Why Get PT 1st? Here are the facts

In Female Pelvic Pain, Male Pelvic Pain by Stephanie Prendergast7 Comments

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By Stephanie Prendergast

 

Vaginal pain. Burning with urination. Post-ejaculatory pain. Constipation. Genital pain following bowel movements. Pelvic pain that prevents sitting, exercising, wearing pants and having pleasurable intercourse.

When a person develops these symptoms, physical therapy is not the first avenue of treatment they turn to for help. In fact, physical therapists are not even considered at all. This week, we’ll discuss why this old way of thinking needs to CHANGE. Additionally, we’ll explain how the “Get PT 1st” campaign is leading the way in this movement.

We’ve heard it before. You didn’t know we existed, right? Throughout the years, patients continue to inform me the reason they never sought a physical therapist for treatment first, was because they were unaware pelvic physical therapists existed, and are actually qualified to help them.

Many individuals do not realize that physical therapists hold advanced degrees in musculoskeletal and neurologic health, and are treating a wide range of disorders beyond the commonly thought of sports or surgical rehabilitation.

On December 1st, physical therapists came together on social media to raise awareness about our profession and how we serve the community. The campaign is titled “GetPT1st”. The team at PHRC supports this campaign and this week we will tell you that you can and should get PT first if you are suffering from a pelvic floor disorder.

 

Did you know that a majority of people with pelvic pain have “tight” pelvic floor muscles that are associated with their symptoms?

 

Physical therapy is first-line treatment that can help women eliminate vulvar pain

Chronic vulvar pain affects approximately 8% of the female population under 40 years old in the USA, with prevalence increasing to 18% across the lifespan. (Ruby H. N. Nguyen, Rachael M. Turner, Jared Sieling, David A. Williams, James S. Hodges, Bernard L. Harlow, Feasibility of Collecting Vulvar Pain Variability and its Correlates Using Prospective Collection with Smartphones 2014)

Physical therapy is first-line treatment that can help men and women with  Interstitial Cystitis

Over 1 million people are affected by IC in the United States alone [Hanno, 2002;Jones and Nyberg, 1997], in fact; an office survey indicated that 575 in every 100,000 women have IC [Rosenberg and Hazzard, 2005]. Another study on self-reported adult IC cases in an urban community estimated its prevalence to be approximately 4% [Ibrahim et al. 2007]. Children and adolescents can also have IC [Shear and Mayer, 2006]; patients with IC have had 10 times higher prevalence of bladder problems as children than the general population [Hanno, 2007].

Physical Therapy is first-line treatment that can help men suffering from Chronic Nonbacterial Prostatitis/Male Pelvic Pain

 

Chronic prostatitis (CP) or chronic pelvic pain syndrome (CPPS) affects 2%-14% of the male population, and chronic prostatitis is the most common urologic diagnosis in men aged <50 years.

The definition of CP/CPPS states urinary symptoms are present in the absence of a prostate infection. (Pontari et al. New developments in the diagnosis and treatment of CP/CPPS. Current Opinion, November 2013).

 

71% of women in a survey of 205 educated postpartum women were unaware of the impact of pregnancy on the pelvic floor muscles.

 

21% of nulliparous women in a 269 women study presented with Levator Ani avulsion following a vaginal delivery (Deft. relationship between postpartum levator ani muscle avulsion and signs and symptoms of pelvic floor dysfunction. BJOG 2014 Feb 121: 1164 -1172).

64.3% of women reported sexual dysfunction in the first year following childbirth. (Khajehi M. Prevalence and risk factors of sexual dysfunction in postpartum Australian women. J Sex Med 2015 June; 12(6):1415-26.

24% of postpartum women still experienced pain with intercourse at 18 months postpartum (McDonald et al. Dyspareunia and childbirth: a prospective cohort study. BJOG 2015)

85% of women stated that given verbal instruction alone did not help them to properly perform a Kegel. *Dunbar A. understanding vaginal childbirth: what do women understand about the consequences of vaginal childbirth.J  Wo Health PT 2011 May/August 35 (2) 51 – 56)

Did you know that pelvic floor physical therapy is mandatory for postpartum women in many other countries such as France, Australia, and England? This is because pelvic floor physical therapy can help prepartum women prepare for birth and postpartum moms restore their musculoskeletal health, eliminate incontinence, prevent pelvic organ prolapse, and return to pain-free sex.

 

Did you know that weak or ‘low tone’ pelvic floor muscles are associated with urinary and fecal incontinence, erectile dysfunction, and pelvic organ prolapse?

 

Physical Therapy can help with Stress Urinary Incontinence

Did you know that weak or ‘low tone’ pelvic floor muscles are associated with urinary and fecal incontinence, erectile dysfunction, and pelvic organ prolapse? 80% of women by the age of 50 experience Stress Urinary Incontinence. Pelvic floor muscle training was associated with a cure of stress urinary incontinence. (Dumoulin C et al. Neurourol Urodyn. Nov 2014)

30 – 85 % of men develop stress urinary incontinence following a radical prostatectomy. Early pelvic floor muscle training hastened the recovery of continence and reduced the severity at 1, 3 and 6 months postoperatively. (Ribeiro LH et al. J Urol. Sept 2014; 184 (3):1034 -9).

Physical Therapy can help with Erectile Dysfunction

 

Several studies have looked at the prevalence of ED. At age 40, approximately 40% of men are affected. The rate increases to nearly 70% in men aged 70 years. The prevalence of complete ED increases from 5% to 15% as age increases from 40 to 70 years.1

Physical Therapy can help with Pelvic Organ Prolapse

 

In the 16,616 women with a uterus, the rate of uterine prolapse was 14.2%; the rate of cystocele was 34.3%; and the rate of rectocele was 18.6%. For the 10,727 women who had undergone a hysterectomy, the prevalence of cystocele was 32.9% and of rectocele was 18.3%. (Susan L. Hendrix, DO,Pelvic organ prolapse in the Women’s Health Initiative: Gravity and gravidity. Am J Obstet Gynecol 2002;186:1160-6.)

Pelvic floor physical therapy can help optimize musculoskeletal health, reducing the symptoms of prolapse, help prepare the body for surgery if necessary, and speed post-operative recovery.

 

Did you know….

 

In many states a person can go directly to a physical therapist without a referral from a physician? (For more information about your state: https://www.apta.org/uploadedFiles/APTAorg/Advocacy/State/Issues/Direct_Access/DirectAccessbyState.pdf)

You need to know….

 

Pelvic floor physical therapy can help vulvar pain, chronic nonbacterial prostatitis/CPPS, Interstitial Cystitis, and Pudendal Neuralgia. (link blogs: http://pelvicpainrehab.com/patient-questions/401/what-is-a-good-pelvic-pain-pt-session-like/, http://pelvicpainrehab.com/male-pelvic-pain/460/male-pelvic-pain-its-time-to-treat-men-right/http://pelvicpainrehab.com/female-pelvic-pain/488/case-study-pt-for-a-vulvodynia-diagnosis/)

Pelvic floor physical therapy can help prepartum women prepare for birth and postpartum moms restore their musculoskeletal health, eliminate incontinence, prevent pelvic organ prolapse, and return to pain-free sex: http://pelvicpainrehab.com/pregnancy/540/pelvic-floor-rehab-its-time-to-treat-new-moms-right/

Early pelvic floor muscle training hastened the recovery of continence and reduced the severity at 1, 3 and 6 months in postoperative men following prostatectomy. (Ribeiro LH et al. J Urol. Sept 2014; 184 (3):1034 -9). (Link blog: http://pelvicpainrehab.com/male-pelvic-pain/2322/men-kegels/

A study from the University of the West in the U.K. found that pelvic exercises helped 40 percent of men with ED regain normal erectile function. They also helped an additional 33.5 percent significantly improve erectile function. Additional research suggests pelvic muscle training may be helpful for treating ED as well as other pelvic health issues. (link blog:http://pelvicpainrehab.com/male-pelvic-pain/2322/men-kegels/

 

….that you can and should find a pelvic floor physical therapist and  Get PT 1st.

To find a pelvic floor physical therapist:

American Physical Therapy Association, Section on Women’s Health:

http://www.womenshealthapta.org/pt-locator/

International Pelvic Pain Society: http://pelvicpain.org/patients/find-a-medical-provider.aspx

 

Best,

Stephanie Prendergast, MPT

 

stephanieStephanie grew up in South Jersey, and currently sees patients in our Los Angeles office. She received her bachelor’s degree in exercise physiology from Rutgers University, and her master’s in physical therapy at the Medical College of Pennsylvania and Hahnemann University in Philadelphia. For balance, Steph turns to yoga, music, and her calm and loving King Charles Cavalier Spaniel, Abbie. For adventure, she gets her fix from scuba diving and global travel.

 

Comments

  1. Within a week of my urogyn finding little holes in my bladder lining and diagnosing interstitial cystitis and PFD, I did some research, found a pelvic floor physical therapist, and asked my doctor for a physical therapy referral so that insurance would help cover the cost of physical therapy. Within two months of physical therapy, my PT began to suspect that I was dealing with pudendal entrapment and went to my urogyn to discuss it. My urogyn did some nerve blocks and other things and found that indeed there was damage to my pudendal nerves. After 1 1/2 years of physical therapy, nerve blocks, trigger point injections, and more recently pudendal ablations and acupuncture, I am doing much better and have some skills to relieve my pain myself with gentle exercises and stretches, releasing trigger points, following the IC diet as well as the Crohns diet, relaxation, etc. It turns out the Crohns disease, which was diagnosed over 30 years ago, turned out to be the culprit with the PFD, not the IC as was first thought. Please do not limit your education to urogyns. Please put gastros on your list too. My PFD got so bad that my knees were collapsing and I was falling several times a day. My hips needed to learn how to engage again. While sitting for more than a few minutes at a time will probably never be possible, I can now walk my dog a short distance and go downstairs to do laundry. Slowly, but surely, I am feeling stronger and better emotionally too as I see improvement with my physical abilities and learned to help myself with pain relief. I do not want to live in a “fog” from pain meds, and I have been able to get rid of them. I gradually worked down frequency of PT visits and can go weeks without a visit unless my Crohns flares. None of this would have happened if it hadn’t been for my physical therapist and I’m so grateful.

    For me and I imagine others too, the thought of pelvic floor physical therapy was horrible because of the invasive nature and pain. My pelvic floor was so tight that the urogyn couldn’t do a pelvic exam. The ride to get to PT caused extreme pain with every vibration of the car and bump in the road. During the first appointment when the PT asked me extremely personal questions, I got up to walk out and told her that this just wasn’t for me. She patiently explained why the questions about intercourse, sexual assault, bowel movements, urination frequency, etc. were important and finished asking those questions little by little over the next few months as my comfort level with her increased. I appreciated her respect for my feelings.

    Ultimately, it has taken a multi-disciplinary group of professionals to give me my life back. It will never be what it was, but I’m learning to like the things that I can do. Included in this multi-disciplinary team is this blog. You’ve helped me through some very dark days. It was your blog that led me to find a pelvic floor PT in the first place. Thank you for being there!

  2. Great post Stephanie! I absolutely believe women’s health care would change for the better if pelvic floor Physical Therapy was standard of care pre and postpartum, and our first-line treatment for symptoms related to the pelvic floor. I hope to see that someday soon. Keep up the great work! Lorraine

  3. I’ve been suffering with severe pelvic pain for three years and have undergone much testing, many treatment paths and endured misdiagnosis and stigma. It was finally suggested to me that pelvic floor physical therapy might be a great avenue to try. Thank you for this post and your informative site. I wondered–do you know of any practitioners in RI and does your office in Waltham MA take insurance? Thank you so much for the work you do and the hope you provide.

    1. Thank you for sharing. I thought I was alone.
      I live in a tad underdeveloped country where chronic pelvic pain is unheard of & I have the almost identical situation you (N) described.
      Thank you Stephanie; your articles have helped me understand that I’m not alone.

  4. To Whom it May Concern
    I am Male and have a painful life, the past seven years, from my Pudendal nerve, what should I do.

    1. Author

      Hi Rob,

      We suggest finding a pelvic floor physical therapist in your area through the APTA or IPPS websites. You will also find more suggestions in our book, Pelvic Pain Explained (available on Amazon), and in our blogs on Pudendal Neuralgia.

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