Support for Pelvic Pain in Unexpected Places

When you are experiencing pelvic pain, or pain of any kind, you may go through a range of emotions and more than likely will have a lot of questions ranging from “Why am I in pain?” to “Is this going to get better on its own?”. These are not easy questions to answer, and finding support and the right person to ask them to can be very difficult. The following are great resources that you can use in a variety of ways. You can use them to vent about issues, get advice on a range of topics, or offer your support to others dealing with pelvic pain. Just remember that these websites are not run by health care providers so be sure to consult with a medical professional before beginning any sort of treatment recommended.

Reddit

Chronic Pain Subreddit

Pelvic Floor Dysfunction Subreddit

Reddit calls itself “The front page of the internet” and is described as a “social, news, entertainment network”. If you just browse the site casually you may not think it is the best place to share your experiences with pelvic pain. However, if you dig a little deeper you can find communities like “Chronic Pain” or “Pelvic Floor” full of supportive people who are happy to share advice on things such as tips for staying warm in cold weather to advice on post surgery recovery.

Facebook

American Chronic Pain Association

Chronic Pelvic Pain Network

You most likely have a Facebook page, and while it is great for staying up to date with friends and family it can also be a great way to connect with others living with pelvic pain. Like Reddit, there are many groups whose, members offer support and advice on pelvic pain related topics. Groups may even have meet-up events so you can connect face to face with others with pelvic pain.

Twitter

Twitter

Twitter is another social network that allows you to connect with others in similar situations. Using hashtags (the # symbol) you can see who is tweeting about things relating to your pelvic pain. Popular hashtags for those who have pelvic pain include #pelvicpain, #pelvichealth, #pain, and many others. You can reply to people who use these hashtags with advice, questions, or just to offer your support. Just make sure to keep it brief as 140 characters goes quick! Make sure to follow @SandyHiltonPT,  @SarahHaagPT, and @EntropyPhysio once you get set-up.

The internet is a great place to find support, if you find the right communities. The communities mentioned here is not an exhaustive list, but it does include places whose members are active and helpful. Make sure to contact Sandy or Sarah at Entropy Physiotherapy so they can answer any questions you may have and help you resolve your pelvic pain.

Nate Mancillas SPT, MS

Redefining Your New Normal

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  Warm red leather with great traction and no concern for rain or snow, my favorite boots sit in the corner of the closet, the soft tops sagging into pouty folds. They were benched last winter after a rough year of ankle sprains, soreness and nagging foot pain. “I’m good as long as I don’t wear heels or my boots.”

The new normal isn’t normal.

• Give up the favorite boots or heels and that foot pain is gone.
• Don’t turn your head as far and your neck doesn’t hurt.
• Move the dishes to the lowest shelf and reaching isn’t a problem.
• Take the elevator instead of the stairs and then you won’t be out of breath.
• Stop running and that little leak of incontinence is gone.

Clever adaptations and life can go on undisturbed. Silently and surely losing out on things you once did, things you loved to do that kept you feeling strong and healthy.

The signs of the inevitable decay with age?

NO! Absolutely not.

Let’s turn this around and create a NEW NORMAL where you take back the things you love!

What if….

When you notice that you’ve stopped doing something to avoid a pain, pinch, stab or ache you take that warning sign as a chance to change instead of to avoid? What if you design a plan that identifies the challenge and sets clear, measurable steps for reclaiming what you love to do?

What if you find the sore spots as opportunity to improve and erase them, while still doing what you love to do?

Run Climb stairs Play tennis Lift weights Reach the high shelf Get up and down from the floor Wear those gorgeous boots! Dance Laugh

Don’t give it up. Make a plan. If that’s hard, intimidating or if someone (including you) has told you it’s not possible, please give Sarah or Sandy a call… we’d love to help you change the story! Resilience is great… thriving is even better!

Thanks for reading,

Sandy

It's prostatitis... or is it??

Hey Fellas!  This one if for you! Prostatitis is one of those diagnoses that may be given to a man who is experiencing discomfort 'down there'.  Men with this diagnosis have described their discomfort as pressure, burning throughout the saddle region, of 'like sitting on a golf ball'.  Functional complaints range from decreased stream when urinating, urinary frequency or urgency, 'never feeling empty', as well as various forms of sexual discomfort and dysfunction.

Usually the diagnosis of prostatitis  is made by a urologist.  A very common course of care is a combination of antibiotics and Flomax.  The antibiotics are to treat any infection that may be causing the inflammation.  The Flomax is to relax the smooth muscles in the urinary tract to improve urine flow.  When this works - it works!!  Unfortunately when it doesn't work men are left wondering what they can do...  or resign themselves to just dealing with their complaints on their own... or taking antibiotics again and again.  The worst thing is when you're doing the things you're supposed to be doing and it doesn't help.

If you'd like to read more about prostatitis, you can check out this blog post.

If you'd rather, you can check out this short video.

[embed width="320" height="240"]https://youtu.be/eA_GYqAbFOo[/embed]

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.

Part of an Interdisciplinary Team

When Should Health Professionals Refer a Patient to Women’s (and Men’s) Physical Therapy? Thanks to the great job by the LA Times there is renewed interest and increased visibility around the too-often taboo subjects of peeing, pooping and sex.  It’s not necessary to suffer these problems in silence or shame, and there are qualified professionals who can help you find the care, support and courage you need. You can recover your health!

What is this special kind of Physical Therapist?

Physical Therapists who specialize in pelvic health are a key component of an interdisciplinary team.  We do a musculoskeletal screen of the spine, pelvis, legs, check on breathing and coordination, PLUS we know how (and when) to do an internal pelvic examination to determine how the internal pelvic muscles are doing.  It’s not all about Kegel’s  - a healthy muscle can contract AND relax. If the problem is an unrecognized/unaware pelvic contraction then there is a need to learn to lengthen/relax and recover the nuance and bounce of the pelvic muscles.  Specialized Pelvic Health therapists also understand how complex pain is, and respect that pain in the pelvic area comes with additional complexity.  We can do our evaluations and treatments with pain science underpinning our treatments and help to calm a sensitive nervous system.  (No Pain and Plenty of Gain).

How would you know WHEN to refer a person to a Women’s (and Men’s) Physical Therapist?

Part of a routine examination gives the clues:

• Urinary Incontinence (Stress or Urgency/Frequency)
• Pain in the genitals
• Pain with intercourse
• Unresolved Hip/SI pain in the absence of pathology
• Fecal Incontinence
• Back/hip pain in pregnancy
• Heaviness or pressure in the perineum (Pelvic Organ Prolapse)

Any of these problems should be evaluated by a specialized physician, typically a Urogynecologist, Urologist or Gynecologist.  Once pathology is ruled out, the next step should be a Physical Therapist that specializes in pelvic health.  That’s a bold statement – read on!

Sex should never hurt – there are a variety of reasons why it might, and pain neuroscience education combined with careful graded exposure to tissue stretch and fitness, manual therapy and consultation with a qualified sex therapist if needed will help restore not only tolerance to sex, but the enjoyment and glorious benefits associated with orgasm.

It is not normal to leak urine, although it is common and 1 in 3 women report this problem. Stress incontinence and Urgency/Frequency respond to education and training.  Physical therapists can design a program to regain control and restore function.  Some more information is here and here.

It is not normal to leak stool either, or to be constipated.  Bowel health can be a bit complicated and we typically work closely with a physician to ensure bowel health and interdisciplinary treatments. We’ve addressed this previously here.

Pain in the perineum is to be taken seriously and treated (labia, testicles, penis, vaginal or rectal pain).  After a good evaluation by an MD to rule out pathology, you should come to see a pelvic health therapist.  We know that pain is 100% a protective response that may not have as much to do with the tissue health as we think.  There’s a patient education book underway that will address pelvic pain from a biosphyscosocial perspective – which is what the pain science literature is pointing to as the most effective way to treat pain.  In the mean time, we love this video.

Low back, hip or SI pain that isn’t responding to treatment may involve a coordination issue that includes the internal pelvic muscles.  Normal movement is a combination of multiple systems and sensory awareness, the pelvic muscles are important in this symphony of motion.  If things aren’t getting better, consider an internal pelvic evaluation to see if the pelvic musculature is coordinated, supple and able to both contract AND relax.

There may be a strong sense of hesitation to talk about these things – by the health professional and by the person experiencing it…  but since we can make a difference in a persons most basic necessity of life – don’t hesitate to refer!

Where would you find a qualified therapist?

The American Physical Therapy Association and the Section on Women’s Health have locators to find qualified therapists in your area.  There are growing lists in Canada, the UK and Australia as well.  If there isn’t a qualified provider in your area it may be worth a phone call or consultation with the closest you can find.  We can help, often we will see measurable change in 2 or 3 weeks.

You're not broken...

Pain stinks. But we will all likely have to deal with it at some time in our lives. Understanding pain, and understanding that you're not likely broken can be a very powerful pain reducer.[embed width="320" height="240"]https://www.youtube.com/watch?v=ALlNFxnO1BA&feature=youtu.be[/embed]

Learn more here:

Bronnie Thompson authors the wonderful HealthSkills blog and has a word for people who are experiencing pain:

For a visual look at what is going on with Pain, the TedX talk from Professor Lorimer Moseley is a classic.

[embed width="320" height="240"]https://www.youtube.com/watch?v=gwd-wLdIHjs&feature=youtu.be[/embed]

Understanding Pain - In less than 5 minutes

Pain is an experience most of us will have at some point in our life.  Thankfully, the scientific understanding of pain has improved drastically over the years.  Unfortunately, there are still lots of misconceptions and misunderstandings about what pain is and what to do about it.  Here's a short, fun clip that might help you think a little differently about pain. [embed width="320" height="240"]http://www.youtube.com/watch?v=4b8oB757DKc&feature=youtu.be[/embed]