It might seem difficult to talk about “the vaginas and abdomens and the anuses and the penises of Montreal,” but there’s help for pain and loss of control.
As many as 40 per cent of women leak urine after childbirth. After menopause, the figure is even higher. One woman in five has pain with sex. One man in nine has persistent genital pain.
These are massive numbers, says Montreal physiotherapist Amadea S. Kezar. Why aren’t we talking about them more?
Problems like bladder and bowel leakage, pain with intercourse and pelvic pain are so common that it’s “ridiculous” that they remain taboo subjects, said Kezar, clinical director of Montreal’s ASK Physiothérapie clinic (her initials are ASK). She wants people to ask more questions about their pelvic floor health.
Kezar, 38, specializes in pelvic floor physiotherapy, a specialized field focused on improving control of the muscles that help us control our bladders and bowels and also help sexual function.
In addressing a recent women’s conference, she described the work as treating “the vaginas and abdomens and the anuses and the penises of Montreal.”
There are postmenopausal women who have given up intimacy because intercourse is so painful and they think, wrongly, that there is nothing they can do about it, Kezar said. “I love treating the postmenopausal population because they respond so well.”
The vagina can narrow with menopause and become less flexible and this can make intercourse painful; often the vaginal muscles begin to contract in anticipation of the pain. Kezar works with women to educate them about relaxing their pelvic floor muscles, she prescribes exercises and slowly introduces cylindrical dilators of graduated sizes to help them “to learn how to comfortably allow entry and to gently widen the canal by stretching the surrounding muscles,” she explained.
Monique — like several of Kezar’s patients who spoke to The Gazette, she asked that her family name not be used — had been telling her gynaecologist for years that something was wrong, that her husband was unable to penetrate her without her experiencing excruciating pain. Her doctor sent her for tests and prescribed creams and gels but nothing helped until he referred her to Kezar.
“After four visits of stretching my pelvis in every possible way, with no pain, my body started to act like it always had before,” she said.
Most patients seen at the Ste-Catherine St. W. clinic are women, but Kezar believes that “among men there is more pelvic and penile pain than is talked about.” This includes urinary leakage, urgency and frequency and genital pain.
“After my third child, I literally felt I had no control over my pee. … I would be laughing — and I would have pee dripping.”
Charles was peeing 20 or 25 times a day when he had his first session with Kezar. “It would happen when I was stressed, travelling or having an important meeting,” he said. “It took control of my life. I never knew when I would have to go.”
For years, it was assumed he had a prostate inflammation or an enlarged prostate gland. He didn’t. The problem was a selective tension in the muscles of his pelvic floor. Kezar gave him exercises to create awareness of how he was gripping his pelvic floor muscles and how to relax them, as well as strategies to suppress bladder urgency. He said his condition has improved dramatically.
“When I say that she saved me, I am not saying it lightly,” Charles said. “This was a miracle.”
Kezar, who has a master’s degree in physiotherapy from McGill University and been practising for 10 years, opened the ASK clinic three years ago. Today five physiotherapists work at the clinic. “I love this work,” she said. “It is gratifying and you do make change.”
Treatment is a partnership with the patient, she explained. A part of her work is hands on, helping to release muscles or using techniques to help patients be more aware of muscles they need to be activating. She also gives them practical and functional exercises and strategies to practise at home.
“After my third child, I literally felt I had no control over my pee,” said Elyssa Feldman. “I would be laughing — and I would have pee dripping.”
After four sessions with Kezar, “I felt a huge difference. She helped me realize that I had muscles inside that I had control over — and she helped me isolate and control those muscles.”
Feldman, 38, liked how Kezar “makes her patients feel so comfortable. You are talking about very private issues but in a very matter-of-fact way. She normalizes everything, which is really important.”
Pelvic physiotherapy “explains to you how pain works and specifically your pain,” said Eileen Mary Howolka, who has a gynaecological condition called endometriosis that has caused her to suffer pelvic pain for more than a decade.
“You become the person managing your own pain. As someone with chronic pain, I now have all these tools to manage and help mitigate the symptoms and things to fall back on when I have a flare.
“I have learned how to chill out and, when I start to feel more symptoms, I can do exercises that Amadea gave me to help me relax,” said Howolka, 25.
Persistent pain in such an intimate area can cause tremendous anxiety, Kezar said. Moiz, 29, was experiencing pelvic and genital pain so severe that he said he was considering suicide by the time he first sought treatment with her a year ago.
“We could improve people’s quality of life sooner with more referrals from doctors and more public awareness,” Kezar said.
Said Moiz: “I used to be this very active guy, going to the gym — and one day I started to get pain in the lower abdomen, moving from the back to the groin. It was a pain that no urologist could identify. It was constant, 10 on 10. It was very hard for me. It made me grumpy. It changed my personality forever.”
Part of his treatment involved breathing exercises and de-stressing strategies. “The best analogy is imagine someone with clenched shoulders up to their ears. Your pelvic floor is clenched. You have to train the brain to let it go,” Moiz said. “Amadea gave me tools to cope. The journey goes on, but I am on the road to recovery.”
This article was orignally published on MONTREAL GAZETTE