How Madonna Beat UTI-like Sensations and Pain with Intercourse
Many people come to The Pelvic Model thinking they are alone in their symptoms. To be fair, the pelvis is a taboo subject, and it is not common to talk about it freely. When things go awry in the pelvic region, it could be hard to talk about with others including professionals.
Part of The Pelvic Model’s mission is to destigmatize the pelvis in order for people to get the help they need. As a step towards this mission, we’ll share a story about one of our patients who successfully beat her urinary symptoms and pain with sex.
About the patient:
Let’s get a full picture of this patient; we’ll call her Madonna (not to be mistaken by Madonna the singer). Madonna is a woman in her 50’s. She is an avid yogi, happily married to her beloved partner, and has an amazing career. Currently, she works a remote job that requires ample computer time. She has multiple dogs, and she is generally a high-functioning individual. One thing she does note is that she has anxiety, especially heightened when she first came into the clinic.
Madonna first came to The Pelvic Model in late January of 2022, and she was not in the best mental or physical shape of her life. She was desperately seeking advice and someone to guide her on how she could get rid of her symptoms: pain at the entrance of the vagina and urethra, especially after urination, lower abdominal discomfort, and pain with sex. She also felt a “gripping” sensation over her bladder, which is surprisingly a common symptom in those with pelvic dysfunction. She admits she normally is an anxious person, but not knowing what is going on with her body has skyrocketed her nerves and desperation to get rid of her symptoms. Her symptoms were so severe at this time that she was not able to get a good night’s sleep due to nocturia (waking up in the middle of the night to urinate), and it was keeping her from having an intimate relationship with her partner. As you can imagine this negatively impacted a multitude of areas of her life, significantly affecting her quality of life.
Prior to coming to our clinic, she had sought professional help from many providers, including urologists, to no avail. Prior to our initial evaluation, she had taken many rounds of antibiotics although she reported she never tested positive for a UTI (which was tested due to complaints of pain at the entrance of the vagina and urethra, and “gripping” around the bladder). Like many people who come to The Pelvic Model, she did not know what was going on, and she was terrified this would last forever.
What we found:
Everyone who comes into the clinic will have an initial evaluation. Based on what the patient tells us, we prioritize what we look at that day, and then we delve deeper into subsequent visits. For Madonna, it was a priority to look at the connective tissue in her abdomen and pelvis, abdominal visceral fascia, of course, pelvic floor muscles and nerves, and her vestibule.
The connective tissue (aka fascia) around her sit bones, rectum, perineum, vulva and lower abdomen was significantly restricted on the right side more than her left.
Visceral fascia restrictions were found around her bladder, uterus, and sigmoid colon.
Her pelvic floor was definitely restricted all over, and she had difficulty relaxing her pelvic floor after a contraction. Further, the pudendal nerve on her right side was irritable.
We administered a q-tip test in which we touch various points of the vestibule with a q-tip. This showed that her vestibule was painful throughout, right side more than her left.
What does this mean?
The reason why we check the fascia around the pelvis, abdomen, and back (we normally make time for structures we hadn’t gotten to in future visits), is that restrictions in the fascia can contribute to these types of symptoms. For example, our fascia covers everything under our skin and over every structure (muscles, nerves, blood vessels, etc.) like a continuous 3D web. All of these structures in our body need to move as we move. Think about nerves needing to move in our body as we bend over, for example. If the fascia around these structures is restricted, it can definitely cause some problems.
Next, let’s discuss the visceral fascia. Because she is demonstrating urinary symptoms, we made sure to look around her bladder. If the fascia is not mobile around her bladder, it can prevent increased urinary symptoms because her bladder cannot contract and relax comfortably, as it should. We then looked at the uterus. All fascia is connected, and pulling around the uterus could pull around the bladder. Think about grabbing your shirt from one end. You’re going to notice tugging on the other end of your shirt, right? Same thing with fascia. Lastly, we checked around the sigmoid colon because restrictions around here can create bladder pressure as well. She did note that she is not currently constipated; however, she has a history of constipation in the past. This gives clues as to what structures to check in case it is contributing to her discomfort.
Now, we’re getting to why you’re here: the pelvic floor.
Pelvic floor muscles share some of the same innervations as the bladder. If someone has pelvic floor restrictions and dysfunction, it can translate into urinary urge, frequency, or feeling like they have a UTI. Since everyone has a pelvic floor, anyone is susceptible to feeling these symptoms. So- even if you own a penis, you may still experience these symptoms and wonder, “Why are test results showing I don’t have bacterial prostatitis, an STI, or UTI?” It could be your pelvic floor. Further, if the pudendal nerve (the nerve that shares some of the same innervations as the bladder) is irritated, it can create urinary symptoms. With Madonna, this created discomfort around her vulva, and it exacerbated her urinary symptoms.
And finally, a positive q-tip test on Madonna hinted that she has hormone deficiencies, most likely due to menopause. The vestibule is a structure that needs estrogen and testosterone, and once your ovaries stop producing these much-needed hormones, they can experience Genitourinary Syndrome of Menopause (GSM) – a blog about this is to come!
Let’s put it all together
It makes sense why we would look at all of those structures individually; however, what’s the bigger picture?
As we have learned, the vestibule can get irritated by many different things: hormones, nerves, muscles (and more). With Madonna, a driving force with this is because of menopause. When sex hormone levels dip from menopause, one can start to experience what is called Genitourinary Syndrome of Menopause. Symptoms include:
Insert symptoms.
Genital:
Vaginal dryness
Irritation/burning/itching
Leukorrhea
Thinning/graying of pubic hair
Vaginal/pelvic pain and pressure
Vaginal vault prolapse
Sexual:
Dyspareunia: pain with sex
Reduced lubrication
Post-coital bleeding: bleeding after sex
Decreased arousal, orgasm, and desire
Loss of libido, arousal
Dysorgasmia
Urinary:
Dysuria: pain with urination
Urgency
Stress/urinary incontinence
Recurrent urinary tract infections
Urethral prolapse
Ischemia of vesical trigone
We are going to touch on this in an upcoming blog as well.
So, if you think about it, the tissue at the entrance of the vagina and urethra is irritated, and that itself can cause muscle guarding. Muscle guarding can irritate the pudendal nerve. These symptoms are generally not talked about, and if you don’t know that this can happen it can cause an anxious person to spiral. In turn, the anxiety can create more pelvic muscle guarding, and it becomes a whole pain feedback loop.
How Madonna beat pelvic floor dysfunction
After finding everything above, we worked on all her musculoskeletal impairments which greatly reduced all symptoms. However, we knew that the musculoskeletal system may not be the whole picture, and including medical management to address her hormones was crucial. After an assessment of her hormones, she started applying a topical cream to improve the condition of her vestibule and further protect her from urinary symptoms and pain.
Mind you, although this is a few sentences long, we spent ample time working on these factors and addressing how anxiety plays a role in her symptoms and continued muscle guarding. It took many months to calm down her nervous system, and all of her persistence and hard work paid off. She also addressed her gut due to the number of antibiotics she had taken. Now, a year later after her initial evaluation, she hardly comes into the clinic. When she does, it is only for maintenance to make sure everything is all good.
Madonna put in the hard work. She showed up for her weekly appointments, took all the tools we had given her, and she implemented them all in her life for a full recovery. She is now able to work in her job uninterrupted with the incessant need to urinate. She is able to revive intimacy with her partner, which was a major goal for her. She now has the tools to reduce flares that may arise in her life without the need of our help. In the bigger picture, this not only helps her symptoms but the quality of her life. Madonna has successfully overcome pelvic floor dysfunction, and we could not be more proud of her.
