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The only choice was surgery. The urologist made an incision down the seam in the middle of the scrotum and removed the damaged tissue. There was pain after the surgery, Matt said, but nothing as severe as the pain which brought him to the hospital after the puck’s errant contact with his groin. This surgical pain settled down, healing took place, and all seemed to return to normal.

It was not until three months later when Matt noticed that he was having difficulty with sex. He had developed premature ejaculation. There was also a strange sensation of fullness and tenderness in his testicles after climax. How had this happened, Matt wondered? And what could be done? Was there treatment for this?

It was Matt’s wife who found our clinic. This was not surprising, as women typically have a more visceral connection with their pelvic floors; we have periods as teenagers, we get examined internally when most men do not until later years and we often have pregnancies which put this area of our bodies in the spotlight. Matt came to Pelvic Floor physical therapy with his wife, Maria.

Maria explained that she was concerned about her husband’s premature ejaculation and discomfort after sex. Not only did Maria and Matt want to return to their very robust sex life, they also wanted to conceive a child. It was helpful to have both partners attend this initial session. 
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Matt returned for several physical therapy appointments by himself after that first evaluation. He learned methods to relax the muscles of his perineum. It was the scar adhesions of his testicular surgery that caused his muscles to go into spasm; this was driving the premature ejaculation and pain after intercourse he was experiencing. He learned techniques to release the scarring and relax his muscles and taught his wife how to help him. Together, this couple worked to recover Matt’s sexual and
pelvic health.  

It was nothing short of wonderful to get a letter from Matt a few months after he stopped attending PT. The letter read as follows:

“It was not easy to come to a physical therapy office and talk about erections. But I am so glad that I did it. Since then, Maria and I are able to have the kind of sex that we did before the injury. I am also back to playing hockey, but only one night a week. This is because we are expecting a baby girl in a few months and I need to be at home more to get ready for the baby.”

What was so successful about the outcome of this story, you might ask? Firstly, Matt had a traumatic injury to his groin and developed symptoms immediately thereafter, so the causation of the problem was easy to determine. Secondly, Matt was open to this type of therapy and it was readily available to him in the area in which he lived. Finally, and what is most important about this story, is that Matt and his wife Maria tackled the problem together. They both had to adjust their expectations, lifestyles and learn to overcome something which might have driven them apart. Instead, it brought them closer together.

Pelvic Floor physical therapy helped to make this happen. With a baby girl to reinforce the story! There is great power in looking at life’s problems and seeking help. It requires staring down our opponent on the ice. We need the shoulder pads and the mouth guards, but the puck might still hit us in the worst possible spot. With a team approach, we can recover. We cannot allow the fear of the puck to keep us out of the ice rink. Just like Matt and Maria, we have to keep skating.

Written by Becca Ironside, PT

Vincent found our clinic by chance. He scoured the Internet, looking for a reason to explain the confounding pain in his pelvis. Vincent had a high-stress, corporate job wherein he sat all day long. He began to notice pain in his perineum while sitting. The longer he sat, the worse the pain became. ​

“I am so fortunate to live in America,” Theresa continued. “My Irish in-laws call me ‘A spoiled Yank’. I used to love it when they referred to me that way. I have everything a person could want. Except that now I am terrified of being in public and have to wear adult diapers. I do not feel like a spoiled Yank anymore.”

I knew that Theresa was at the end of her tether. She had tried prescription medication, daily Imodium, altering her diet and kept her legs tightly crossed at all times to avoid what still happened. I explained to her what Pelvic Floor Physical Therapy was all about. That in this type of clinic, we would do an internal examination to discern if the muscles of her perineum might be driving the fecal incontinence.

“I have been through so much already. If you have to do an internal examination, so be it,” Theresa declared. After an exam of the musculature of Theresa’s pelvic floor, it felt as though her muscles were in moderate to severe spasm. These muscles control urination and defecation; they were firing so rapidly that she could not contain feces within her colon, and worked incessantly to force it out. The function of the large intestine is to pull water out of our foodstuffs and allow feces to become solid. This was not happening in Theresa’s case, because the food was not in her colon for enough time, and her stool was unformed and messy. This explained her chronic diarrhea.

The treatment plan for Theresa included deep breathing, relaxation of her pelvic floor muscles and some natural over-the-counter additives to bulk up her stool. “This sounds counter-intuitive to me,” Theresa said at first. “If I relax the muscles, then won’t more feces escape unplanned?” I smiled at her and explained that if she wanted to try something new, she would have to trust me.

It took almost three months of once-weekly treatment in our clinic, with a really good home program, for Theresa’s symptoms to subside. But subside, they did. She now has solid bowel movements twice daily and can control them wonderfully. Gone are the pull-ups and the fear of accidents. Her commute to work and social life have been restored to normalcy.

“I cannot believe how this treatment has helped me! I wonder if this would be available to my relatives in Ireland? I hope so. But at any rate, I feel like a ‘spoiled Yank’ once more,” Theresa remarked. Pelvic Floor Physical Therapy is gaining rank, accessibility and respect all over the world. It likely is available to her in-laws in Donegal, Ireland. The trick is to find ways to talk about these issues and overcome the embarrassment surrounding words like rectum, feces, and stool.

This is what we do, as pelvic floor physical therapists. One client at a time. For spoiled Yanks, people from Ireland and every other continent, men and women, young and older, there is help. We live in a time when anything is possible.

Written by Becca Ironside, PT. Becca is also a published Author of Fiction.
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I met a woman named Eva* at the Pelvic Floor clinic. She came for physical therapy to address urinary leakage, which she has endured for over ten years. I had to glance at her date of birth to make sure of her age. Eva is 85 years old, and she looks spectacular. “What is your secret to looking so young and vibrant?” I asked her. “Maybe it is having good friends. Wonderful children and grandchildren. Or maybe it is just my good Danish genes,” she replied.​ 

​Eva told me that she began leaking urine several years ago, but her condition is getting worse. She told me that she cannot go to the beach anymore at Point Pleasant, which is her favorite thing to do. In her medical history, I learned that Eva had had three pregnancies with vaginal births. She does not drink enough water, mostly in fear of losing even more urine. Based on her age and prior history of childbearing, I was working under the assumption that Eva had weakness in her pelvic floor muscles. Maybe a little prolapse of the bladder.

“A lot of young women come here with complaints of pain with sex,” I told her. Eva’s eyes opened wide. “Do you mean to tell me that there is treatment for that? I had two husbands and sex was awful with both of them. The pain was unbearable. I never understood what the big fuss about sex was all about.”

Here was a woman in her eighties who had lived with pelvic floor dysfunction her entire life. The painful intercourse made sense, given how much tension she was holding in her musculature. I devised a treatment program for Eva to allow the muscles of her pelvic floor to elongate. She was given a home program of self-stretching, diaphragmatic breathing exercises, and an activity known as the pelvic floor drop, which is the opposite of the famed Kegels we have all read about in McCall’s Magazine.

Eva has returned several times to our clinic. She has far less urinary leakage, is drinking more water (she has retrained her bladder to accommodate this), and practices yoga and deep breathing.  She is planning a month-long trip to Florida, wherein she will be able to go to the beach in a bathing suit encasing her lithe body without fear.

I learned something wonderful during my treatment of Eva. I rejoice in living in a time when help is now possible for these things that have plagued women for centuries. I also learned that it is never too late to change. Eva is 85. And if she responded so readily to this therapy, then anything is possible.

*The name and some personal details of this patient have been changed, according to the laws of the Health Care Portability and Accountability Act. But the symptoms of Eva and the outcome of her treatment are true. Pelvic Floor Physical Therapy works!

Patient: 66-year- old female with mesh repair of rectal and bladder prolapse 10 years ago.
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Chief Complaint: “Knife-like” pelvic pain 10/10 with physical activity the following year, pelvic pain with urinary urgency, 6 voids at night.

Past Medical History: Diagnosis of interstitial cystitis 2 years ago, lumbar arthritis, thyroid condition.

Physical Therapy Treatment: Education on lifestyle modification for prolapse; breathing exercises; bladder retraining; manual release to pelvic floor and restricted internal scars; stretches for pelvis, hips, and low back; gentle core strengthening exercises.

Results: Pelvic pain 1/10 with physical activity, 0 discomfort with 2-hour drive, and 3 voids at night in 17 visits!

​Physical Therapy Treatment: proper voiding techniques, general healthy eating habits, nerve glides, bowel massage, pelvic floor biofeedback, manual therapy for pelvic floor, leg stretches, core abdominal strengthening.

Results: 14 visits - 0 loss of stool between bowel movements, 0 urine leakage with activity or urgency, 0 pads. Patient is able to walk 15 minutes per day for exercise.

Patient: 42-year-old female
 
Chief Complaint: Urine leakage with urgency after vaginal delivery of 2nd child + emergency hysterectomy; 6 night voids
 
Past Medical/Surgical History: Repair of prolapse the following year + Oxybutynin with 50% decrease in symptoms; history of low back pain, irritable bowel syndrome
 
Physical Therapy Treatment: proper voiding techniques; lower body stretches; prolapse management; posture and breathing exercises; abdominal scar release

Results: 0 urine leakage with 1.5 hour urinary intervals, 0 night voids, 0 Oxybutynin in 12 visits!

Patient: 21-year-old female

Chief Complaint: Painful intercourse with first encounter

Past Medical/Surgical History: Crohn’s disease, managed with diet; removal of gallbladder 2 years ago

Physical Therapy Treatment: Posture education; breathing exercises; pelvic and hip stretches; manual therapy for pelvic floor and review of techniques with partner; progressive vaginal dilator stretching

Results: 0 pain with intercourse in 14 visits!

Physical Therapy Treatment: Manual therapy to hips; low back and hip stretches; posture correction; gentle abdominal and low back strengthening; home program.

Results: Left groin/hip pain 3/10 only after prolonged sitting, undisturbed sleep, 0 urinary urgency or bladder discomfort in 5 visits! No pelvic floor work necessary.

Patient: 76-year-old female, who reports going into menopause early (early 40s).

Chief Complaint: Painful intercourse that started 10 years ago; also difficulty initiating urination in social situations.

Past Medical History: Osteopenia, thyroid condition, low back pain.

Physical Therapy Treatment: Progressive stretching with vaginal dilators; manual therapy to pelvic floor and urethral tissues; urinary voiding schedule; relaxation techniques; hip stretches; core muscle strengthening.

Results: Patient is able to resume intercourse with 0 pain. 0 urinary hesitation or urgency with 3 hour urinary intervals, 1 void at night. 13 visits!

Physical Therapy Treatment: Biofeedback to pelvic floor; manual therapy to pelvic floor, low back, hips; posture education; hip stretching; core trunk strengthening; home program

Results: Patient voids once every 2 hours, 2x at night. Patient reports having control of urinary urgency. 0 low back pain. 10 visits!

Patient: 63-year-old male who works in a lab, walks 1 mile per day for exercise.

Chief Complaint: Constant “dribbling” of urine after removal of prostate.

Patient voided every ½ hour during the day, and 2x at night. Patient used 2 pads daily, leaking 100-300 cc per day.

Past Medical History: Low back surgery, inguinal hernia repair, prostate cancer 

Physical Therapy Treatment: Biofeedback to pelvic floor; bladder retraining; pelvic floor exercise; proprioceptive muscle training; postural exercises; core strengthening; home program

Results: Patient voids once per hour, and 1x at night. Patient uses 1 thin pad, leaking 3-5 cc per day after 13 visits.

Past Medical History: 2 vaginal births, insomnia since last birth 3 years ago.

Physical Therapy Treatment: Manual therapy to pelvic floor and abdomen; review of proper bowel evacuation and stool formation; breathing mechanics; postural education and exercise; LE stretching; core strengthening exercises; HEP.

Results: Complete bowel evacuation 1-2x per day without straining or altered mechanics after 8 visits.

Patient: 83-year-old female

Chief Complaint: 4/10 R posterior pelvic pain and rectal pain increasing in the evening, that started after hysterectomy 6 years ago

Past Medical History: surgical revision vaginally, local estrogen; gallbladder removal, irritable bowel syndrome

Physical Therapy Treatment: abdominal bowel massage; review of proper bowel evacuation methods and stool formation; manual therapy to gluteal muscles, pelvic floor, and hip adductors; nerve gliding techniques; TENS unit training for home; HEP

Results: 0 out of 10 pelvic and rectal pain after 13 visits

Patient: 46-year-old female

Chief Complaint: 10 out of 10 coccyx pain that increases with sitting, or transfer to standing; no trauma

Past Medical History: Surgical block and injection to coccyx with only temporary relief