Saturday, April 19, 2014

Interstitial Cystitis

Last month, I posted a Q&A about urogynecology and the topic of Interstitial Cystitis came up. So, many of you may be wondering, "what's that?" or "how can pelvic PT help?"

Interstitial Cystitis (IC) is pain in the bladder in combination with pain in the lower urinary tract system as well, with an absence of infection. Pain can also occur in the urethra, vulva, vagina, testicles, rectum and throughout the pelvis. Upon viewing of the inside of the bladder of those with IC, tiny wounds or ulcers are often found in the bladder wall that are contributing to the pain. In addition to pain, urinary frequency and urgency are found in the majority of patients with IC as they often rush to the restroom to avoid and/or reduce their pain.

Most of the patients that I see who have IC have seen many doctors and it has taken months or years before they received a diagnosis. They have been diagnosed with recurrent bladder infections and may have taken antibiotics for years without success. Unfortunately many health care practitioners are still unaware about IC. From my understanding, medical schools do not provide a lot of education about the specific pelvic pain diagnoses that I encounter on a daily basis, including IC. These are areas of interest that doctors must choose to seek out continuing education. Many doctors are unaware of the treatment options available, but fortunately there is a growing group of specialists and practitioners throughout the U.S. that are working to help those suffering with IC. And things are continuing to move in the right direction! At the 2013 meeting of the American Urological Association, two new courses were offered that trained urologists in the diagnosis of chronic pelvic pain and a very strong emphasis was placed on the examination of the pelvic floor muscles and the use of physical therapy as an important treatment tool.

This is exciting and postive news because I have seen firsthand how much physical therapy can help with the symptoms of IC! Physical therapy will not cure IC, but can help manage the symptoms of pain that these patients suffer from. Because of the pain and irritation in the pelvis that occurs with IC, many have pelvic floor dysfunction, where they develop tight, painful muscles and trigger points. Just like in other areas of the body, our muscles try to guard from the perceived injury associated with pain by tightening. However, when the tension is continuous, painful trigger points and muscle dysfunction occurs. This contributes to a pain cycle that can be broken with manual treatment, stretching and relaxation exercises for key muscle groups.

Physical therapy is key in the management of IC symptoms, but the number one, most important strategy for those with IC is changing your diet. It's also the one thing that people don't want to hear. Often, I have patients who would rather take expensive medications for the rest of their life than modify what they are putting into their bodies in regards to food and drink. But think back to those ulcers in your bladder. When you consume things that are highly acidic and
caffeinated, like sodas, coffee, citrus, and tomatoes it is like pouring acid into those wounds. You know what else is highly acidic? Cranberry juice! The one thing you have always heard is good for your bladder! The thinking behind that is that the cranberry juice makes your urine so acidic that it kills or prevents bacteria that causes a UTI from growing. So for people with IC that acidity is going to seriously irritate your bladder! Would you pour acid into a wound on your arm? Then why are you doing it to your bladder? Water consumption is also very important. When you don't get enough water during the day, your urine becomes more concentrated and acidic which, again, irritates the bladder. In addition to addressing your pelvic floor dysfunction, a pelvic PT who is familiar with IC can help educate you on what you should or shouldn't be eating. For more information about how your diet affects IC click the link below where the IC Network has some great information.

The IC Diet

If you are suffering with IC and need to find a healthcare provider who can help you get on the right path with managing your symptoms, there is some great information, again from the IC Network here. Working with the right doctor and physical therapist can help to keep your bladder happy, which in turn keeps you happy!
Happy bladder! I Heart Guts
As an aside, I LOVE the line of plush organs from I Heart Guts. The caption for the bladder is "Urine Good Hands," and I hope that you will find the right health care providers so that you will be!

Saturday, April 12, 2014

Blog About Pelvic Pain

I have been on a brief hiatus from writing due to being in charge of a fundraising walk. It's been a busy month for me, but I am going to be back posting soon. In the mean time, I have some new reading material for you! My co-worker and friend Sara Sauder, PT, DPT has recently launched her own blog specifically about pelvic pain. It's going to be a great resource for those dealing with pelvic pain. Go check it out!

Blog About Pelvic Pain

Monday, March 3, 2014

Q & A About Urogynecology

Diagnoses that contribute to pelvic pain, such as interstitial cystitis and vulvodynia are challenging to manage. A collaborative approach among healthcare providers is in the best interest of patients. It is important to find not only a skilled physical therapist, but other skilled providers as well. In keeping with the recent theme of Q & A, here's an interview with Audrey Baum, Certified Women’s Health Care Nurse Practitioner, working with Dr. Tomas Antonini at Central Texas Urogynecology and Continence Center. Audrey has been a great resource and great collaborator with our clinic and here is a little peek into her practice.

What's Up Down There (WUDT): What diagnoses does your practice treat the most?
Audrey Baum, WHNP

AB: We primarily treat urinary incontinence and pelvic organ prolapse. We also treat fecal incontinence, interstitial cystitis, recurrent UTIs, recurrent vaginal infections, most types of sexual dysfunction and vulvar vestibulitis/vulvodynia.

WUDT: What are the different treatment options available to patients for IC?

AB: Treatments center on diet modification, stress management, pain management and medication. All treatment plans are customized to fit individual patient needs. Diet modification includes instruction on IC-friendly diets, identifying personal dietary triggers and developing a diet that fits with the patient’s lifestyle.

Stress management is essential and we focus on finding exercise or meditative programs that work for the patient, as well as counseling when needed. We stress non-narcotic management of pain and focus on flare/trigger control and physical therapy with experienced therapists. Mild non-narcotic pain relievers are prescribed infrequently (we refer to pain management specialists if stronger pain relief is needed).

We also offer in-office bladder installations for times when immediate pain relief is required and can instruct the patient on how to do these at home, if needed. Cystoscopy with hydrodistention is a procedure done in the OR that can sometimes relieve pain symptoms for several weeks or months.

Medication includes Elmiron and other aids to control bothersome IC bladder symptoms, including overactive bladder medications. Patients with severe symptoms unrelieved by these measures can try InterStim, an implanted nerve modulator, or Botox.

WUDT: Does your practice treat vulvar vestibulitis, and if so what treatments are available?

AB: Yes. Treatment is individualized and includes many of the same areas as IC. We focus on non-narcotic pain relief, including commercial and compounded topical medications or suppositories and hot/cold therapy. We refer to physical therapy as appropriate.

WUDT: What do you like best about practicing in urogynecology?

AB: Changing people’s lives! We give patients back their ability to sit through a movie, walk without pain, exercise without wearing a pad, shop without memorizing bathroom locations and have sex without discomfort. It is very rewarding to hear how happy people are (we see lots of joyful tears).

WUDT: What is the most challenging part of practicing in urogynecology?

AB: Managing chronic pain. It is a frustrating problem for both us and our patients.

WUDT: What started your interested in urogynecology?

AB: I stepped in to help out a urogynecologist for six weeks while her physician's assistant was in China adopting a baby and I fell in love with the specialty. That was eight years ago and I haven’t looked back.
Thanks to Audrey Baum, WHNP and Sara Sauder, PT, DPT for their collaboration on this article!


Monday, February 17, 2014

Ask me anything!

I'd like to start this new year off asking for some input from my readers. What do you want to know? Do you have questions that you are too embarrassed to ask your doctor or other health care professionals? Do you need answers about your pelvic floor but don't have a pelvic floor therapist? I would love to answer your questions (to the extent possible without examining you!)! Go to the contact tab on this page and send me an email. All those posing questions will remain anonymous.

Friday, February 7, 2014

Why Am I a Pelvic Floor Physical Therapist?

This is a question I get asked regularly. It's usually said in some version of "I don't want to offend you, and I'm happy that you do, but why in the world would you want to do this type of therapy?" It's a valid question. I do rectal and vaginal exams or treatments on a daily basis. If I'm not doing some sort of internal treatment, then I am placing electrodes around your anus. Given that, I can't say that its the most glamorous job around. But I love my job. I get to help people who have been suffering for years and I am able to give them not only hope, but results. You get used to treating that "area" of the body pretty quickly, although I do think it takes a special person to be able to talk about urine, sex and bowel movements all day.

So, how did I get into myself into this?
I got interested in this type of physical therapy for a couple of reasons. First, because of my grandmother. My grandmother is 90 and has had issues with fecal and urinary incontinence for years. (She probably wouldn't be super happy about me telling this to the world wide web, but she doesn't know how to use a computer, so what she doesn't know won't hurt her.) She has at times felt chained to her toilet, with no confidence that she can go out and do the activities that she wants without having an embarrassing accident. She actually missed my graduation from PT school because she didn't feel she could be that far from a bathroom for so long. I wanted to be able to help people suffering like this. To have to miss out on huge life events of those you love is unacceptable when there is treatment available! By becoming a pelvic PT, I am one more person who is available to help those suffering with urinary and bowel issues. Despite the growing demand, there are not that many of us out there.

The second reason is more personal. I have endometriosis and had suffered with the debilitating pain associated with this condition for several years. When I was diagnosed, I was told that my options were surgery or hormonal treatment, neither of which was a good solution for me. So in the process of trying to figure out what I could do for myself, I found pelvic physical therapy. This has truly made a difference in my life and I wanted to be able to help others who were going through the frustrating situation that I had been through. So many people suffer with pelvic pain for years before they are directed to a physical therapist who can help treat many of the issues contributing to their pain.

When I first started treating pelvic floor dysfunction, I wondered if it would be as rewarding as my previous job treating neurological conditions, such as stroke and spinal cord injury. The answer is that I think it is more rewarding. I am able to help people overcome private issues that negatively impact their lives on a daily basis and I am treating an underserved population. Just looking at the Austin area, a search on the American Physical Therapy Association website for those specializing in pelvic floor dysfunction brings up 10 therapists. The number of general physical therapists was 75. Granted this is not entirely representative of the PT population, as Austin tends to be a hub for pelvic PT. Sullivan Physical Therapy, where I work, has 7 pelvic therapists and we are one of the largest pelvic specialty clinics in the United States. So if 10 to 75 is the ratio in Austin you can imagine how low those numbers are in other areas. Unfortunately, this causes many people throughout the US to be unaware that there is help out there for their issues. This is why I do this blog. I want to reach as many people as possible and educate everyone I can so that people know all their options and don't have to suffer needlessly.

Thursday, January 23, 2014

Sullivan Physical Therapy - A Voice for Education

So excited to be getting the word out about pelvic floor physical therapy! Sullivan Physical Therapy was featured in the December edition of Texas MD. Click on the link below and go to page 26 for the full article!

Monday, January 20, 2014

2014 Update

After a brief hiatus over the holidays, "What's Up Down There?" is back! In 2014 I will be working hard to get as much info as possible out about pelvic floor physical therapy. I will be adding information more often, so check in weekly to find out what's new! For today, I'll leave you with a little humor for this Monday morning.
Courtesy Camilla & Rose Greeting Cards