Sunday, July 16, 2017

Pelvic Floor Dysfunction and IC

Since a long time, I have wanted to go through Pelvic Floor therapy. My instincts say that my IC is related to Pelvic Floor Dysfunction or (PFD). I met a pain doctor in Mumbai who also felt the same. However the problem is in India we do not have any skilled pelvic floor therapist yet.
Many people with interstitial cystitis (IC) have problems with the group of muscles in the lower pelvic area and develop a condition called pelvic floor dysfunction (PFD). If you have IC and a poor urine stream, feel the need to push or bear down to urinate,  and have painful intercourse, you may have PFD. Treating PFD may be very helpful in reducing symptoms and pain for some IC patients—most patients see improvement after several weeks of therapy.

The “pelvic floor” refers to a group of muscles that attach to the front, back, and sides of the pelvic bone and sacrum (the large fused bone at the bottom of your spine, just above the tailbone). Like a sling or hammock, these muscles support the organs in the pelvis, including the bladder, uterus or prostate, and rectum. They also wrap around your urethra, rectum, and vagina (in women).
Coordinated contracting and relaxing of these muscles controls bowel and bladder functions—the pelvic floor must relax to allow for urination, bowel movements, and, in women, sexual intercourse.
PFD is usually related to the presence of too much tension (or high-tone), the opposite of the too-relaxed state (or low-tone) that contributes to incontinence. However, sometimes IC patients with PFD can have a combination of muscles that are too tense and too relaxed.
In patients who have IC or other pelvic pain conditions, these muscles may be tight or in spasm, have a combination of tightness and weakness, or have pain-triggering spots or knots called “trigger points.”
Many of the urinary, bowel, or sexual symptoms IC patients experience can be signs of PFD, including:
Urinary urgency, frequency, or hesitancy, stopping and starting, painful urination, or incomplete emptying
Constipation, straining, pain with bowel movements
Unexplained pain in your low back, pelvic region, genital area, or rectum
Pain during or after intercourse or orgasm
Uncoordinated muscle contractions causing the pelvic floor muscles to spasm
Physicians or physical therapist (PT) who is specially trained in treating PFD diagnose the condition during a physical examination. However there is lack of IC specific PTs in India.
PT ‘s diagnose using external and internal “hands-on” or manual techniques to evaluate the function of the pelvic floor muscles, they can assess your ability to contract and relax these muscles.
Bones and muscles of your lower back, hips, and sacroiliac joint can stress your pelvic floor muscles. Your doctor or PT will first check externally and internally for problems such as muscle spasms, muscle knots, and weakness or sacroiliac misalignment (where your sacrum and upper hipbones meet).
If an internal examination is too uncomfortable for you, they may use externally placed electrodes, placed on the perineum (area between the vagina and rectum in women/testicles and rectum in men) and/or sacrum (a triangular bone at the base of your spine) to measure whether you are able to effectively contract and relax your pelvic floor muscles.
Another way to measure pelvic floor contractions is with a perineometer, a small, tampon-like sensing device placed into the vagina or rectum.
Physical therapist (PT) should be specially trained in the techniques that help IC and pelvic pain patients.
Physical therapy to treat these problems can go a long way toward easing pain and bladder symptoms. The physical therapy techniques that help relax and lengthen tight muscles and release trigger points are different from the ones that help incontinence patients, who mainly need to strengthen the pelvic floor through Kegel exercises. IC patients DO NOT DO KEGEL. Kegel exercises, frequently used to treat incontinence, may make both IC and PFD symptoms worsen.

The goal of PFD therapy for IC patients is to relax these muscles and avoid stressing them. Treatment usually combines self-care, medicines, physical therapy, and home exercise.
Self-Care—Avoid pushing or straining when urinating and treat constipation. Relaxing the muscles in the pelvic floor area overall is important. Using methods such as warm baths at least twice a day is helpful.
Medicines—Low doses of muscle relaxants may be helpful. Maintaining good posture to keep pressure off your bladder and pelvic organs and using stretching or other techniques such as yoga to avoid tightening and spasms in the other pelvic muscles, also help PFD therapy to succeed.
Physical therapy—a physical therapist specially trained in pelvic floor rehabilitation may take the following steps to help you obtain relief from your PFD:
External and internal evaluation of pelvis
External and internal manual therapy
Application of various devices to help relax your pelvic floor
Training in home exercise and therapy.

The book HealingPelvic Pain  by Amy Stein is very useful to start with basic exercises on Pelvic Floor. There are also Youtube videos to help us. Yoga also helps.

If you are having too much trouble then just try the following position. It should ease your problem a bit.

Few other postures are as follows:

Image Courtesy: Google
Resource: ICA


  1. Thank you for sharing it. Tibial nerve stimulation i.e ptns and tens unit is also good for ic

  2. Hi Balaka. I am travelling with my daughter to India for 3 weeks in Dec/Jan and she has been newly diagnosed with IC. She is so lucky she seems to be symptom free when she is careful with her diet however we would love you to publish an Indian Restaurant Eating Guide.... maybe the names of some dishes? She is very disappointed by the prospect of living on straight naan and rice while I taste every heavenly morsel on her behalf. Sigh. I love food and so does she so what should she try to make her food list more tantalising? (We will be in Southern India, TN, KL, KA)

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