pain after pelvic floor physical therapy

i am writing today because i am in severe emotional and physical pain, and i need help and i know you all will understand. months ago my ob/gyn said my pelvic floor was in severe spasm and she also suspected endo. i had a lap and she didnt find anything. i was relieved, but i have seen that some women had several laps before their endo was found, and i feel like its possible that may happen with me. i just recently started pelvic floor physical therapy.

to back up: there is a correlation betweeen the pain and anxiety. it all stems from my miscarriage. it was in 2011, and i am still grieving and it has turned my life upside down. ever since then, i have an anxiety attack every time i have anything done in the pelvic area. i really think i may have PTSD in addition to grief.

i just had my 2nd pt session. today she did the internal exam, and i am having severe spasms. the worst is in the levator ani- its so spasmed that there is actually a ridge there. she gave that and other areas an 8 out of 10. it was incredibly painful. i am still in horrible pain even after taking my pain meds, and it was very upsetting emotionally...

i know that some of you have done pelvic floor pt. i am wondering about your experiences and also if any of you have been affected emotionally by it. i am also writing i think because i am so sad and i just feel really upset and alone.. thank you so much for listening and for how supportive and caring you all are.

6 Replies

  • Emsa, I'm sorry you have had such a rough time and your emotional pain is still so raw after all this time.

    8/10 on a spasm is a serious spasm. A spasm is a tightening of the muscles and yours has been tight for a couple of years. Our bodies are clever, each cell knows its job, and when the cells are renewed, the new cells follow on with the job. This is called the body blueprint. When we have an injury, or trauma, then the blueprint changes. Your spasm has changed your blueprint so now any new cells copy the spasm rather than the original relaxed muscle.

    The physio will loosen the spasm a little bit. But all those cells that have followed the new blueprint don't like it because its different to what they know. So although physio loosens up the muscle, all those cells following the new blueprint say, wait a minute, this is not right, and try and change back to how they were. Its this change back that causes the pain after physio.

    If you have physio enough times, these cells begin to stop fighting back, so that the muscle stays relaxed for longer. And this allows the blueprint to be re-written again, more in line with the normal. All this activity is controlled by the brain and chemical receptors within each cell.

    It will take a lot of physio, and unfortunately a lot of extra pain, but it can be released. Sometimes knowing the pain process makes it less scary, and also knowing that the body is reacting as it is designed to do, even if its in the wrong context can help.

    When you are ready, exploring your emotions over the tragic loss of your baby, may also help to release the spasm, as you say, they are connected. Our bodies have pockets of emotions locked up all over the place, again its the brain and body dealing with something thats too painful to think about, so it makes a physical pain to make it real and to divert the attention from the original pain.

    So in a nutshell the extra pain after physio is normal. Treating the spasm will release it but it will be an extremely painful process over a very long time. It may be helped by exploring your emotions. You can get through this, there are many agencies to help and support you.

    Wishing you all the best

  • Emsa, I'm so sorry to hear that you are suffering so much both physically and emotionally.

    I have recently started physio and have had four sessions so far - no internal work yet - my physio wanted to concentrate on my back, hip and leg pain first. She has found lots of trigger points and knotted muscles. She has also give me exercises to do in between sessions. My experience has been extra pain just after a session but overall getting better with the muscles smoothing out gradually and my pain levels becoming lower. If the muscles have been knotted and spasmed for a long time - then that becomes normal for them and it takes time (and a good physio) for the muscles to relax back to where they used to be. After the first session I did feel emotional - I think that this was because finally I was releasing some long held pain.

    I completely understand that you feel anxious when you have anything done in the pelvic area - I'm the same; just the thought of it makes me tense up! I've found that concentrating on deep breathing through examinations, ultrasounds etc helps with some of the pain and the fear.

    Gradually the muscles will start to release but it takes a lot of time and patience. It is an emotional experience because you are releasing both physical and emotional pain.

    Take care and good luck

  • I am sorry to hear you are having such a rough time. I am a pelvic floor therapist and can tell you that this is very normal after we begin internal work. There are other things that the therapist can do to try and calm down those tissues. She can try working externally first and then work back towards the vagina if the anxiety is too high. We will use modalities such as a TENS unit to decrease the sensitivity of the nerves. You could try taking a warm bath with Epsom salt (make sure you have no allergies) to try and assist relaxation in the tissues. I have found with patients that I treat who are having your complaints that I utilize surface EMG and relaxation breathing patterns to decrease the anxiety associated with things approaching the vagina. I truly believe that when we have an emotional aspect associated with this problem you already maintain the muscles in a tight and shortened state. The therapy will work but it will take time. Make sure you are communicating with the therapist that you are working with so that she knows the reaction that you are having. You may want to consider speaking to a counselor to deal with the emotional aspect of what you are going thru. I find the combination for my patients to be extremely helpful. I wish you the best.

  • Hi,

    Sorry to hear u are having such a bad time. I have seen a women's health Physio for a different condition but similar to what u are saying my muscles were so tense. I was not pleasant at first, but it will get easier. When I first went my Physio looked at other areas like my tummy which was really tense and the muscles around my hip and through the perifomis muscle she worked on this before doing anything internally as all these areas attach to the pelvic floor. She also gave me exercises to help release my tummy muscles.

    Hope this helps

  • i want you all to know that i appreciate your posts so, so much. you are really helping me. i am sorry i didnt respond sooner; it is hard for me to even think about it and ive just been unable to do so. i know though that pushing it down makes it worse, not better.

    thank you so much for explaing to me what happens physically. understaning the pain process does make it less scary. it helps me so much to be able to understand why my body is reacting the way that it is, and the more i understand what is going on with me, the more i feel in control.

    i think the therapy will help a lot. however, i think this pain might well continue until i am in a better place emotionally. im having a lot of pain right now, and i think its because mother's day and the day we most likely conceived are both happening this weekend. its hard for me to even write that...

    my therapist gave me a lot of info on products you can use at home- a pelvic floor massage tool to massage the trigger points, dilators that come in a set and gradually increase in size, and a dilator that heats up. i was wondering if any of you have used these or know anything about any other products, and if you have used them how helpful they are.

    thank you all so very much again. you are so kind and caring, and what you wrote really means a lot to me.

  • Does anyone know of a pelvic physio who does internal work in North Yorkshire?

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