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Pelvic Floor & IC - Quick Summary

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  • Pelvic Floor & IC - Quick Summary

    About IC & Pelvic Floor Dysfunction

    The single greatest change in interstitial cystitis treatment in the past decade is the integration of pelvic floor assessments and treatments in most interstitial cystitis clinics. Why?? It appears that the great majority of IC patients have or are experiencing pelvic floor muscle tension to the point that it interferes with urination and/or creates pain and discomfort.

    The pelvic floor is composed of an overlapping series of muscles which form a sling or funnel that holds the pelvic organs in place. Frequently, these muscles can be strained by childbirth, bicycle riding, accidents and even ballet, thus creating either painfully tight trigger points or weak, unsupportive muscles.

    For IC patients, the health of the pelvic floor muscles merit a second glance. Why? When you are in pain, your body tries to protect you through what is known as a "guarding reflex." Thus, if you have pain in your bladder, the pelvic floor muscles automatically tense to protect you. And, once the pain has resolved, the muscle tension usually goes away. But chronic, consistent pain may create chronic, consistent muscle tension which we call "pelvic floor dysfunction."

    Signs of muscle tension include:
    • muscle burning due to the build of of lactic acid
    • difficulty starting urination
    • feeling as if something is being pushed into, or pulled out of, the urethra or vagina.
    • feeling as if a heavy object is in the pelvis.

    Signs of muscle weakness may be:
    • an uncomfortable feeling of pressure or heaviness
    • leaking of urine when coughing, laughing, running or doing exercise,
    • bulding of the bladder into the vagina (cystoscele)
    • bulging of the rectum into the vagina (rectocele)
    • the dropping of the uterus into the vagina.

    The Pelvic Floor Assessment

    If you are interested in learning more about your pelvic floor, your first goal is to obtain a pelvic floor assessment by a physician or physical therapist who is familiar with the latest in pelvic floor theories. Generally, the examination is done both externally and internally. The therapist may do an examination of the abdominal and perineal muscles to locate tender muscle areas. For women, a vaginal exam will allow the therapist to palpate the various internal pelvic floor muscles. Men will have their pelvic floor assessed through a simple rectal exam.

    Pelvic Floor Treatments

    A proactive approach to maintaining pelvic floor health is a vital tool in an IC patient treatment arsenal and can prevent future bladder problems (i.e. stress incontinence, leakage) from developing. If your care provider finds that you have muscle problems, there are two common approaches to pelvic floor treatment: (1) myofascial release and (2) biofeedback

    Myofascial release is used to directly massage and reduce any myofascial trigger points (muscle knots) found. It may take several (many) sessions of physical therapy to reduce the tension in those muscle areas. In some cases, doctors may inject a local anesthetic directly into the muscle knot to relieve and reduce pain. Remember, muscle knots are tender. This therapy may be initially uncomfortable. Heat or ice may help reduce symptoms. If they are uncomfortable, talk with your care provider about how you can reduce your symptoms.

    Biofeedback involves the use of a small machine and a wand, gently inserted in the vagina. It measures muscle tone and offers a pitched, audible sound to help patients relax the proper muscle areas. This can eventually be done at home, after proper training.

    You can find a list of physical therapists who specialize in pelvic floor dysfunction on our website at:
    Last edited by icnmgrjill; 02-15-2011, 09:32 AM.
    Would you like to talk with someone about your IC struggles? The ICN now offers personal coaching sessions that include myself, Julie Beyer RD on the diet and Dr. Heather Howard on Sexuality.

    Looking for books, magazines & reports on IC? Please visit the ICN Shop at: Your ICN subscription & purchases in our shop support these message boards, chats and special events. BECOME AN ICN ANGEL TODAY!

    Please remember that the information on the ICN is provided with the understanding that ICN, its founder, staff, volunteers, and participants are not engaged in rendering medical or professional medical services. We cannot and do not give medical advice. Only your personal physician can do this for you.

  • #2
    concern about intravaginal PT

    I had a remission of almost fifteen yrs. I lost it after I got the shingles and had severe post herpetic pain. It started shortly after the php ended. It was no where as severe as it had been.

    Thank God the bladder pain quieted down. But I have severe vaginal itching under the bladder wall. Gabapentin, which I had been on already and Lactimal help. I never stopped the Atarax. I did have pelvic floor spasms when first diagnosed and severe guarding. I worked through them using a TENS device in a unique and unusual way. It sounds very much like the PT work.



    • #3
      I was in pt for pelvic floor spasms for two months. At first the internal vaginal muscle work was too much for me so the therapist worked externally for a few sessions, and also used the tens unit on my pelvic area. There are quite a few things the therapist can do other than the vaginal myofascial release, but some therapists feel it's not quite as effective as the internal. The external pt on the pelvic and sacral area felt really good. Something must of worked because my muscle spasms in the pelvic floor stopped. I continue my pelvic stretches at home now.


      • #4
        Just had my first session yesterday, external and internal massage. WOW. I have received immediate results and have been suffering with urethral issues for 4 years. No drug has been even close to this helpful. I used ice and ibuprofen afterward and that was good too. I will go twice a week for 4 weeks and then we will decide a course of action.
        I have not been this hopeful in years.
        I live in springfield mo and will be happy to supply the name of my therapist.
        I actually feel happy today.


        • #5
          When you find a good therapist who knows how to do this type of therapy it makes all the difference in the world. My first few sessions were pretty painful, but after the muscles were relaxed it was great.


          • #6
            looking for recommended chair

            I have been unable to find the chair that I believe was mentioned in one of Jill's posts. It is an office chair with many moveable parts and was I believe around $499? Does anyone remember seeing that post?



            • #7
              Confused about PFD and Biofeedback.

              I went for my first session of Biofeedback today...I was expecting her to say my pelvic floor muscles are too tight...however, she said the exact opposite...I can completely relax my muscles, and she said my contractions were kind of weak. She wants me to do Kegels, but everything I've read says Kegels tend to make IC pain worse. I don't have incontinence, pain with intercourse, or prolapse (things that Kegels usually address)...I have frequency, urgency, and pain...definitely don't want to make it worse.

              So I'm confused...the therapist admitted she has never worked with someone with IC, only patients with incontinence...but I'm assuming the Biofeedback machine doesn't lie...should I go get a 2nd opinion from another PT (my urologist works with a PT who has helped several IC patients...the only catch is I would have to drive an hour to get there, and driving causes my pain to increase).

     contractions registered at 2.5...Is this really weak according to the Biofeedback machine?


              • #8
       former urologist did a pelvic exam and said I had PFD...the very next day, my gyno did an exam and said he was almost 100% sure I didn't have PFD...hence, the confusion.


                • #9
                  Melanie, stay away from Kegels whether you have PFD or not. As you said, if you're not incontinent or experiencing prolapse, they're not for you. I was ignorant of the problems Kegels could cause for an IC bladder and did them for many months. They really set me back in my recovery. If you have PFD, your muscles would be weak from being so tight all the time, if that makes sense. They would need to be relaxed and lengthened before strengthened. My suggestion would be to find a PT who specializes in pelvic floor rehab or urogynecologist to make a diagnosis and go from there.

                  Hope that helps!
                  34 years old, bladder symptoms all my life
                  diagnosed with PFD and VV October 2009; IC May 2010

                  Current meds:
                  Cystoprotek 2 pills twice a day, Hydroxyzine 10 mg, Gabapentin 600 mg, Myrbetriq 25mg, Zoloft 25 mg, Mircrogestin, capsaicin cream (for vulva)
                  Other past treatments:
                  IC diet, physical therapy, Traumeel injections as needed, TENS unit, heating pad, instills with sodium bicarb, lidocaine, and mucosa compositum
                  Tried and didn't work:
                  Pyridium, Singlair, Nortriptyline, Elmiron, lidocaine and heparin instills (worked at first, then didn't anymore), various creams, acupuncture


                  • #10
                    Melanie, I just had my second vist with my therapist who knows alot about IC. she's doing external work on my abdomen and inner thigh area plus she added a tens until yesterday and I was pain free for two hours.

                    I've had success with most of my meds for at least 4 weeks into the med therapy but then it seems all heck breaks loose. So i'm hoping I get a tens unit tomorrow so I can take it home.
                    IC diagnosis 3 weeks ago.
                    Vesicare 10 mg once daily
                    IBS and Gerd-Zegerid
                    IC diet
                    Elmiron 100 mg three daily
                    Hydroxyzine 25 mg at night
                    Amitriptyline 10mg at night
                    Diovan 60/12.5 daily
                    Topral 50 mg daily
                    Zoloft 100 mg at night
                    Klonopin .5 twice daily


                    • #11
                      Physical therapist in southwest Michigan

                      Does anyone have a physical therapist to recommend in Southwest Michigan that has experience in PFD and therapy for it please? Also, what Drs do you recommend in Michigan for IC. I am willing to go anywhere in the State or in South Bend Indiana. Thanks for you response.



                      • #12
                        i saw a urogynecologist who has magic fingers. she did a internal pelvic and found tightness and my 'hot spot.' upped valium suppositories to ten mg twice a day. Said pt for eight wks and if no improvement she'd do trigger pt injections.Very component manner.

                        Saw pt who i think did evaluation and did internal and external work. She's very experienced and i loved her. Then she told me she isn't that available so can only see me off and on.I was booked with another pt who I realize didn't have the extent of training.

                        Session with her left me in pain. She said it would resolve next day. I had a nightmare night and now having more symptoms. place is closed for holiday but I'm afraid this pt is not right for me. I'm much worse than i've been in months. Have pain in clitoris that I got from acupuncture and certain meds.


                        • #13
                          Everyone on this thread sounds so much like me. Someone said "today, I feel happy" sad that our lives have come to this, isn't it? But, I am amazed how alike we all our in our positives attitudes, willingness to be open to anything, new meds and alll kinds of treatment. I love coming to this IC board because you are the only people that truly understand how I feel. We always have hope.

                          I start new pelvic floor therapy on Tuesday and am really nervous. I have tried it once and had a terrible experience. Now I feel like I am ready to try it again. I have to drive an hour each way twice a week for treatment plus the cost of gas.................I sure hope it is worth it.

                          I could really use some encouragement please?? And what to expect and what are the red flags to look out for?

                          Thanks for your support.


                          • #14
                            If anyone knows of a good PFD therapist in the Eastern side of Washington State, plz let me know. Seattle is 4 hrs away from me so that wouldn't work for me.
                            symptoms when in a flare:

                            I feel everything in my urethra but I know its really my bladder. Pressure, stinging, urgency,tingling feeling thats hard to describe.
                            *I have a fibroid on my uterus near my bladder.

                            100mg Amitripyline ( I have seriously gained almost 50lbs on this drug but I feel it works)
                            Flexoril 10mg (doesn't work)
                            Hydrocodone 5/325 PRN
                            Cetalopram 40mg *severe anxiety over flare

                            Physical therapy hasnt really helped but I love her! I've learned so much! She states that my muscles around
                            My urethra are very tight.

                            currently seeing a Gyn in my town and a Uro in Seattle (4 hrs away)

                            I have had lots of long term remissions. Currently been struggling with good & bad days since Jan 2012

                            find me on Facebook! Brandy Schildknecht Covington


                            • #15
                              Wow, I had no clue that Kegels could worsen IC symptoms. I had read other post about the PFD, and PT for it, so I assumed that Kegels was what the PT was.

                              I've been doing Kegels every day now thinking I was helping myself. I'm not incontinent and I don't have prolapse.

                              Sully, it's been a long time since your post, did you find anyone to help you?

                              Brandy, I hope you find someone also.