May is Pelvic Pain Awareness Month

What is Chronic Pelvic Pain (CPP)? Any pelvic or abdominal pain that lasts for more than 6 months or pain without an obvious cause that has been present for less than 6 months is considered CPP. CPP is a common and debilitating health care problem, and is estimated to affect about 25 million women. More than half of these women have to decrease their daily activities 1 or more days per month, 90% have pain with intercourse, and 25% have to spend 2-3 days per month in bed because of their pain. Although less common, CPP can also affect men and is often diagnosed as “chronic prostatitis”. People across the gender spectrum including transgender, LGBTQ and gender non-conforming, are also affected by CPP. It is poorly studied in this patient population at this time, and healthcare is often not easily accessible.

How is Chronic Pelvic Pain Treated? At Progress PT – Midlothian, we take a careful, thorough history and perform a full head-to-toe examination including a postural and gait assessment. Based on this evaluation, we can begin to determine the cause of your pain. CPP often has multiple sources including the original “injury” such as an ovarian cyst or bladder pain, referred pain from organs, skin, or muscles, myofascial pain which presents as trigger points or tender areas in the muscles of your abdomen, back or pelvis, and the influence of your brain, emotions and behavior. To successfully address CPP, we work closely with other health care providers including urogynecologists, psychologists, gastroenterologists, primary care physicians, pain management specialists, acupuncturists, chiropractors, and dieticians.

Can what you eat affect your pain? The research says YES! Studies show that reducing or eliminating foods and beverages that provoke systemic inflammation such as processed meats and trans fats found in fried food, increasing anti-oxidant rich foods, eliminate toxins such as aspartame, and adding probiotics can help reduce chronic pain. One recent study showed that a strict gluten-free diet was associated with lowering the odds of peripheral nerve pain by almost 90%. Vitamins D and B12, and fermented cod liver oil have been shown in multiple studies to help reduce pain. Certain foods, such as bone broth, can help normalize inflammatory processes, or be alternatives to NSAIDS. For more information about specific foods, please ask your PT or PTA!

Pelvic Organ Prolapse

Pelvic Organ Prolapse (POP): The Facts

Pelvic organ prolapse occurs when there is a loss of support for one or more of your pelvic organs. These include your rectum, bladder, and uterus. So what exactly is happening? To simplify, there are three ways by which our bodies support these pelvic organs, including: 1) the passive structures like fascia and ligaments, 2) the active structures like pelvic floor muscles and how strong they are, and 3) the neuromotor system or how well you use your muscles. For example, if you pushed to vaginally deliver a child, have weakness and/or atrophy in your pelvic floor muscles, or do not automatically contract your pelvic floor and deep abdominals prior to lifting, coughing, etc you are more likely to have POP. Additional risk factors include connective tissue disorders, chronic coughing, heavy or repetitive lifting, trauma during vaginal delivery, and multiple pregnancies/births. POP can be graded by your Gynecologist or Urogynecologist on a 1-4 scale (1 being minimal prolapse), and vaginal wall laxity can be assessed by your pelvic floor Physical Therapist.


What Are The Symptoms of Pelvic Organ Prolapse?

Many women report a feeling of vaginal bulging or fullness or a feeling of falling out vaginally or rectally. Often, these symptoms are aggravated by prolonged upright activity such as walking, carrying children, or exercise. Some women experience pain with intercourse and difficulty emptying their bowel or bladder. Upon inspection, one might see a bulge or protrusion at or extending from their vaginal opening.

What is the Treatment for Pelvic Organ Prolapse?

At Progress PT – Midlothian, your Physical Therapist will do a complete head to toe functional assessment that includes an in depth look at your abdominal wall and pelvic floor muscles. By doing this, we can assess your passive, active and neuromotor systems that provide support to your pelvic organs. We are looking for strong pelvic floor muscles that work with your deep abdominal muscles to support your pelvic contents throughout daily tasks such as getting out of a chair or lifting/carrying children or groceries. If we do not see these qualities, we can provide you with an initial PT program to address any dysfunction identified. If one of these three systems is not functioning fully, you can worsen your prolapse or your symptoms by performing the wrong exercises/activities or by not managing your abdominal pressure correctly. Occasionally, your PT or doctor may suggest a pessary to support your pelvic contents while you are working through your PT program. Depending upon the severity of your prolapse, a small percentage of people may need surgery after physical therapy to address remaining deficits.


Concerned about a possible prolapse? Call us today at 804-918-8515 to make an appointment for an evaluation!

In the news…. Sexual Health and PT

A 2019 article published in Sexual Medicine Reviews Amy Stein, PT, MPT, DPT, BCB-PMD, IF, Sara K. Sauder, PT DPT, and Jessica Reale, PT, DPT, WCS discuss the role of pelvic floor PT in sexual health for men and women. Amy, Sara, and Jessica reviewed the most updated, peer-reviewed literature and determined that pelvic PTs successfully treat sexual dysfunction through multi-modal, individualized treatment. Pelvic Health Physical Therapists such as Dr. Miller and Dr. Rexrode perform an evaluation for sexual dysfunction by taking a thorough history and performing a complete musculoskeletal screen. This means your PT is looking at you from head to toe to assess for various musculoskeletal impairments such as pelvic stability/mobility, spinal mobility/stability, hip mobility/stability and of course pelvic floor muscle function. Your plan of care is then determined by synthesizing the data from the history and screen, with consideration for your specific goals. The PT or Physical Therapy Assistant (PTA) will select treatments consisting of manual therapies, patient education, muscle re-training, and exercise to address the problems found and help you meet your goals.


Physical Therapy and Radical Prostatectomy

An estimated one-sixth of men will suffer from prostate cancer in their lifetime. Radical prostatectomy is the most common therapy for prostate cancer, but often leads to urinary incontinence (UI). In fact, it is reported that up to 80% of men have UI one month post-operatively, and 30-45% continue to have UI at one year. Pelvic floor muscle training is a common conservative treatment to address UI in men and women. Multiple studies have reported on the effectiveness of this approach; most recently, a 2019 meta-analysis published in the Asian Journal of Andrology. Wu, et al. found that the best available and most current research demonstrates pelvic floor muscle exercise guided by a physical therapist post-operatively decreases urinary incontinence and increases quality of life for patients at early and long-term stages. A study by Goode, et al published in JAMA in 2011 shows  the efficacy of patient education + individualized physical therapy exercise  to reduce the number of incontinence episodes in men with persistent urinary incontinence 1-7 years post-radical prostatectomy.

At Progress PT – Midlothian, our clinicians have specialized training in both oncological rehabilitation and care of the male patient. We apply tools such as pelvic floor muscle re-education, strengthening, and coordination utilizing biofeedback, rehabilitative ultrasound imaging and manual therapies to assist patients in regaining control. Because recovery from prostate surgery/cancer also has an impact on patients’ psychosocial livelihood, comprehensive education as well as use of restorative yoga and diaphragmatic breathing improve our outcomes. Topics may include proper voiding behavior, stress management, common bladder irritants, body mechanics for lifting, as well as nutrition to improve bowel elimination. Our goal is to treat each patient as an individual so their treatment will be unique, as we help them return to activities such as marathon running, golf, gardening and more without worry.