Kim Mize holds up a model of the pelvis that she uses to show patients where their pelvic floor muscles are. It looks a little like she’s about to Poor Yorick the pelvis, and she has been known to make light with patients to get them comfortable talking about the problems she treats: urinary incontinence, pain during sex and pelvic floor problems after prostate surgery. “It’s a bit of a taboo subject,” Mize says. Accordingly, her exam room is as private as she can make it, with an attached restroom so patients don’t have to venture into a hallway once their appointment has begun.
Mize has been at Alpine Physical Therapy on Stockyard Road since June. Prior to that, she was at the University of Montana School of Physical Therapy, where she still teaches, for more than 14 years, and she’s specialized in pelvic health for more than 20.
When she first started in the field, pelvic floor rehabilitation was known mainly as a way to help women with urinary incontinence after childbirth. The primary exercise used for that — Kegels, named for the doctor who first prescribed them — can be difficult to learn without instruction. Most patients who benefit from her instruction are fighting against the pelvic floor muscles, Mize says. “It’s three things: [they’re] holding their breath, using their abs and using their glutes.”
While a weak pelvic floor is the most common patient complaint, Mize, like other specialists, also treats problems that arise because of a pelvic floor that is too tense.
“Much like you carry tension in your neck, like your neck muscles or your upper shoulder muscles that kind of give you headaches or just painful knots in your muscles, some people have knots in their pelvic floor,” Mize says. “So it feels like a headache in the pelvis, essentially. So these women that have this will sometimes not be able to tolerate penetration, so intercourse is not fun.”
Mize says most of her patients arrive with straightforward cases of pelvic floor weakness, and about 25 percent are men. Patients with problems related to pelvic floor tension are fewer in number for a variety of reasons, Mize says.
“Part of that is there are other people that do what I do in town, and so they see some of them,” she says. (There are pelvic floor specialists at Three Rivers, Valley and Missoula Bone and Joint.) And part of it is that they just suffer silently. “They are having pain, and either they’re not telling their physician or the physician doesn’t know that we treat it.”
Doctors will often seek a medical reason for pain during intercourse, Mize says, and while some physicians will immediately refer patients to physical therapy for incontinence and pelvic pain, others send them all the way to Minnesota before they make it into her office. “I’m still having people come to me from the Mayo Clinic … their regular doctor didn’t know what to do with them, sent them to Rochester, Minnesota, and they have a full-day workup, and then they say, ‘Oh, you need a physical therapist,’” Mize says. “It’s like, I was here all along!”
As with any other muscle, there are ways to release trigger points in pelvic floor muscles. Mize can do an examination and find those points so the patient knows where they are, and there’s a tool called a Pelviwand (previously known as the Therawand) that patients can learn to use themselves to release trigger points. The Pelviwand bears some resemblance to G-spot stimulators, but is distinguished by being made in the U.S. with medical-grade cast acrylic, according to Liz Janapol, the CEO of Pelvic Therapy Incorporated. Janapol says PTI is working toward FDA approval for its devices, but until then the company’s website bears a disclaimer reading, “Novelty use only.”
The usual initial examination process is digital, during which Mize manually measures pelvic floor strength and demonstrates the proper way to contract and relax muscles. For patients who wish to avoid an internal examination, Mize uses an ultrasound to show them their muscles. “They can see their pelvic floor lift and relax, and relate that to what it feels like, and then their exercises are more effective and they don’t have to undress. They just have to put a probe on their belly,” she says.
Mize still sees patients who are surprised there is a treatment for their pain, which she says should be recognized as a treatable condition.
“I have frequently said before, and I’ll say again, that intimacy should not hurt,” Mize says. “Sex shouldn’t be painful.”