Excerpt: 'Heal Pelvic Pain'

PHOTO The book "Heal Pelvic Pain" is shown.Courtesy McGraw-Hill
The book "Heal Pelvic Pain" is shown.

Millions of women experience pain during sex. But it's an intimate problem that few women talk about, even with their closest friends. Tight pelvic muscles are a leading cause of sex pain, according to experts.

Physical therapist Amy Stein specializes in pelvic floor dysfunction, at Beyond Basics Physical Therapy in New York City. In her book, 'Heal Pelvic Pain: The Proven Stretching, Strengthening, and Nutrition Program for Relieving Pain, Incontinence,& I.B.S, and Other Symptoms Without Surgery,' Stein outlines therapies, treatments and exercises to heal some pelvic pain.

VIDEO: Physical therapist Amy Stein outlines easy exercises to treat some pelvic pain.Play

Read an excerpt of the book below.


Say goodbye to your pelvic pain.

No matter how much it hurts, no matter how long you've suffered, no matter how many different pills you've taken or treatments you've undergone, the program in this book can help alleviate your pain or disorder and start the healing.

No drugs, no surgery. Instead, this is a program of natural healing -- of exercises, massage, nutrition, and self-care therapies that will focus on the true underlying condition of your pain. Heal the condition, and your symptoms will go away—and that's just what the program in this book can help you achieve.

To start, I'll explain what pelvic floor disorder is, why doctors have trouble diagnosing it, why you may have had so much trouble treating it so far, and how you can feel better as quickly as possible.

The first thing you should know is that you are not alone. Of course, nobody likes to talk about bladder problems or painful sex or itching or burning in the genital region, so you may not hear or read much about pelvic floor disorders. But the truth is that millions of us suffer from these disorders -- women and men, athletes and couch potatoes, young and old, even children.

Mostly, it's women who suffer. As I write this, 9.2 million women have pelvic floor disorder but don't know it because it has not been properly diagnosed. And the sad fact is that if you're a woman, you have at least a 5 percent chance of suffering chronic pelvic pain.

But your pain right now is what counts. That's why you're reading this book. You may be one of the more than 30 million women who have irritable bowel syndrome or one of the 700,000 with the urinary frequency, urgency, and pain that are collectively referred to as painful bladder syndrome or interstitial cystitis.

Maybe you suffer some form of incontinence, especially if you gave birth recently or exercise frequently.

Maybe you have some form of sexual dysfunction; 43 percent of women do. Pain during intercourse, performance problems, and declines in sexual response and enjoyment are all more common than you think. All can adversely affect your relationship with your partner. And all can be treated with the natural healing program in this book.

The Pelvic Floor

What is the pelvic floor? The pelvic floor is all the muscles, plus the nerves controlling the muscles, plus the tissues -- called fascia -- that connect everything together, plus the ligaments that link bone to bone and bone to organ that are attached to the front, back, and sides of the pelvis, from the pubic bone in the front of the body all the way back to the tailbone. These muscles, nerves, tissues, and ligaments sheathe the floor of the pelvis and together act like a sling or hammock to support the pelvic organs -- the urinary tract, digestive tract, and reproductive organs -- including the bladder, the uterus (or in men, the prostate), and the colon.

This is an essential part of your body's core, the center of gravity in your frame, the place where movement originates -- in a sense, the seat of raw power in your body. Eastern religions attribute spiritual as well as physical significance to this part of the body, seeing it as the place where the vital energy of your life force resides.

In much of Hindu tradition, it is the coiled serpent of Kundalini, waiting to be awakened into energy. In Chinese culture, the pelvic floor is the home of chi, the life energy that must flow freely in our bodies in order for us to remain healthy. In Japanese martial arts, it is the hara, the vital center of the self -- located just three fingers below the navel and three fingers inward toward the spine. The recognition of this vital life force is at the heart of spiritual practice in these traditions, and it is the focus of the physical exercises that invariably accompany such practices.

Western scientific research confirms that a strong and healthy pelvic floor at the core is essential to overall health and fitness. It's critical to feeling good. It's key to that sense of physical vigor that is so important to your sense of well-being.

The Muscles of the Pelvic Floor

All the muscles of the pelvic floor work together to support the pelvic organs and to assist in bladder, bowel, and sexual function and with trunk stability and mobility. But each muscle also has its specific individual role.

The pelvic floor has two parts. The upper part comprises the superficial layers of the pelvic floor. The muscles here constitute the urogenital diaphragm, also known as the urogenital triangle because the muscles form a triangle. These muscles are the bulbocavernosus, ischiocavernosus, and the transverse perineum, all of which assist in orgasm and bladder control in both men and women.

Excerpts: 'Heal Pelvic Pain'

The lower part of the pelvic floor, sometimes called the anal triangle contains all the other muscles of the pelvic floor, all of which are found in the deep layers of the pelvic sling. These muscles include the levator ani, the urethral and anal sphincters, and the coccygeus, piriformis, and obturator internus.

The levator ani muscle moves the coccyx or tailbone. It is made up of the pubococcygeus (an important muscle that assists in orgasm in men and women), the puborectalis, and the iliococcygeus. Both muscles originate at the pubic bone. The pubococcygeus attaches to the coccyx bone, or tailbone, and the puborectalis wraps around the rectum. The puborectalis assists in bowel emptying; therefore, if the puborectalis is tight or spasmed, this might result in incomplete or difficult bowel emptying.

The urethral and anal sphincter muscles assist in bladder and bowel function in men and women.

The obturator internus, coccygeus, and piriformis all work together but have slightly different roles. The obturator internus is also a hip rotator and is the conduit for a very important nerve, the pudendal nerve, that helps control a great deal of pelvic floor function. A dysfunction in the obturator internus can therefore result in a slew of problems. The coccygeus muscle assists the levator ani muscles in moving the coccyx bone or tail-bone when the muscles are contracted. The piriformis, like the obturator internus, is also a hip rotator.

Experts in evolution theorize that the pelvic floor musculature once controlled the tails of our apelike ancestors, before hands proved to be more effective. Eventually, the use of hands naturally selected a new branch of evolutionary development. In that new branch, which eventually became us, the tails went away, but the muscles remained. Now, however, instead of controlling wagging and hanging from trees, the muscles took on the function of helping to support the body's core. So today, the evolved pelvic floor serves three vital purposes:

It upholds and cushions the organs within the pelvis and lower abdomen: urinary organs, digestive organs, and reproductive organs.

It controls continence by signaling elimination urges to the bladder and bowel and by opening and closing the urethra and anal canals to allow voiding.

It is the mechanism of sexual function, contracting the muscles around the female and male genitalia to respond to arousal and to enhance appreciation.

These are big and important jobs, which may be why so many thick, closely connected muscles are involved. We can characterize these pelvic floor muscles in several ways. First, they're voluntary muscles. That is, we control them consciously. This is different from the smooth muscles of the bladder, intestines, lungs, and blood vessels, which are involuntary; that is, they're controlled by our nervous systems in such a way that they operate automatically.

Second, the muscles of the pelvic floor are skeletal muscles. That means they are attached to the skeletal frame. When we contract the pelvic floor muscles, the energy of the contraction applies force to the tailbone.

The pelvic floor muscles also come in two "speeds." About 70 percent of the pelvic floor muscle fibers are slow-twitch or slow-contraction fibers; the rest are fast-twitch fibers. Put simply, the slow-twitch muscle fibers fuel endurance. They're the marathoners of muscles, providing support and resisting fatigue. Think of the muscles in your lower back: they are mostly slow-twitch fibers that can work for a long time without tiring. That's essential, because these are the muscles responsible for helping keep you upright. The slow-twitch muscles that make up the bulk of your pelvic floor are that kind of slow-to-tire, persistently supportive muscles.

Fast-twitch fibers, by contrast, provide the quick forcefulness of sprinters. The muscles that move your eyes, for example, are fast-twitch muscles. In the pelvic floor, the fast-twitch muscles assist in controlling the contraction and relaxation that open and close the bladder and bowel and that serve the sexual function so essentially.

While both the slow-twitch and fast-twitch muscles lose strength as the body ages, the fast-twitch muscle fibers do so more readily. The slow-twitch muscles that make the pelvic floor a center of endurance and support tend to keep their power and function longer—unless there is trauma or injury. In a sense, the power to endure remains, while the power to perform some of the pelvic floor's key functions can diminish.

Excerpts: 'Heal Pelvic Pain'

That's natural. As we get older, our powers diminish. That's why it's so important to stay as fit as we can for as long as we can; physical strength and vigor are the best defense against the aging process.

That's certainly true where the pelvic floor muscles are concerned. It's no exaggeration to say that a healthy pelvic core is a major component of a healthy you. For that reason, it's important to pay attention to any pelvic pain or disorder; it could be a signal that something may be wrong. And unfortunately, lots of things can go wrong.

Pain at the Core

Of course, anytime you have a mechanism as highly complex as the pelvic floor, with all those muscles, nerves, tissues, and ligaments holding all those organs and attached to all that bone, it's prone to things going wrong. Basically, however, there are four root causes of pelvic floor disorders: inflammation, infection, trauma, and a range of what we might term "mechanical" muscular conditions—and any number of contributing factors that set the causes in motion.

Any kind of chronic inflammatory condition in any of the pelvic organs can originate a disorder.

So can any kind of infection: urinary tract infection, yeast infection, bacterial infection, or a major disease that affects the area.

Certainly, an injury from an accident or fall can cause dysfunction. Surgery—a hysterectomy, prostatectomy, or Caesarean section—can leave the muscles weak or injured. And physical or sexual abuse may also produce harmful trauma.

But it's equally possible that an individual's pelvic floor disorder has been caused by simple weakness in the trunk and pelvic stabilizers. Or maybe the person's spine and pelvis are misaligned. The individual may simply have been born with these conditions; it's not uncommon to inherit a weak trunk or a spinal misalignment. Or the conditions could be a result of poor posture, excessive strain from heavy lifting or other physical activities, or working at a repetitive-motion job. It is possible that you are using the pelvic floor muscles incorrectly, resulting in incoordination of the muscles. All can overload and/or shorten the pelvic floor muscles. Such stress weakens the muscles and decreases their range of motion.

Moreover, it doesn't take much to throw a monkey wrench into the works and kick off a disorder in the pelvic floor. Something as common as childbirth can do it. So can wearing clothing that is too tight, sliding too hard into third base at the Fourth of July softball game, using the wrong over-the-counter treatment for a yeast infection, or even playing a wind instrument. Any or all of these triggering factors could lead to a spasm or weakness or impairment of the muscles, producing dysfunctions ranging from debilitating pain to irritable bowel syndrome to skin disorders to erectile dysfunction and/or lowered libido.

And here's the problem: precisely because the pelvic floor muscles are so closely interconnected, any kind of disorder anywhere in the pelvic floor can have an impact on any or all of the pelvic floor's other functions. You might strain a muscle during a gym workout and find that you are having a hard time fighting urinary urgency and a painful time having sex with your partner—all from a spasm suffered during spinning class! This is the heart of the matter: one pelvic floor dysfunction may lead to another. And another. And still another. One disorder anywhere might therefore cause disabling pain, incontinence, urinary and bowel retention, and sexual dysfunction—often, all at once.

What's more, since the pelvic floor connects our upper and lower body, a dysfunction in the floor can, unfortunately, affect both upper and lower body. I've treated patients for pelvic floor disorder who then reported that their foot pain or back pain disappeared with the treatment. The reason? Pain from their pelvic floor had radiated downward or upward to affect these other areas of the body.

In fact, that's typical. All those muscles, nerves, tissues, and ligaments networked together in support of the pelvic organs simply turn into speedy highways for the pain from a pelvic floor dysfunction. What starts at the core is soon cascading every which way throughout your body. That's why so many people who suffer from a pelvic floor disorder feel a combination of symptoms, and it's why their suffering may not stop at the pelvic region.

And it's the main reason why pelvic floor disorder is rarely the first thing we think of for the range of symptoms the disorder can prompt. A case of diarrhea may send us to the Pepto Bismol bottle or the gastroenterologist. Vaginal pain prompts us to make an appointment with the gynecologist. And back pain is typically a signal to go see an orthopedist or lie down for a couple of days with some heat and ice.

Excerpts: 'Heal Pelvic Pain'

The problem is compounded by the fact that once in the doctor's office, many pelvic floor disorders are often diagnosed as a problem in the organ. They feel like organ pain even if there's no infection there, and they can mimic organ disorders, so that's what doctors tend to treat, even though the pain is actually radiating out from a dysfunction in the muscle, tissue, nerve, ligament, or all of them.

Wherever it hurts, these dysfunctions can affect the quality of life in the most intimate arenas of life; at their worst, their impact can make the individual utterly miserable every minute of the day.

Consequences of Pelvic Floor Disorders

Think what can happen if the pelvic floor no longer performs its vital functions well. If the organs of the pelvis—reproductive organs, bladder, bowel—are not well supported against gravity and cushioned against pressure, they literally may begin to drop. As they sag, they fail to work properly, and pressure and pain may ensue. Incontinence may result. And finally, surgery may be required.

If the muscles that control the urges and openings for evacuation grow weak or are impaired, the result will be difficulty in either evacuating or retaining—or both. You'll experience strain, bloating, diarrhea, and abdominal and/or pelvic pain. You may suffer incontinence and a range of other urinary and bowel symptoms as well.

If the muscles that power sexual activity grow weak or are over-tensed, your ability to respond to your partner will be diminished—and so will your enjoyment and your partner's. At worst, if the tension is really bad, penetration may prove painful, even impossible, for the woman, while men may suffer pain following ejaculation.

Ending the Pain, Healing the Disorder

The whole subject of pelvic pain may be one you're uncomfortable talking about—to your partner, a friend, even to your doctor. Maybe you assumed that the pain or discomfort would subside, then go away in time. Or maybe you've decided it's just something you have to learn to live with.

No, you don't. In fact, you shouldn't.

My program of natural healing is about solutions to your pain that you can do yourself. When I work with patients one-on-one in my physical therapy studio, I prescribe strengthening, stretching, and relaxation exercises, modifications to diet and lifestyle behavior, and the application of manual techniques, biofeedback, deep massage, heat and cold, and the other specialized treatment methods of physical therapy. I've adapted all those modalities, as we call them in physical therapy, into a program you can do at home, by yourself, without having to take medication or buy special equipment.

The exercise program consists of a set of simple movements you can do both in the privacy of your house and throughout the day, wherever you are; you'll learn them in a phased approach. You'll also find nutritional recommendations aimed at alleviating your discomfort and suggestions for home spa treatments that let you soothe your discomfort and pamper yourself.

And the fact is that what you learn in this book can do more than end your pain and cure your disorder. These exercises and self-care therapies can also help you forestall the effects of aging. They can help you enhance the physical intimacy you enjoy with your partner. They can give you a new level of physical strength at the core that will translate into a better sense of well-being in every aspect of your life.

Are you ready to begin?