Pelvic Floor Physical Therapy, Trauma Edition?
October 26, 2020 2:03 PM Subscribe
My doctor has recommended pelvic floor physical therapy, which I am going to do although I am not happy about it. If you have done pelvic floor physical therapy, especially if you also have trauma, I am very interested to hear from you!
I have emerging bladder prolapse and my doctor has recommended pelvic floor physical therapy to address the issue. I am committed to going but I have trauma* that makes even routine pelvic exams upsetting and triggering and I am not looking forward to physical therapy. I am mostly interested in knowing what to expect and any advice you have for making the experience less traumatizing.
I have been spiraling emotionally since being referred to do pelvic floor physical therapy, because I don't know what to expect and I am catastrophizing about how invasive it will be.
-What can I expect? How many visits? Maybe just diagrams and paperwork while in the office, and then homework to do in private?? One can dream...
-Is there anything you did or requested during sessions that helped you?
-Are pelvic floor physical therapists trained for trauma? I'm sure it varies by practitioner but is there a baseline I can expect?
-Relatedly, should I tell my physical therapist? Will she ask? I very much do not want to but perhaps it will be helpful?
I'm a late thirties cisgender woman, no kids or pregnancies, history of a few painful gynecological interventions (cryotherapy, IUD) and trauma (sexual assault).
*I have extensively processed my trauma in talk therapy and through body work, it is not an issue in my relationship or elsewhere in my life, just in cases where I am forced to be in a physically vulnerable position (like a pelvic exam) with people I don't know/trust (like a new clinician).
I have emerging bladder prolapse and my doctor has recommended pelvic floor physical therapy to address the issue. I am committed to going but I have trauma* that makes even routine pelvic exams upsetting and triggering and I am not looking forward to physical therapy. I am mostly interested in knowing what to expect and any advice you have for making the experience less traumatizing.
I have been spiraling emotionally since being referred to do pelvic floor physical therapy, because I don't know what to expect and I am catastrophizing about how invasive it will be.
-What can I expect? How many visits? Maybe just diagrams and paperwork while in the office, and then homework to do in private?? One can dream...
-Is there anything you did or requested during sessions that helped you?
-Are pelvic floor physical therapists trained for trauma? I'm sure it varies by practitioner but is there a baseline I can expect?
-Relatedly, should I tell my physical therapist? Will she ask? I very much do not want to but perhaps it will be helpful?
I'm a late thirties cisgender woman, no kids or pregnancies, history of a few painful gynecological interventions (cryotherapy, IUD) and trauma (sexual assault).
*I have extensively processed my trauma in talk therapy and through body work, it is not an issue in my relationship or elsewhere in my life, just in cases where I am forced to be in a physically vulnerable position (like a pelvic exam) with people I don't know/trust (like a new clinician).
If you are in Toronto, feel free to memail me for a recco. My PPPT was amazing, very calm and... "respectfully casual" would be a good way to put it? And she was VERY consent oriented. She once asked if I was ready for her to do something. I was actually fine with it and I said yes- but I kind of jokingly rolled my eyes, like, "who could ever be ready for that". She immediately and calmly stepped back out of my personal space, and gently said "It's ok, we don't have to do that now! Would you like to do more crunches, or we could take a little break?" It was literally the most respect any healthcare provider had EVER shown me, all through a life of gyno appointments, pregnancy checks, birth, and postpartum. I was so shocked to see the difference it makes when someone gives a shit about ACTUAL CONSENT that I teared up. She was amazing.
posted by nouvelle-personne at 2:40 PM on October 26, 2020 [8 favorites]
posted by nouvelle-personne at 2:40 PM on October 26, 2020 [8 favorites]
I have family members I have taken to PFPT. One person did (with full consent) get an internal exam (not at the first appointment, I think it was 3-4 apt in). The other person has purely excercises which resemble conventional physio excercises. A gentle abdominal (external exam) was done, but no different than a standard abdominal exam. One did 5? 6? appointments, but continues to do excercises years later. The other is followed on an ongoing basis.
For all medical things, you can choose to consent to procedures, and delay or just say no to certain procedures. I think a lot of women have concerns about pelvic floor therapy, and having concerns related to trauma is probably a lot of more common than you think!
If nothing else, understanding the anatomy and some coaching around excercises/stretches you can do on your own, in your own time, is likely to be helpful. However, if you find someone you are comfortable with, there is more that they can offer.
There is also biofeedback (think a small insertable with pressure sensors) which literally can gamify strengthening to right muscles. TENS is sometimes an option in PFPT depending on goals, and this is external applied away from the pelvic floor (like on lower back, or sometimes legs). As mentioned above, external or internal manipulation can also relieve pelvic floor muscle spasm which is totally a thing.
A good PFPT will look at the goals, help you asses what you're comfortable with, and build a relationship. If you meet someone and you're not comfortable, find someone else!
posted by Northbysomewhatcrazy at 2:45 PM on October 26, 2020 [1 favorite]
For all medical things, you can choose to consent to procedures, and delay or just say no to certain procedures. I think a lot of women have concerns about pelvic floor therapy, and having concerns related to trauma is probably a lot of more common than you think!
If nothing else, understanding the anatomy and some coaching around excercises/stretches you can do on your own, in your own time, is likely to be helpful. However, if you find someone you are comfortable with, there is more that they can offer.
There is also biofeedback (think a small insertable with pressure sensors) which literally can gamify strengthening to right muscles. TENS is sometimes an option in PFPT depending on goals, and this is external applied away from the pelvic floor (like on lower back, or sometimes legs). As mentioned above, external or internal manipulation can also relieve pelvic floor muscle spasm which is totally a thing.
A good PFPT will look at the goals, help you asses what you're comfortable with, and build a relationship. If you meet someone and you're not comfortable, find someone else!
posted by Northbysomewhatcrazy at 2:45 PM on October 26, 2020 [1 favorite]
I had 10 months of PFPT for pelvic pain (endometriosis, fibroids, and what turned out to be a very tight pelvic floor). I hated it and didn't feel like it did that much for my pain, but on the other hand, it was just sort of a shot in the dark to see if it could help. I did get some techniques out of it that I still use today, and I learned that I do *not* need to do kegels, like, ever, because I need to be doing the opposite. That part was very helpful! And yeah, I can also say that my gyn appointments are no big deal AT ALL now, because I'm very good at relaxing those muscles. My endo specialist gyn said last month that he's maybe never seen an endo patient have such an easy physical exam!
As for the trauma part, I will second those in this thread who had really caring, careful, thoughtful and concerned PTs. I have maybe not ever seen a medical practitioner who was as thoughtful about consent and trauma as my PFPT was. I think it would be important for you to at least share a little of your past with her so that she can be informed to be extra clear with you in situations that are likely to trigger you.
As for what was involved, we didn't jump right into internal manipulations. That took a few sessions. There was a lot of interviewing, then diagrams and explanations, some paperwork, some exercises to do at home. Then external manipulations. Then, eventually, internal work, which honestly I hated because it was pushing on things that hurt, LOL. Not fun, but that's not everyone's experience -- it depends on what you're getting worked on for.
All in all, I'm glad I at least tried it. I kind of wish I'd only given it 6 months because I think that's as much good as it did for me. But I don't have to wonder if it could help.
posted by fiercecupcake at 3:29 PM on October 26, 2020
As for the trauma part, I will second those in this thread who had really caring, careful, thoughtful and concerned PTs. I have maybe not ever seen a medical practitioner who was as thoughtful about consent and trauma as my PFPT was. I think it would be important for you to at least share a little of your past with her so that she can be informed to be extra clear with you in situations that are likely to trigger you.
As for what was involved, we didn't jump right into internal manipulations. That took a few sessions. There was a lot of interviewing, then diagrams and explanations, some paperwork, some exercises to do at home. Then external manipulations. Then, eventually, internal work, which honestly I hated because it was pushing on things that hurt, LOL. Not fun, but that's not everyone's experience -- it depends on what you're getting worked on for.
All in all, I'm glad I at least tried it. I kind of wish I'd only given it 6 months because I think that's as much good as it did for me. But I don't have to wonder if it could help.
posted by fiercecupcake at 3:29 PM on October 26, 2020
I went for hip and back pain that was exacerbated by pregnancy, after regular PT did not work. I did not need an internal exam or manipulations so my experience is different than many, but I will echo that my therapist was extremely kind and sensitive. I have a lot of anxiety with doctors and I was able to trust her and feel comfortable. And she was extremely knowledgeable!
posted by mai at 3:48 PM on October 26, 2020
posted by mai at 3:48 PM on October 26, 2020
I have done this and have a sexual assault/trauma history. I'll echo that my experience was very good, much better than I expected. I did do internal work when I was ready and it was very gentle and much better than a pap smear. I would encourage you to disclose your trauma history to your PT as she will likely be great about it. Please go ahead and do this, it can be so helpful!
posted by medusa at 3:59 PM on October 26, 2020 [1 favorite]
posted by medusa at 3:59 PM on October 26, 2020 [1 favorite]
My experience was I was treated as though I had trauma even though I said I didn't. I find having my hair washed at a salon too much of a breach of my private space (it's bad enough I started cutting my own hair), and I got through pelvic floor therapy with zero bad memories.
posted by Dynex at 6:53 PM on October 26, 2020
posted by Dynex at 6:53 PM on October 26, 2020
I did pelvic floor physical therapy about 12 years ago, also for vaginismus like leftover_scrabble_rack describes. I didn't have preexisting trauma but did have a lot of nervousness, pain, and sensitivity about pelvic exams and pretty much anything or anyone touching my groin.
PT was very helpful and even relaxing. I saw a female therapist who was experienced with this type of therapy. She followed my lead and the only times she touched me were to attach some sensors to my pelvic region for biofeedback and a few external checks to see what my baseline tension level was. My therapy consisted of lying down in a dark warm room with a screen displaying a biofeedback image (a circle, a flower). The sensors would respond to how tense my muscles were, and make the picture change (tense muscles = small circle; relaxed muscles = opening wider circle). I worked on basically training my muscles to relax or tighten at will as I slowly inserted dilators (first very small, then larger as I got used to it). The therapist stayed out of the therapy room for most of my sessions so it was just me in this dark room. I was also given stretches to do at home. Ultimately it worked - I think I did it for about 3 - 4 months - and I was able to get pelvic exams, use tampons, have sex, etc. without issues.
I will add one thing that helped me for the couple years I was navigating this issue, was to write down a quick summary of my history/issue in advance, and just have the doctor(s) read it at the appointment instead of me stammering out an explanation (I often teared up when telling people about my vaginismus, so this also got around that). "I have vaginismus and pelvic exams are very difficult and painful. I prefer to insert the speculum myself and then you can check placement and adjust as needed." If you think it'd be helpful, you could try writing out a note for the therapist re: your history of trauma and what approach would be best for you.
posted by castlebravo at 7:25 AM on October 27, 2020 [1 favorite]
PT was very helpful and even relaxing. I saw a female therapist who was experienced with this type of therapy. She followed my lead and the only times she touched me were to attach some sensors to my pelvic region for biofeedback and a few external checks to see what my baseline tension level was. My therapy consisted of lying down in a dark warm room with a screen displaying a biofeedback image (a circle, a flower). The sensors would respond to how tense my muscles were, and make the picture change (tense muscles = small circle; relaxed muscles = opening wider circle). I worked on basically training my muscles to relax or tighten at will as I slowly inserted dilators (first very small, then larger as I got used to it). The therapist stayed out of the therapy room for most of my sessions so it was just me in this dark room. I was also given stretches to do at home. Ultimately it worked - I think I did it for about 3 - 4 months - and I was able to get pelvic exams, use tampons, have sex, etc. without issues.
I will add one thing that helped me for the couple years I was navigating this issue, was to write down a quick summary of my history/issue in advance, and just have the doctor(s) read it at the appointment instead of me stammering out an explanation (I often teared up when telling people about my vaginismus, so this also got around that). "I have vaginismus and pelvic exams are very difficult and painful. I prefer to insert the speculum myself and then you can check placement and adjust as needed." If you think it'd be helpful, you could try writing out a note for the therapist re: your history of trauma and what approach would be best for you.
posted by castlebravo at 7:25 AM on October 27, 2020 [1 favorite]
Soooo my solution to this was to pop one (1) clonazepam before each appointment which let me feel relaxed - almost to the point of feeling goofy - though still alert and 'together' for the next hour.
The appointment itself was not at all the issue (my anxiety and panic was), and I was already trying to address the trauma via long-term psychotherapy, so like, there was no deeper solution that I could try. As I saw it, my panic attack before every pelvic floor exams/therapy was a stupid, shallow, momentary problem that deserved a stupid, shallow, momentary solution. And it worked great.
Note: I had no history of substance abuse or other complicating conditions, YMMV.
posted by MiraK at 9:24 AM on October 27, 2020
The appointment itself was not at all the issue (my anxiety and panic was), and I was already trying to address the trauma via long-term psychotherapy, so like, there was no deeper solution that I could try. As I saw it, my panic attack before every pelvic floor exams/therapy was a stupid, shallow, momentary problem that deserved a stupid, shallow, momentary solution. And it worked great.
Note: I had no history of substance abuse or other complicating conditions, YMMV.
posted by MiraK at 9:24 AM on October 27, 2020
I did PFPT about 5 years ago for vaginismus, which meant that I was constantly clenching my muscles and they would spasm painfully for years. I had a fair amount of trauma and paranoia from doctors not taking me seriously or ordering invasive procedures to try and diagnose me. When I finally did get my correct diagnosis, PT was the only thing that helped me, and was easily the most positive medical experience of my life.
I will recommend that you try a place that specializes in women's health, and not somewhere like Athletico which only has pelvic floor PT in tiny print on their website. My physical therapist was clearly used to working with women who had a fair amount of trauma whether from assault or from childbirth, and she absolutely put me at ease. I did tell her in general terms what I had experienced, but didn't go into specifics and she didn't ask.
I think we only did "internal" work in the first 2-3 appointments, just so she could determine which muscles were spasming. This involved just a single finger or sometimes two, and she kind of narrated what she was doing so that I knew what was going on. The next 3-4 sessions were done via biofeedback, which just required sensors on my back and butt, while we worked through some exercises to relax and strengthen those muscles. My last 2 sessions were regular PT for strengthening my back, hip, and leg muscles and I remained clothed throughout. I did have regular assignments to work on at home, but I could honestly do most of them while driving or watching tv.
I keep up on my exercises and haven't had to go back. Honestly, I wish I did it far earlier. If you're in the western Chicago suburbs, message me if you want a recommendation.
posted by little king trashmouth at 9:34 AM on October 27, 2020 [1 favorite]
I will recommend that you try a place that specializes in women's health, and not somewhere like Athletico which only has pelvic floor PT in tiny print on their website. My physical therapist was clearly used to working with women who had a fair amount of trauma whether from assault or from childbirth, and she absolutely put me at ease. I did tell her in general terms what I had experienced, but didn't go into specifics and she didn't ask.
I think we only did "internal" work in the first 2-3 appointments, just so she could determine which muscles were spasming. This involved just a single finger or sometimes two, and she kind of narrated what she was doing so that I knew what was going on. The next 3-4 sessions were done via biofeedback, which just required sensors on my back and butt, while we worked through some exercises to relax and strengthen those muscles. My last 2 sessions were regular PT for strengthening my back, hip, and leg muscles and I remained clothed throughout. I did have regular assignments to work on at home, but I could honestly do most of them while driving or watching tv.
I keep up on my exercises and haven't had to go back. Honestly, I wish I did it far earlier. If you're in the western Chicago suburbs, message me if you want a recommendation.
posted by little king trashmouth at 9:34 AM on October 27, 2020 [1 favorite]
This thread is closed to new comments.
I think I went for about 6 months, on a weekly basis. The appointment were either 30 or 60 minutes; I can't remember. The first one or two appointments were about talking about my history and looking at a model of the pelvic floor to understand how everything works. Then we moved onto the actual PT part. First, she did some muscle release work on the outside of my pubic area; pressing down firmly on clenched muscles to get them to loosen up, for example. We then moved onto what are called dilators, which are plastic rods of various thickness that you insert into the vagina to get it comfortable with that stretch/sensation.
Yes, we had to do the dilators in the actual exam room. I wouldn't have had the nerve to do it myself, so I'm glad my doctor did it with me. I also had my own set so I could do homework between sessions. We started with just her finger, then a tiny rod, then a slightly bigger one, etc.
At the end of six months, I had a Pap and pelvic that was so incredibly easy that my OB-GYN said I was more relaxed than 90% of patients, including people who had given birth multiple times.
Ten years later, I still do the dilators for a few weeks before physical exams. In the last 10 days, I've had both a Pap/pelvic AND a transvaginal ultrasound, and both of them were NBD because I can still rely on my PFPT exercises and training.
I have no idea whether PFPTs in general are trained in trauma, but I found my PT to be extremely sensitive, compassionate, and patient. I never felt freaked out or rushed. Sometimes I cannot BELIEVE I was able to do all of that, but her bedside manner made it possible. If you talk to your PFPT and they don't seem sensitive to your needs or issues, hopefully you can find another one! That part was really important for me.
I am happy to talk more about this privately if you'd like! Good luck -- PFPT was the best thing I ever did.
posted by leftover_scrabble_rack at 2:27 PM on October 26, 2020 [8 favorites]