Tag 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


RESEARCH UPDATE: Exercise may reduce perception of pain

New post published by the New York Times this week highlights how exercise may reduce perception of pain. The post focuses on a new study published this month in Medicine & Science in Sports & Exercise. In this study, researchers found that people who exercised had less perception of pain when a stimulus was applied to their arm compared to people who did not exercise. See the full article in the New York Times Here!

Aerobic exercise is often something we recommend here at Proaxis Pelvic PT for men and women struggling with chronic pelvic pain, and many do find it to be helpful. What do you think? Have you found exercise helpful in reducing your pain? Let us know in the comments!

exercise Exercise is the Best Preventive Drug (Study)


The Importance of Holistic and Integrated Care for Survivors of Sexual Assault Experiencing Pelvic Pain

By Jessica Powley, PT, DPT, WCS

 It is well-established in clinical research that survivors of sexual abuse are more likely to experience future sexual dysfunction than those who have not experienced abuse. The reasons behind this are thought to be multifactorial and may be related to post-traumatic stress as well as physical symptoms as a result of this stress and anxiety. As a pelvic physical therapist, I often work with strong women (and men!) who have survived sexual trauma and abuse, either as children or adults. Most commonly, these people will have been referred to me for some version of pelvic pain—vulvodynia, interstitial cystitis, vaginismus, or general pelvic pain. One of our theories behind this pain is that the trauma experienced by the muscles of the pelvis leads to a “tensing” and “protective” response. Over time, this natural response creates shortened, irritated pelvic floor muscles which can cause severe pain.

While treating the pelvic floor muscles, I often recommend that my patients work with a psychological professional concurrently in order to address the psychological components of their pain. Now, does that mean I believe their pain is “in their heads?” Not in the least bit. With many of these people, their pain is very real and very physical—meaning, we know that their muscles are causing pain. However, our mind can be a very strong driving force which can either promote recovery or hinder it. The role of the brain in pain has been well-established. Lorimer Moseley and David Butler are two neuroscientists who have done extensive research in this area (two of my favorite researchers! Yes, I am a nerd.) If you are interested in reading more about this, please check out their website (http://www.noigroup.com/en/Home) and I personally recommend the books, Explain Pain and Painful Yarns.  Clinically, I often find that recovery with patients is much improved when both the physical and psychological aspects are addressed concurrently.

But what about a person who undergoes psychological counseling and treatment but does not receive the physical treatment? New research published in the Journal of Sexual Medicine suggests that symptoms will continue to persist. In this research, women who had survived sexual assault as adolescents as well as received psychological therapy for post-traumatic stress disorder were compared with age-matched controls in regards to sexual activity and symptoms of sexual dysfunction. Although sexual activity level was equal between groups, survivors of sexual abuse were 2.7 times more likely to experience pelvic floor dysfunction than their peers, as well as 2.4 times more likely to experience sexual dysfunction such as difficulty with lubrication and pain. These results led researchers to conclude that survivors of sexual abuse should truly be cared for by a multidisciplinary team to address both physical and psychological effects of abuse.

Our bodies work in synergy. If people are to achieve optimal function of any part of their bodies, problems must be addressed in a holistic manner. Throughout the world of healthcare, there has been a strong push for multidisciplinary care, and this should be the case as well for survivors of sexual abuse. Teams of physicians, nurses, physical therapists, psychologists, and nutritionists can work together to help a person move toward recovery. Just as the body cannot be treated without the mind, so the mind should not be treated without the body.

Reference: Postma RBicanic Ivan der Vaart HLaan E. Pelvic Floor Muscle Problems Mediate Sexual Problems in Young Adult Rape Victims. J Sex Med. 2013 May 16

Pelvic Physical Therapy in the News!!


We are always SO excited to see Pelvic Physical Therapy mentioned in the news, and this has been a great week for that to happen! 

Yesterday, Elle Magazine published an excellent interview with Amy Stein, author of Heal Pelvic Pain and excellent clinician treating pelvic floor dysfunction in New York.  Although this article highlights treating pelvic pain, Amy discusses several of the diagnoses we regularly treat! She also highlights the reasons many physicians do not refer patients as often as they should. Amy states,

“Well, OB/GYNs go to school to deliver babies, and they know about hormonal changes and menopause, but they really don’t know how to assess the pelvic floor muscles, or that that’s even an option. When they see these patients, they don’t know what to do with, so [they say] “It’s in your head” or “Go have a glass of wine.” I honestly think it’s just a lack of education—they should know the right questions to ask so that they can refer out.”

Thankfully, there are excellent physicians who do exactly that; however, we still have room to go! Thank you Amy & Elle Magazine for bringing this issue to the public! Read more: Pelvic Floor Issues – Amy Stein Interview on Treating Pelvic Dysfunction – ELLE 

2. To make this week even better, The Today Show spoke about Pelvic Physical Therapy in their “Gross Anatomy” Q&A session this morning! We were quite pleased to see physical therapy among the first treatment options discussed to help with urinary leakage! The physicians on the show also encouraged women to seek treatment sooner rather than later–there is no reason a person should leak urine for 10 years without getting help! Check out the video clip: http://www.today.com/id/49063771/ns/today-video/#52809239 

Let’s keep the news coming and work to continue spreading awareness! 

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