Do you have pelvic floor dysfunction and have been searching for treatment options? Maybe you’ve come across internal manual therapy are wondering, does pelvic floor therapy hurt? Do know that Pelvic floor therapy should never involve just internal manual work because it makes no sense to work on the ‘floor’ when the ‘house’ is unstable. The ‘house’ is the pelvis and what is attached to it and if you think there is nothing wrong with your ‘house’ you are mistaken. One thing to note is that pelvic floor-related issues are never isolated and frankly by the time they disappear or are done being treated, if the floor was the only part treated, then the ‘house’ is involved as well.woman bending down and pressing on another woman’s lower abdomen

I have written extensive blogs related to the pelvic floor which you may find on my website;  you owe it to yourself to at least know where the pelvic floor is, how it gets weak, how to strengthen it, and how to prevent the pelvic floor from getting weak. It is important to note that there are 2 ways to get a weak pelvic floor:

  1. One is from being overworked
  2. And the other is from being underworked

So even in the case of spasms of the pelvic floor muscles, there is a definite weakness that has to be addressed.


Where is the Pelvic Floor?


Imagine your pelvis is a bowl with the spine being attached to the top of the back part and the hips at the bottom. The inside surface of the bowl, not just the bottom of the bowl, is your pelvic floor. The pelvic floor is directly impacted and is worked out by walking. So of course anything that interferes with how we walk impacts the pelvic floor. Stop for a second and think about this last statement! Anything that interferes with how we walk impacts the pelvic floor so that means if you sit for so long, you have an issue with your pelvic floor. If you went skiing and did the splits accidentally you have an issue, if you sprained your ankle hiking, it is impacted, if you wear high heels, it is impacted… you get the point!

If pelvic floor dysfunction was the name of a book, this book has many chapters and not every chapter involves internal manual work. In fact, we hastily go to internal manual work for the treatment of pelvic floor dysfunction when in fact, that should come second or be done at the same time as the other exercises that are most often missed.


Is It Normal to Have Pain with Pelvic Floor Therapy?


If you are referring to internal manual work done for the pelvic floor as pelvic floor therapy, then stop. That should be just a part of the treatment and in some cases, when the muscles of the first, second, or even the third layer of the pelvic floor (from inside) are tight, it can be uncomfortable and painful.

In my opinion, the reason behind this tightness is multi-faceted and not entertaining the emotional or cultural aspects related to the external genitalia especially in women, I would say there has to be a history of trauma to the pelvis and its attachments (spine and hips) that leads to that tightness. This trauma does not have to be an obvious one. For instance, a runner that runs long distances and does not stop when they should, dragging the body to get to the finish line when the body can’t handle the distance can easily have a spastic pelvic floor. Why? Because the adductors and hip stabilizers become dysfunctional in performance and the dysfunction carries over to normal daily living.

Think of the bowl that has contents inside of it and there are forces that pull it in all different directions. It is like sitting on a roller coaster that pulls you around; no wonder those muscles get spastic and tight, causing insertion of anything painful. When dysfunctional movements occur, muscles get weak or overused and the pelvic floor muscles are no exception.

Once again, not all pelvic floor muscles are accessed from inside and frankly, only the ones that are along the vagina or anus that are reachable by the index finger are the ones that have the potential to be worked on when doing the internal manual work.

What Does Comprehensive Pelvic Floor Treatment Include?

As listed in my blog: ‘Why does pelvic floor dysfunction occur and how to fix it’, you can see how the internal manual work may or may not be involved in the treatment of pelvic floor dysfunction and the following list does not cause any pain.

Internal manual therapy is not the only option for the treatment of pelvic floor dysfunction; if you have pelvic floor dysfunction and need help, make sure to contact me to schedule a 15 min. phone call.

Dr. Shakib