Pelvic floor therapy after menopause

[CatsandCars]

Hi, I am in the US, so a few things are different, but I am looking for help. I have MS, and I have muscle tightness or spasticity in other places as well as pelvic pain and tightness of my hip flexors. When I the hip pain worsens, so does the pelvic pain. I found a specialist who wants me to use vaginal Valium suppositories to help relax the muscles to make physical therapy easier to tolerate. I am taking another benzodiazepine for sleep/anxiety (clonazepam) and I'm not sure if the doctor prescribing that will want me to mix the two, especially since I am taking opioids and baclofen, which both tend to slow respiration.

So my question is, does your doctor give you local muscle relaxers before physical therapy? Or are oral ones, like baclofen, good enough?

Another thing that really scares me is that I am well past menopause and the doctor wants me to use vaginal estrogen to make the internal therapy more tolerable. I would love to be able to use it, but I've tried it before and every time it has started out okay, but within a week or two, I get terrible pelvic pain. As bad as it gets. Doctors seem surprised by this. Has this happened to anyone else?

Is physical therapy even possible with postmenopausal atrophy?

I start therapy in less than two weeks, so I will be able to ask the therapist then, but I am in desperate need of help and I'm worried that what seemed like my best option may not be ideal or even possible.

[kellerfly]

Hello, I am also in the US. I used to take vaginal Valium, but my dr has told me it doesn’t work (I feel it did, but whatever) — so I am on vaginal and oral baclofen. I am in physical therapy — and they are so careful with me. If they aren’t being careful and slow with you, find another internal therapist! I know they are not easy to find, but truly, I did not like one, and I found another. I also have them do dry needling as well as internal release. That is not easy to find, but many are including this in physical therapy now.

Not sure if this helped, but I hope you can find relief.

[CatsandCars in reply to kellerfly]

Thank you for responding. It's good to hear that your PT is gentle. I've developed anxiety from having health issues that doctors can't seem to address. This particular problem has been keeping me from walking any farther than the mailbox for over a year. So I guess I need to try to rein in the anxiety until I actually speak with the therapist. Easier said than done, though.

[Cookie24]

I use Flexeril suppository. It works better for me than Baclofen.

[CatsandCars in reply to Cookie24]

That's interesting, thanks. I actually have a baclofen pump in addition to the oral baclofen, so I'm not sure if my doctors would want me to mix the two. Just like my situation with my clonazepam and the suggested valium! I'm just on too many things already. But I am so glad it's working for you, and I will ask about it!

[GGCat]

I have Levator Ani syndrome for which I take baclofen (prescribed as 10mg 3x daily, but I only take it at night because it makes me too drowsy in the daytime). I'm 10 years older than you - so 18 years post-menopausal - and last year had 6 months of PT that included internal therapy. I had no problem with it (no estrogen). I had PT a few years ago - and continue the exercises on my own - for my hip flexors and fasciitis in my outer thigh. But my pain may be nothing like yours, so internal therapy may be different for you. I hope this helps.

(Also, I had a few years of chronic bronchitis and discovered a few years back that when they gave me a steroid injection - Kenalog - in my hip for the bronchitis, it greatly eased my pelvic floor pain for 2 or 3 months. My primary care doctor listened and he allows me to take them up to 3 times a year. I try to go somewhat past 4 months, but much past 18 weeks really interferes with my sleep and my life. ) Edit: It usually takes 7-14 days for me to really notice the benefit of the Kenalog injection.

[CatsandCars in reply to GGCat]

Thanks so much for letting me know that it's theoretically possible. I do have atrophy so I think that's part of the problem, but it's good to know. Thanks for mentioning the Kenalog, too.

[Konagirl60]

Hello. I’m 66 and vaginal estrogen did NOT agree with me at all. It made me very bloated and it caused more pain. I’m like you.

If vaginal moistness is a concern, can you access SeaBuckthorn gel caplets or juice? It’s Nature’s best rehydration and it contains Omega 6. It might be worth a try. Aloe Vera juice may help as well.

I used vaginal Valium suppositories for 10 years due to having severe pudendal neuralgia. They helped the muscle spasms under my bladder and in my small intestines. Mine were 10mg each and my pain was so bad I needed to use two of them every night.

Maybe one 5 mg Valium suppository is all you’d need. I did use the suppositories along with my sleeping pill and I had no serious side effects but I did have morning drowsiness. Valium is a light sedative.

A key point someone else mentioned is that the PT MUST BE GENTLE. I had a PT who was so vigorous in manipulating up my vagina and into my rectum that she injured me permanently. That is NOT acceptable.

Keep me posted. Try not to worry.

[CatsandCars in reply to Konagirl60]

Thanks so much for replying! I went ahead and filled the 5 mg Valium suppositories in my optimism, but I'm waiting to hear back from my doctor who prescribes the clonazepam to see if I can mix the two, along with the muscle relaxer and pain pills. I don't want to stop breathing! Maybe that's what I should tell the urogynecologist. She seemed pretty upset on my second appointment that I hadn't used the Valium or estrogen . So I started using the estrogen, and when it hurts I will call the doctor and tell them, and hopefully they'll realize I can't use it. I already feel like I have sausage fingers.

Sorry for venting. It means so much to know that someone else has worsening pain with estrogen! Doctors don't seem to understand it, and I was wondering if it could possibly be a coincidence that the pain got bad every time I used estrogen. This will be the third time I've tried it (four if you count Intrarosa, which does the same thing). It's good to know I'm not crazy.

I am so sorry that you had a bad PT damage your body! That's so terrible. It sounds like you don't need the Valium anymore; is your pain level better now? I hope you were able to get the right treatment.

I will definitely make the therapist stop if it's too painful. Until the need for pelvic floor therapy arose, I was pretty comfortable/content just using hyaluronic acid suppositories (Reveree or Hyalogyn).

Do you take the Sea Buckthorn gel/juice orally?

I will meet the therapist next week, and I'm hoping that she can tell me more. Maybe she can have me use dilators or something. And be gentle!

Thank you again for your response.

[Konagirl60 in reply to CatsandCars]

How did your appointment go?

[CatsandCars in reply to Konagirl60]

Hi, thanks for asking! I had my initial appointment last week, and my first actual appointment today. I guess it went pretty well. She had me go through the home exercise routine, which is more than what I had done previously (20 reps of some of them, and she wants me to do them every day, plus use the dilators) which kind of bums me out a little bit - I was hoping to ease into it a little more, but of course I have to do what she tells me. The external work was pretty good; the internal stuff was more uncomfortable, but the therapist kept it relatively short. She kept asking me if I was okay the whole time, which is probably a good sign. I'm pretty sore, and the pain is worse but it didn't seem bad while she was working on me.

The doctor told me to try just using a small amount of estrogen once a week and see how that goes. I'm not happy about it, but I'm going to see if I can stand it for another week.

Thank you again for checking up on me. The doctor said they "can't promote the use of supplements" when I asked about the sea buckthorn, but I'm not ruling it out if the estrogen doesn't work out.

[Konagirl60 in reply to CatsandCars]

What is the purpose of the dilator? Has your PT determined whether you can do a ‘ reverse’ kegal? I couldn’t because of my entrapment.

My PT said I was lazy when in actuality using a dilator made me worsen considerably. I should never have been told to do kegels with a dilator while I had my pudendal nerve pinched in three spots! PT’s make mistakes.

The Sea Buckthorn is wonderful. I know you’ll make the right decision. Keep me posted.

[CatsandCars in reply to Konagirl60]

I'm not doing kegels at this point. The dilators are supposed to make the muscles and the fascia less painful. I am okay with doing it (she left it up to me). It's just that, like the exercises, I am going to have to find the time to do it. That's the only part that's going to be difficult.

[Konagirl60 in reply to CatsandCars]

Don’t give up. You’ll find the time. You matter.

[CatsandCars in reply to Konagirl60]

Thanks! Don't worry, I won't. It's taken a long time and a painfully expensive change in insurance to get these providers, and my quality of life has really suffered, so I didn't mean to give the impression that I am anything less than highly motivated. 😊 I appreciate your encouragement!

[Konagirl60]

Yes, I had the three surgeries I needed ( all done many many years too late due to medical incompetence in Canada ). I weaned off the Valium after using it for 13 years. It was not easy…it took 6 months and I’ve never sweated so much and felt so unbalanced mentally as I did getting it out of my system. I did survive though and it’s out of my system.

Good luck with the estrogen. The SeaBuckthorn I use is a gel caplet. It’s amazing.

Keep me posted