Silence pelvic floor pain for good

Unbearable pain, thought to be caused by hemorrhoids, plagued Jane Peters for five years. When the discomfort was too much to tolerate, Peters requested a visit with a specialist. But she wasn’t satisfied, and sought a second opinion from Bayhealth Colorectal Surgeon Elsa Goldstein, MD, who referred Peters to Bayhealth Outpatient Rehabilitation for pelvic floor therapy.

The “pelvic floor” is a group of muscles that provide support to the organs and control bowel and bladder functions. Dysfunction or weakness of these muscles can result in a variety of problems including incontinence or pain. Through the pelvic floor rehab program, treatment includes myofascial release, dilator therapy, education regarding triggers and modifying activities, biofeedback, and therapeutic exercises.

Peters was diagnosed with a pelvic floor condition called levator ani syndrome/spasm and not hemorrhoids. Levator ani syndrome refers to pain experienced in the back part of the pelvis. Symptoms include pain while sitting and discomfort after a bowel movement.

Bayhealth Physical Therapists Jessica Bayer, PT, DPT, WCS, CLT, and Christine Boddicker, PT, DPT, encourage people to talk about pelvic floor pain with their doctors. “This isn’t a condition people are comfortable talking about,” said Boddicker. “Although talking about pelvic pain and incontinence can be embarrassing, it’s better to talk about it than live with the pain in silence.”

When Boddicker and Bayer first meet with patients, they do a thorough pelvic floor assessment and completely review the patient’s health history. Peters was instantly put at ease during her initial examination with Bayer in early 2017. “The fact Jane was referred to therapy was a good sign because it meant she didn’t need surgery,” Bayer said. “When I initially met with Jane, I conducted an entire pelvic floor assessment to see how her muscular functioning was doing.” From there, Peters’ therapy continued through the spring and summer, with her final session in July.

Life before pelvic floor therapy was uncomfortable for Peters. She couldn’t stand still, sit, lie down, or drive, and only found minor reprieve from pain while pacing around the house. It wasn’t until she began physical therapy that she experienced relief.

Following therapy, Peters is able to sit without needing a pillow or balled-up towel under her bottom. She’s also back to doing the things she loves, such as gardening. “I couldn’t be happier with my experience. I still have some tenderness, but I’m doing very well. I wish I had known about pelvic floor therapy years ago so I wouldn’t have suffered for so long,” Peters said.

Bayer and Boddicker attribute Peters’ success to her determination in addressing the problem. She was a true advocate in her health throughout the process, refusing to settle until she was comfortable with a diagnosis and got the help she needed.

“Anyone who is suffering from pain in their pelvic floor region, I highly recommend talking to your physician and be as comprehensive in your analysis of your pain as you can,” encouraged Peters. “Don’t put this off, and if you get help but are still suffering, don’t be afraid to ask to see someone else.”

Q & A with Dr. Goldstein

Dr. Goldstein sheds some light on pelvic floor disorders and the options available for treating urinary and fecal incontinence.

What is the pelvic floor?

The pelvic floor is a muscular structure that supports the pelvic organs of the bladder, uterus, vagina, and rectum.

What are pelvic disorders?

The most common pelvic disorders involve the weakening of the pelvic floor. That’s when you have bladder, rectal, or uterine prolapse. Prolapse is when the body parts essentially fall out of position. This prolapse causes incontinence with urine or stool.

Who tends to have these disorders?

Women are far more likely to have pelvic floor problems, as the main cause is a combination of childbirth and aging. The most common age group is women over 50. Men can have problems as well, but women are far more likely. Women who have had a large baby are also at higher risk.

When should I seek help?

Once you notice symptoms and they begin affecting your life, it’s time to seek help.

What are the symptoms?

The most common symptoms are urine or fecal leakage. Some women will experience leakage when they cough, sneeze or exercise. Other women will have leakage no matter the circumstances. With fecal incontinence, some women may leak gas or stool. There’s also an increased urgency, where you may have limited or no warning that you need to use the bathroom.

What are the treatment options?

The most common treatment is pelvic floor therapy. Most people respond well to the therapy and do not need any further intervention, such as surgery. How long does treatment take? For many people, treatment is once a week for a few months. It’s very similar to going to physical therapy.

Are there any risk factors?

Women who have given birth are at a higher risk of developing pelvic floor problems. Additionally, anyone who is diabetic, people taking certain medications, and anyone who has undergone radiation treatment to the pelvis are at a higher risk. Those with neurological disorders and a history of rectal surgery are also at a greater risk.

How common are these problems?

This is a very common problem and women should not be embarrassed. Nearly 20 percent of the population has pelvic floor problems. Women suffer in silence and aren’t telling their doctors or family members. They don’t seek treatment and instead just make lifestyle adjustments. But it doesn’t have to be that way. We work with women to create a specific treatment plan and restore lifestyle and dignity.

Dr. Goldstein treats patients at Bayhealth Colon and Rectal Surgery in Milford and Lewes. To make an appointment call 302-503-2700 or learn at

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