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Dr. Barbara Bolen

Exercises for Pelvic Floor Dysfunction

By March 8, 2013

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One of my favorite things about this job is that I learn about IBS not just from reading journals, but from the great information sent to me from generous readers. Some time ago, I had published a blog announcing an article written by Marguerite Ogle, About.com Guide to Pilates: "Exercises to Strengthen the Pelvic Floor". What I have since learned is that when it comes to treating pelvic floor dysfunction (PFD), what is needed is to stretch the pelvic floor muscles, not strengthen them.

What I have also learned is that there are many physical therapists who specialize in this kind of work. They use manual therapy techniques, in addition to things like biofeedback and relaxation exercises, to help to relax and retrain the pelvic floor muscles. These services are typically covered by insurance. If you think that your bowel or bladder trouble may be related to PFD, this is certainly an avenue to pursue. The following article, written by Brett Sears, About.com Guide to Physical Therapy, will help you to find an appropriate therapist:

Related Reading from Dr. Bolen, Your IBS Guide:

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April 9, 2013 at 7:14 pm
(1) JETZY1 says:

I was told I had PFD after having an anal manometry and defecography test at a well-known clinic. They wanted me to go through an intense 2-week physical therapy for PFD at their clinic. This was 6 years ago. My insurance refused to cover the therapy. After going to local PTs who tried to help but didn’t believe in biofeedback, I went back to the clinic for some motility testing last year and again they wanted me to go through their 2-week therapy. I thought that by now that biofeedback would have enough evidence for insurance to cover it but apparently that isn’t the case. I’ve heard the same thing from other patients. I’m now trying to appeal with my insurance company but when I spoke to them they weren’t optimistic ‘m waiting for a decision from them yet.. And the cost is too prohibitive for most people to pay on their own. The Dr. I saw at the clinic said there was nothing she could for me other than recommend this therapy. This seems very cruel- if you don’t happen to have the right insurance or can’t win the lottery you are out of luck! Plus I’m insured through my job so I don’t have much choice when it comes to insurance. None of the plans they offer will cover biofeedback therapy for PFD.

December 21, 2013 at 4:34 pm
(2) maria says:

I, too, was just diagnosed with PFD after years of pain and bloating and being told it was IBS, I finally figured out first that I had a female issue – no Dr. told me the symptoms could be the same — nd had a hysterectomy and found not endometriosis but chronic pelvic syndrome with other issues. I felt great afterward and the bloating and pain went away. A few months later a different kind of pain, pelvic, began, and a different kind of bloating. I have been miserable again since, nearly a year. The GI Drs completely ignoring what I was telling them. I, too, went to a Clinic that says the 2 week therapy is the only treatment and my insurance also will not pay. Funny they will pay for the diagnostic but not for something that would keep the patient from running to more and more doctors in search of the answer. I have no more life, I do nothing, I go nowhere, and I cannot wear anything but baggy clothes. I feel humiliated and degraded — not that the therapy sounds like much fun but if it would help relieve the symptoms. I am barely 50 and wish I had never been born. By the way, my crappy insurance is Humana. That company has always been terrible and if I had a choice I would switch.

January 1, 2014 at 8:57 pm
(3) Danielle says:

In reading others comments I wanted to share my experience and learning in an effort to help.

I too have Pelvic Floor Dysfunction (PFD) and was first diagnosed by a GI, then a Uro-Gynecologist (who said by the way that it was unusual that a GI got it right). I am adopted and do not know my family history, thus I had an ultra-sound and colonoscopy to rule out any other conditions (and because I’m close to 50 yrs anyway). Insurance did cover this given unknown family history.

Part #1
I have been going to a Physical Therapist for a year now and it has worked wonders. With myofacial massage the spasms in the vaginal area can be “worked out”, as well as the unfortunate newly formed rectal massage spasms due to a bicycle fall in the summer, and a fall down stairs a couple of months ago.
I have learned a lot and I advise ALL women with this condition to “stay the course” to improve YOUR HEALTH — this will NOT go away, and if you are suffering from constant chronic pain, the risk is that your pain receptors may have over-fired and may be more sensitive to “a baseline normal” creating a very bad situation for your healing and normal health. (Pain inhibits the muscles from working properly, getting enough oxygen, and relaxing which is imperative to your healing process). If you are in constant pain, and do not sleep well (get “restorative” sleep) this can and often does worsen the condition,
After a follow up visit to my Uro-Gynecologist, she prescribed a few things to address the problem of chronic pain that has been occurring for a year now — again, this MUST be done to allow the muscles to start healing (reset themselves to normal before physical therapy can really work!)

January 1, 2014 at 8:59 pm
(4) Danielle says:

Prescriptions: #1 – Diazepam (valium) which gets inserted vaginally or rectally and greatly reduces the spasms taken at night before bed to aid in restorative sleep; #2 Amitriptyline – mild dosage of this anti-depressant because this classification of drug is shown to help eliminate long-term chronic pain; #3 Seasonique “the pill” to eliminate periods for 3 months. It should be noted that I have been taking extra-strength Ibupropren for a year now, mostly at the max daily dosage (which has concerned me for risks tied to long-term usage) and it was NOT eliminating the pain. I am an “anti-drug” person by nature, however the combination of these new three drugs has changed my quality of life. (When this all started 1 year ago my symptoms were very severe: uncontrolled and urgent bowel movements (with major gas) — pooped my pants 3 months earlier; lower back pain; unable to sit for longer than 1 hour without extreme pain; unable to ski although a strong skier. These symptoms presented themselves similarly to a bowel cancer of which I thought I had (a close family member passed away from this disease), and I was scared to death that I was in real trouble).
I understand concerns regarding the costs of Physical Therapy — We have private insurance and pay out of pocket $1200 monthly alone for the therapy. I likely have another 4 months to go and then my lower “Iso-Abs” will be strengthened and with Kegels and other pelvic exercises I should be recovered as far as possible. This treatment time would have been GREATLY REDUCED if I had followed up with my Uro-Gynecologist sooner, who would have been able to address the pain which was getting in the way of the Physical Therapy treatment (not to mention, changing my quality of life).

January 1, 2014 at 9:01 pm
(5) Danielle says:

Ladies, if you have Pelvic Floor Dysfunction YOU MUST ADDRESS THIS AT ALL COSTS! It will NOT go away (especially if you are having chronic pain) and you GREATLY RISK future bladder conditions and additional problems (new pain symptoms in the pelvic floor area, back, legs, etc…) which often lead to full hysterectomies later in life.
Also interesting, in Europe, Pelvic Therapy is RECOMMENDED FOR ALL WOMEN WITH VAGINAL CHILD DELIVERIES and is a STANDARD TREATMENT OF CARE.. and is covered by insurance there — IT IS PROVEN TO WORK. (Here in the USA, the condition is left alone, women suffer, and later in life additional complications arise leading to SURGICAL TREATMENTS to solve the problem).


(Also, btw, I have been a fit woman prior to this experience that started last year… usually bicycle 80 miles weekly, and took martial arts for 2 years and still have strong upper abdominal muscles. The biofeedback is needed to learn how to gently and correctly isolate lower abdominal muscles and kegels (tighten and release… therapists watch your muscles and recommend personal plan with # of exercises daily depending on your personal response, muscle relaxation and ability and condition) WITHOUT using upper abs!) You cannot learn to do this correctly and effectively without biofeedback.

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