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

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.

What can we do to help?

How would an orthopedic Physical Therapist know when to refer a patient to a Women’s (and Men’s) Physical Therapist? This question came up on Twitter today and we think it is a great one.

Part of a routine orthopedic physical therapy examination should include checking for common Red Flags:

• Incontinence of bowel or bladder (Stress or Urgency/Frequency)
• Pain in the genitals
• Sexual dysfunction including pain with intercourse
• Unresolving Hip/SI pain in the absence of pathology
• Back/hip pain in pregnancy
• Heaviness or pressure in the perineum (Pelvic Organ Prolapse)

If a Medical Doctor has already seen the patient and pathology is ruled out, the next step should be referring this patient for a consultation or treatment with a Physical Therapist that specializes in pelvic health.

What is the difference?

A physical therapist who specializes in women’s and men’s health will be able to do an internal pelvic assessment that may include:

• Coordination of the pelvic muscles and the ability to contract and relax.
• Tissue mobility, the pelvic muscles should be non-painful.
• A detailed history of bowel and bladder function and habits.
• Assessing the ability to integrate the pelvic muscles in normal activities.
• Reassuring the patient that it is never normal to have pain during sex, incontinence can be helped by a well-designed program, and it is never normal to leak.

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.

Do You Really Have to Go?

Here's a super-short thought on what you can do to curb that 'gotta go' feeling...  Drugs aren't the only way to manage an urge!!  Check in with your local pelvic floor therapist for more information!!!

Over Active Bladder Simplified

An offering from Sarah on what might be going on with your bladder...

Runners: Lose the Leak!

 

Waylaid from exercise by having to stop to pee too often?

Don’t bother going out to run for fear that you will wet on yourself?

Have you had to give up the thing that you love because you leak when you run?

You are totally not alone.  Research shows that 1 in 3 women leak a little with activity.  Healthy, young and active women leak.  And it doesn’t have to be this way!  You can lose the leak.  Read on and get back to running with confidence.

Despite the TV commercials encouraging you to address your issue with  medications or to use a pretty pad, there is much more you can do than to settle for dry mouth or diapers for the rest of your life.  Your first step is to understand what is happening.  The next step is to take action to get back to what you enjoy.

Incontinence, the involuntary loss of urine, happens to over 25 million women in the United States alone. Many of these women are under 30 years old and have never had children.  A study on young girls and incontinence finds 20% of otherwise healthy young girls are giving up on exercise because they pee a little when they run.^1,2 Or jump. Or laugh.  This is not OK and it’s frustrating for the person, and for the pelvic health therapists who KNOW that we can make a difference in your lives.

Who leaks? Not just old or pregnant people!  One study asked 291 elite women athletes and dancers about if they leak and 51.9% said yes.¹ And not just during training or competition.  Another study found that 20% of young women stop exercising because of leakage.² Interestingly, a study of healthy fitness instructors also found 26% experience urinary incontinence.³

So what can be done?  The first thing that needs to be established, is what type of incontinence do you have?  The treatment for stress incontinence is different and urinary urgency or urge incontinence.  Some people have both!!  Now what??  Kegels may help (if you’re doing them right), but they might not!  A skilled Women’s Health Physical Therapist can help you learn what you need to do.  You may not need any exercises at all!!

References:

1. Thyssen et al. Urinary incontinence in Elite Female Athletes and Dancers. Int Urogynecol J (2002) 13:15-17.
2. Nygaard I et al.  Exercise and Incontinence. Obstet Gynecol 1990; 75:848-851.
3. Bo K, Bratland-Sanda S, Sundgot-Borgen J. Urinary incontinence among group fitness instructors including yoga and Pilates teachers. Neurourol Urodyn 2011;30:370-373.