“I’m supposed to put that WHERE??”
There are incredible tools on the market that can help you treat your own pelvic floor muscles - HOW FREAKING COOL! In any realm of Physical/Occupational Therapy, it is the therapists’ responsibility to give you tools and homework for your continued success. In Pelvic Floor Therapy, we often recommend different tools to aid in healing and promote independence with your home program. Yes, sometimes we get the “deer in the headlight” look when we show sample tools in the clinic so we wanted to discuss when and what we recommend them for!
A pelvic wand is a great tool to use for self trigger point release on tight pelvic floor muscles. Trigger points are areas of a muscle that are painful to touch due to guarding or taught bands within the muscle. Sometimes these taught bands can cause a referral pattern of pain, such as pain into the butt, back, abdomen or down the back of the leg. Trigger points can contribute to sexual pain, achy sensations from deep inside the pelvis, painful or frequent urination, tailbone pain, groin pain, constipation, and pain around the bladder.
Most pelvic wands have a curved end to provide leverage, which allows you to access the hard-to-reach muscles of the pelvic floor. Pelvic wands can be made with acrylic or silicon and can be made with features such as vibration and temperature therapy. If a pelvic wand is recommended to you as a treatment tool, a pelvic floor PT can help show you where to target your treatment with the wand to help release tight muscles and decrease pain.
Vaginal dilators, sometimes known as vaginal trainers, are smooth tube shaped medical devices used to stretch your vaginal and/or rectal openings (yes, you can use them to help treat anal sphincter spasms, too!). Dilators are typically sold in a set with different sizes that progress from small (about the size of a finger) to larger circumferences and lengths. Dilators can be made of plastic or silicon and may include features such as magnets.
Dilators are commonly used to address issues such as vaginismus, dyspareunia (painful sex), physical changes from radiation therapy, vaginal atrophy, scarring or damaged tissues, muscle spasms, and psychological triggers associated with vaginal penetration. Dilators are also prescribed after gender confirmation surgery for patients with a neo vagina to help prevent scar tissue from forming and to maintain depth and width of the vaginal canal.
When starting to use dilators, a pelvic floor physical therapist can recommend what size dilator to start with and create an individualized treatment plan for you to follow. With consistency, you will notice that you can gradually start to progress to a larger size dilator with easier penetration and less discomfort.
The Ohnut is a great tool to use if depth of penetration during intercourse seems to be the trigger of your pain. Ohnut is sold in a set of 4 interlocking rings that are worn externally and are condom compatible. Think of it as a bumper that goes around the base of the penis or toy. Since rings can be added or removed, Ohnut allows you to explore different depths based on your comfort level. You can also safely use silicone or water based lubricant while using Ohnut.
Poise Impressa and Uresta
Poise Impressa and Uresta are two tools used to help with stress urinary incontinence. Stress urinary incontinence is leakage of urine during moments of physical activity that increases abdominal pressure, such as coughing, sneezing, laughing, and exercise. These tools are not used to treat urge urinary incontinence, which is when you leak urine when you have a sudden urge to urinate.
Poise Impressa is an over the counter product that is designed for temporary relief of stress urinary incontinence by lifting and supporting the urethra. Impressa is a non-absorbent, disposable, and removable product that is inserted into the vagina like a tampon. It is sold in a sizing kit with three size options (low, medium, and high support) based on your needs. Impressa can be used during the day or just for certain activities when you need a little extra support.
If you’re looking for a product that is more sustainable, Uresta may be a better option for you. Uresta can be reused for a year with proper cleaning after each use. Uresta does require a prescription from your medical doctor which can be obtained by your physical therapist. Uresta can be inserted into the vagina in the morning and left until the evening or just used during specific trigger activities, such as exercise. It also comes in three different sizes for optimal comfort and support. This device acts as a secondary support to stabilize the urethra and gently kink it closed.
Pessaries are removable devices that are prescribed for support in the case of Pelvic Organ Prolapse. They come in different shapes/sizes and at this moment are best fit and prescribed by your gynecologist, urologist or urogynecologist (although in certain states, therapists are beginning to train to add this to our scope of practice!). Some patients utilize pessaries just for work, exercise or more high impact activities and otherwise don’t require all day use. It is a more conservative option to surgery and can be a great tool for women of any age!
With any medical device, it is important to collaborate with a healthcare professional (preferably a pelvic floor therapist!) to ensure the proper fit and use. The goal is to feel confident and comfortable when using a pelvic floor tool to help aid you on your healing journey.
As always, you can find a pelvic floor therapist near you using the directory www.pelvicrehab.com or through the American Physical Therapy Association.