- Step-by-Step Guidance
- Pain Science Lessons
- Dynamic Meditations
- Brain Retraining Techniques
When it comes to pelvic floor dysfunction, Evelyn Hecht has seen it all in her 20+ years of experience: pain with sex, vulvodynia, interstitial cystitis, urinary frequency, pain associated with endometriosis, pudendal neuralgia, irritable bowel syndrome, constipation, post-surgical symptoms, and more. Throughout her career, she has found that the journey OUT of pain is just as unique and individual as the journey INTO pain. That's why she treats her patients with a more holistic approach, looking beyond the diagnosis to help them connect their symptoms with life experiences, thought patterns, learned nervous system habits, and more. Join us as Evelyn discusses the tips, strategies, and ideas that have helped thousands heal from pelvic floor dysfunctions.
Evelyn is currently accepting patients at her practice, EMH Physical Therapy in New York City. In addition to her practice, she has collaborated to create Pelvic Track - an app that helps people learn what kinds of physical exercises are good for the pelvis, track their bladder & bowel moments and chart their progress over time.
Initially the first step in the pelvic world was to look at the tissues. What muscles are tight? What nerve might be encroached or too tense? But I’ve learned over the years of being in this field that you have to look at the whole system. Most people, when they have pelvic floor issues, they’ve had it for at least 10 or 15 years. It could be chronic holding patterns. It could be issues of tension and fear. So, it’s important to educate patients about what happens to the brain and the nervous system when you’ve had a dysfunction or a pain for that long.
There’s naturally lots of things that change and that could be retrained. So, the first thing I look at with pelvic pain and pelvic floor dysfunction is how you are breathing. Most of the people that I assess are breathing not with their diaphragms but with their secondary accessory breathing muscles, which are their neck and upper shoulders. That type of breathing stimulates the fight-flight sympathetic nervous system, which keeps you on edge and keeps your brain feeling like you’re in danger, making it send pain signals to the area it’s used to sending them to, to keep you protected.
Each time you breathe in the diaphragm lowers itself. And as it lowers it also allows the lowering of the pelvic floor. So, each time you’re breathing in deeply and breathing out, the pelvic floor is also getting a nice rythmnic movement. There’s an inhale where there’s a nice gentle bulging and an exhale where it returns to its resting position.
And why is breathing so important? The stimulation of the parasympathetic nervous system allows the brain to feel safe and calm. A lot of people with pelvic floor dysfunction have some type of digestive, GI or constipation related problem. When you’re in a state of tension (fight-flight) then the rest and digest nervous system is quiet. It can’t work. So we teach patients a lot about breath-work and stimulating the parasympathetic nervous system. We also educate them about how the brain is involved with sending pain and discomfort to the tissues.
What keeps pain in our body is our fear of the unknown – when is it going to come again? It used to come when I would do this and this, so I won’t do that again. The fear and anxiety of when this is going to happen again really keeps us in a tension state. So it’s really hard to believe that you, even though you are dealing with things like “I was in a car accident”, “ I’m diagnosed with endometriosis”, “I’m in a horrible relationship”, still have the ability to heal. That’s a hard thing to do. It is not an easy road. But it’s doable. And it’s doable with you taking an active role in learning more about yourself, which is not always easy either. Learning that you felt calm after you went to that acupuncturist. And your reactions to your child who was a little bit nasty weren’t so strong.
It’s almost like you want to start thinking about the subtleties of yourself. Learning a little bit about what makes you feel at a good place. And, as with your writing exercises, probably finding out what makes you feel joy. Doing the writing work about forgiveness. I find that those who can understand that getting through forgiving the person who created this problem for you or forgiving yourself for what you may have done is a big, big effort. But it’s possible. Take these little steps towards feeling good for even 2 minutes, and they may get a little longer as the days go on. But these are the things that teach you what your body responds to and to believe in your healing ability.
We go through lives - our emotional life, our social life, our physical life – and we’re going to take hits. For lack of a better word, that’s just part of our growth. Sometimes we go through these traumas and these challenges. How can we understand that it’s okay to have a little bit of a 2 out of 10 discomfort here and there?
I think the all or none approach to life just doesn’t work. There’s lots and lots of beautiful pastel colors, rose colors, that you can find. You can accept that this is what you have. And by doing some of the Curable work and following through with some of the movement work that your therapist has taught you and taking the medication as you need to, you can head towards the healing process. Over time, being consistent with these may allow you to see that you are able to do a little bit more than you did before. Or that you’re able to sit for more than 25 minutes. It builds upon itself. The work can be done in small bits if you’d like. You are your own best healer.