What to Look for When You're Looking for Help with Pelvic Pain

Pelvic Pain can be hard to deal with.  The amazing amount of information (both good and bad, accurate and inaccurate) can be overwhelming.  How do you wade through everything and find the help that is right from you? Here are a few suggestions that you may find helpful.  Remember:  If you feel scared or hopeless, you’ve just not yet found the right person to help you.

Medically Induced Healthcare Issues

Healthcare can do better....

This weekend I had the good fortune to attend  a wonderful course, Comprehensive Management of Bowel Dysfunction.  As a pelvic health physio, patients with gastrointestinal, digestive, and bowel issues are always challenging.  And the fact of the matter is, if you ask your patients (even the ones coming to see you for their knees), they’d tell you about their bowels.

As much as I love talking about bowel issues, one of the most profound things that I experienced in this class was a completely comfortable, completely pain-free vaginal and rectal exam.  That’s right, even the rectal exam.

It got me thinking about what my patients go through on their quest for health.  The exams they experience, the things that they are told about their condition, and the testing they must endure are unfortunately unhelpful.   Many patients will come into the clinic ‘worse’ after visiting their physician for a recheck, or after undergoing ‘further testing’. Why are the examinations and tests people are put through making them worse?

In our clinic, we’ve started referring to these as ‘medically induced conditions’.

We unfortunately see this often.  Patients traumatized following their medical interventions or hospitalizations or physical therapy treatments.  Why does this continue to happen??  Is it necessary to ‘get worse before you get better’?  Is it necessary to endure further testing?  Here are some thoughts and questions for patients and clinicians to ponder.  I hope it makes clinicians (physios, physicians, anyone touching a patient ever) reflect and reconsider their actions/suggestions/prescriptions.  I hope it makes patients speak up if they’re being hurt.

1. If you poke anything hard enough, it’ll probably hurt.  This goes double for poking into any orifice.
2. Poking something hard enough to make it hurt won’t necessarily tell you what to do to help that person.  Especially if the person has already told you, ‘it hurts if this bit gets poked’.
3. Testing should be done to help rule out red flags, or to help direct the plan of care.
4. Patients should understand why they’re having a test, and understand how the results will impact their plan of care.
5. Clinicians should take the time to make the healthcare experience better.  Make the patient comfortable.  Take the time to explain what you’re doing.  Take the time to answer the questions.  Pay attention to verbal and non-verbal indications that what you’re doing to them is causing pain.
6. If a patient says ‘ouch, that hurts’, or they’re squirming on the table, stop hurting them.  Take a minute and reflect on what might be happening, and why in spite of your perfect technique this patient is not feeling better.
7. If a patient isn’t getting better, doing whatever you’re doing harder, deeper or more often isn’t likely the answer.

I have a hopeful heart, that even when patients have negative healthcare experiences, the healthcare practitioners are basically good people with good intentions.  There are a lot of us who also fancy ourselves to be wonderfully qualified:  specializations, advanced degrees, conference and course attendance trying to acquire  new knowledge, new skills, and new evidence to educate those patients.  Professional development (heck, learning in general) should be life-long.  However that knowledge should not replace common sense and good manners.

Your Vagina is Awesome….

Even after 3 kids.  Even after menopause.  Even if you didn’t know how awesome it is.  

As a pelvic health therapist, it amazes and saddens me that in 2014, women are still ashamed, self-conscious, and confused by their lady bits.

I’d like to address a few of the myths and inaccuracies that I’ve heard, in and out of the clinic…

1)   It can be a challenge to see your vagina.  – The vagina is essentially a hallway from your uterus to the outside world.  It’s a hallway that can stretch.  A lot.  If you can see your vagina without trying, you might want to see a physician…  Vaginal prolapse can happen, and it would need to be addressed.

2)   The parts you can see vary much from person to person.  And I’ve never seen an ugly one. -  The first thing most of us run into if we’re to take a peek at our genitals is the labia majora. If we separate those, we’ll be able to see the labia minora, clitoris, as well as the vaginal opening.  These bits do change with arousal, childbearing, and age.  If you’re curious about what ‘normal’ is, I recommend the documentary The Perfect Vagina.  

3)   The vagina is not the same as your pelvic floor. – The pelvic floor muscles are a group of muscles that are located in the bottom of your pelvis, spanning from your pubic bone, to your tailbone, and out to each ‘sits bones’.  The pelvic floor has 3 openings for us ladies:  (starting from the front) An opening for our urethra to urinate, an opening for our vagina (for sex and childbirth), and finally our anus for defecation.  The pelvic floor also plays a role in respiration and core stability.  Bladder, bowel, and sexual function can all be impacted by pelvic floor muscles that are not functioning up to par, which brings us to my next point.

4)   Having a baby can greatly impact the function of your pelvic floor muscles.  There’s much to say about this…

1. If you give birth vaginally, you’re pelvic floor muscles stretch more than any other muscle at any time in your life.  It is one of the wonders of the world that a woman can pass a child through her pelvic floor, and more often than not, regain fairly good bowel and bladder control quickly, and resume sexual activity in as little as 6 weeks.
2. If you give birth via C-Section, you did not get the ‘easy way out’.  Studies show that pelvic floor dysfunction (bowel, bladder and/or sexual dysfunction) are just as high in women 12 months after a C-section as they are in women who have a vaginal delivery.
3. Some women recover more quickly than others.  Some women just think they’ve recovered.  There are several common things that women experience after childbirth, such as incontinence or painful intercourse.  These are certainly common, but should not be considered ‘normal’, and therefore ignored.  There is much to be done to improve these symptoms, and I’d seek out a qualified pelvic health therapist to get an assessment as soon as possible.

5)   Even if you haven’t had a baby, it’s ok to get help for pieces that don’t seem to be working as well as you’d like. - Sometimes things aren’t as good as you’d like.  Yep.  I’m talking about sex.  Lack of enjoyment, lack of desire, lacking the ability to have orgasms…  These can be more complicated, but not impossible to address.  Identifying the different pieces that may be contributing to the situation is key.  There are physical, medical, mental and emotional issues that can contribute in various ways to sexual dysfunction.  Understanding what your bits are, and what they’re supposed to be doing can go a long way in decreasing fear and anxiety relating to sexual dysfunction/lack of enjoyment.

If you find yourself in a situation where you don’t love your vagina, get help.  Don’t assume nothing can be done, and don’t suffer in silence.  If you’ve not had a physical lately, I’d recommend you check in with your gynecologist.  If you feel like you can’t talk to them, or feel like you’re not being heard, don’t give up.  We’re happy to offer some suggestions on a starting point for you to start your journey to better sex.

Prostatitis - Can Pelvic Floor Physical Therapy Help?

Prostatitis is one of the most common diagnoses that men are given if they’re having a new onset of pain “down there” or urinary issues.  ‘Prostatitis’ literally means ‘inflammation of the prostate’.  There are two basic types of prostatitis, acute and chronic. Identifying which kind is present is important in determining the best course of treatment.  

Acute bacterial prostatitis is an infection of the prostate.  Like any other infection, symptoms can come on suddenly, including chills and fever.  Other symptoms might include pain in the bladder or when urinating.  Acute bacterial prostatitis is best treated by your doctor with antibiotics.

Chronic prostatitis has a few manifestations. First, chronic bacterial prostatitis is characterized by gradual onset, and recurrent urinary tract infections.  The other is chronic pelvic pain syndrome or nonbacterial prostatitis.

Most men who begin to experience discomfort or dysfunction in their nether regions will head to their doctor to remedy the situation.  As stated earlier, if the pain or dysfunction is caused by an infection, medical intervention is necessary. However, there are times where the medical intervention does not end up relieving the man of his pain or during the course of medical intervention it is determined that there is not an infection present.  So what can be done for the patient with pain but no infection?

This is the type of ‘prostatitis’ where pelvic physical therapy may help.  Physical therapists are experts in treating pain, and identifying ways to manage or eliminate it.  Chronic pelvic pain syndrome is a condition where a man may or may not have any inflammation in his prostate.  Or if he does, it may or may not actually be contributing to his complaints of pain or dysfunction.  Understanding the behavior of the pain, as well as the function of the anatomy in the area (low back, pelvic floor, hips, bladder, bowel and sexual function) can help develop a better understanding as to why the pelvic pain is persisting.  Understanding all of the potential contributors to a man’s complaint of ‘pelvic issues’ is key to providing the most effective intervention.

There is a fourth type of prostatitis called ‘asymptomatic inflammatory prostatitis’.  This type of prostatitis doesn’t have any symptoms of pain or dysfunction, but ‘signs of inflammation are found when the patient is being evaluated for something else’.  If there are no symptoms, and no infection, there does not need to be any treatment for this condition.

Anytime a patient (male or female) comes to me with 'chronic UTIs', I always ask if they were confirmed with a culture.  I've seen too many people get treated for 'repeated' infections with no cultures.  Does the person have burning with urination and frequency and the patient and doc are assuming infection?  And if there is pain due to something else (pelvic floor dysfunction, non-relaxing pelvic floor, etc), a painful bout of urination could make that pelvic floor freak out more. Or if they're already sensitized to pain in that area, then an infection (which hurts)  could contribute to ramping up any symptoms in that area.  Often prostatitis is more often an assumption than an 'I had a positive test for prostatitis'.  A guy has pelvic pain, he is almost certainly going to be diagnosed with pudendal neuralgia or prostatitis, with very little differential diagnosis done.

Acute Bacterial ProstatitisAcute Infection!  See doctor, get medication and everything should be fine.	Chronic Bacterial ProstatitisRecurrent infections, antibiotics still likely to help, but may take longer
Chronic ProstatitisCharacterized by pain and discomfort.  I wonder if this is really ‘inflammation of prostate’ or if it is a pain syndrome blamed on the prostate.  Antibiotics don’t usually help, maybe Pelvic PT can!	Asymptomatic Inflammatory ProstatitisNo symptoms to complain of, but inflammation if found incidentally.  Not typically treated.

If infection has been ruled out or treated, but symptoms of pain or dysfunction persist, consider consulting with a skilled pelvic floor therapist.  A skilled pelvic floor therapist can assess your pelvic floor muscles for tenderness, ability to contract and relax, as well as assessing other potential contributors to your pain.  Physical therapists can also help with function.  Unfortunately most of the advice I found online for men experiencing pelvic pain were to just avoid all things that might exacerbate their symptoms, like sitting or riding a bike.  While I don’t suggest doing things purposefully to exacerbate pain, understanding the cause of the pain and addressing it will allow you to keep doing the things you love.