How Pelvic Floor Therapy Can Help Alleviate PCOS Pain

If you've been diagnosed with PCOS (polycystic ovary syndrome), you may have been told that your treatment options are limited to medication or lifestyle changes. But there's another powerful tool that deserves a place in your PCOS management toolkit: pelvic floor physical therapy.

PCOS is an endocrine system condition that impacts the reproductive system due to it's effect on hormones and the ovaries, which can have an affect on your menstrual cycle. Pelvic floor physical therapy can play an integral role in your holistic PCOS treatment plan, alongside medical management and nutrition recommendations.

What is PCOS?

PCOS is a common condition that affects up to 15% of people assigned female at birth who are of reproductive age. 

One piece of PCOS is that it can lead to the ovaries creating excess hormones called androgens. Androgens are primarily responsible for the development of male physical characteristics. The development of PCOS causes a hormonal imbalance which can then lead to irregular menstrual cycles, missed periods, unpredictable ovulation, heavy periods, excess hair growth, and infertility.

PCOS is usually diagnosed if you present with two of the following four factors:

• Elevated testosterone levels
• Elevated androgen levels which may cause symptoms of hirsutism (excess hair growth on the face, arms, chest or abdomen
• Enlarged ovaries or the appearance of cysts on the ovaries via ultrasound
• ‍
  Infrequent or irregular ovulation resulting in fewer than 8 menstrual periods per year

PCOS vs. Endometriosis: What’s the difference?

While PCOS indirectly affects the reproductive system, endometriosis is a reproductive system condition that affects about 1 in 10 people assigned female at birth worldwide. Both conditions can cause pelvic pain, heavy periods, and infertility.  

Endometriosis, however, occurs when tissue similar to the lining of the uterus grows outside the uterus. Your healthcare provider will likely recommend either medication and/or surgery as treatment options. (Depending on your diagnosis and your specific case; surgery isn’t usually recommended for PCOS patients).

What does PCOS pain feel like?

Describing PCOS pain can be challenging, as pain isn’t even officially considered a common symptom of the condition. But that doesn’t mean your PCOS-related pain doesn’t exist. PCOS can potentially increase your risk of dysmenorrhea (painful periods), and irritable bowel syndrome, all of which are linked to dyspareunia or pain with sex.

“Something we typically see with PCOS patients is an overactive pelvic floor causing a lot of pelvic pain,” observes Dr. Sarah Clampett, PT, DPT, Head of Clinical, Virtual at Origin.

No matter how you may experience your PCOS symptoms, whether it’s painful sex or severe period pain, pelvic floor physical therapy is a natural treatment option that can offer pain relief, as well as help you understand your body better.

Benefits of pelvic floor physical therapy

While pelvic floor physical therapy can’t heal or cure PCOS, working with a physical therapist “can help with the underlying symptoms and symptom management, particularly around pelvic pain, painful periods or painful sex,” says Dr. Clampett. Your physical therapist will address your own unique presentation, but in general, you can expect to work on “both strengthening and lengthening the pelvic floor muscles,” says Dr. Clampett. “We’ll see those muscles [are] overactive and holding on tight in a protective mechanism.” 

Another area you can work on with your physical therapist are methods for “breaking the pain pathway from the brain to the pelvic floor,” says Dr. Clampett. This can help manage common PCOS symptoms like painful periods.

What PCOS patients can expect in a pelvic floor therapy typical session

Whether it’s pain from intercourse, pain from tampons, or menstrual cramps, “the body tends to protect itself,” explains Dr. Clampett. “Like with a knee injury or ankle injury, your quad or your calf are going to really tighten up to protect that painful area; the pelvic floor does the same thing.”

So even though everyone presents differently, you can expect to work on downtraining, which is a method of relaxing your pelvic floor muscles, and lengthening to help relax your pelvic floor muscles. “It's going to be a lot of breathing, a lot of stretching, and a lot of creating a safe space to help to address that tension,” says Dr. Clampett. “We’ll partner to create a treatment and a care plan that works for you, so you can get the most out of these sessions.”

You can also expect to discuss lifestyle strategies with your physical therapist to help manage your PCOS symptoms, “especially since those symptoms can be cyclical, depending on where you are in your cycle,” says Dr. Clampett. 

Exercises to help with PCOS pain

• Downtraining: These exercises focus on breathing, lengthening, and trying to create more space between your sitz bones. This can include stretching, and yoga poses like cat-cow pose, child’s pose, or happy baby. “Anything that brings length, as opposed to contraction and tension,” says Dr. Clampett.
• Uptraining: Strengthening exercises like kegels can help improve the power, endurance, flexibility, and coordination of your pelvic floor muscles.‍
• Abdominal mobilization exercises: These can help make sure “you have a range of motion for the tissues in both your abdomen and pelvic floor,” explains Dr. Clampett.

Why should PCOS patients consider physical therapy? 

“Physical therapy is a great adjunct treatment option,” says Dr. Clampett. Even if you’re on a medical management plan for your PCOS, she recommends pelvic floor PT so you can improve your range of motion and coordination, as well as be even more attuned to your body. Pelvic floor PT can help “teach you about your body,” and about “what's normal, what's not normal, and what your pelvic floor does when it's functioning normally,” or even “how your [pelvic floor] is functioning abnormally due to the pain or even a side effect of any of the medication or the interventions that you’re undergoing.”

Another reason we recommend physical therapy is it’s an untapped resource for stress relief. First of all, PCOS can go undiagnosed for a long time; many people don’t receive a diagnosis until they seek fertility treatment. “You can be stuck in a medical maze trying to get answers,” observes Dr. Clampett. “And so the pelvic floor also carries some of your stressful or emotional toll.” 

So even though you may have a diagnosis in hand, the body keeps the score. “You’ve been holding so much tension and stress in your pelvic floor for so long trying to get the answers you need,” says Dr. Clampett. “Physical therapy can also help address some of the tension and the symptoms that might be caused by the stress and the anxiety around trying to get a solution and a reason behind your pain.”

Questions to ask your physical therapist

If you’re seeking pelvic floor therapy, “I think it can be really empowering to know what your baseline is,” says Dr. Clampett. “The more information you have, the more powerful you become on your healing journey.” 

As a patient, you have every right to be a counterpart to your provider. Dr. Clampett recommends being “very vocal” and “asking every question that you think of,” because in the world of pelvic floor therapy, “there’s no such thing as TMI!”

Here are some questions to help kick things off:

• Is my pelvic floor overactive or underactive? 
• What do I need to work on? 
• How can I be an active participant in the PT process?

If you’re ready to learn more about pelvic floor therapy as an alternative treatment for PCOS, book a visit today, either in-person or virtually.