An important goal for all patients is becoming independent and being able to self-manage their symptoms. A home exercise program can include, for many with hypertonic (too much tone) or pelvic floor with spasm, the use of dilators. This will allow for self-treatment of the pelvic floor muscles.
Dilators come in varied sizes and nowadays shapes. They are also known as wands. There are straight dilators and curved dilators. These tools are non-irritating and smooth. Depending on the company, the sizes increase gradually and can be changed depending on the patient’s tolerance. They can be used to stretch, massage and release tender points and they help reduce the hypersensitivity of the Vestibule and Introitus. If used correctly and under supervision, dilators are a great way to advance in your treatment plan and decrease pain whether it be pain with penetration or deeper pain. Both women and men can use dilators.
Dilators can be used to mobilize scar tissue such as after an Episiotomy. Penetration can be eased and pelvic examinations will become more comfortable.
In most cases, the dilator should be used several times a week (this may depend on how many times you are seeing your physical therapist per week). In our clinic we tend to have patients using it 3-5 times per week. Most patients will spend 10 minutes per dilator session, but initially maybe only a few minutes to ease into the process.
Patients can use techniques such as deep breathing and guided imagery to ease the process. Mirrors can be useful as well. Mirrors allow the patient to observe the process of something inserting or touching. As this becomes an easier process, the patient who is using a mirror will recognize the new pattern or pain free touch and penetration.
As the dilator becomes easier to use, one can move on to the bigger sizes. This may happen in one session or many. Some patients will leave the dilator in for their home treatment session; others will press on muscles to stretch them. And others will move the dilator in and out, to repeat the penetration process. All this depends on your symptoms and goals.
Dilators can be purchased by patients (no prescription needed), but I highly recommend following the guidance of a professional for their use. Check out our blog on favorite items to see some of the brands we use (http://coredynamicspt.com/2018/01/18/some-of-our-faves-a-resource-guide/).
When used correctly, patients don’t need to worry about hurting themselves with the dilator. The goal is not to increase the pain but to become more aware of the areas which need more help and help you consciously relax those muscles. Some people do find themselves sore after using the dilator. In this case, we recommend ease back or combine the session with gentle stretching and perhaps warm soak. The direction of your physical therapist or other health care provider will allow you to progress appropriately and at the correct speed.