By Jandra Mueller, DPT, MS, PHRC Encinitas
Here is the story of a 21 year old male with many GI complaints and pelvic pain, who eagerly wanted to get back to normalcy and achieved that, although still ongoing, through the services offered at PHRC. We will refer to him as “Michael” so that his identity remains anonymous.
Michael found PHRC on his own search because he had been experiencing tip/head of penis pain with intercourse, painful erections and post-ejaculation pain. Additionally, he had reported loose stools every morning and changes in urination. His symptoms started after a trip to Italy, and upon return, had also learned he had Chlamydia. He was treated with four different courses of antibiotics, but infections still remained, until that final course. During the course of this time, he had been to the emergency room and several doctors including a holistic doctor, gastroenterologist, and two different urologists, diagnosed not only with an STI, but also possible C-Diff and a parasite. He was treated with probiotics and a bowel regimen which gave some relief but then his diarrhea had returned. He had also been told he had “prostatitis,” although no culture had been taken to confirm this. He reported trying Whole30 for a couple of weeks with no change in symptoms. In addition to the above symptoms, he reported losing twenty pounds, difficulty working out, and difficulty with sitting without pain.
His goal was “to drastically improve his symptoms and his overall health in this area by any means.” Our goals for him of course were to address these areas to improve his health, return to pain-free sitting, able to perform his daily functions without pain or discomfort, and normalize his bowel function and tolerate all foods again.
Here are his findings during his pelvic floor evaluation at PHRC are below:
- Hypertonus (tightness) in his pelvic floor
- Pain with palpation (touching) to his pelvic floor muscles
- Moderate connective tissue (fascia) in all the tissues around his pelvis – abdomen, inner thighs, pelvis, and sit bones
- Muscle trigger points in his abdominal muscles, adductors, bulbocavernosus and ischiocavernosus
- Fair motor control – meaning he was able to do a contraction, relax, and bulge, but there needed to be improvement in this area to make sure everything was working properly
To better understand these muscles – we have a blog on pelvic floor anatomy and how the external muscles can also be involved in causing dysfunction.
His PT recognized that there was more to his story that was impacting not only his pelvic floor, but his overall health and referred him to Jandra Mueller, for an in depth evaluation of his gastrointestinal function and bowel health.
During his nutrition evaluation, we first focused on what triggered these symptoms, but also reviewed his overall health history and other factors about his past that may have contributed to his current condition. We reviewed aspects about his current diet and any history with diets he’s had, his sleep habits, current medications and supplements, and tests he has performed in the past with other providers. Based on all of this information, we determined that he would benefit from a comprehensive stool test to look at his digestion, absorption, gut inflammation, dysbiosis patterns, and potential pathogens including parasites.
His main findings and complaints are listed below:
- Feeling of abdominal bloating and heaviness after a meal
- Lacking both macro- (carbs, proteins, fats) and micronutrients (vitamins and minerals)
- Urinary urgency and frequency
- Lowered cardiovascular exercise tolerance
- Great family support in making necessary changes
As we waited for the information from the stool test, we started tackling the obvious things – was he getting enough fiber? Was it the right kind of fiber? Was he eating good quality food to ensure he wasn’t consuming unwanted pesticides, bacteria, and antibiotics that his food had been treated with? We also looked at his protein status since one of his concerns with losing weight.
Stool test findings:
- Severe dysbiosis (imbalanced gut bacteria): 10/10
- Lowered overall gut bacteria
- Moderately high inflammation markers: 4/10
- Moderately poor digestion: 4/10
- High markers for intestinal permeability or “leaky gut”
- No parasites – YAY!
What does this mean?
Because of all the antibiotics he took, the amount of bacteria in his gut was lower than an average healthy person. Additionally, because of the antibiotics he had taken, it killed off a lot of the “good” bugs, and left a lot of the “bad” bugs which, when in balance, all have a job to do and are important. The bad thing is, some of the bacteria that are normally good, tend to be more resistant to antibiotics and are not killed off in the same way that the “good” bugs are, and now, we have a problem.
His poor digestive markers showed that he was not digesting fat well, which means that he is not necessarily getting all the benefits of healthy fat, which can promote more inflammation in his body, and contribute to low vitamins that are fat soluble such as Vitamin A, D, E, and K. Poor digestion of fat may have also been contributing to his diarrhea, and his weight loss.
High inflammation & “Leaky Gut”
He had markers of high inflammation, which means that “something” in his gut was causing a reaction – based on his findings this was the altered balance of gut bacteria where there were too many byproducts of the bad bugs, and there was not enough of the “good” bugs to keep this in balance. He also showed that he had intestinal permeability issues or “leaky gut” which can be caused by the same factors causing leaky gut. Additionally, these two findings along with the dysbiosis can also account for some of his urinary symptoms.
One great thing was that his test showed no more parasites – YAY! This was very exciting because it means that all of those antibiotics weren’t for nothing. They actually did eradicate the parasite, which may have caused all this wreckage in the first place.
Where did we start?
It seems that there is a lot to address to get better, which may be daunting. Well, there is, and unfortunately, the findings on his test, are not that different from many others suffering from pelvic pain issues. Before we even knew the results of his test, we started with his diet. As much as supplements and medications can help to solve these problems, diet has to be a key part of the picture.
We discussed fiber first, he was not eating enough soluble fiber. This is important because it bulks up your stool. We discussed adding in oats for breakfast in a variety of ways – oatmeal, overnight oats, oats in smoothies, etc.
His body was already having a hard time getting rid of toxins, so we discussed how to make sure he was picking good quality food, including wild-caught fish, grass-fed beef, pasture raised eggs, and antibiotic-free, pesticide free chicken and produce.
Before we had the stool tests results, we changed up his supplements to be more ideal for his current situation. We placed him on a probiotic that was specific for diarrhea. We also added a digestive enzyme to help him digest foods, feel less bloated, and give his body a little help to get the nutrients he needs from his food. And yes, this was before we knew he even needed the digestive support – just based on the pattern of symptoms he had.
Once we had the results of his test, we added some supplements to specifically address his findings. This included a powder with a blend of nutrients to help the gut lining heal, we added another probiotic that would help balance out the “good” and “bad” gut bugs, and another supplement that can both help the overall inflammation in his gut, and overall system for continued relief of his pelvic pain symptoms.
Where is he now?
While his healing journey is still ongoing, he reports regular bowel movements, return of his appetite and weight is almost back to normal. Here is what he’d like to share with you all:
“Before I started with Jandra, I was having a hard time all around: had very little appetite, wasn’t digesting properly, and almost never had regular bowel movements. On top of all that I lost nearly 20lbs over the course of about six months. After working with her, my weight is almost back to normal, I’m digesting properly and have a big appetite. Struggling with my health was difficult both physically and emotionally, and I’m super grateful I had Jandra in my corner throughout the process. She has a great bedside manner (hard to pull off, especially over Zoom!) and I always felt like she was thinking the same right along with me. Highly recommended.”
Pelvic pain is complex and it takes a toll on not just our physical health, but our mental health as well. Getting to the root of the issue can be a long journey, but accepting that “this is my new normal” may not have to be the end for you. The gut is incredibly amazing and when not treated properly, can cause issues all throughout the body. Diet is a huge part of that, but it’s not the only part, you could have the best diet and feel terrible. Nutrition should be personalized and food should not be thought of as “good” or “bad,” but as something you enjoy and should not fear.
You can read more about our integrative health and nutrition services at PHRC on our most recent blog on the services we offer, and about how pelvic floor physical therapy helps male pelvic pain.
Are you unable to come see us in person? We offer virtual physical therapy appointments too!
Due to COVID-19, we understand people may prefer to utilize our services from their homes. We also understand that many people do not have access to pelvic floor physical therapy and we are here to help! The Pelvic Health and Rehabilitation Center is a multi-city company of highly trained and specialized pelvic floor physical therapists committed to helping people optimize their pelvic health and eliminate pelvic pain and dysfunction. We are here for you and ready to help, whether it is in-person or online.
Virtual sessions are available with PHRC pelvic floor physical therapists via our video platform, Zoom, or via phone. For more information and to schedule, please visit our digital healthcare page.
In addition to virtual consultation with our physical therapists, we also offer integrative health services with Jandra Mueller, DPT, MS. Jandra is a pelvic floor physical therapist who also has her Master’s degree in Integrative Health and Nutrition. She offers services such as hormone testing via the DUTCH test, comprehensive stool testing for gastrointestinal health concerns, and integrative health coaching and meal planning. For more information about her services and to schedule, please visit our Integrative Health website page.
PHRC is also offering individualized movement sessions, hosted by Karah Charette, DPT. Karah is a pelvic floor physical therapist at the Berkeley and San Francisco locations. She is certified in classical mat and reformer Pilates, as well as a registered 200 hour Ashtanga Vinyasa yoga teacher. There are 30 min and 60 min sessions options where you can: (1) Consult on what type of Pilates or yoga class would be appropriate to participate in (2) Review ways to modify poses to fit your individual needs and (3) Create a synthesis of your home exercise program into a movement flow. To schedule a 1-on-1 appointment call us at (510) 922-9836
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