller or swiss ball. Position the ball on your belly , you may need to experiment with placement to get the best stretch.

Now you have loosened up the lower lumbar muscles you can perform your anterior pelvic tilt correction exercises.

Its also important to release the psoas muscles before performing anterior pelvic tilt correction exercises, I have previously written a post on this subject ->

The Psoas and the Pelvic Floor - Release the Psoas to Heal Pelvic Pain.

there you go , another riveting post :) as always I hope it helps someone out there