{"id":1485,"date":"2016-02-05T17:32:32","date_gmt":"2016-02-05T17:32:32","guid":{"rendered":"https:\/\/breakthroughpt.confluentclinics.com\/blog\/let-who-put-what-where-finding-a-cure-for-pelvic-pain\/"},"modified":"2023-03-16T18:04:00","modified_gmt":"2023-03-16T18:04:00","slug":"let-who-put-what-where-finding-a-cure-for-pelvic-pain","status":"publish","type":"post","link":"https:\/\/breakthrough-pt.com\/es\/blog\/let-who-put-what-where-finding-a-cure-for-pelvic-pain\/","title":{"rendered":"Disfunci\u00f3n del suelo p\u00e9lvico frente a ITU: c\u00f3mo tratar el dolor p\u00e9lvico cr\u00f3nico"},"content":{"rendered":"
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Finding The Cause Of Pelvic Pain<\/h2>\n

My condition first presented as a harm- less, if painful, urinary tract infection. I was on a work getaway in the New England woods, far from my regular doctor, when the symptoms began. \u201cI just need some antibiotics,\u201d I told the regional clinic\u2019s nurse-practitioner. I\u2019d had many UTIs in the past, I assured her. I knew what they felt like, and they felt exactly like this. Nonetheless, she insisted on testing my urine. She returned to the exam room, perplexed. She\u2019d found no bacteria, she said, but wanted to send my sample to another lab. \u201cIf that test also comes back negative, you might have interstitial cystitis.\u201d She gave me some handouts about \u201cIC,\u201d and refused to write me a prescription for antibiotics until she received my lab results in two days.\u00a0Two days<\/em>? Had this woman ever had a UTI? The burning pain, as anyone who has had one knows, impedes your every waking millisecond. Your consciousness relocates to your crotch. A friend of mine\u2014a doctor, in fact\u2014suffered UTI-like burning for months before he had surgery to correct a problem with his urethra. Afterward he told me, \u201cI\u2019d rather cut off one arm than experience that pain again.\u201d<\/p>\n

Later that night, I looked through the IC information the nurse-practitioner had given me. IC is a chronic inflammation of the bladder wall. No one knows why you get it, and there is no cure or treatment. There is no reliable way\u2014or sometimes no way at all\u2014to relieve the pain. Do not read those handouts! I admonished myself. You have a UTI!<\/p>\n

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Find Out If Physical Therapy Is Right For You<\/h2>\t\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t
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Schedule an appointment with a licensed physical therapist to help recover from your chronic pain through hands-on manual therapy.<\/span><\/p>\t\t<\/div>\n\t\t\t\t\t

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Ruling Out UTI For Pelvic Pain<\/h2>\n

I did not have a UTI. The culture came back negative. According to the nurse and her pamphlets, all signs were pointing to the cystitis. In a panic, I called my doctor in New York; New York doctors have cures for everything. \u201cYou\u2019ll just have to ride it out,\u201d my GP said when I described my symptoms and the preliminary diagnosis. \u201cIf women ruled the world, we might have a cure for interstitial cystitis,\u201d he said, sighing. \u201cBut they don\u2019t.\u201d<\/p>\n

Happy times. I turned to the Internet for solace. I learned that diet can cause \u201cflares,\u201d i.e., more intensely painful episodes. I learned that sex can cause flares (not that sex interested me). I spent the next few days weeping in the woods about all the sex I should have had. Why had I ever claimed I was \u201ctoo tired\u201d?\u00a0What was wrong with me<\/em>? I had a perfectly good vagina back then, why hadn\u2019t I used it more?<\/p>\n

Not that the problem was my vagina. Or, well, not exactly. A week after my first symptoms appeared, I returned to New York City and began the testing hell of \u201cdiagnosis by exclusion.\u201d IC is a diagnosis you receive by not receiving any other. One by one, my urologist crossed off the alternatives\u2014not kidney stones, not a yeast infection. Soon we were left with just one grim option: bladder cancer. But my bladder-cancer test was more than a week away, and even a day in chronic-pain terms might as well be a decade. I asked my urologist if, in the meantime, I might start some of the treatments she\u2019d suggested I could try to \u201clower my pain baseline\u201d if I proved to have the condition. One was acupuncture. (You know you\u2019re in uncharted medical territory when your Western doctor cites acupuncture as your best pain-relief option.) The other was pelvic- floor physical therapy. She didn\u2019t tell me what it entailed; I didn\u2019t ask. I was too desperate to be curious.<\/p>\n

Starting Pelvic Floor Physical Therapy<\/h2>\n

Which meant that I walked in to my first appointment without the slightest clue what I\u2019d encounter. Would I have to take off my clothes? Yes, I would. Would I have to allow a woman to put her rubber-gloved hand inside my vagina and reach so far into it that I was pretty sure she\u2019d entered a hidden compartment that no longer qualified as \u201cmy vagina\u201d? Yes to both. Yes to anything, if it would get me out of pain. Prior to this, I thought of myself as\u2014had even bragged about being\u2014a person with a high pain threshold. I\u2019d stoically endured regular migraines for more than 30 years; I\u2019d had two natural childbirths. But this burning around my urethra (and clitoris) stripped me of my identity. I became nothing but a nerve-ending receptor. During my darkest hours, I\u2019d been reduced to scary math. How many years must I live this way? How old must my children be before my suicide won\u2019t psychologically destroy them?<\/p>\n

While I lay on the exam table, my therapist, Sarah Emannuel, explained that the pelvic floor is like a braided hammock of muscles suspended beneath your pelvic bone. Because quarters are so close down there\u2014your urethra, your vagina, and your bowel are all near neighbors\u2014the pelvic-floor muscles, when they misbehave, can disrupt the normal functioning of all three.<\/p>\n

She conducted a thorough interview involving everything from my reproductive history to my diet to my sleep patterns. She asked me to describe the pain and where it was located. I still felt the burning, but I\u2019d also developed a terrible, raw ache on the inside right wall of my vagina, almost like a contusion caused by the rough sex I definitely wasn\u2019t having. \u201cThat doesn\u2019t sound like IC,\u201d she said of this last symptom. Emannuel put her hand inside me, touching my hip bone from the inside. She then hooked her fingers under my pelvic bone to access the soft tissue be- neath. \u201cThat\u2019s it!\u201d I said. Using her fingers, she pushed firmly into the spot. I felt as if I\u2019d been temporarily sprung; the sensation was akin to the relief you feel after your tight shoulder muscles are given an almost painfully intense massage. I left her office in a daze. She hadn\u2019t confirmed anything, diagnostically speaking, but she had assured me that IC really was very rare.<\/p>\n

What Is Pelvic Floor Dysfunction?<\/h2>\n

And after two sessions, Emannuel was fairly certain I did not have it. (Of all the patients who\u2019ve come to her with a diagnosis of IC, only one, she believes, really had it; another therapist I spoke with agreed that IC is overdiagnosed by doctors.) What I definitely did have was pelvic-floor dysfunction (PFD) and, more specifically, a \u201ctrigger point\u201d\u2014a tight and spasming muscle\u2014in my pelvic floor, for which there are a number of possible causes. PFD is a broad category that covers a wide range of conditions such as incontinence, irritable bowel syndrome, and discomfort during sex. My trigger point might have been caused by doing Kegel exercises either obsessively or incorrectly (nope), or a past trauma to the area (not that I could recall), or pregnancy\/childbirth (in my case, too long ago to be the culprit), or obesity (no). Trigger points also can be due to stress (bingo). People hold tension in their pelvis, just like they do in their shoulders or back.<\/p>\n<\/div>\n<\/div>\n<\/div>\n

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My visits to Emannuel involved a few different treatments. First, she used her hand to massage the muscle from the inside. Then from the outside she massaged my entire right side below my waist. She gave me homework: I had to lie on a hard surface with a tennis ball under my right buttock and do deep-breathing exercises to help me relax, and I needed to pay attention to whether I was holding tension in my pelvic floor and, if so, release it.<\/p>\n

Why Pelvic Floor Physical Therapy Is Important<\/h2>\n

As marginal or strange as pelvic-floor physical therapy might sound, it became clear to me quickly that it shouldn\u2019t be viewed as a wacky last-ditch effort to solve a rare problem. The problem, for starters, is common. The National Institutes for Health notes that one in four American women suffers from a pelvic- floor issue at some point in her life. It\u2019s also important to understand that the therapy isn\u2019t just for post-pregnancy incontinence problems. (This was the natural assumption made by friends whom I told about my condition; it was a pleasure to correct them by saying, \u201cActually, the problem is that my vagina is too tight,\u201d even if that wasn\u2019t technically true.) According to Amy Stein, author of\u00a0Heal Pelvic Pain<\/em>\u00a0and founder of Beyond Basics Physical Therapy in Manhattan (its tagline, \u201cWe Go Above and Beyond!,\u201d might be more apt if it were, \u201cWe Go Below and Beyond!\u201d), more than 90 percent of her patients have the opposite of muscle weakness. Instead, they have muscle tension that impairs bladder and bowel functions and causes sex-related pain or discomfort. \u201cIf you have pelvic pain, if your doctor keeps giving you antibiotics and telling you that you have a yeast or a urinary tract infection\u2014if you keep going back, and you keep getting the same answer\u2014it\u2019s worth consulting a pelvic-floor physical therapist,\u201d she says, then ticks off a list of symptoms that might warrant seeing one, including a diagnosis of irritable bowel syndrome, having to pee all the time (or just feel- ing like you have to; I was shocked to learn that a person with a healthy bladder should pee only once every two to three hours), or experiencing pain in or around the outside of your vagina just before, during, or after sex.<\/p>\n

The therapy has been around only since the late \u201990s. Stein first encountered the trailblazers of the profession as a physical-therapy graduate student, when the mother of her then boyfriend developed a bladder infection following a hysterectomy. Months later, the woman\u2019s bladder and lower-back pain persisted. Stein asked one of her professors what he thought the cause might be.<\/p>\n

\u201cMy school did problem-based learning,\u201d she said. \u201cMy professor asked me, \u2018What do you think it is?\u2019 \u201d<\/p>\n

Stein laid out her books and concluded, based on the pain\u2019s location, that it was related to the muscles in the pelvic floor. She spoke with a urologist, who recommended she consult a therapy group that specialized in pelvic-floor is- sues. In 2001, she began studying with Holly Herman, who, along with Kathe Wallace\u2014both women are pioneers of the therapy\u2014founded the Herman & Wallace Pelvic Rehabilitation Institute in Seattle. (Stein cites Rhonda Kotarinos as another early advocate\u2014Kotarinos worked in a hospital and witnessed how women were sent home after childbirth with unaddressed pelvic-floor issues, such as sloppy stitching after episiotomies that would lead to excessive scar- ring and a future life of painful sex.) When Stein graduated, she worked for a sports-orthopedic practice. She started introducing pelvic-floor work and within two years had enough clients to open a dedicated practice.<\/p>\n

Finding Relief For Pelvic Pain<\/h2>\n

For many women with pelvic pain, finding treatment is complicated by the fact that the problem is with such a culturally sensitive part of the body. How many people will you buttonhole about your troublesome vagina in hopes that you\u2019ll encounter someone who\u2019s had a similar experience? Probably not too many. Also, doctors are not as informed or sensitive as they might be. Let\u2019s take my own ob-gyn as an example. Al- though she\u2019s part of a respected Manhattan practice on Central Park West (i.e., a fancy address), she\u2019d never heard of pelvic-floor physical therapy. Assuming I was referring to a treatment for urinary incontinence, she said she sends her patients with \u201cpelvic-floor\u201d problems to urologists. When I asked about is- sues involving the vagina\u2014painful sex, for example\u2014she said, \u201cOh, you mean vulvodynia? That\u2019s a hard one.\u201d (Vulvodynia is excruciating pain in the vulva.) There\u2019s no cure, she said; instead doctors try to treat the condition with surgery, nerve cauterization, and drugs. When I told her that she really should look into pelvic-floor physical therapy for her patients, and that many of them might be helped through less-invasive means, she said, running out the door, \u201cInteresting, leave the info with my receptionist!\u201d<\/p>\n\n

As Andrew Goldstein, MD, director of Centers for Vulvovaginal Disorders, writes in his foreword to Stein\u2019s book, even as recently as the 1990s medical schools didn\u2019t consider physical therapy of any kind to be a first line of defense (surgery and medication were the immediate treatments; therapy aided recovery), and ob-gyns in general weren\u2019t interested in pelvic-floor issues. Goldstein says that of the 20,000 hours of studying he did as an intern and a resident of obstetrics and gynecology, only one hour was devoted to vulval pain and sexual dysfunction. He also notes that women who suffered pain during sex were thought to be responding psychologically to a past sexual trauma. The problem was not in their vaginas; the problem was in their heads.<\/p>\n

Emannuel told me of a girl suffering from vulvodynia who, despite being unable to have sex or even undergo a routine gynecological exam, was told by doctors for 10 years that the pain was psychological. When I met Emannuel, she had been working with this patient for months, and the girl was almost ready to have sex with her boyfriend.<\/p>\n

Lest you think that vulvodynia is rare, a study published last year in the\u00a0American Journal of Obstetrics & Gynecology<\/em>\u00a0found that more than 8 percent of women suffer from it and concluded that the condition \u201cis common, although rarely diagnosed.\u201d (By way of comparison, the same percentage of people suffer from asthma\u2014but that number includes women and men.) And of course, vulvodynia is only one type of pelvic-floor pain. A 2010 study published in\u00a0BMC Family Practice<\/em>\u00a0concluded that \u201cGPs expressed elements of therapeutic nihilism about [pelvic-floor pain],\u201d and \u201cdespite practice nurses taking on increasing responsibilities for the management of patients with long term conditions, respondents did not feel that chronic pelvic pain was an area that they were comfortable in managing.\u201d It also noted that in 35 percent of women, the pre- liminary medical diagnoses they receive (endometriosis, for example) aren\u2019t confirmed by follow-up tests, leading these women back to square one, and into a time- and money-intensive \u201ccycle of re-investigation and re-referral.\u201d Doctors, the study pointed out, call women who present with chronic pelvic-pain symptoms \u201cheartsink patients,\u201d because this condition is so difficult to treat.<\/p>\n

I was fortunate enough to find a urologist who knew about pelvic-floor physical therapy, but even so, her primary focus was on testing. It was only because I pushed that I went to therapy as early as I did.<\/p>\n

Catching PFD Early<\/h2>\n

The good news for people who catch their PFD, however it manifests, early is that a physical therapist can, in many cases and often with just a few visits, make the pain disappear. If a patient has been suffering for years\u2014either because she was ashamed to seek help, or because she figured her urinary condition was a natural function of having kids and getting older\u2014the treatment can take up to a year, and the pain can remain more persistent, even chronic. \u201cYou\u2019ll have better long-term results be- fore the pain becomes processed by your brain as \u2018natural,\u2019 \u201d Stein said.<\/p>\n

After four sessions with Emannuel, I wasn\u2019t quite cured, but I couldn\u2019t continue seeing her. I was relocating for the summer to a rural state devoid of pelvic-floor therapists. Emannuel recommended I buy \u201cthe crystal wand\u201d\u2014an S-curved Lucite sex toy designed to help a woman find her G-spot that\u2019s been re- purposed by pelvic-floor physical therapists. During our final session, she taught me how to hook the toy under my pelvic bone to find my trigger point, which I could knead with the tool\u2019s rounded tip. Throughout the summer, that tool saved me. I became skilled at noticing the first signs of a trigger-point attack\u2014a slight urethral pain, which, I realized, I\u2019d experienced frequently in the past and had always before attributed to dehydration (meaning this trigger point had existed, in milder form, for years)\u2014so that I could work at the muscles before the symptoms got worse. And work them I did. I was in the woods again; there was no one there to help me but me.<\/p>\n

Now more than a year after my first symptom appeared, I barely suffer at all. As I\u2019m writing these words, I can feel a vague tightness, but this is because I\u2019ve been sitting on a hard wooden chair in the library for the past five hours. As Stein says of PFD, \u201cIt\u2019s similar to chronic back pain. You need to learn your limitations.\u201d My limitations are sitting\u2014airplane trips, car rides, long days at the library. Relaxation is key during these times. So is my wand.<\/p>\n

Trusting Physical Therapy<\/h2>\n

During those three weeks when I believed I had IC, I read countless online accounts by women who\u2019d been in debilitating pain for years, women who kept strict diets and abstained from sex but who often were bedridden nonetheless, unable to work and forced to dedicate their lives to managing their suffering. After I discovered that I didn\u2019t have IC, I despaired for these women. They number in the hundreds online, and who knows how many more thousands off-line. I couldn\u2019t possibly reply to each of them, and so I thought instead that I\u2019d write about it. I hope that many more women can limit their scary pain to just a few weeks, as I did, instead of suffering needlessly for the rest of their lives.<\/p>\n

This article was originally posted on ELLE Magazine\u2019s website in August 2015. \u00a0Click here to view it.<\/a><\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/article>\n<\/section>","protected":false},"excerpt":{"rendered":"

Encontrar la causa del dolor p\u00e9lvico Mi condici\u00f3n se present\u00f3 primero como una infecci\u00f3n del tracto urinario inofensiva, aunque dolorosa. Estaba en una escapada de trabajo [\u2026]<\/p>","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[41],"tags":[],"class_list":["post-1485","post","type-post","status-publish","format-standard","hentry","category-health-news-you-can-use"],"acf":[],"yoast_head":"\nPelvic Floor Dysfunction vs. UTI - How to Treat Chronic Pelvic Pain<\/title>\n<meta name=\"description\" content=\"It's important to distinguish the difference between Pelvic Floor Dysfunction vs. a UTI. 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