Health Organization for Pudendal Education

I have only had two very unproductive sessions.... Concerned she's dragging it out just o charge me more.
I have not felt any improvement, but she has not started any soft tissue mobilization or anything actually PHYSICAL yet. The only omework I was given was to do resrorative yoga positions, and head lifts to try and strengthen/fix the division in my abdominals as result of damage from 2 pregnancies.

She's said these things (pt) takes time. I'm asking all of you, who would know best from experience: HOW LONG UNTIL I KNOW IT'S NOT WORKING? Does it have to feel worse before it feels better? should I see someone else?

Any input is much appreciated. I will update my signature to include my "backstory" soon...I'm new o all this. Pain nonstop for last 1.5 months, intermittent since may.

Thanks

Is your PT PN aware and trained? There are lots of pelvic floor PTs, but most only know how to treat incontience, which is very different than pelvic pain. There are several good articles on Pelvic Health and Rehab in San Francisco's blog about what is good PT and what to do if you knwo more than your PT, etc. http://www.pelvicpainrehab.com/blog/ Not sure where you are located, but I am in a small town and there is no one that is very good around me so I have to travel 2.5 hrs to see a good PT, unfortuantely I can only do that once a month. I would say after a couple of sessions you should be able to tell if a PT is knowledgeable enough to help you. But if you find one who can do the internal/external myofascial/trigger point work and look at alignment of the pelvis you need to stick with it at least 12 sessions in my opinion to see if it is going to help at all. But it could take much longer to actually see any real improvement.

Thank you Faith. This pt was listed on this site. She was the on,y pn pt in my area. I just imagined shed get right in ther and go to work...too much talking, IMO. 12 sessions. Ok, I'll take your word for it. Hopefully by November I can have some scans done to be a better idea of my problem areas, structurally speaking. Thanks again for I put.

I see you can't afford scans right now, but they could make a difference in knowing whether PT will help or not. If you have spinal problems or hip issues generating your pain - internal pelvic floor PT will not likely help the cause of your pain. But I understand your predicament. All you can is what you can do. I just threw 12 sessions out there. PT is is expensive and if you don't feel like you are getting your money's worth you don't have to continue. 6 sessions may be enough to see if this PT is going to do anything much to help you. Only you can decide if you think it's worth it. It's a hard place to be I know. I've had mediocre PT on/off for 2.5 years now....very frustrating.

Hi Pizz,
Two PT sessions really isn't enough to determine if it will help or not. I agree with Faith - 6 to 8 visits may be more helpful with making that determination. Have you spoken with your PT to ask her what her impressions are and what her plan is? How you respond to the therapy will also be telling. Please listen to your body and keep the lines of communication open between you and your therapist.

Got to agree with faith and Karyn, pizzarios.
As Karyn mentioned, I would ask her to evaluate what she thinks is causing the problems and how she thinks her work will be able to help, but we all know how complicated the pelvis is so you will probably need a few more sessions and your own feed back from those sessions to determine if any good can come of it. I hope that it is of benefit to you but I can understand how frustrating this all is too, especially when money is tight but you need a solution.
Take care,
Helen.

I have been i pt off and on for 3 years. And i would be much worse without it.

MY PT is much more of a 30min massage trying to keep all the muscles of the groin relaxed and supple so that they do not spasm and contract triggering the nerve.
The other part is internal work going in trough the anal canal and massaging the nerve and tendons. This can also help break up any scar tissue that is there.

If i got more than a week without PT I can feel it getting tight and the pain increases.

In my case PT is considered maintenance and the insurance has accepted it due to incontinence side effects of PNE.

Hello all,

So sorry for the long delay in the response. It's been a very crazy end of summer for me.
I am 5-6 sessions in with PT. I felt a tremendous amount of nerve pain relief, after the 4th session. This was the first time (other than initial exam) that the did lots of internal trigger point release and myofascial (sp) work. It was glorious. But in that period between that session and the one the week after, I started to have debilitating lower back/hip pain in the place of the nerve pain. It was more tolerable than the burning/stabbing sensations in my vulva & urethra, but very challenging to care for my two young sons with all that going on. I went back for another session and she had me reach down to touch my toes a few times before starting another session.....well, the nerve pain came back that night and has been intermittent since then. Not as bad as it was before starting PT, but not great. I still also have this intermittent hip/back pain as well. It's been 2 weeks since last PT because she went on vacation, and it's all gotten worse since then. New things have developed: Stabbing inner thigh/groin area pain and LOTS of popping/cracking noises in my left hip (all my pain is on my left side) when I walk or sit or do pretty much anything. Bending, sitting for long periods and laying on my back are all solid actions that always bring on pain - where as before, it was hard to tell what exactly would trigger it. It will still come and go with no rythme or reason, but those things I've been able to spot for sure.

I ask her what she thinks is wrong with me at every single sessions. She always just pauses and says that she thinks there are many things at play, and that it's hard to determine what exactly it is, as she thinks there are mutliple layers of fuckery going on in my pelvis. It's also a chicken-or-the-egg scenario. Did IC trigger additional pain/muscle problems or did something like PN cause IC or muscle pain blah blah blah blah.

But on another note, had a 3T pelvic MRI last Friday. Don't know results yet. It was NOT the Potter (Boooooo) but as broke as we are, I'm lucky I was able to get one at all. Flying 6 hours to NY for a $3000 scan is out of the question right now.

So I ask you fine people: Should I keep on with it? PT that is? The "homework" I do doesn't seem to really put a dent in the pain and sometimes it even seems to make it worse. The woman I am seeing is super PN knowledgable and studied with the PN PTS in San Fran w/the PN dr specialist there. So she knows her stuff..

I am wondering - if it is indeed PN, are my symptoms indicative of entrapment or neuralgia?

I don't ask for much, do I.

Have a lovely evening and I hope you are all feeling well, if not totally pain free tonight. Thanks again.

This is a tricky one to answer as you have had some relief from some treatment.
It sounded like she was relaxing some pelvic floor muscles and that is when you had a reduction in your pain?
This would indicate that pelvic floor tension could be your problem and therefore the nerve(s) once released can function properly again, indicating that there is no actual 'physical entrapment' once the muscles relax.
Of course your scan may give you answers. It may show why your pelvic floor is tight in the first place, show some other pathology to explain the whole thing??
As your therapist says there may be many things at play. I think, if I had found improvement with some of her work, I would continue for a few more sessions. After 5-6 sessions without any improvement I would call it quits. I guess you have to weigh up if the improvement was worth it. I would clutch at any improvement and hope for more, if it were me.
I think I would continue, until the imaging shows something conclusive; which you have to remember, physio may still help (especially as she does sound as if she knows what she is doing) or if you haven't had any more benefit after a few more sessions.
Take care,
Helen

When Istarted PT the pelvic floor was really tight and it was very painfull, After a few months i was feeling the same as you. My PT went on vacation for two weeks and the pain went way up.

PT may not be fixing the issue at this time, but it may be damage control right now, making sure those muscles dont contract back around the nerve making it worse.