Category Archives: Pelvic Pain

Managing a Holiday Flare-Up


First, and foremost, a very HAPPY THANKSGIVING! from all of us at Proaxis Pelvic PT! We are so thankful to you–our patients, readers, and friends for all you do to support the work we do, and for allowing us to be a part of your health journey. We are very grateful to be a part of your life.

Now, every year around the holidays, an interesting scenario happens. Many patients come in worried, stressed, and often disappointed as their symptoms tend to go a little “backwards” through the holiday buzz. Often times, they don’t necessarily connect the two together, but instead, come in to their appointment frustrated that things are not going well. And it could be anything– people struggling with bladder control may be leaking more, people with constipation may be having more difficulty, and people experiencing pain may see their pain spike. But, why does this happen? Sometimes, we can’t identify a cause—it just does But during the holidays, there are often a few key things that I find will contribute to a change in symptoms:

  • Stress: Holidays are wonderful, awesome times to be with those we love and celebrate together. However, it is very common for this wonderful season to be accompanied by stress– planning, cooking, eating–spending lots of time with family, etc. Stress is often accompanied by increased muscle activity, increased sympathetic nervous system output, and thus can lead to a spike in pain or changes in bowel and bladder.
  • Diet: I shouldn’t need to explain this (we LOVE eating over the holidays), but many people will change their diets significantly throughout the months of November and December. We eat more rich foods, change our eating routines, and very likely consume slightly different fluids than we typically do. As you may remember from previous posts, the bowels love routine and changing this will likely impact the system.  In addition, both our bowel sand bladder are influenced by the fluids we take in and may become irritated if we are consuming fluids that are acidic, carbonated, caffeinated, artificially sweetened or containing alcohol (Jenna wrote a great post about that last year)
  • Inconsistency in Routine: Even the most compliant and consistent person may have difficulty staying in a healthy routine over the holidays. Often times, people will find it difficult to get in their recommended exercises, and may find themselves slipping from the habits recommended to them by their healthcare team. This can often lead to a worsening of symptoms (bladder, bowel and pain).

So, what to do when this happens?

  • First, do your best to stay calm and stay positive. I know it can be very frustrating when you are hurting/leaking/etc, but realize that this is likely just a small “hiccup” in your progress. Try not to let stress take over (see above), and instead, try to take a proactive approach to calming down the “flare,” whether it be bowel, bladder or pain problems. Check out this great post from Pelvic Health & Rehabilitation Institute for more great info on “How to not freak out during a flare”.
  • Next, evaluate the previous few days and take note of any of the items mentioned above. Did you have a few glasses of wine with dinner last night? Did you skip the fiber for the potatoes and turkey at Thanksgiving? Did that one relative show up at dinner and make you crazy? Have you forgotten to drink your normal water amount with all that Black Friday shopping?
  • Finally, make a plan to get back on track. Fill up that water bottle and start getting fluid. Skip the leftovers for a big salad for lunch. Spend some time doing a guided meditation or breathing routine to calm your body. Take a few minutes to do your exercises. Use an icepack to calm down painful areas.

Most importantly, remember to keep positive. It is easy to go down a negative road when symptoms seem to worsen suddenly, but remember that your journey to better health is in fact a journey. There will be ups and downs, but you are not alone. E-mail your PT if you need to for a little encouragement. Take a deep breath, and enjoy this holiday season.

Have a very Happy Thanksgiving!

Jessica Powley Reale, PT, DPT, WCS


Have Chronic Prostatitis/Chronic Pelvic Pain Syndrome?

Nutrition is not an area that physical therapists specialize in, however it is a crucial component to holistic care for a patient suffering from chronic pelvic pain. At Proaxis Therapy, we address nutrition by having our patients complete Pain, Bladder, and/or Bowel Diaries to better assess the impact of diet on their symptoms. We then further provide patients with education and resources to improve their diet and lifestyle habits that may be contributing to dysfunction.


Check out this recent research article that investigates the effects of certain types of food on patients’ symptoms.

Effects of foods and beverages on the symptoms of chronic prostatitis/chronic pelvic pain syndrome.

Pelvic Floor Involvement in a Female Athlete


In 2013, The International Journal of Sports Physical Therapy published a fascinating case report. “A 45-year-old female distance runner was referred to physical therapy for proximal hamstring pain that had been present for several months”. The differential diagnosis of hamstring syndrome was placed on this patient and she was treated appropriately. However, there was much more involved in her pain than just the hamstrings. “Further examination led to a secondary diagnosis of pelvic floor hypertonic disorder. Interventions to address the pelvic floor led to resolution of symptoms and return to running.”

This is a great case of the varied complaints a patient with an overactive pelvic floor may report, but when treated appropriately, patients can regain their optimal level of function.

Do you have any difficult patients where you believe the pelvic floor may be involved? Or are you a patient who is suffering from pelvic girdle pain and you think your pelvic floor might be involved? Find a local Pelvic Floor PT to help you on your journey!

Burning Itching and Pain, Oh My!

Most of us women at one time or another in our lives will see our doctor for treatment for a yeast infection. However, if you are someone who has “swore” you had a yeast infection, only to go to the doctor and have them tell you everything “looks fine”, or maybe you just self- treat frequently with over the counter meds for frequent burning and itchiness, then this post is for you! And, if you’ve ever had any “weird sensations” in your pelvis or vulvar area (see below) then this post is for you too!

While you may have heard of your pelvic floor, a group of muscles in your pelvis that are responsible for maintaining bladder and bowel control (among other things), most people don’t think much about the nerves that supply the area of your pelvis. Just like you can move the wrong way and irritate a nerve in your back, get carpal tunnel syndrome, or get compression of your sciatic nerve that can cause leg pain, the nerves in your pelvis can also become irritated!

One nerve in particular, the pudendal nerve, is responsible for supplying sensation to the clitoris, labia, and areas around the vagina and anus. In addition, the pudendal nerve also is responsible for innervating some of the pelvic floor muscles, including the urethral sphincter and external anal sphincter (which helps with bowel control). When the pudendal nerve or a portion of it, becomes irritated you may feel many different symptoms. You may feel like you have a yeast infection, are “on fire down there”, feel itchy, feel like your urethra is irritated, have clitoral pain ,experience shooting pains into your vagina, or feel like you have hemorrhoid, or feel like you are sitting on a “rock” to name a few.


So, how does the nerve get irritated? Irritation to the nerve typically happens either if the nerve is compressed, stretched, or restricted so that it does not glide normally. Nerve irritation can sometimes happen if you cycle a lot (which puts pressure on the nerve), with prolonged sitting, after working out, or after having sex. Childbirth can also stretch the nerve, causing it to be irritated. In addition, if you had an episiotomy or tore during childbirth requiring stiches, scar tissue can form, restricting the nerve and causing symptoms.

So, if you notice these symptoms, what can you do about it? Obviously if your burning or irritation is accompanied by unusual discharge, a fever or other symptoms you would want to seek out your health care provider for treatment as this could signal a potential infection. But, if no red flag symptoms exist and you feel the irritation may be more of the nerve variety, seek out a physical therapist certified in the treatment of the pelvic floor. Pelvic floor treatment includes helping to relax tight muscles that might be compressing the nerve, as well as massaging or mobilizing the tissue around the nerve to help it move more freely. Sometimes, patients will feel better immediately, and other times, it takes a few visits before the symptoms subside.

And what about all of the men who might be reading this? You have a pudendal nerve as well. Pudendal nerve irritation for you can cause pain in the penis, scrotum and around the anus as well as some difficulty with erection. If you think you may be having symptoms pelvic floor therapy may help you as well!

Written by: Kim Osler PT, DPT, WCS


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