Pelvic floor Myth Busters
We can bet you've heard some of these common misconceptions about the pelvic floor.
Men don't have pelvic floor muscles.
Men do indeed have pelvic floor muscles, which can be trained for improved bladder control, especially after prostate surgery. Men can identify their pelvic floor muscles by stopping the flow of urination midstream or tightening the muscles that prevent the passing of gas.
There's no improving pelvic floor muscle strength once you had a baby, the damage is done.
In fact, postnatal Kegel exercises can be especially important in managing the urinary incontinence that is common among postnatal women. Pelvic floor exercises can help women of all ages and lifestyles, pre-and post-childbirth.
I have limited mobility, so I can't do Kegel exercises.
It's a common misconception that pelvic floor exercises must be done on the floor. They can actually be done in any position – standing, sitting, or lying down and the exercises are quite effective when a person is standing up.
Pelvic floor exercises won't help me – I'm too old.
Just as you're never too old for some level of cardiovascular and muscle toning exercise, age is not a barrier when it comes to Kegel exercises. Postmenopausal women can benefit from pelvic floor exercises just as younger women can, especially when it comes to reducing the incidence of urinary incontinence.
April 4, 2016
Best Approach to Managing Bladder Pain: Patient Centered and Collaborative Approach
Speer LM, Mushkbar S, Erbele T. Chronic Pelvic Pain in Women. Am Fam Physician. 2016 Mar 1;93(5):380-7.
In this article below, aimed at providing practical recommendations for family physicians to follow, the authors argue for a collaborative, patient centered approach to managing chronic pelvic pain in women with interstitial cystitis/bladder pain syndrome (IC/BPS) and other conditions. In particular, they recommend engaging the patient via a “biopsychosocial approach” that includes treatment of IC/BPS, depression, and any other diagnosed and related disease process. In terms of specific drugs, they say that there is limited evidence supporting the treatment of chronic pelvic pain with gabapentin (Neurontin), nonsteroidal anti-inflammatory drugs, tricyclic antidepressants, and serotonin-norepinephrine reuptake inhibitors (SSRIs). They recommend behavioral therapy and call it an “integral” part of treatment, as well as pelvic floor physical therapy, which may be helpful for many patients. They call hysterectomy a treatment of “last resort” and warn that only about a half of patients report significant improvement after the procedure.
Am Fam Physician. 2016 Mar 1;93(5):380-7.
Chronic Pelvic Pain in Women
- 1University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA.
Chronic pelvic pain in women is defined as persistent, noncyclic pain perceived to be in structures related to the pelvis and lasting more than six months. Often no specific etiology can be identified, and it can be conceptualized as a chronic regional pain syndrome or functional somatic pain syndrome. It is typically associated with other functional somatic pain syndromes (e.g., irritable bowel syndrome, nonspecific chronic fatigue syndrome) and mental health disorders (e.g., posttraumatic stress disorder, depression). Diagnosis is based on findings from the history and physical examination. Pelvic ultrasonography is indicated to rule out anatomic abnormalities. Referral for diagnostic evaluation of endometriosis by laparoscopy is usually indicated in severe cases. Curative treatment is elusive, and evidence-based therapies are limited. Patient engagement in a biopsychosocial approach is recommended, with treatment of any identifiable disease process such as endometriosis, interstitial cystitis/painful bladder syndrome, and comorbid depression. Potentially beneficial medications include depot medro-xyprogesterone, gabapentin, nonsteroidal anti-inflammatory drugs, and gonadotropin-releasing hormone agonists with add-back hormone therapy. Pelvic floor physical therapy may be helpful. Behavioral therapy is an integral part of treatment. In select cases, neuro-modulation of sacral nerves may be appropriate. Hysterectomy may be considered as a last resort if pain seems to be of uterine origin, although significant improvement occurs in only about one-half of cases. Chronic pelvic pain should be managed with a collaborative, patient-centered approach.
WEDNESDAY, MARCH 16, 2016
CDC: Physical Therapy, Other Non-Drug, Non-Opioid Approaches Should be First-Line Treatment for Chronic Pain
In its final version of guidelines for prescribing opioids for chronic pain, the US Centers for Disease Control and Prevention (CDC) minces no words about the importance of physical therapy and other nondrug/nonopioid approaches, and delivers a clear message that physical therapists (PTs) and physical therapist assistants (PTAs) have known for some time: there are better, safer ways to treat chronic pain than the use of opioids.
Nonpharmacologic therapy and nonopioid pharmacologic therapy are preferred for chronic pain," the CDC states in its first recommendation. "The contextual evidence review found that many nonpharmacologic therapies, including physical therapy, weight loss for knee osteoarthritis, psychological therapies such as [cognitive behavioral therapy, or CBT], and certain interventional procedures can ameliorate chronic pain."
The CDC guidelines were created in response to growing rates of opioid use disorder and opioid overdose, a problem fueled by ever-increasing rates of opioid prescriptions written by primary care providers—approximately 259 million prescriptions written in 2012 alone. In its introduction to the guideline, CDC cites from 1 study that among 15- 64-year-olds who received opioids for noncancer pain, 1 in 550 died from an opioid-related overdose at a median of 2.6 years from their first prescription.
A draft version of the guidelines were published in late 2015 as part of a CDC call for comments. APTA responded with strong support for the recommendations, writing that approaches such as physical therapy "have been underutilized, and, therefore, can serve as a primary strategy to reducing prescription pain medication abuse and improving the lives of individuals with chronic pain."
Other stakeholders were less enthusiastic. According to a report from National Public Radio, some critics questioned the CDC recommendation against using opioids as a first-line treatment for chronic pain.
In that NPR report, Debra Houry, director of CDC's National Center for Injury Prevention and Control, responded by pointing to weak evidence supporting the benefits of opioids for chronic pain and growing evidence pointing to the risks. "We have decided that because of that, and the uncertain benefits of opioids, that continuing to prescribe them for chronic pain is not warranted," Houry said. "On the other end, nonopioids, there is evidence for their benefits."
In addition to the statement around first-line treatment, the CDC guideline includes recommendations that address the importance of establishing treatment goals, discussing risks of opioids with patients, choosing appropriate dosage and release factors, and conducting thorough follow-up assessments once a patient has been prescribed an opioid. The guidelines are not intended to apply to opioid use related to patients with cancer, palliative, or end-of-life care.
News of the CDC guidelines spread quickly, with major media outlets includingNewsweek, USA Today, The Wall Street Journal, and others reporting on the recommendations that arrive amidst increased national attention on the epidemic of opioid abuse and heroin use across the country. APTA is participating in a White House initiative to address the problem through, among other things, increased public awareness.
Those APTA public awareness efforts include a page on MoveForwardPT.com, the association's website for consumers looking for information on physical therapy, with information on the risks of opioids and physical therapy's role in the treatment of pain.
In addition to the guideline, CDC also released a checklist and fact sheet that outline the basics of the larger document. Both stress that nonopioid therapies should be "tried and optimized" before considering an opioid prescription as well as during reassessment of a patient who has received a prescription for opioids.
Posted by News Now Staff at 4:35 PM
Labels: Health Care Headlines
March 9, 2016
BREATHING TECHNIQUES TO ELIMINATE PELVIC PAIN
When is the last time you thought about breathing? Unless you recently finished a yoga class, chances are it’s been awhile! Luckily, breathing is something we do automatically. We don’t have to think to make it happen. However, are we breathing correctly?
We live in a busy, high paced world and we all face daily stressors. Maybe you woke up late only to find that your coffee maker is broken, you forgot to pick up your pants from the dry cleaner and your child informs you over breakfast that she forgot about her history project due tomorrow. Did you feel your chest tighten and your breath become shallow after reading that sentence? Probably! But, what can you do about it?
Diaphragmatic (belly) breathing is the answer and it is a key factor in eliminating pelvic pain! The diaphragm is the major muscle responsible for breathing. As babies we innately know how to breathe. Watch a baby or a child breathing and you will notice her belly expand with inhalation and flatten with exhalation.
This is not how most adults breathe! Stress causes most adults to breathe into their upper chest and not into their belly.
I recently had a patient with this exact issue! She had such intense pelvic pain that it was difficult for her to walk! I assessed her breathing and realized that she was not able to coordinate her breathing. This means her belly was flattening when she was breathing in and was expanding when she was breathing out. The diaphragm and the pelvic floor are intimately connected. If the diaphragm is not moving down as it should when we inhale, then the pelvic floor cannot relax with inhalation. The goal in pelvic physical therapy is to coordinate your breathing and your pelvic floor mobility. As you inhale, your pelvic floor relaxes. As you exhale, your pelvic floor lifts.
After working on breathing techniques and utilizing other pelvic physical therapy treatments, such as biofeedback, the patient noticed a significant decrease in her pelvic pain.
Stress definitely makes pain worse! Breathing helps!
Here are some ways to start decreasing your pain levels…
Find some time to focus on your breathing. It’s nice to do this lying down but you can also do it in the car while you are waiting for your kids, or sitting in a waiting room waiting for an appointment. This way you can incorporate breathing into your life!
Place one hand over your belly button, and focus on breathing into your belly. Breathe in through your nose. You can choose to breathe out through your nose or mouth. Notice if you are breathing into your upper chest. When you breathe in you should feel your belly expand and when you breathe out you should feel your belly flatten. Try to do this for 5 minutes twice a day and notice the benefits!