The Physical Therapist
I wasn’t sure what to expect.
Working in a Maternity hospital gave me some exposure to Women’s Health physical therapists that rattled off the same repetitive rant to most women;
how to protect your separated abdominal muscles
how get out of bed after a c-section
how to properly sit on the toilet when passing urine and opening your bowels
And, the always popular and very necessary, “Kegel exercises” – how to strengthen your pelvic floor
That was the extent of my knowledge of physical therapists specialising in women’s health.
This particular “physio” (the Aussie slang for physical therapist) worked out of the OBGYN Clinic/Fertility Centre I had been attending and I sat in anticipation, wondering how she was going to help me.
We went through my history AGAIN (this was becoming a regular occurrence) and she asked me about my level of exercise.
“I’ve pretty much stopped most types of exercise,” I confessed, “I only walk, swim and do the occasional yoga now.”
I felt weak and pathetic.
I had tried to resume physical activity so many times, but the consequences of certain exercises were so severe that eventually I had to stop.
Such as;
A 3-5km RUN and I would hardly be able to walk for the next week due to such severe pelvic and sciatic pain.
BIKE RIDING caused such unbearable spasms in my back and abdomen that after 30 minutes of riding I could hardly breathe.
PILATES would set off my pelvic pain due to all the core exercises
YOGA was hit and miss. Sometimes the stretches would make me feel better but sometimes I would suffer with such pain and inflammation that I couldn’t muster up the courage to go back to another class for at least a month.
GYM CLASSES were an epic fail. I gave up on those years ago.
WATERSKIING, my husband’s passion, was also now off the table.
As I relayed my symptoms and my defeat I became overwhelmed by my PERCEIVED “WEAKNESS” (even though I now had my diagnosis of severe endometriosis).
The physio, on the other hand, COMMENDED me.
“Wow,” she said in approval, “you are a good ten steps ahead of most of the women that I see.”
I blinked in confusion.
“You are doing all the right things,” she re-assured me.
She went on to explain how endometriosis was affecting my pelvic floor and my chronic pain;
Women with chronic pain have more nerve endings, a heightened response to stimuli and a very low threshold for pain activation
People with chronic pain actually have changes in their brain (as seen on MRI’s)
Most exercises can actually irritate and trigger severe spasming of the pelvic floor and abdominal muscles (making chronic pelvic pain even worse)
My pelvic floor and core have been “guarding” (TENSE and ACTIVATED) from twenty years of chronic pain and will therefore require LOTS of training and “reprogramming”
I was dumbfounded. It all made sense, but I had “normalised my symptoms” and pushed through so much over the years that it had never occurred to me to investigate chronic pain or even see a specialist.
I thought back to the previous physio who had taken me to the gym and, with nothing but good intentions, prescribed me a special work-out routine to strengthen my core and my pelvic floor. I remember quitting the regime (with a generous dose of guilt) once the pain became unbearable.
She then asked me about my diet.
I told her I was predominantly GLUTEN, DIARY and refined SUGAR FREE.
She looked impressed.
She then explained how foods that cause inflammation and gas irritate your bowel (which is already more sensitive due to the endometriosis and chronic inflammation), which in turn irritates your abdomen, which then irritates your pelvic floor and those hyper-sensitive nerves, which then, of course, causes MORE pelvic pain.
My jaw dropped.
She also explained that…..
having constant bloating (which I always did, and have been asked an innumerable amount of times if I was pregnant) is obviously embarrassing
therefore we suck our stomach in, which further tenses and activates the core and pelvic floor (obviously….. making things significantly worse)
so then instead of doing diaphragmatic breathing with a soft belly, we breathe with our upper chest, which activates our neck muscles causing them to become tight and tense and therefore causing chronic tension headaches.
My jaw hit the floor this time.
I was beyond speechless.
“So therefore,” she finished casually, as though she had not just blown my mind, “simply following a FODMAD diet could help decrease your bloating, your pelvic pain and your tension headaches.”
With zero hesitation I immediately downloaded the FODMAP diet app created by Monash University (here in Australia) and vowed to follow their strict protocol, no matter how hard it was.
The physio handed me several sheets of information, and with continued casualness asked if I would like a “manual pelvic floor release”.
“Sure,” I stuttered, not knowing what that entailed.
A few minutes later I found myself lying on a treatment table, my bottom half undressed, a towel draped over my thighs and my legs spread wide open.
This was becoming a regular occurrence.
Word of caution for those embarking on the journey of infertility treatments…..
Don’t bother carefully taking your dignity off, folding it gently and wrapping it up for later use. YOU WILL NEVER GET IT BACK. Just throw it out the window and radically accept that your dignity is gone.
My nursing/midwifery background has obviously prepared me for such a journey as this. I am able to view and understand the scientific and physiological function of the body parts, such as the vagina, uterus, pelvic floor etc., in an unemotional and logical way……and that helps it feel less invasive.
It would also be hypocritical of me to complain, as I have performed many invasive procedures that were obviously necessary, but understandably traumatic to the patient.
And now it’s the flip side…I AM the patient.
The emotions of loss, grief and trauma are a natural and inevitable part of this journey, but are also be HEIGHTENED if you’ve never been exposed to such invasive medical procedures before.
It IS TRAUMATIC.
My heart goes out to the women on this journey.
Acknowledge your strength and resilience, but allow yourself the space to grieve the loss of your dreams and your dignity.
SO…….with a lubricated, gloved finger the physio proceeded to release the tight “bands” in my pelvic floor muscles.
I tried to maintain casual conversation as her fingers twisted and turned inside me, finding spasming muscles and more tight bands, but the pain and spasms took my breath away. The pain began to radiate through my abdomen. She encouraged me to take deep breaths and coached me on diaphragmatic and belly breathing.
“I can actually feel your pelvic floor relax when you do those breaths,” she said with encouragement, her fingers still inside me.
It was such a strange and confronting experience.
I wasn’t sure how to process it.
I wanted to laugh at the absurdity of it all, and yet I wanted to burst into tears. Laughter eventually prevailed and I found humour was slowly become one of my main coping strategies.
The “manual release” finally ended and I found myself in a bemused daze as I cleaned myself up and put my clothes back on.
This was to be one of many treatments that would eventually bring me significant relief from my chronic pelvic pain.
Eventually I would reach a place of apathy and acquiesce, removing my clothes with robotic execution and minimal emotional reaction.
Needles would be placed in my abdominal muscles and my gluts
Lubricated fingers would release tense muscles in my pelvic floor
I would practice my diaphragmatic breathing through the treatment
I would clean off the lubricant and re-dress myself
I would profusely thank the physio for giving me this effective treatment
And I’d be on my way
Welcome to the daily life of an infertile.
I also ordered the Therawand and Pelvic floor Relaxation meditation CD in order to continue some treatments at home.
https://www.pelvicexercises.com.au/pelvic-floor-muscle-tension-article/
(this is for Australia, so obviously find an online shop specific to your country)
https://pelvicpain.org/docs/patients/basic-chronic-pelvic-pain.aspx
Doing your own pelvic release at home with the therawand can be quite effective, except it took me a while to get the pressure right as I was actually exacerbating my symptoms by pushing too hard and causing my muscles to spasm more and become more tight and tense, which is obviously counterproductive. It takes time and practice to figure out how much pressure to apply yourself.
The main advice I got from the physio is to only press the muscle/band until it’s a LITTLE uncomfortable. If it’s very painful then you are going to make things worse. HARDER IS NOT BETTER. Unfortunately, women with pelvic pain have quite a high pain tolerance and therefore are not a good judge of a “little” bit of pain.
