Health Topics

Physical Therapy for Pelvic Pain

Andrew Schorr:

Thank you for joining us today for our live program from New York City. I’m Andrew Schorr broadcasting live and delighted to be here in the town where I grew up. We’re at the Women’s Sexual Health Foundation. Sitting across from me is Amy Stein. She is a physical therapist who helps women with all of these painful issues that can get in the way of sex. She had a big August. She had a baby. Was that your first baby Amy?

Ms. Stein:

Yes, that was my first baby.

Andrew Schorr:

And then you delivered another “baby” a book, “Heal Pelvic Pain.”

Ms. Stein:

Yes, yes it was very exciting month.

Andrew Schorr:

Okay, so there may be millions of women who have had pelvic pain at one time or another. Can it be healed, and how does physical therapy help?

Ms. Stein:

Basically I’m a physical therapist, and I specialize in pelvic floor dysfunction in the musculoskeletal system, and if there is a musculoskeletal disorder with the pelvic floor it can be helped through various manual therapies, stretching, massage techniques as manual therapy, strengthening as well as using biofeedback, which some people are familiar with, to help learn to relax the muscles as well as to help strengthen the muscles.

Andrew Schorr:

Now let’s talk about some topics that I’ve come across in our earlier programs. We did a program on pelvic organ prolapse. So here one woman had a baby, a big baby, and things were just not organized the same say afterwards, and she felt like her insides were coming out, and that terrified her about sex and also even made it painful.

So she was doing Kegels and other exercises. Tell us how that sort and maybe sometimes along with surgery or maybe not can help them get back in the game, if you will.

Ms. Stein:

There are many causes of pelvic floor dysfunction, childbirth being one of them, surgery being another, as well as just a simple thing as a urinary tract infection or a yeast infection, and it can wreck havoc in the pelvic floor muscles, and pelvic organ prolapse is a syndrome that can result from weak pelvic floor muscles, and it can happen from childbirth because with childbirth the muscles are stretching, but fortunately there is a way to fix it.

Specifically for pelvic organ prolapse you can do Kegel exercises, which is contracting the pelvic floor muscles to strengthen those muscles which help support the pelvic organs, and they help with sexual function as well as bladder and bowel function, so that’s another important topic all in itself is that pelvic floor dysfunction can disrupt bladder, bowel, and sexual function.

Andrew Schorr:

All right let’s talk about that because we’re talking about millions of people; incontinence and there were all sorts of TV ads, you know, but some women have leaking; and they say, ‘Whoa, how can I have sex when I’m worried about urinary leakage?’

Ms. Stein:

Right, and that again just leakage can be helped with strengthening exercises, with Kegel exercises, and it’s important to do repetition. I’ve had many women come to me saying that they’re still incontinent or they’re still having difficulty with orgasm because their muscles are weak. Then we go through their exercise routine with the Kegel exercises, and either they’re not doing enough or they’re actually doing them incorrectly, and that’s where the biofeedback can come in handy or just someone looking at the muscles and feeling the muscles to see if they are doing the exercises correctly, and I know women get very frustrated because they say, ‘I’m doing these Kegels and nothing’s happening.’ It is possible that they’re doing them incorrectly. So it’s key to get a proper treatment and diagnosis for that.

Andrew Schorr:

All right, let me understand. You talked about biofeedback. Let’s get specific. Something is inserted in the vagina?

Ms. Stein:

You can.

Andrew Schorr:

Tell us how this works.

Ms. Stein:

It can be inserted. It actually can be inserted vaginally or rectally, just a small probe. If the patient is experiencing vaginal pain then they can actually use a probe rectally, or there are pads that you can put around the anal area that help to show what’s going on with these pelvic floor muscles. The pelvic floor muscles, let me go back to what you asked originally, they connect from the pubic bones from the front of the pelvic bone to the tailbone, and it helps support the organs and it helps with bladder, bowel, and sexual function, so if you have a dysfunction it is important to get a proper diagnosis, and biofeedback is one of the ways to get that proper diagnosis.

Andrew Schorr:

Okay and there are physical therapists who specialize in this who work with M.D.s typically, have their own practice as well who can help you shape up, if you will.

Ms. Stein:

Right, and a lot of M.D’s actually don’t even know that physical therapy exists to help this patient population. One important thing that I’d like to reach out to women about is that if they go to a gynecologist’s office, and if they have any sort of discomfort, more than usual discomfort with the examination from the gynecologist, then that is not normal, and a lot of women thing that that’s normal. A lot of women also think that painful intercourse or painful sexual activity is normal, and it absolutely is not normal, and there are ways to fix it through natural healing techniques, which I do mention in my book, and as well I know that a lot of M.D.s don’t talk about the topic, so if you are uncomfortable talking about the topic you can just hand your doctor the book and say, ‘I think I have some of these problems.’

Andrew Schorr:

I’ve got some questions for you. I want to ask a long one here Tamara. Here’s one on our question grid here. It says, ‘I’ve been suffering from chronic pelvic pain for almost three years with no solution from any gynecologist, pain specialists, physical therapists,’ she says she’s been to. ‘I’ve had treatments such as epidurals, acupuncture administered by a doctor, various kinds of physical therapy, therapeutic massage including pelvic floor treatments, countless pain medications. My GP and pain specialist have advised me to accept my situation as chronic pain and just live with it with no clear solution or diagnosis. Is there any suggestion you could make that could have me look in some other direction?’ She’s just exasperated.

Ms. Stein:

Right. The first thing I’d have to say is don’t accept this as a solution, that this is the way it should be. That’s for sure. You need to, it’s possible that the practitioners that you went to were not as familiar or as trained in pelvic floor dysfunction or pelvic pain, so that is key to find someone that has extensive training. Just like a new physical therapist coming out of school may not have as much training as someone that’s been doing it for 20 years, or there are physical therapists that just do Kegel exercises or just do biofeedback, and that is not looking at the whole picture. So that’s important as well.

You need to seek a physical therapist that specializes in massage techniques for pelvic pain. As well some just aren’t trained as much as others, so that can be a very frustrating factor if you go to someone for treatment and they just aren’t as familiar with the subject.

Andrew Schorr:

So do women have to suffer? I mean it’s often something they suffer in silence. This woman was very proactive, but I would agree with you completely. There’s an art of health care, and for us to think that anybody, that each person who wears a white coat has the same knowledge, even if they have the same title and on the surface seem to have the same training, they don’t.

Ms. Stein:

Right.

Andrew Schorr:

And so I agree with you completely. So we have women with incontinence that gets in the way of sex, pain that gets in the way of sex, maybe physical changes that get in the way of sex, and yet women often are afraid to talk about it or they think if they bring it up they’ll be “dissed” if you will often and not necessarily by a male physician but somebody they go to who they go to for another health problem, and they’re afraid to bring this up.

Ms. Stein:

That was actually one of the main reasons why I wrote my book was to get the word out there, to let people know that there are tons, millions of other women suffering. Up to 43% of adult women suffer from painful intercourse at one point in their life, and one out of four women suffer from pelvic floor dysfunction, so you are not alone. If you are sitting at a table with four friends then one of them has suffered from pelvic floor dysfunction or is suffering, so it is key to get a proper diagnosis from someone that is trained in the area, and not all physicians are trained. Many physicians actually say they don’t even talk about the musculoskeletal components of pelvic floor dysfunction. They don’t even realize that the muscles and the nerves just like anywhere else in the body can be an issue in that area. Many people are familiar with physical therapy for back pain, neck pain. This isn’t any different. It’s their muscles, their nerves, their tissues, and there could be problems in any of those areas, and it needs to be addressed from a musculoskeletal point if that’s the problem.

Andrew Schorr:

It’s funny you know here in New York I’ve been seeing all these gyms, and a lot of people working out, people getting in shape. Of course what’s great here in Manhattan is people walk a lot, which is great. So I think people are very conscious about their arms and their legs and maybe their cardiovascular system and the muscles that are involved and being in shape and toned up, but yet here we’re talking about muscles and other structures there that need to be tuned up to enjoy sex, and yet we don’t work on it.

Ms. Stein:

Right. One is that there’s a lack of awareness that you can do exercises to improve sexual function, to increase orgasm, to improve libido, and if there are any leaking issues that can be corrected through strengthening exercises. So one is that there’s just not as much of an awareness, and then two is that people are embarrassed to talk about it. They’re embarrassed to tell friends and their doctor that they are having issues, and unfortunately they are embarrassed because they shouldn’t be. Every woman should discuss this with their doctor or healthcare provider. It shouldn’t be an issue. If you don’t feel comfortable discussing it with your particular doctor there is another one out there that you can discuss this problem with. You may have to do some research, but there are people out there that are maybe more educated in this area.

Andrew Schorr:

So this book was a real mission for you?

Ms. Stein:

It was. It was, and I am not a, writing is not my strength. Physical therapy is my strength, so it was challenging, but you know what helped me were my patients. My patients were the ones who really helped me to write the book. They helped motivate me. They also helped teach me how to explain it in easy terms. So I think the book is helpful just for someone to pick up and read on their own and try some of the exercises on their own, which was my mission of writing it.

Andrew Schorr:

Now I know, the book describes this and I’m sure you have diagrams and all that, but is there anything you can tell us on the radio to give women some pointers, a little bit of a how-to?

Ms. Stein:

Sure. Well basically I divide the book into two separate problems. One is leaking and incontinence, decreased libido, decreased orgasm because of weak pelvic floor muscles. That is where those Kegel exercise which some women are familiar with, the strengthening of the muscles is very important and not just doing one or two here or there. Just like you go to the gym and you exercise your biceps, your arm muscles, your leg muscles, you have to do repetitions of the Kegel exercises. So if you do have any of the issues I just mentioned you would need to do 10 repetitions 2-3 times a day even, and you would need to do 2 different types of exercises; a short contraction of the muscle and a longer contraction in order to get the different muscle fibers. There are muscle fibers for endurance as well as for sprinting all throughout your body, so it’s important to address both muscle fibers.

The second program is the pain issues or the retention issues; urinary, bladder, bowel, frequency, urgency, retention, irritable bowel syndrome, interstitial cystitis. These are more of the pain or tension syndromes, and that requires more of manual therapy, more stretches, more deep breathing and relaxation versus Kegels. Kegels can actually make this condition worse, so it’s important to differentiate what is going on to find out what’s happening, and in the book I actually go through the different symptoms that you would experience and what program you should follow.

Andrew Schorr:

Okay, so the book again is “Heal Pelvic Pain.” The author is Amy Stein, a beautiful lady who is sitting in front of me speaking at the Women’s Sexual Health Foundation conference, and you had the baby and the book came out at the same time. What’s the baby’s name?

Ms. Stein:

The baby’s name is Zachary, and he’s adorable.

Andrew Schorr:

How old is he now?

Ms. Stein:

Seven months.

Andrew Schorr:

How is he doing?

Ms. Stein:

He’s wonderful. And then also recently but at the same time that I was writing the book I also wrote a chapter for the female sexual disorders evaluation and treatment, which is going to be given to medical schools, which is very exciting because they haven’t had a book like this before, and there’s a whole chapter on physical therapy and the treatment techniques. So, it’s getting out there. The words finally spreading and I’m very excited that the words getting out.

Andrew Schorr:

Amy, before we go, a number of the people I’ve talked to have said you know years ago we didn’t talk about breast cancer and now it’s talked about all the time, it’s very much a correct topic to talk about an important topic to talk about, but we don’t talk about sexual health issues in women. Do you think we can get there? Follow the model in breast cancer that it can be something that just of course we talk about, of course we’re working on it, of course women deserve the best.

Ms. Stein:

I hope so and about three weeks ago, ABC’s 20/20 just taped a segment on female sexual dysfunction. So we’re hoping that different shows and radio show like yours…

Andrew Schorr:

We’re scooping them…

Ms. Stein:

That different radio shows like yours will step up to the plate and address this issue and make everyone aware that there is an issue and we shouldn’t brush it under the table. That we should talk about it.

Andrew Schorr:

Alright, we’ve been doing that today. I want to thank you Amy Stein for being with us and your work and your devotion to this and I hope you have a great weekend with Zachary when you go home, I’m sure he’s waiting for Mom isn’t he. I bet he is.

Well this is what we’ve been doing during the last hour is talking about women’s sexual health and it makes sense were doing this live broadcast from the women’s sexual health foundation. It’s thrilling to be back, its great to talk about this issue. We have a whole section of our website www.patientpower.info/women where there is so much more and then of course we’ve got our vast library now of over 1000 programs on health issues across the board that are all on Patient Power. Tell your friends, we will be posting the replay of this and the transcript and this is our mission to you. Andrew Schorr and producer Tamara Perkins signing off from New York City. And always we like to say, knowledge can be the best medicine of all.

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