Interview with Soula Mantalvanos – Australian Artist Living With Pudendal Neuralgia

Soula Mantalvanos is an Australian artist living with pudendal neuralgia.  She runs a website  and a blog that chronicles her life since developing pelvic pain.  These mediums are helping people around the world learn more about pudendal neuralgia (PN) and how to find the much deserved medical care they need.  Soula has created a book titled Art & Chronic Pain – A Self Portrait which portrays her pain experience in the most beautiful and honest way.  Most recently she gave a talk to 180 pain specialists at Australia’s 2014 Alliance for Improving the Management of Pain.  She is an open person.  Soula was willing to answer my questions and I am thankful for this as she is very eloquent in shedding light into what it is like to live with a pain that no one else can see.

Please know that this is Soula’s story.  Your story is just that – your story.  If you have pelvic pain, I want you to appreciate that each narrative and each journey is unique.  Gather what you can from listening to others that know what you are going through, learn from what they have to say and use that to take one more step forward.

 

HomePagePortraitChronicPain1.  What was your life like before you developed pelvic pain and how has it changed?

My husband, Theo and I, shared a life which included our 10yr graphic design business in a home/office warehouse setup in the arty hub of Collingwood, Melbourne. We travelled overseas every year and enjoyed long drives on the weekend, a very full social life with family, friends, work and community functions. When I wasn’t in the design studio you’d find me in the art studio or practising my exercise rituals. I practised yoga four mornings a week, I used to end my routine (for those familiar with the yoga poses) with 8 mins in shoulder stand, 8 mins in plough pose before Shavasana.

I always had an abundance of energy, ideas flowed endlessly through my head and I executed all of them. I had no limits, I had no pain, I had no health issues.

 

2.  How did you develop pelvic pain?

It all began March 2007. I sat on a fitball in our design studio, conscious of the risks of office sitting position, but in March, 2007 that antiburst fitball burst and I fell onto our concrete floor.

 

3.  What were your symptoms when the pain began and what are your symptoms now?

I remember the heat, the toothache like pain, but I also had this feeling that a 3-4 inch needle was sitting inside the right buttock. That particular ‘needle’ feeling didn’t seem to be causing pain strangely. The pain levels didn’t subside after 8 weeks as hoped, in fact I began to get worse. My heel seemed less tolerant of pressure as time went on. Eventually I had to walk on my toes, in a soft shoe all day, never barefoot, not even in the shower. I felt I had my finger stuck in a powerpoint, the surge up my spine at times was intolerable. I didn’t know at the time what I was experiencing was ‘sensory’ pain so I couldn’t understand why loud sounds, vibrations, being in busy surroundings would add to my pain levels. If it wasn’t this sensory pain, it was the toothache-like pain, if it wasn’t that it was fire-like pain, it was non-stop.

Now my sensory pain is minimal but I would still call myself sensitive (you seem to compare everything to the worst pain you’ve experienced, so ‘minimal’ is really still a bit of a bother), I avoid loud parties/crowds etc. as I have learnt this does increase my pain levels. This issue was resolved when I thought to just check things out with my gynaecologist. He found a thickened rectovaginal septum and extracted that. I could once again shower barefoot and that feeling of a needle in my backside disappeared.

Not realising I had a nerve block til much later, I had 3 amazing months and thought I was fine after the procedure. My toothache-like pain came back as I became active however, and so did the fire. I have managed to reduce both these symptoms but it’s taken some hefty treatment, not to mention the magical diagnosis.

So I guess to answer your question in short – the pain I felt when I fell is the same (except the needle feeling), however it’s a much lower level, it’s tolerable, I’m even pain-free at times.

 

4.  Did you know anyone with pelvic pain before you began experiencing it yourself?

No, other than period pain/gyneocological issues I’d not heard of this kind of pain.

 

5.  Can you describe some of the first medical appointments that you went to in attempts to find a diagnose and a treatment for your pelvic pain?

It might be easier if I tell you which medical appointments I didn’t go to.  For some reason I never got around to seeing an Osteopath, but I saw everyone else!  As an artist I’m much better communicating in pictures:

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5.  How were you diagnosed with pudendal neuralgia?  How did you learn more about pudendal neuralgia?

After 4 years of searching and the pain levels rising to the point where I couldn’t sit or stand and fatigue was consuming my body & brain, I had a cortisone injection to my coccyx and the results were very telling. I had 3 amazing days which is a neuropathic response so my orthopaedic surgeon referred me on. I was so desperate by the time I saw the neurosurgeon I asked him to chop my coccyx off.  He suggested we don’t opt for such invasive action but rather I try a peripheral stimulation device. He had presented my case to many other surgeons, even overseas and to the boards he sits on.  They all suggested the same device as it was a less invasive option.

My trial was successful and the device was implanted almost 4 years after my accident. The reason I mention this is not only is it significant to my treatment and pain relief but it lead to my diagnosis. I was able to read again after the pain levels were reduced with the stimulation device and I picked up ‘The Brain that Changes Itself’ by Norman Doidge. It referenced Australian professor Lorimer Moseley and his mirror therapy technique and how he is taking that further so I googled his name and found many email addresses. I emailed!

It astounded me that so many people had looked in and out of my body and this man read an email and replied, “Tell me where you are and I’ll put you in the right hands”… he did exactly that.  4.5 years after my injury I saw Anne-Florence Plante at Melbourne’s Royal Women’s Hospital (Physiotherapy Department) and within minutes we were speaking the same language.  She not only diagnosed me , she had terms for my pain descriptions, explanations and even treatment. She even showed me a technique to release the entrapped nerve and relieve my pain when I needed to.

Anne-Florence taught me most of what I know.  In fact, she handed me her research and said, “Build a website, tell your story” as I was adamant to help others and prevent them losing 4.5 years in the search for diagnosis. Her research was an encyclopedia in PN [pudendal neuralgia].  It led me to all the specialists in the world and I contacted as many as I could to ask permission to include them on my website.  They still send me research and news.  I have to know everything there is to know about PN if I have a chance to beat it.

 

5.  What inspired you to write your blog and to create your book?

As I mentioned above, awareness was the main reason for creating the website www.pudendalnerve.com.au. There was no information anywhere at the time.  There is a bit more online now but I often find what’s online is not very hopeful. It’s never a patient voice – someone you can identify with.  I wanted to make it more personal and keep it up to date too. The website has an incredible amount of visits all around the world.

The book was a cathartic exercise for me and a creative one too. I wanted to also create a companion for others with PN. I wanted the book to serve a purpose for those that have no idea what PN is and I didn’t want it to be a huge bio, it had to be short and with many images.

 

6.  How has experiencing pelvic pain affected your relationship with family and friends?

Sadly it affected my family relationship as we can’t do the things we used to or even see each other as often. When I think about how PN has affected my friends, I could almost say it’s sifted the goodies from the badies actually!  And I’ve made so many new friends in my local community as they are the ones I can physically get to (at the local cafe, restaurant, gallery opening etc). You really do find out who your friends are.

I’m sad I can’t go away with friends/family, go out for a day, drive out to a winery for a Sunday lunch, attend many of the special birthdays and occasions… but I just can’t do anything about it. I fill that gap now with artwork.  I’m lucky I have creativity.

Most affected and most upsetting is seeing my husband’s life and our relationship change. We are certainly getting through PN and the massive change of life, but it is very difficult, we’ve lost our freedom, our spontaneity, we are under much more pressure and there are great sacrifices to make daily. I also rely on his help 24/7, he is my biggest treatment by far. Without him none of my treatment would be affective I believe.

 

7.  How has experiencing pelvic pain affected your sexuality?  

It has grately impacted Theo’s and my sexual relationship. Like everything else in our life, this also had to change and we had to adapt. Even worse is the difficulty and frustration of having to get your head around persevering with this intimate and beautiful part of our relationship when you know it’s going to cause pain. So many aspects have to be considered:  when, where, how, is there recovery time afterwards, what activities was I doing before that might impact… it really is incredibly saddening. But, I was worse.  Before the removal of the thickened rectovaginal septum I had awful clitoral stimulation.  THAT was horrific. I could only describe it as torture. I obviously had way too much pressure in my pelvis and the removal of that septum thankfully resolved that issue.

 

8.  What are some of the best pieces of advice that you have received in regards to your pelvic pain?

My physiotherapist and her diagnosing me was the best by far. I can’t say I’ve had much great advice.  I’ve had to find out so much on my own and what there is to find out really isn’t “advice” – it’s coping mechanisms. Recently I began to read Naomi Wolf’s Vagina and it calmed me to hear that every woman’s pelvis is unique. That helped me understand why I always felt no one was experiencing what I was and why the treatments for PN were different for all of us.

 

9.  What are some of the worst pieces of advice that you have received in regards to your pelvic pain?

The worst comments and “advice” came prior to my diagnosis in this form: “This is chronic pain”, “It’s quality of life for you now Soula, go home and get comfortable”, “Accept it and don’t ever investigate your issue”, and the classic, “It’s all in your head”.  Since my diagnosis, I’ve really appreciated my Traditional Chinese therapist who explained my concern for my legs giving way during an enormous lightening strike (felt like it landed on our kitchen bench and I happened to be walking past that second). He said, “Soula you must remember your initial injury is a shock to the nervous system, so it is there you will feel anything first”.  That just makes so much sense to me, that advice came just a few months ago.

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10.  Are there any special products that you use that you find helpful and worth sharing?

Treatments: It has to be No. 1 my implant which has been a wonderful, life-saving device. I’m wearing some great cooling patches called Pain Reliev Cooling Patches (no that’s not incorrect spelling) which seriously stop the spasm and in my lower back region. When I initially started them I was ready to give up on the 3rd day, but perhaps some pain was being drawn out, the 4th day was heaven and now I use them for a little extra ammunition or pain relief rather than daily. Although he isn’t a product, Theo is my biggest treatment.  PN needs understanding and help, a lot of it. The internet and my smart phone are essentials. They have kept me connected to the world – they are my legs and arms.  Look what’s happened here… all internet!  Another thing that’s not a product, but rather a huge gift, is my creativity. I guess a very special product is my home – my sanctuary which we setup and renovated to suit my limitations (or should I say abilities).  It’s so important to love your own space when you’re quite confined to it. And finally, another thing that’s not a product (sorry) – my community. I live in a very creative hub so a small walk finds me at a gallery opening or at a cafe, and having been here for well over a decade, the people are really like my family. It’s very important to feel connected to the world when you can’t physically participate much. I use my seating aid a lot. I made that, you can see it here: http://www.pudendalnerve.com.au/2012/11/28/take-a-seat-if-you-can/

 

11.  What does your medical team look like and what is each provider’s role?

I’ve always handled treatments one at a time so I can really measure effectiveness. It’s very hard to tell what works or doesn’t with PN, it takes a longer time to see a difference so now I’m at Traditional Chinese Medicine (TCM) (specifically acupuncture and herbs), and a monthly remedial massage.  My TCM has made an incredible difference to, not only my pain, but my fatigue levels.  The fatigue is falling away.  I used to struggle handing a 5 minute task.  Now, even if I’m in pain and have to rest, I can often keep drawing or writing while resting. It’s a huge difference.  I feel my TCM has also prevented further nerve blocks, time will tell about that. And remedial massage is obviously necessary because I can’t exercise all my body and get it moving.  I am on a little medication, in fact I split my tablets. I’m actually feeling very independent –  this is a very small list of appointments now. I see my TCM once a month.  I hope I can maintain the distance between appointments, time will tell.

 

12.  If you are receiving physical therapy, what does this treatment look like?

I haven’t felt I’ve needed physiotherapy with the acupuncture and remedial massage and I am happy to report I recently began yoga (finally able to!) so I’m loving yourpaceyoga.com‘s yoga for pelvic pain cd. I find this is all about opening the pelvis, releasing, breathing, no squeezing, no chore work, no pressure in the area and it’s really working. I do a portion of the cd that I feel is ok for me and hopefully will work up to the rest. I cannot lie on my back so that rules out many exercises. The sitting ones I do with my special seating aid.

 

13.  What would you like to say to someone who is just starting to experience pelvic pain?

Well it’s hard to say, we all experience pelvic pain so differently and all seem to be introduced to it differently. I would hope I wouldn’t have to say anything and their issue would be a short one, but if it’s someone who has been experiencing the pain more than 6 months I’d say definitely see a pelvic pain specialist and at that early stage, a physiotherapist (who really knows what they’re doing) would hopefully be able to resolve the issue before it gets out of hand.  There are some great Facebook groups that may help find someone in a local area.  I have a post and am trying very hard to get a list of practitioners reputable in relieving pelvic pain on there.  Also, pelvicpain.org is the world organisation, they have lots of info on their site. If they are chronically experiencing pelvic pain and it’s post 6 months, I would suggest rest, rest, rest, not to be heroic about the pain and to listen to the body. If it feels better resting, then do lots of that. I pushed through thinking nothing of my pain and I do have a niggle about that. Another thing I would probably say is to go slow trying treatments, one at a time and write everything down. Take the pressure off yourself.  Let family and friends know you’re not your usual self and that you will need time and understanding. If the person in pain is working, I would certainly suggest time away from work. Although I dislike saying it, pelvic pain is a lengthy journey and there is no short cut.  It must be travelled cautiously and slowly even when you have a great day (look out for that PN trick, gets me even 7 years later!).

 

14.  What medications are you taking?

Amitryptaline 10mg – it’s called Endep here.  I split the tablet and take 2.5 mg in the morning and night and alternate with 2.5mg and 5mg the next day. I had a terrible experience with medication during my first two years of having it. I was prescribed Lyrica and Lovan (so that’s a nerve inhibitor and an antidepressant)… honestly, I couldn’t recognise myself. I had to turn spell check on the computer and reteach myself to cross the road.  I was so disoriented I couldn’t put three apples in order if you asked me to… it was an awful time. I lasted 6 months and thankfully learned from the masked pain what caused more pain for me, and also that I could never take those sorts of doses again (nor are they a long term plan). So after my second nerve block, a practitioner suggested I team up my block with Endep. I started with 1/4 tablet every third day and worked my way up to my current dose.  I stopped when I got so sleepy I couldn’t get up and thankfully it was enough of a dose to give me pain relief. I’m not sure we need the doses prescribed to us.  It doesn’t make sense that we would all need the same dose and I don’t know why the tablets are not made smaller. I hope to be off Endep too one day.

 

15.  Do you plan to try new treatments in the future, if so, which ones and why?

I feel I’ve run out of options, to be honest.  I am content with my efforts at the moment and will continue. The only treatment that I think about is perhaps another nerve block, but as I mentioned, I think the acupuncture is covering this.  Although I’ve had better pain levels after a nerve block, I think it’s because I’m doing more that the levels are rising, rather than not having the block.  I prefer natural therapies also, so if I can manage that way, I certainly would prefer it.  I could be less active, I’m trying to work at the moment and although that’s happening in my home/warehouse setup, it’s an incredible pressure for me, but one, again, I hope to sustain.

 

16.  Who has provided inspiration for you?

My physiotherapist has been most inspiring.  She gave me hope and she clarifies my thoughts. I feel, as a creative person, inspiration comes as a bit of a gift to you.  My mind, although occupied and interrupted very much by pain, is always also on creative expression, so even if I am in pain, how to express it distracts me.  I look at Frida Kahlo’s work and she does inspire me, but I have a different way of expressing my reality. It’s sad to say, but as far as looking at others with PN, there are not many I can look to who have conquered the issue.  There is a “Sorella” I have in California whom I cyber met when she wrote to me after reading my website and she tells me she’s much better now.  I will certainly be waiting for her next update and if it’s a good one and she writes about more progress I’ll definitely be looking to her for inspiration.

 

17.  Where do you find support from?

Theo is my Number 1 support, no one comes remotely second even. He helps me every half hour of the day and he does it with so much love. He protects us.  He does so much so that we can sit down and have that dinner or drink “up the road”, so we get valuable time together. He understands creativity is a huge part of my life and helps me so that I can create.  He wouldn’t dare I use my capacity on 15 minutes cleaning and lose a whole afternoon (if not more), instead saving me that capacity for the studio or, so I can work and feel part of our life again.  He understands my limitations.   He doesn’t understand PN, he can’t possibly, but he listens and he believes me.

 

18.  Have you found any books helpful in providing support or in opening your eyes to a new perspective?

Well I certainly loved putting my book together.  There wasn’t anything out there like it.  It’s a comfort and when you’re in so much pain you can’t speak, you can let someone read what’s going on with you.  I wanted it to be a companion so that others with PN would feel I was there with them, there’s nothing out there like it.  Most books are too lengthy, you end up reading another person’s scenario and thinking “that’s not me”.

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I’m also currently reading Amy Stein’s Heal Pelvic Pain and finding it a great resource.  I read it and think “this may not be for my extreme level of PN”, but I’m certainly going to try the exercises and see how I go.  It makes sense to me that our pelvis could well be a huge tense group of muscles and nerves.  At the very least I know these approaches will provide more relief, the yoga I’m doing is similar and it has provided relief already.  Before my implant I’m not sure I would have said that, I felt nothing could change my pain signals.  I was in so much pain all the time… pelvic pain does change, it’s just really slow and needs a lot of your attention.  Of course, early detection is key.  I wish I had seen my diagnosing physiotherapist in the first few weeks, I bet I wouldn’t be here now!

Fore more information about Soula Mantalvanos, please visit her site at www.pudendalnerve.com.au.

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Readers of Blog About Pelvic Pain can get a copy of Art & Chronic Pain – A Self Portrait with the postage fee waived.

Please email me at [email protected] with any questions, or you can leave them anonymously in the comment section below.

What If You Can’t Find a Pelvic Floor Therapist?

If you’re lucky enough to find a pelvic floor physical therapist in your area, good for you!  You are hopefully on your way to seeing some change in your quality of life.

Unfortunately, however, there are many people that do not live close to an experienced therapist.  This means that some travel may be involved.  Many of my patients come from neighboring cities to get weekly treatments for their pelvic pain.  It is not a perfect scenario as some of them have an increase in their symptoms in just the drive that takes them to my clinic and back home.  But, it is the only option that they have right now and they have decided that it is more beneficial to make the drive and get care than to stay at home without care.

If you know of a good pelvic floor physical therapist in a neighboring city, weigh the pros and cons of becoming their patient.  You might want to give it a trial run for a few weeks to see if making the effort to see them is worth it for you.  This is a huge commitment.  It could mean taking off a considerable amount of time from work for you and possibly for someone that might need to drive you.  (Some of my patients just cannot sit so they cannot drive themselves.  Therapy itself is not going to preclude you from driving independently.)

For those of you who live in a city or even a state that does not have pelvic floor physical therapy options – you can still get help.  A few clinics in the country have programs for out-of-state patients, mine included.  This means that you can make appointments in a clinic and get treatment by a very experienced therapist.  The therapist should be teaching you a home program that is tailored to your needs.  Some of these clinics even encourage you to bring a guest.  This could be either a physical therapist from your hometown that is willing to learn new techniques to treat you, or it could be a loved one that will be trained in safe, effective techniques that could benefit you in the long run.  The treatment that you will receive at home will be helpful and move you forward, but it will not substitute seeing a very experienced pelvic floor physical therapist consistently.  This scenario is not perfect, but it is the best available option if you live in an area without a lot of pelvic floor knowledge.  Another issue that arises from only going for an out-of-state visit is that there is poor follow-up.  See if your therapist can continue communication with you for several weeks after your visit so they can continue to tweak your home program as necessary.  Treatments are not cookie-cutter for each diagnosis, so while we might be able to teach you some really powerful stuff for a home program, once you go home and get it started, you might need to change a few things.  This is where keeping email or phone communication for a bit will come in really handy.

Below is a list of pelvic floor physical therapy clinics that have out-of-town patient programs:

 

Please contact me with any questions at [email protected] or leave them anonymously in the comment section below.

God’s Honest Truth About Your Therapist’s Education

The other day my husband and I were at the park rolling a ball with our infant son.  A little girl came up and started playing with us.  She took it upon herself to make up a game where if we had the ball, we had to say one word before we rolled it.  My son rolled the ball and said “Eh!” and we all squealed with glee because he is sooo smart.  The little girl took the ball and said “Okay, it’s my turn.  My word issssss……..Poo poo is the worst thing in the world and everyone hates it but I love it!”  And she rolled the ball.  My husband and I exchanged glances.  That was not one word and I let her know that.  I told her that she made up the rules, but she wasn’t following them.  So, she took the ball again and said “Okay, my word isssss….”  I stopped her and said “Are you going to talk about poo poo again?”  She said “No!  My word isssss…..Diarrhea is so disgusting and everyone hates it, but it’s like milk and chocolate and it makes you throw up and I want to eat it!”

Let’s pause here – for effect.

Okay, let’s continue with the story.  I say “Little girl, that’s not one word and you kind of did talk about poo poo again.”  So then I pull out a bottle of milk and start feeding my son.  The girl points to the bottle and then points to my chest and says “Did that milk come from there?”  That’s when my husband said “How old are you?”  She was six.

I tell this story because it’s awesome.  If this little girl doesn’t become a pelvic floor physical therapist, then she’ll never be happy and so many people in the future with pelvic pain will never get better.  She has what it takes.  She’s got passion!  Now, I’m not saying pelvic floor therapists want to eat diarrhea or throw up, it’s just that we are wired to be drawn to things that most people aren’t.  We love our jobs, we are really concerned about pelvic floor issues and we want to learn more.  This is what you need from your therapist.  But, you also need them to have a decent education.

If you’re going to call up your potential therapists and ask questions, it makes sense for you to have a platform from which to start from.  This post lets you into a little secret – the world of our education.  It’s fascinating how anyone decides to become a pelvic floor therapist, it’s equally fascinating (to me at least) to learn how therapists educate themselves.

So, here most of the ways therapists learn about pelvic floor rehab:

Physical Therapy School

Some of us learn zero about the pelvic floor in school.  I’m in that category.  We learn about the pelvis, the back and the hips, but we do not all learn about the pelvic floor muscles, the nerves or about bowel, bladder or, God forbid, sexual function.  The extent of my class’ education was a blurb about a few pelvic reflexes (which pertained to spinal cord injuries and muscular dystrophy) and a visit from a local pelvic floor physical therapist.  The therapist spoke about pregnancy-related issues.  I was sick that day.  So, my physical therapy school education on the pelvic floor meant that I knew what the bulbospinal and cremaster reflexes were AND I knew that a woman with muscular dystrophy might have poor sensation at the pelvis.  She could use a vibrator during sexual activity.  This is the extent of pelvic floor rehab that I learned in school.

But, for others, this isn’t the case.  Some schools place a decent emphasis on the pelvic floor, so it really is different for everyone.

Want to hear a funny story?

It probably will come as no surprise to my classmates that I am a pelvic floor therapist.  When I learned about the bulbospinal reflex, the lecture was being taught by a guest speaker who was a local neurologist.  He showed a slide which had a picture of an anus and next to that was a picture of a penis.  The title of the slide was “Bulbospinal Reflex”.  He got to the slide and said “And here is the bulbospinal reflex”.  That was it.  Well, I really could only relate to the knee reflex that we all know about.  And, how do you activate the knee reflex?  By tapping the tendon at the knee.  So, how was this guy going to come to me and tell me that there is a reflex involving the penis and the anus without telling me how the hell you activate it?  He quickly went on to another slide that was a lot more comfortable for him to discuss.  Something really boring.  I raised my hand high and proud and this is what happened:

Me:  “Umm, can you go back to that last slide, the one with the anus and the penis?  You moved on from it so quickly and I don’t quite understand it.”  (Giggling from the class.)

Neurologist:  “Uh, sure.”

Me:  “Okay, so how does this reflex work?  Do you…flick…the penis?”  (Even more giggling from the class and some repositioning in their seats.)

Neurologist:  (pause) “No.”  (pause)  “No.”  (pause)  “That is a penis.  You never flick the penis.”  (Laughter from the class.)

So, there you have it.  I now know that you never flick a penis.  And if you didn’t know that already, you know it now.  So, for you flickers out there, stop already!

Clinical Rotations

As a student physical therapist, you are required to do rotations in different clinical settings.  It is not a requirement to do a rotation with a pelvic floor physical therapist.  Those students who are interested in this specialty may very well decide to commit a rotation to pelvic floor therapy.  Depending on who their mentoring therapist was, they could have learned a lot or they could have learned very little.  Some rotations are two weeks long, some are 12 weeks long.  Ask your therapist how long their rotation was.  Someone who did a rotation for 12 weeks is going to be pretty comfortable treating pelvic floor issues, but that doesn’t necessarily mean that they treated pelvic pain.  So, if you are talking to a potential therapist and they say they did a clinical rotation in pelvic floor physical therapy, ask them what diagnoses they saw and how these diagnoses were treated and what the range of outcomes were for those patients.

We take on many students at our clinic, Sullivan Physical Therapy.  Because we are a specialty clinic that exclusively treats the pelvic floor, our students are exposed to a wide array of diagnoses and get exposure to different treatment techniques because they have an opportunity to spend time with seven different therapists.

Residency

After graduating from physical therapy school, a therapist can decide to complete a residency program in pelvic floor physical therapy.  This is a program that will expose them to many different diagnoses and their education will involve a strong orthopedic component.  This is a commitment of 9-12 months for most therapists.  This is a pretty big deal, ya’ll.  There are only a handful of residency programs in the country and many therapists want to be a part of these programs.  Only a few are selected each year.  The chosen therapists send in their resume, references and undergo an interview process.  It’s a great way to get a well-rounded pelvic floor physical therapy education.

Continuing Education

Ah, continuing education.  This is a big one.  As I said before, therapist’s are required to do a minimum number of continuing education hours, including ethics education, every two years.  But, what does this really mean.  It means so many things.  So…many…things.

We can get our education through online sources or through classes that we must attend in person.

Online sources of education have their place.  For example, if I’m going to take an ethics class, I am not going to drive to a class for that.  I’m going to do that online.  In addition, if I want to learn more about herbs or supplements or diets or anatomy, then I don’t need to be in a classroom for that, online is just fine.  However, there are some therapists out there who want to take 100% of their required continuing education online and do the bare minimum to keep their license.  This means they will learn more “stuff”, but they won’t necessarily learn more hands on skills.  If you talk to a therapist who is doing 100% of their continuing education online, I would look elsewhere.  This is a big red flag.

Most pelvic floor physical therapists who want to learn more hands on skills, will go through either the American Physical Therapy Association’s (APTA) courses or they will take courses through Herman and Wallace.  Both institutions have a lot to offer.  Yes, there are other institutions that a therapist can go through, but these are probably the most well known right now.

APTA’s SOWH

The APTA’s specialty section for pelvic floor physical therapy (the Section of Women’s Health) offers a series of three courses that, by completion, lab testing, post-course testing and write-up of a case report, will provide that therapist with a certification called the Certificate of Achievement in Pelvic Physical Therapy.  The initials for this are CAPP-PELVIC.  There is an analogous certification for those who take two courses in pregnancy, pass the lab testing, a post-course test and a write-up of a case report.  This is called the Certificate of Achievement in Pelvic and Postpartum Physical Therapy.  The initials for this are CAPP-OB.  You will not see any of these initials behind a therapist’s name, but you may hear them mention it when you talk with them or it will be under their biographical information on their clinic’s website.

Herman and Wallace

While I’ve already discussed (in a previous post) the certification that Herman and Wallace provide after sitting for their exam, they also have broad spectrum of courses that are offered.

*Note*

A word about these certifications and courses.  It is strongly encouraged, but not mandatory, for physical therapists who go through these series of classes to spend considerable time between courses treating pelvic floor patients.  The SOWH and Herman and Wallace do their best to make this clear when therapists sign up for their courses, but this is not always a reality for participating physical therapists.  What does this mean for you as someone living with pelvic pain?  This means (worst case scenario) that it is possible for a therapist to become CAPP-PELVIC or CAPP-OB certified or go through a series of courses through Herman and Wallace having seen as little as one pelvic floor patient ever.  I have known several people who became CAPP-PELVIC certified in less than a year’s time, maybe even six months time, because their employer paid for these classes and wanted their therapists to start a pelvic floor rehab program.  While the intention is notable, the results are not always in the best interest of a complex pelvic pain patient who is desperately seeking help.  This is why I repeat, again, always, always call and speak to your therapist and ask about their experience in treating pelvic pain patients before going in for your first day.  If you have options, you want to make the best choice for you.

Working with other pelvic floor physical therapists

I can’t say enough about this.  Iron sharpens iron.  It is so important for the growth of a therapist to be surrounded by other people who are in this specialty.  If your therapist has a question about a diagnosis then they can easily ask their co-worker.  If your therapist is stumped, then they can brainstorm with other staff members.  If they need another set of eyes to look at you, then they can have you assessed by another therapist in the practice.  These are intangibles that do not exist for a lot of pelvic floor physical therapists who are practicing on their own.  What’s good for your therapist’s growth is good for you!

Shadowing

Shadowing is a wonderful way for a therapist to gain more knowledge and skills.  Many clinics allow for other therapists to shadow them for a day or two.  This is an invaluable experience for many therapists, myself included.  At my clinic, we offer shadowing, but I also really like to travel to shadow other therapists and physicians.  The more we know, the better off you are.

Mentors

It’s important for every therapist to have a mentor.  A mentor is their “go to” person for all their questions.  My mentor is my boss and owner of our clinic, Kimberlee Sullivan.  She grew a clinic from one therapist to seven therapists out of a need to serve the growing patient population of people with pelvic floor dysfunction.  She did this based on good ethics and good pelvic floor treatments.  She answers my questions and challenges me to become a better clinician.  So, this is a great question to ask your potential therapist.  Who is their mentor and why?

In defense of those learning pelvic floor physical therapy…

While I very aggressively encourage you in getting to know the background and experience level of your potential therapists, I do have to say a few more things.  There are new pelvic floor therapists with very little patient experience that are intuitive, passionate, smart and very good at treating pelvic pain.  In these therapists, you can see the gross little girl from the park.  There are pelvic floor therapists with years under their belt, but they might not be very good.  Typically, your best situation is a therapist with experience in pelvic pain, but everyone has to start somewhere.  These therapists will get better every day.  I become a better therapist every day.  I wish I could go back and help some of my first patients again.  Hell, I wish I could treat some of my patients from six months ago again.  Bottom line – interview your potential therapists and  make the best decision for you.  Trust your gut and make some changes if you are not getting better.

 

If you have any questions, please email me at [email protected] or leave them in the comment section below.

What Do All These Letters Mean? and What I Really Think About Biofeedback

I think it’s important to understand what all the letters behind a professional’s name means.  At times I wonder if patients or referring physicians are swayed by the letters that we can collect.  The more letters, the better we must be, right?  No.  Not right.

In fact, the initials behind a physical therapist’s names mean a number of different things and it’s my goal in this post to decipher them for you.

Please know, in this post, I’m going to make a lot of friends and a lot of enemies.  But, it doesn’t matter because the purpose of this entire blog is to help you navigate through your pain experience.  And, helping you understand who is working with you is a part of my goal.

Let’s get started.  I will give examples of the different initials you might encounter using my name as an example.  And, for full disclosure purposes, I am Sara K. Sauder PT, DPT.

 

Sara K. Sauder PT

Some people have a Bachelor degree in Physical Therapy.  These are going to be your slightly older physical therapists.  Years ago, it used to be that you could get this degree in an undergraduate program.  These people are still practicing.  The benefits of working with these people is that they have a lot of experience in the clinic.  They may not have gone back to get a Master’s or a Doctorate degree because it’s time-consuming and expensive.  They may feel quite established in their practice.  There is a world of information that has come out since they were in school, but they are likely tapping into this through continuing education.  And please note, all physical therapists must do a minimum amount of continuing education, including an ethics class, every two years in order to renew their license.

 

Sara K. Sauder PT, MPT

This means that you are working with a licensed physical therapist who has a Master’s in Physical Therapy.  Most physical therapy schools now only offer a Doctor of Physical Therapy degree.  But, when I graduated in 2007, my school offered a Master’s of Physical Therapy degree, so that’s what I came out with.

 

Sara K. Sauder PT, DPT

This means that you are working with a licensed physical therapist who has a Doctorate of Physical Therapy.  This is a clinical doctorate, so it is not the same as a PhD.  I tell people that it is above a Master’s degree, but below a PhD on the totem pole.  Yes, I can be called Dr. Sauder.  No, I do not allow anyone to call me that.  As I’ve said before, most physical therapy schools since about 2009 only offer a Doctor of Physical Therapy to students.

 

Sara K. Sauder PT, DPT, BCB-PMD

This means that you are working with a therapist that is biofeedback certified.  This means that they have worked a minimum amount of hours using biofeedback on patients and they have completed and passed a written test on biofeedback.

Biofeedback is a way for you to visualize what your pelvic floor muscles are doing on a screen or other device.  You are attached to the biofeedback machine either by external electrodes (which cause no pain at all because it is reading you, not doing something to you) or by a vaginal or rectal probe that is placed inside you.  There are very few to zero times when I think it is necessary to use the internal probe, especially if we are working with someone with pelvic pain!

Every now and then you see these initials behind someone’s name.  Some physicians and some patients really want to see someone who is biofeedback certified because they have more confidence in their biofeedback skills.   I have personally been asked if I’m biofeedback certified several times.  I am not.

Here is my thought:  If a therapist is biofeedback certified, they have definitely used biofeedback before and they have definitely passed a written test asking many questions about biofeedback.  That is great.  However, biofeedback itself is not the only, nor the best tool for most pain patients.  I know, I know, everywhere you look on the internet and every book you ever read that is written by a physician is going to hail biofeedback as a vital part of pelvic pain rehabilitation.  But, I do not believe this is true any more.  I believe that this used to be true.  See, pelvic floor physical therapy is a relatively new specialty.  However, the diagnoses that we are treating are not new diagnoses.  So, in the beginning, I think that biofeedback was a huge phenomenon because it was a way for patient’s to visualize what their pelvic floor muscles were doing and attempt to gain control over that in a time where the specialty of pelvic floor physical therapy was really lacking and had a lot to learn.  There were not a lot of other options at the time.  However, now there is a lot of new information about the role of releasing trigger points, releasing connective tissue restrictions, nerve mobilizations, how diet and allergens can influence pain, etc.  In my book, these hands on techniques and lifestyle modifications are far more effective in treating pelvic pain than using biofeedback on a regular basis.

My other issue is that sometimes biofeedback doesn’t work the way you expect it to.  Sometimes the pelvic floor muscles are so overactive that the biofeedback registers as a flat line, as if there is no overactivity at all.  So, this gives you and your therapist really nothing to work with.

Now, don’t get me wrong.  Biofeedback can be useful for pain in showing someone how to relax their muscles.  If that works, then cool.  But, I don’t think that a patient really needs to use this for every treatment in therapy.  I think a few sessions, when necessary, can be helpful.  You see, your therapist can tell if your muscles are overactive and if you are relaxing them when they are doing internal work either rectally or vaginally.

Do I seem biased here?  Do I?

 

Sara K. Sauder PT, DPT, WCS

This means that you are working with someone who is a board certified Women’s Health Clinical Specialist.  In my experience, these are therapists that really know their stuff.  Why?  Because they passed a test that took about six months to a year of preparation in order to pass.  This test is incredibly expensive and you are really a bit in the hole if you do not pass it, therefore therapists are really going to make sure they know the information well if they are going to bother to take this exam.  These therapists have to have a minimum of 2,000 hours working in pelvic floor physical therapy in order to qualify to even take the test.  The test covers women’s health issues over the lifespan including pregnancy.  It also covers cancer and lymphedema.  One thing that the test does not cover:  Men.  There is zero testing information on men.

 

Sara K. Sauder PT, DPT, OCS

This  means that you are working with someone who is a board certified Orthopedic Clinical Specialist.  This is the orthopedic equivalent to the Women’s Health Clinical Specialist described above.  So, the same conditions apply.  This person spent a lot of money to take their test, had a minimum requirement for time spent with orthopedic patients and spent a lot of time studying for their test.  Why would you ever see this behind your pelvic floor physical therapist’s name?  Lots of reasons.  Your therapist may have transitioned from a primarily orthopedic background into pelvic floor physical therapy.  Or, their patient’s might be half orthopedic and half pelvic floor patients.  Or, they wanted to be well rounded and decided that they needed to learn more about orthopedics in order to best treat their pelvic floor patients.  Orthopedics is a huge part of treating pelvic floor conditions, so it’s a real plus to have your therapist using all their gears.

 

Sara K. Sauder PT, DPT, FAAOMPT

So, in a similar vein to the OCS, the FAAOMPT is really an orthopedic specialist.  These initials stand for Fellow in the American Academy of Orthopedic Manual Physical Therapy and people who have these initials are called “fellows”.  These people have devoted years to specializing in orthopedics and should be very knowledgeable in this area.  To give you an idea of their background, I will tell you about my experience.  Before I dove into pelvic floor physical therapy finger first, I dabbled in it here and there.  At the time, I thought I wanted to devote myself to orthopedics so I started a fellowship program.  This meant that I would take about 19 courses every six weeks.  Each course would take anywhere from 2-4 days.  There would be testing at every course.  Then, I was to complete time in a clinic with a fellow who was to act as my mentor for several hundred hours.  This process could take a person from beginning to end about 2-3 years.  This is a huge financial and time commitment.  The amount of studying necessary is incredible.  These people should know their orthopedics.  However, once you become a fellow, you are a fellow for ten years, then you need to take a test to continue your fellow status.  So, it is possible for someone 8 years out to just stop using the wealth of information that they once had.  I’ve seen this before, so I think it’s worth mentioning.  And again, why is this important to pelvic floor physical therapy?  Well, this type of therapist is really committed to orthopedics, so they may be called upon to take a look at you from time to time for orthopedic advice, but I would be really surprised to see a fellow acting as your primary pelvic floor physical therapist.

 

Sara K. Sauder PT, DPT, CLT

This means that you are working with someone who is a Certified Lymphedema Therapist.  This person has taken many courses and an exam to qualify for the certification.   The therapist has to have at least 135 hours of training in lymphedema treatment to be able to sit for the exam.  A lymphedema therapist is going to help patients with lymphedema issues which have typically resulted from a cancer history.  If they’re not requiring lymphedema certification, I do believe that most, if not all residency programs incorporate significant lymphedema training.

 

Sara K. Sauder PT, DPT, PRPC

This is a pretty new acronym and it comes from an educational facility called Herman and Wallace.  This is a certification that stands for Pelvic Rehabilitation Practitioner Certification.  You do not have to be a physical therapist to get this certification.  You have to have at least 2000 hours of pelvic floor patient care experience.  So far, it sounds pretty similar to the Women’s Health Clinical Specialist.  There is one difference though, this test does cover men’s pelvic floor issues.  That’s a plus.

 

If you have any questions please email me at [email protected] or comment in the section below.

Interview with Amy Stein – Author of Heal Pelvic Pain

Amy Stein is a force in the world of pelvic floor physical therapy.  For many, she is the first pelvic floor physical therapist that they are aware of, thanks to her book Heal Pelvic Pain.  She wears many hats which have made her an incredibly well-rounded resource for those looking to end their pelvic pain.  She is a physical therapist, author, business owner, pillar in the International Pelvic Pain Society and a member of many other professional organizations.  Her expertise has been sought out in medical textbooks and popular media such as 20/20, Dr. Oz, and Elle and Prevention magazine.

I was lucky enough to be able to talk with her about her thoughts on pelvic floor physical therapy’s current state, the status of physician awareness of pelvic pain, what options patients have when they plateau, the highways of progress that we need to build as a specialty and how she does it all with two kids and a business.

 

1.  How did you become interested in pelvic floor physical therapy?

Amy:  It was actually during PT school.  A friend’s mother had a total hysterectomy and then also had opted to remove a cyst on her bladder. Looking back years and years later, I think she ended up with pudendal neuralgia. While I was in PT school, I was trying to figure out was going on.  Things had been ruled out like back pain.  She had an MRI.  She actually got an infection right after the surgery, a bladder infection, but that was resolved.  So everything was resolved but she still had these bladder symptoms, bowel and severe pelvic pain.  I went to a school that taught Problem Based Learning.

Sara:  Like EBP?  Evidenced Based Practice?

Amy:  Similar.  They adapted it from Harvard Medical School.  It’s basically that you teach yourself and colleagues everything.  Which I thought some of it was good, but some of it, like anatomy, I didn’t think was so good.  We were the only class that had anatomy Problem Based Learning, so we had to figure out the anatomy on our own.  And then they realized that it wasn’t so good because a lot of people in our year failed their test.   So back to my friends’ mother:  I went to my teacher and said “This is what is going on. She is experiencing this, this and this.” And they said “Why don’t you figure it out?”.  I looked at the books and basically realized that it could be coming from lower down the chain because they had done an MRI of the lumbar spine and they had ruled that out.  So, basically, from looking at the books and trying to figure that out, I thought, maybe it’s coming from the sacral nerves and the pudendal nerve.

Sara: Do you feel that your professors had a hypothesis for this, or did they have no clue and they wanted you to figure it out?

Amy:  I don’t think they really knew, but one said “Maybe it is lower down. More like pelvic pain than low back pain.”  They agreed with me.  But, that was one out of four professors that I asked.  And I think, that’s probably still the main stream.  I think that many physical therapists don’t know that pelvic floor physical therapists exist.

Sara:  Yeah, I see that as well and I always wondered if there was a regional difference.  I do think that in some parts of the country there is more of a spotlight on pelvic floor physical therapists.  But, I do think that the main vein is that this is a specialty that maybe just treats incontinence, if they know anything about it at all.

Amy:  Right, right.

 

2.  Have you ever gotten negative feedback from a practitioner who did not understand what pelvic floor physical therapy is?  If so, how did you handle this?

Amy:  Yes.  I had a very interesting experience with a physician, actually.  I was treating a patient for vestibulitis and you know, at the time, this was years ago, I didn’t know the difference between provoked or unprovoked.  Is it just nerve endings or is it actual pelvic floor issues?  I think that’s still controversial.  Some people think it’s always pelvic floor issues and that you shouldn’t do a vestibulectomy and some people feel it’s a proliferation of nerve endings.  Back to the story:  I was treating a woman who had pain right at the opening [of the vagina] and she had bowel issues, so I wasn’t sure what was going on.  And she did go from an extra small dilator to a medium dilator.  The physician called me up and yelled at me and said “You’re wasting this patient’s time.  She is vitamin D deficient.”  People did think that this particular physician was very limited in her expertise too.  But, she definitely yelled at me and said that I was not treating her patient well and that she was vitamin D deficient, even though I got her from an extra small to a medium dilator.

And then I’ve also had a lot of orthopedic surgeons [who were] very negative, like pelvic pain doesn’t exist at all.  So, we still have a long way to go.  I think that we’ve learned a lot, but we still have a long way to go.   There is a big hospital here and it’s all orthopedic and they’re known around the country because they treat a lot of professional teams.  We’ve introduced to two physicians that hip pathologies could be attributed to pelvic pain.  And, at first, the whole shield went up, but then, they started to accept that “okay” there’s quite a large population that has urinary symptoms and tailbone symptoms, so maybe there is a correlation.  But, they still don’t want to fully deal with it.  They still send the patient to hip physical therapy and they’re in the hospital and usually the PT’s send to us thinking “Oh, they’ve got these other issues going on”.  Quite a bit of resistance, but we are getting a little closer.

 

3.  Has being a board member and Secretary of the International Pelvic Pain Society changed your practice or your relationship with other providers that do pelvic floor therapy?

Amy:  I think it gives you more prestige, just amongst physicians.  It definitely has helped, the whole IPPS to realize the importance of physical therapy.  Stephanie  Prendergast and I have been very involved with them from very early on.  I think other people were too.  I think Rhonda Kotarinos may have been, but then she started putting her energy more into research.  I think we helped to open up the eyes of physicians more and I think that’s really helped pelvic floor physical therapists.  It’s so, well, I should say the majority of it is so refreshing.  I say the majority because there are some physicians who say that surgery is the only way to go, surgery is the only cure.  But, that’s much less and they also will get the rebuttals from the physical therapists  and some of the physicians at the conferences.  IPPS is half physical therapists and half physicians and other providers.  And then, just the other thing, I recently got asked to write a chapter in the pelvic pain textbook, from someone from Harvard, she’s putting that together.  I don’t know if I would have had that opportunity if I wasn’t on the board because she emailed everyone on the board and said “I’d like to do this, are you interested?”

Sara:  Since you’re talking about writing for a textbook – is that going to be for medical students?

Amy:  I believe, yes.  It’s going to be for physicians, physicians assistants, and students.  There is currently a book out there, which I wrote a chapter with Dee Hartmann on physical therapy treatment.  Talli Rosenbaum in Israel wrote a chapter on evaluation.  That book’s called Female Sexual Dysfunction Evaluation and Treatment and it goes through all the different sexual dysfunctions including mental health, skin conditions, pelvic floor obviously, cancer, endometriosis. It’s a very thorough textbook.  It’s not that well known.  It’s definitely known among ISSWSH [International Society for the Study of Women’s Sexual Health], who basically put together the textbook.

 

4.  Who are your mentors?

Amy:  Mine have been Rhonda Kotarinos as well as Holly Herman and Kathy Wallace.  Those are the people with whom I took my classes.  I took classes with Holly Herman and Kathy Wallace, and Rhonda I spent two days with shadowing.  And I recommend to other people too.  I think shadowing is great.  So, we offer shadowing and you can have the option, like now, teaching, and Rhonda still offers it.  And, Stephanie Prendergrast, she’s a very good colleague of mine.  We were pretty parallel.  She is well known too, and she is in California and they have a shadowing program too.

Sara:  And I know Stephanie has said that Rhonda is her mentor too.

Amy:  Yes.  I went to see Jerome Weiss, actually a patient flew me there.  She was, I guess she was treated by Jerome Weiss, and maybe started PT there and then she moved to NY.  She wanted me to learn more about the PT and meet Jerome Weiss.  And, he did nerve blocks while I was there and acupuncture.  He was definitely an inspiration, physician-wise.  Because, he was probably the first, that I saw, that really treated pelvic pain.

Sara:  So, this was years ago?

Amy:  So, I started treating pelvic pain pretty much right out of school in ’99.  And then I went to visit him in 2001 when the patient flew me there.  And that’s when I met Stephanie.

Sara:  Okay, because she was working for him at the time.

Amy:  Yes.  And then I think about a year later, she stopped.

 

5.  If you weren’t a pelvic floor physical therapist, what would you be doing?

Amy:  Umm, I have no idea.  I don’t know!  I feel like I was always very interested in midwifery – like being a mid-wife.  So, out of school I thought I wanted to do neuro[rehab], and honestly, I couldn’t get a job right out of school, it was when PT was at it’s peak.  Much more supply than demand, and then I ended up going into orthopedics, by default.  But, I always had that interest in pelvic floor because of my friend.  So, neuro[rehab] and then I also had a dream of being a mid-wife, delivering babies.

 

6.  How do you establish balance between treating, traveling and personal life?

Amy:  That is a very big challenge, because I’m so passionate about pelvic pain and studying, I hesitated to even accept writing this textbook chapter because I know it will take time away from my business and my family, but, I know it’s a good cause.  It’s definitely quite a challenge.  I only treat about ten hours of patients a week, so for this chapter, for instance, I try to keep my work week to 40 hours.  We do travel quite a bit to visit family.  We took our first big trip away this week.   Fortunately, my business runs smoothly, most of the time, and there are five other therapists, so it does give me that flexibility.  I fortunately, also have a very good babysitter, so that helps.

 

7.  What inspired you to write Heal Pelvic Pain?

Amy:  To be honest, a patient.  I love being a physical therapist and I love practicing, but I’m not a good writer though.  A patient approached me and said “You have to write a book”.  I was a month away from getting married and I said I would have to put that on hold until after the wedding.  So I did.  And, I also told her up front, I said “I’m not a good writer.”  And she said “I will get you a private editor and think about all the good you will be doing.”  So, I got a private editor and basically what I did was I wrote as if I was speaking to a patient and then she helped to edit it, so it was very clear and precise and then McGraw-Hill picked it up and of course, they had, you know, four editors.  It was wonderful writing it, definitely.  It was a lot of work, but it was wonderful and I’m so happy I did it.

Sara:  It’s basically the staple for anyone that has pelvic pain and it’s so accessible the way you guys put it together.

Amy:  Yeah, and I thank my private editor for helping me.  I did it, but she helped ties, I would say “spasm” and she would say “No, no, you can’t say spasm, I don’t know what spasm means”.  She would say “Okay, what’s another word for spasm, give me three other words!”

Sara:  Interesting, because we don’t even think about that.  It doesn’t even seem like a medical term, but you are right.  So that’s a good point.

Amy:  Yeah, so she was very helpful.  And it was so, so rewarding.  I get Facebook messages, Amazon reviews, emails that say “You’ve changed my life.  I’m now seeing a pelvic floor physical therapist.”  Or “I did your book and I’m all better.”  That’s not a lot of people, but there are a couple Amazon reviews that say they did the book and they are doing a lot better.

Sara:  And those are just the people that are going on to write about it, so who knows what it is doing for others.  I think it’s great that this is such a helpful, accessible book and it’s written by a pelvic floor physical therapist and I think it gives a lot of us a little bit more credibility when we are just speaking to physicians, because they have heard of this book too.  I think it’s just helped the community in general, so I’m very thankful that you’ve done that.

Amy:  By the way, I don’t know if you guys get a lot of Spanish speaking patients, but I’ve recently had it translated into Spanish.  It’s on Amazon right now.  I did it myself.  McGraw-Hill didn’t want to do it.  It’s called Sana el Dolor Pelvico and it’s on Amazon.  It’s a little bit different than mine because I had to do it myself.  It’s a little different than the English version, the cover is a little bit different.  And then I just did a video that’s called Healing Abdominal and Pelvic Pain.  And that came about because patients said that I need to do a video along with my book so they can sit down and relax and do the stretches instead of looking at the book.  For example, what if they are feeling more pain?  So the video goes through massage techniques, external and internal and I use a pelvic model for the internal.  Then it goes through about 25 minutes of stretching.

Sara:  That sounds like a great idea, just for the 3D aspect of it.

 

8.  How do you like to hang your toilet paper?  Over or under and why?  It is a topic we often discuss in our own clinic.

Amy:  Oh, that’s so funny.  Well, I’ll tell you, I didn’t even realize that it made a difference and then I had a friend in college say “Why do you hang your toilet paper like this?”  I didn’t even care, I was an “either or” person.   And then she opened my eyes to put it with, I guess, it coming over.  But really, I’m “either or”, I could have gone both ways.

Sara:  Alright.

Amy:  Why?  What is the thought behind that?

Sara:  Well, people feel that if you put it under, then it just unravels forever and you are wasting toilet paper or you are getting it dirty.  And then, some people don’t like putting it over, because it’s a little bit harder to pull it.  So, some people have specific ways they like to do it.  I like to mess everyone up and I’ll just switch back and forth when I switch the toilet paper roll.

Amy:  Oh, you go back and forth too?

Sara:  I go back and forth on purpose, though.  I just like to create a little chaos.

Amy:  I guess I was creating chaos without knowing it.

 

9.  What does the breakdown of your clinic load look like?  Incontinence versus pain.

Amy:  I would say we have close to 95% pain, pelvic pain.

Sara:  I guess that makes sense, if you wrote the book on it.

Amy:  Yeah.  And we have 35-40% men.  We do have a couple of prenatal and orthopedic and then we also do have a couple urgency/frequency.  We don’t have a lot of just straight incontinence.  I think it’s about 90% [pain] because we do get some post-prostatectomy.  So we have 10% that is post-prostatectomy, prenatal, orthopedic, urgency/frequency without pain and stress incontinence.  So that’s 10% and the other 90% is pelvic pain.

 

10.  Do you have any advice for patients with chronic pelvic pain that reach a plateau with physical therapy treatment?

Amy:  I do.  One is: get a second opinion in your office, or from another physical therapist.   Well, probably, first is the physical therapist needs to take a step back [and think] “Am I missing something?” [They need to] talk with their colleagues first and see if they need to add anything.  A second set of eyes is helpful.  Or, [see] if someone has a different specialty.  So like, in our office, we have someone that does visceral manipulations, and I found that can be helpful for some patients, not all, but some.  Also, for the physical therapist, make sure that they are addressing the mental health part of it.  Because, if this person is anxious, then if they are holding their pelvic floor all day long, you are going to struggle with them as physical therapists.  And, also make sure that the patient is following the routine.  And then go over everything through them again.  I know for the physical therapist and the patient this can be tedious.  But, I can’t even tell you how many times I’m like “Okay, how’s the breathing and the pelvic floor drops going?”  [patient says] “Oh, I forgot to do the drops or I don’t think I’m doing it right.”  “Ok, let’s go over that again.”  Also, sometimes they need to get mental health therapy or they may need a medication or a nerve block or something with the treatment.

Sara:  That’s a lot.  I was curious how you would answer that, but that is a lot of good stuff.  And it’s refreshing for me to hear that too.

 

11.  Where do you see Women’s Health physical therapy in the future?

Amy:  Basically what I’ve seen in the last 15 years is a huge growth, but that was starting from almost zero.  There were like four or five people in the country who were doing pelvic floor physical therapy.  So I feel a huge growth, but we’re still only 20% there.  And, will it ever be 100% accepted and recognized?  I don’t think so.  Just like your patient gets meniscus surgery and the physician is like “Oh, you’ll be fine.  Go back to running and skiing” and they end up with patellofemoral syndrome or something else, whereas if you went to physical therapy, they probably would have had a lot of prevention.  So I think it’s heading that way, but you’ll still have resistance.  And then you will have physicians that say only surgery works.

 

12.  If you could let the public know one thing about pelvic pain, what would it be?

Amy:  I would say that musculoskeletal causes is probably one of the most common causes of pelvic pain.  And that if you find the right physical therapist, you can gain a lot of help.

Sara:  I think that’s actually super important.  Questioning who is giving your care.

 

Amy Stein PT, DPT has written Heal Pelvic Pain and Sana el Dolor Pelvico.  She is creator of the video Healing Pelvic and Abdominal Pain: The ultimate home program for patients and a guide for practitioners.  She is a therapist at and owns Beyond Basics Physical Therapy in New York City.  She is one of the founders of Alliance for Pelvic Pain – an annual educational and supportive retreat for people experiencing chronic pelvic pain.

How to Find a PT Clinic

Once you’ve got a referral for pelvic floor physical therapy, now you’ve got to find a therapist to treat you.  If you live in a city with several options, your physician might already have a therapist or a clinic that they have been working with.  Or, they may have a list of several therapists or clinics for you to choose from.  Regardless, you always have the final decision in where you go.  If your doctor refers you to a person or a place that doesn’t suit you, you are not obligated to go there.

If your doctor does not have any suggestions or if you are the one asking for a referral in the first place, then you’ve got a little homework to do.  First, you need to find a pelvic floor clinic or a pelvic floor physical therapist.  Below is a list of ways in which you can find a suitable clinic or therapist for pelvic pain in your area:

 

    • This is the American Physical Therapy Association’s (APTA) physical therapy locator.  You can refine your search by looking for therapists under the specialty “Women’s Health”.  Don’t worry guys, this specialty includes you too.  It’s just a misnomer.
    • This is the Section of Woman’s Health (SOWH) physical therapy locator.  The SOWH is a specialty section of the APTA.  Only pelvic floor physical therapists who are members of this section will be listed.  Please note – not all members are listed in their search section yet.
    • This is the International Pelvic Pain Society link to finding a medical provider.
    • This is a webpage devoted to pudendal neuralgia.  This link lists providers that are familiar with treating pudendal neuralgia.
    • This is the email address for physical therapists Elizabeth Rummer and Stephanie Prendergrast.  They have several clinics in California called Pelvic Health and Rehabilitation Center.  They also have a blog about pelvic health.  They teach classes on pelvic pain and have a running list of healthcare providers who have taken their course.  They are a good resource in finding someone that can help with your pelvic pain.

 

The next step is to make a list of possible pelvic floor physical therapists and call them.  See if they will talk to you on the phone or email with you.  I recommend that you do this even if your physician is strongly suggesting that you go see a particular physical therapist, even if that physical therapist is in their own practice!

You want to ask them if they have seen your symptoms before, what the treatment could be like and what their history of results are like.  Trust me, you do not want to be the first pelvic pain patient that your therapist is treating.  Unfortunately – many, many pelvic floor physical therapists are not well-versed in treating pelvic pain.

Here are some definite clues that you need to continue your search for a therapist:

  • Your treatments are not one-on-one – meaning your therapist is also treating other people during your appointment time
  • Your therapist does not do an internal examination vaginally or rectally
  • Your therapist cannot answer most of your questions or does not seem confident in their own answers
  • Your therapist only has experience with a handful of pelvic pain patients
  • Your therapist is not practicing clean habits with gloves or other equipment
  • Your therapist is always late

If your potential therapists says that they have treated pelvic pain, ask them how often they are treating pelvic pain.  The ideal pelvic floor physical therapist is doing this full-time and is really passionate about treating pelvic pain.  If you can’t have the ideal, that’s okay too.  You can ask your potential therapist where they get new information from, what classes they have taken, do they have other people to bounce ideas around with?  All of these things are good signs.  The key is that you want to be with a therapist that is motivated and excited about getting you better.  You do not want to be with someone scared and stumped.  And that’s the honest truth.

If you have any questions, please email me at [email protected] or leave your question in the comment section below.

What Happens When You See the Doctor for Pelvic Pain and How to Get a Referral to Pelvic Floor Physical Therapy

What to do if you’ve got pelvic pain?  Well, obviously you go to your doctor and tell them your symptoms.  Odds are, if you’re like the general public, your doctor will not be 100% sure about what’s going on.

If you’re a female seeing your doctor for pelvic pain, it’s possible that after a pelvic examination, you will be told that nothing is wrong.  This happens a lot.  See, the doctor is looking for some sign of infection, a cut, bleeding, anything to put their finger on.  (Funny thing, they might not literally put their finger on anything.)  Unfortunately, with pelvic floor dysfunction, the symptoms aren’t always visible to the naked eye.  If the problem is stemming from overactive muscles, this really needs to be assessed by feel by someone who can tell the difference between “normal” and tight vaginal or anal muscles.

You may repeat to your doctor that you feel irritation or stinging or burning or itching, but if they can’t see anything, they probably won’t do anything.  I say probably because there are two other scenarios:

They might just assume you have an infection, despite negative tests or zero testing and go ahead and give you antibiotics or an anti-fungal.

Or, you will be lucky and your doctor will say that they are familiar with your symptoms or they have had a patient in the past with your symptoms and they will prescribe you an appropriate medication or send you to pain management or even send you to pelvic floor physical therapy.

If you’re a male seeing your doctor for pelvic pain, you are probably really familiar with the term “prostatitis”.  Basically, this is inflammation in your prostate.  Do you really have “prostatitis”?  There are different types of prostatitis which are described based on how long you’ve had your “prostatitis” and whether or not you have an active infection.  You, sir, will see a few scenarios:

  • Your doctor may go ahead and give you six weeks worth of antibiotics without doing any testing for infection and you will probably feel better for a few months, but if you don’t actually have “prostatitis”, trust me, your symptoms will come back.
  • Your doctor will test you for an infection and you test positive – you actually have an infection.  You will then get antibiotics.  Once the infection has been cleared, the pelvic pain might return a few months later.  Why?  Well, because your pelvic floor muscles may be in spasm or may be unable to relax as a result of the initial infection.
  • If your doctor does test you for an infection and it is negative, he might still give you antibiotics.  Just as in the first scenario I provided, you will probably feel better for a few months, but your pain will come back.  Something in the antibiotics is probably helping you to feel better.  But, once you’ve completed your medication, your symptoms will likely return.  This is all because your pelvic floor dysfunction has not been addressed, let alone resolved.

The bottom line for both men and women is this:  If you do not get relief with your current treatment plan or your doctor is not familiar with your pelvic pain, ask for more options.  I am a pelvic floor physical therapist and I believe that we need to be part of the treatment plan for pelvic pain.  On average, my patients see about six different specialists before they end up seeing me.  I strongly believe that very few people will get relief from pelvic pain without the assistance of a pelvic floor physical therapist at some point.  So, if you are not getting the help that you need, ask if you can be referred to a pelvic floor physical therapist.  

You have to ask.

Unfortunately, some physicians will not readily offer pelvic floor physical therapy as a treatment option.  More unfortunately, some physicians do not believe that pelvic floor physical therapy can help with pelvic pain.  This is your pain, so it’s really up to you to decide if it is helpful, especially if what you have tried so far isn’t making enough headway for you.

Each state is different when it comes to referral to physical therapy.  In Texas, we have partial Direct Access.  This means that a patient can see a therapist for an evaluation, but they cannot receive any treatment unless a doctor, chiropractor, nurse practitioner or a physician’s assistant has written a prescription for physical therapy.  In other states, a patient can receive physical therapy evaluation and treatment without a prescription from another provider.  This is called Direct Access.

Please know that your doctor ultimately wants to see you get better.  Consider the doctor’s point of view.  It is always challenging to be given a patient with symptoms or a diagnosis that you are not familiar with.  This is true for all healthcare providers.  Your physician will either be excited to learn something new, or he or she may tell you there is nothing they can do.  Both of these scenarios can be appreciated to an extent.  You are either working with someone that will work with you, or your provider is being honest and doesn’t want to waste your time.   If you get the latter response do not worry.  Find a physician willing to help you.  Then, turn lemons into lemonade.  This is an opportunity for you to share what you will be learning with your physicians and then they will be better able to help other patients in the future.

And…what’s up with hamburgers anyways…?  There is no ham in them.  If there were, I’d like to say “Let’s turn ham into hamburgers”.

If you have any questions, please email me at [email protected] or leave them in the comment section below.

How Did I Get Pelvic Floor Dysfunction?

How does one develop pelvic floor dysfunction?

Well, really, there are a lot of variables and the reason is different for every body so I’m going to hit the big ones in this post.

1.  Anatomic Predisposition – Sometimes you are born with your bones, ligaments, muscles connected in such a way that you are primed to appreciate a dysfunction.  I use the word “appreciate” because it sounds sophisticated, but I am sure you don’t “appreciate” dysfunction like you “appreciate” a glass of wine.  This doesn’t mean that you will inevitably have a dysfunction, it just means that if you should have a fall or have a job that requires that you sit for a really, really long time every day, then you probably could end up with pelvic floor dysfunction.  However, if you are lucky enough to avoid anything that could provoke an issue for you, then you could get off scott free.

2.  Infection – Infections are basically an assault on your body.  They are an insult that your body responds to by trying to fight off the culprit and in response your muscles and fascia will likely tense up to protect your most vital parts.  I’m saying that if you have a urinary tract infection, yeast infection, fungal infection, prostate infection, venereal disease, etc. then your pelvic floor muscles, your abdominal muscles, your inner thigh muscles – they all want to protect your genital area.  They’re saying “Hey, if these reproductive parts get attacked – we can’t reproduce.”  It doesn’t matter how old you are or what sex you are or if you even want to reproduce.  This is how our bodies respond in the most primitive way.  So, if you are unlucky enough to have several infections in a row or unlucky enough to be misdiagnosed or inappropriately diagnosed, then your muscles and fascia really over did themselves in trying to protect you.  Not to mention the pelvic inflammation these infections likely caused.  When you go through a period of time with an overactive pelvic floor, then you are going to need help relaxing the pelvic floor.  It’s not going to happen all by itself now.  It used to happen all by itself, but now your pelvic floor just doesn’t trust you anymore.  As a result of this constant state of overactivity, you could feel pain, bladder symptoms, ano/rectal symptoms, urinary incontinence, fecal incontinence.  Some of these symptoms may feel like another infection, but if you actually get tested for an infection, the results may be negative.  It is so important for you to get properly tested every single time you think you have an infection.  If your doctor wants to write you a script for something without testing you first, please ask to come in and be tested.  If you do not have an infection, do not treat yourself.  You could be over-treating or mistreating yourself and this wreaks havoc on your pelvic floor.

3.  Trauma – Falling hard on your bottom could be enough to start a pelvic floor dysfunction, especially if you ignore any pain that you have.  What I typically see is that a patient will have a fall or a car accident and they’ll break their tailbone or just have tailbone pain.  The doctor will say there is really nothing to be done about this pain and with time it will go away.  Well, yes and no.  The tailbone will heal on it’s own if it’s broken, but that doesn’t mean it will always stop hurting on it’s own.  When you insult the tailbone (I use insult also because it’s really a fun word – like our bones are people and need to be respected – it’s true, they deserve respect!), I digress, when you insult the tailbone, you also insult the muscles attaching to the tailbone.  For example, the coccygeus muscle.  These muscles are going to respond just as I mentioned they respond in the section about infections.  They are going to spasm and become overactive in an attempt to protect you.  But, with chronic pain, they don’t always learn to chill out and this could mean that the coccygeus will shorten and since it’s attached to the tailbone, it’s going to pull the tailbone along with it.  Think of it like a dog and it’s walker.  The coccygeus is the dog and it’s determined to chase a squirrel.  The tailbone is the owner walking the dog, but because of this strong force, it’s pulled very strongly into whatever direction the dog wants to go, ie. the tailbone can be pulled excessively forward or to the left or the right or even excessively forward and left or right.  If you experience this for long enough, you are going to start to experience a host of other pelvic pain symptoms.

Trauma can also irritate a very special nerve in the pelvic floor – the pudendal nerve. The pudendal nerve is like the Queen of England.  It controls almost everything in the pelvic floor.  It’s responsible for motor and sensory functions.  This means that it has a large role in controlling whether you can squeeze or relax your muscles and it controls how little or how much you feel – this can even mean you feel way, way too much and you won’t “appreciate” that, trust me.  With trauma, the nerve can be stretched, or as a result of overactivity of the pelvic floor muscles, the nerve can basically be pinched between the muscles and/or ligaments.  From this you could get pain, itching, symptoms of infections, bladder symptoms, ano/rectal symptoms, incontinence, constipation and a host of other issues.

4.  Surgery and Procedures – Surgery is technically an insult, right?  It does traumatize the surrounding musculature and creates inflammation.  But, I believe it deserves it’s own section because, unfortunately, some people go into a urological or gynecological surgery feeling fine and wake up with pelvic pain.  Sure, some degree of pelvic pain is probably expected after a pelvic surgery, but when you wake up with extreme pain that is unrelenting and ignores all the pain medications you are taking, then something is wrong and this needs to be addressed immediately.  Your doctor may examine you and say that everything looks fine, so this can be very confusing.  Trust your gut.  If you should be feeling better and you are not, you need to further investigate what’s going on.  This can happen after a hysterectomy, mesh placement, biopsy, colposcopy, pap smear, etc.  If something gets nicked or stretched or trapped, it’s very possible to develop a pelvic floor dysfunction.

5.  Varicosities – This is a relatively new area for me, but I think it warrants adding to the list.  A varicosity is when the blood vessels become too lax and they aren’t supporting just one way movement of your blood flow.  Your veins have a valve in them to basically stop backwards movement, called reflux.  Both men and women can have varicosities in their pelvis.  The excessive width of the veins and the retirement of the valves in the veins can create quite a large vein and that vein can put pressure on parts of your pelvis, even possibly on some nerves, and this can be uncomfortable.  Typically, if this is an issue for you, you might even have some leg discomfort, you might feel worse at the end of the day, you might feel better lying down, if you’re a female you might have painful periods or painful sex.  This issue can be addressed by an interventional radiologist.

If you have pelvic pain, hopefully some of this clearing up a lot of questions for you.  If you have more questions, please email me at [email protected] or write it in the comment section below.

Signs of Pelvic Floor Dysfunction

Now that you know what the pelvic floor is and what pelvic floor dysfunction is, let’s talk about the symptoms of pelvic floor dysfunction.

The pelvic floor is responsible for maintaining just enough tone to not let your organs fall through (peek a boo!) and it’s muscles are supposed to hang at just the right length so that you don’t pee or poop or fart without your own consent.   If everything isn’t just so then you could “appreciate” any of the following:

 

1.  Bladder Problems:  Ah, bladder problems.  We take bladder function for granted until we notice something is wrong.  A pelvic floor dysfunction could result in any of the following:

  • urinary incontinence – with jumping, coughing, sneezing, laughing, sex OR when you just don’t make it to the bathroom on time
  • strong urinary urges – you know where all the bathrooms are in every store
  • urinary frequency – you know where all the bathrooms are in every store
  • strong urinary urges and frequency – good Lord you don’t like to even leave the house
  • symptoms of a urinary tract infection – you regularly get antibiotics called in for you
  • urinary hesitancy – you wait and you wait, the urine flow starts and stops and starts and stops, it’s shy, it’s cute, right?
  • incomplete emptying of the bladder – you wait and you wait, the urine flow starts and stops, but it doesn’t start again
  • pain with urination or pain after urination
  • pain with filling of the bladder
  • urinary spraying all over yourself and/or the toilet seat

 

2.  Bowel Problems:  Ah, bowel problems.  We take bowel function for granted until we notice something is wrong.  A pelvic floor dysfunction could result in any of the following:

  • fecal incontinence – you may not leave the house often
  • fecal stains on underwear – staining your underwear, no one wants to admit to this, but it happens
  • strong fecal urges – very embarrassing in social situations
  • flatulence – this will also keep you from socializing
  • constipation – this could range from justing being a nuisance to having thoughts of pooping be all you can think about
  • wiping excessively after bowel movements – you are using a lot of toilet paper and your anus is raw
  • incomplete emptying of stool – maybe you feel like you have to keep returning to the bathroom after you try to have a bowel movement
  • pain before, during or after bowel movements – you might hurt when the stool is in your rectum, or it might hurt when it’s passing out of your body, or you might feel discomfort after you’re done pooping

 

3.  Sexual Problems:  This can be really devastating for some people.  It can affect their relationships and how they view their self-worth.  It shouldn’t, but it can definitely have a profound effect on you if you are living with this.  Now, I am very aware that there are a variety of ways to be “sexual” and that there are a variety of ways to appreciate sexual penetration.  I am going to discuss sex in terms of penis to vagina penetration for this post, but I do plan to write more posts about varieties in intimacy.

In females, a pelvic floor dysfunction could result in any of the following:

  • pain with initial vaginal penetration – this may feel like a ring of fire and after initial penetration, maybe, just maybe it feels a little better
  • pain with thrusting – maybe it feels like sandpaper or like sharp knives
  • pain with orgasm – this could create a spasm that is intolerable for you to bear
  • difficulty achieving orgasm – anorgasmia can be very frustrating
  • pain after orgasm or intercourse – soaking in the tub for a few days sounds about right if you experience this, this pain can be anywhere around the pelvis
  • “sit bone” pain – the bones very close to each side of the anus that we sit on, technically called the ischial tuberosities
  • your unpleasant sensations are what I refer to as “pain” and these can be in the abdomen, clitoris, labias, vaginal opening, inside the vagina, at the vulva (the part of the genitals that you can see), at the anus, in the rectum, the legs and at the “sit bones” or the ischial tuberosities

 

In males, a pelvic floor dysfunction could result in any of the following (I’m not going to comment on these because they really are self-explanatory):

  • pain with erections
  • pain with thrusting
  • pain with ejaculation
  • pre-mature ejaculation
  • poor ability to maintain an erection
  • pain after orgasm or intercourse – this pain can be anywhere around the pelvis
  • one testicle ascending
  • both testicles ascending
  • scrotal tissue feeling very tight
  • pain between the scrotum and the anus
  • your unpleasant sensations are what I refer to as “pain” and these can be in the abdomen, base of the penis, shaft of the penis, tip of the penis, scrotum, testicles, perineum (space between the testicles and anus), around the anus, on the anus, inside the rectum and at the “sit bones” or the ischial tuberosities

 

If you have any of these types of symptoms, it is possible for you to have a pelvic floor dysfunction.  However, many of these symptoms can present with other issues as well, so hopefully you are getting screened well by your physician.

If you have any questions, please email me at [email protected] or leave your question in the comment section below.

 

What is Pelvic Floor Dysfunction?

So, you’ve got pelvic pain.

When my patients come in to see me for the first time, they typically say it hurts “there” and they just run their hands around an imaginary circle in front of their pelvis.  Or they will swoop their hands between their legs and touch the air from front to back.  It’s like they’re directing a plane to land…right into their crotch.

I’m really wondering why we are never taught to say vagina, rectum, anus, perineum, penis, scrotum, testicles, clitoris and labia.  That’s what I’m really wondering.  But, it’s okay because I actually love when my patients describe the location of their pain as the “taint” or any number of other anatomically incorrect words.  I think it’s cute and it gives me an excuse to use those words too.  Hey, whatever makes you feel better!  But, in the end, all my patients learn the correct words to use and I then get a much better understanding of what I’m working with.

So, what IS this?  What is pelvic pain?  What is pelvic floor dysfunction?

Let’s start with a simpler question:  What is the pelvic floor?

The pelvic floor is everything at the bottom of the bony structures that make up the pelvis.  This includes muscles, ligaments, nerves and connective tissue.  The part that you can see when you look at your crotch in the mirror – that is your pelvic floor too.  That’s the superficial part of the pelvic floor.  The pelvic floor muscles run from the pubic bone all the way under back to past the anus and up to the tailbone and the sacrum.  Your genitals, yes, they are part of the pelvic floor as well.

Pelvic pain is essentially pain in any of the above described areas.  I’m defining “pain” as any sensation that you do not want to have.  This could be a feeling of tightness, burning, itching, sharpness, foreign objects in your pelvis, heaviness, etc.

Pelvic floor dysfunction is “inappropriate” function of any of the above described areas.  Inappropriate!  I use that word because it best describes how you probably feel when you let out an unauthorized fart from the anus – or, God forbid – the vagina.  Inappropriate!  See?  In all seriousness though, pelvic floor dysfunction can mean that your pelvic floor muscles are too weak, too tight or too loose.  It can also mean that you have a poor ability to control what the muscles are doing.  Maybe if you try to squeeze the muscles – you can’t.  Maybe if you try to relax the muscles – you can’t. Or, you can squeeze the muscles, but they freeze in that tight state.  If it seems like I’m painting a picture that the stars need to be aligned in the sky just right in order to not have a pelvic floor dysfunction.  Well, yeah, sometimes it does seem that way.  Here’s the thing, if you take 50 random people on the streets and examine their pelvic floor – I bet half of them would have a pelvic floor dysfunction.  (Can you imagine that?  I’m picturing myself on a busy street corner, pointing to innocent people walking by and saying “You!  Pelvic exam!  Show me your genitals!)  But, the point is, pelvic floor dysfunction is really, really common. However, it’s when things get really out of hand that this becomes a problem.  Eventually there is a straw that breaks the camel’s back.  (Those poor camel’s.  How embarrassing that it was the straw that did it….).

Another important thing to note:  Pelvic dysfunction does not always equate to pelvic pain.  You can have a dysfunction that leads to urinary incontinence, but that doesn’t necessarily mean you will have pain as well.  However, you could have a pelvic floor dysfunction which results in pain and incontinence.

Is this making sense?  If anything needs to be clarified, email me at [email protected] and reference this blog post, or write your question in the comment section below.  I want to make everything crystal clear or I’m not doing my job.

So, this is pelvic floor dysfunction in a nutshell.  If you could put your pelvic pain in a nutshell, that would be great, wouldn’t it?  Or, maybe you are a guy and already have pain in your nuts.  Man, I’m sorry for you.  Hopefully we can get it out of there, follow me to the next posts….

 

About Me

This is a blog about pelvic pain!  Yes, there are multiple blogs about pelvic floor dysfunctions and this is yet another one.  If you have pelvic floor issues, the fact that multiple easy-to-access blogs exist will excite you.  So, hooray for you!  So, how is this one different?  Well – it’s not.  It’s not different!  It’s just mine and my plan is to devote this blog to pelvic pain.

So why read this one?  Well, I’m sure you’ll learn a lot.  I can’t stop learning and I can’t stop sharing with people.  It’s a problem and if you have pelvic pain, you might benefit from this weird obsession that I have.

Starting off as a younger, younger physical therapist (I’m still really young), I had no idea I would end up loving my job.  That’s right, I wasn’t that into therapy.  I started off in orthopedics treating back pain, ankle pain, knee pain, etc.  It kind of bored me and I was overwhelmed with traditional orthopedics: big gym, three patients being managed at a time, me wearing a glorified Best Buy outfit (collared polo shirt with khaki pants and tennis shoes).  I would never normally wear tennis shoes with anything but work-out pants, that must be noted.  I wanted to quit my job and become a lawyer.  I wasn’t even that into law, but it seemed a little more interesting to me.  I didn’t want to treat fingers and elbows and ankles and toes anymore.  I kind of thought “It’s just a toe, man.  Get over it.”  I know, I know, that’s mean.

But then came along tailbone pain and it was love at first digital insertion.  That’s something I could really get into – literally.  Sure, I was a little scared at first, I mean – wouldn’t you be scared too?  It’s not every day you get to get that close to someone.  But, I treated my first several tailbone patients and realized that I could effect a lot.  My patients started to see improvement in not only their tailbone pain, but in nerve pain, bowel movements, hip and back pain and even had less painful sex.  That’s not to say everyone with tailbone pain will get these same results with improvement, but this is a garden variety of benefits to getting your pelvic pain addressed.  I decided that I really need to dive deeper into this pelvic stuff.  I began a mentorship program with the pelvic floor physical therapist in my clinic.  I took classes, attended a pelvic floor cadaver lab and eventually began working at Sullivan Physical Therapy (which is – in my eyes – a wonderful place to go for pelvic floor physical therapy in Austin).  Am I biased?  Hell yes I am!  I work there and I think that we have amazing talent.

This blog about pelvic pain is a place where I will educate you, pun at you and sometimes cuss at you so I hope you enjoy it as much as I plan to.

Follow me if you want and I’ll probably address most questions you may have.  I will be following comments and will be answering questions via my email address at [email protected]