• Jill M. Arnold, PT, DPT

Dilator What? I have to do what???

Dilators are basically a tampon-shaped hard (but smooth) plastic tool used to stretch the pelvic floor muscles. Just as you wouldn't leave physical therapy for a pulled hamstring without stretches to follow up the manual therapy that was performed so that you maintain the length gained in the appointment, you shouldn't leave without stretches for your pelvic floor unless you are one of the lucky few that flies through therapy; progressing quickly with no need for stretching. (Yay, you!). Muscles have memories, and the pelvic floor may have made memories of how to hold the muscles tight and tensioned depending on how long the pelvic floor dysfunction has been present. The positive is that muscles can be retrained, and new muscle memories can be made. It is very important to, first, teach the pelvic floor that pain-free entry is possible. Then it is important for the muscles to tolerate the dilator inside, and then stretching can be performed as tolerated. The thought is that, paired with manual therapy in appointments, the pelvic floor muscles will tolerate progressing to larger dilators as the tension is decreased internally manually. If intercourse is the goal, then dilators can be progressed so that the specific sized dilator can be tolerated prior to attempting trialing the partner as the next dilator and, eventually, intercourse. Of course, you will need a skilled women's health physical therapist to fit you for the appropriate size dilator to start, provide technique for proper dilator use, teach the important steps in dilator use and transitioning from one size dilator to the next, and being there to answer all of the questions that go along with it. I, personally, feel that how one views dilator use can influence the outcome/ benefit. Viewing dilators as part of your rehabilitation, as your tool to reach those hard to get to sites between visits, and a very important means to reach an end goal is key to positive experiences with the dilators. Patients have also mentioned that using the dilator has improved their frequency and/ or ease of having bowel movements. This can be explained by the fact that the pelvic floor needs to relax in order to have a urination or bowel movement, and the dilator is stretching and relaxing these muscles. Patients have also reported that the dilators have helped to decrease internal pain if they have a spike in symptoms between sessions. Dilators are a regular part of my physical therapy sessions for certain patients; dependent on what they are coming for and how they present. Mindset is key, and recognizing that dilators can be your tool in helping you become an integral part of your own care and healing can be so important. Dilators are not for everyone, and some patients just cannot get comfortable using them. It is then up to the therapist to brainstorm other ways to have close to that benefit for the pelvic floor. Remember that you are only in physical therapy for maybe an average of 1-2 hours per week for pelvic issues, so the way in which you spend your time and the amount of work you put into your pelvic floor outside of physical therapy is so important. The more effort you put in, the more you get out of therapy (and everything)! I strive to help my patients be as independent in relieving their own symptoms as possible. Dilators are one of my favorite ways of doing this! Be friends with your dilators because, for the right person, they can help tremendously!

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