How to Improve Bladder Health

Bladder

Fiona McMahon, DPT

The bladder, not super complex right? Just a tupperware for pee, holding your urine until an opportune time to go. The bladder is so much more than that, integrating information from the brain, muscles of the pelvic floor, and responding to stretch to efficiently serve its purpose. We never think of the bladder until something goes wrong with it.

In honor of bladder health month, we will be exploring the anatomy of the bladder, what is normal for the bladder, what can go wrong with the bladder, and how to best take care of your precious and hard working bladder.

Bladder Anatomy/ Physiology

 

Male or female, we all have the same basic structure of the bladder, with a few exceptions. Here’s what everyone has in their lower urinary tract.

  • Detrusor Muscle: Forms the body of the bladder and is responsible for squeezing the bladder to empty its contents. It spends most of its time relaxed in order to allow for bladder filling.
  • Trigone Muscle: Forms the neck of the bladder, and is a powerful sensory organ. When the trigone stretches in response to the filling of the bladder, it sends a message to the brain that it’s time to pee.
  • Internal Urethral Sphincter: Smooth muscle (involuntary) which seals off the exit of the bladder and allows for continence.
  • External Urethral Sphincter: Striated or voluntary muscles which also seals the exit of the bladder.
  • Urethra: This is the tube that leads out of the bladder and is the pathway for urine into the outside world.

Sex differences:

Men have a prostate. The prostate is a sex organ and is responsible for keeping the semen at the right pH to fertilize a waiting egg. It wraps around the urethra and lives just under the bladder. It also provides a mechanical buttress or support for the bladder, lessening the load on the pelvic floor.  Because of its proximity to the urethra, problems with the prostate can cause problems with the bladder.  An enlarged prostate, which can be a benign part of aging, cancer, or infection, will restrict the flow of urine out of the urethra, resulting in weak stream, painful, burning urination, and difficulty urinating (the same thing happens with tight pelvic floor muscles). A prostate that has been surgically removed, most often has occurred for treatment of prostate cancer can reduce support for the bladder and lead to leaking. For more information on prostate cancer click here  and for more info on prostatitis, click here!

Another important difference between people with female and male anatomy are the respective length of their urethras. Male urethras are a lot longer than female urethras. This is one of the reasons people with female anatomy are more prone to bladder infections. In a female, bacteria have a lot easier time making the trek to the bladder because of the shorter urethra.

Conditions of the Bladder

Incontinence

Incontinence is the involuntary leakage of urine. There are many causes of incontinence. It’s important to know why you are leaking in order to know how to appropriately remedy it. It is possible to have more than one type of incontinence, and when that occurs we call it mixed incontinence.  Let’s go through the types together.

  • Urge incontinence occurs when you leak urine  after a sudden urge to urinate. We call it, lock in key syndrome, because certain events like unlocking the door to your home can cause urge incontinence.  This is the type of incontinence, which should be treated first in cases of mixed urge/stress incontinence.
  • Stress incontinence is the result of pelvic floor weakness that prevents the closure of the external urethral sphincter with activities that increase the pressure on the bladder, like coughing, laughing, lifting or sneezing. Pelvic floor weakness can occur if the muscles and or connective tissues are too loose to create an efficient contraction and more commonly, especially with athletes, too tight or imbalanced, to fully close the external urethral sphincter. Read more about incontinence in athletes here.
  • Functional incontinence occurs when you physically can not get to the bathroom in time to urinate. This is common in the elderly or disabled, who may have trouble ambulating to the bathroom, removing clothing, or transferring from a chair into standing. It is imperative that this type of incontinence is treated aggressively by a physical therapist or occupational therapist as it increases the risk of potentially fatal or disabling falls.

Incomplete voiding

Incomplete voiding is when the bladder does not fully empty.

In a normally functioning patient, volitional effort should not be required to empty the bladder.  A pelvic floor that is unable to relax, will have a smaller opening for urine to pass through or the voluntary muscles involuntarily contract because of muscle spasming, resulting in hesitancy, or incomplete bladder emptying.

Bladder Pain

Pain is our body’s way of telling us there is something wrong. With a new onset of bladder pain, it is important to rule out infection or an organic condition. Often times musculoskeletal conditions or general bladder irritation can mimic bladder infections.  In our practice, we often see patients who had been convinced they had an infection only to find out all of their tests for infection, where in fact, negative and the source of their pain was a tight or shortened pelvic floor.

It is important to understand the character of your bladder pain. Does your bladder hurt as it fills with urine and then feels better only shortly after voiding? If your answer is yes, you may have bladder irritation from urine that isn’t dilute enough (you are not drinking enough water), or you are consuming something irritating like spicy food, caffeine or alcohol. You may also have a condition known as painful bladder syndrome/interstitial cystitis which is contributing to your symptoms. It is important to get a handle on bladder filling pain right away, because it is the first step in treating other conditions such as frequency, urgency, incomplete emptying and retention.

If you have pain and burning during urination with no infection, it is likely the pelvic floor muscles and tissues cannot relax enough to allow urine to flow out without burning, (the pelvic floor also plays a role in bladder filling pain as well). Burning with urination that is not caused by an infection, is treatable with pelvic floor PT.

Frequency:

Everytime I hear someone say “I have a small bladder”, I have the uncontrollable urge to say, “No, you have a sensitive bladder, which can be trained to be better”. Saying you have a small bladder is 95% of the time fatalistic and just untrue. Most bladders, with few exceptions can hold 400-600 mL. Holding capacity can be diminished in cases of constipation, pregnancy and some neurological conditions, but most everyone is working with similarly sized equipment (the exception, being growing children).

Average intervoid interval, aka times between pees, is 2-3 hours, unless you chug a liter of fluid or cups of caffeine in one sitting. An example is being able to make it through James Cameron’s, Titanic, without having to excuse yourself. The trick with the bladder is it’s antsy. It informs you with the first urge to urinate when it is approximately 40% full. Over time, if you listen at that first urge, the bladder will begin to inform you earlier and earlier until you are going once every 20 minutes. Training your bladder to hold more is achieved with ignoring the urge or practicing various behavioral strategies, like deep diaphragmatic breathing with pelvic floor drops, to allow for longer intervals until your bladder capacity is within normal limits. This can be a longer process for those with a more sensitive bladder.

Bladder training is complicated by pain. Pain usually must be treated simultaneously in order to truly get the most benefit from bladder retraining. It is also important to realize that substances like caffeine and alcohol increase urgency and make bladder training more difficult.

How to Manage Bladder Issues:

Fortunately, there is a lot you can do, RIGHT now to manage your bladder symptoms. I find that in my practice and everyday life, there is a certain fatalism about bladder conditions. I can’t count how many times I’ve heard phrases like, “ I just have a small bladder”, “Women my age after babies just leak”, “I am older so I pee more at night” and “it’s always been like this”. The bladder is a trainable organ and the muscles influencing it can be stretched and strengthened like any other muscle in the body. The best part is there is so much you can do for yourself at home. It’s totally worth trying and in many cases is a life changer.

Diet and fluid intake:

It may sound counter intuitive, but drinking plenty of water is good for almost all bladder conditions. Yes I am talking about leaking, urgency, incomplete emptying and frequency. Drinking lots of water keeps your urine nice and dilute, minimizing the irritation of the bladder wall as well as the reactive spasm of the detrusor muscle. You should drink approximately half your bodyweight in ounces of water a day. For example: a 150 lbs person should consume 75 ounces of water a day. You should increase this amount if you are exercising, or experience a lot of sweating or drink a lot of caffeine and or alcohol, which are both dehydrating. It is also important to be mindful of bladder irritants which can worsen bladder issues. Big irritant culprits are alcohol, caffeine, citrus, and spicy food. In children, dairy milk is a common bladder irritant.  Keep in mind that one person’s bladder irritant may not be your bladder irritant. It’s easy to look at lists of bladder irritants and get overwhelmed. Try eliminating a suspected offender for two to three days. If you feel better when you aren’t consuming that item and worse when you add it back in, consider eliminating that item from your diet.  It is also important to eat in a way that prevents constipation, as this worsens bladder symptoms and puts extra pressure on the bladder.

Posture

If you are having problems fully emptying your bladder or you have post void leakage ( dribbles following going to the bathroom) consider your toileting posture. People with bladder issues should sit on the toilet ( even dudes), to allow the pelvic floor muscles to relax and allow the bladder to fully empty.

Bladder Training

If you have bladder frequency or leakage  now is the time to try and train your bladder to hold more urine. Keep in mind you should start treatment to address pain with physical therapy and in certain cases, with medication, to allow you to be successful with bladder training. I always tell my patients to start their bladder retraining at home, where a bathroom is available to take the stress out of possible leaks or not being able to find a bathroom. Start by simply waiting to go to the bathroom 5-10 minutes past your first urge to urinate. Use behavioral strategies, such as deep breathing and pelvic floor drops, mindfulness, distraction and others.  If you don’t have to go after 5-10 minutes, Great! If you do, go to the bathroom. As waiting 10 minutes becomes easy, stretch your time to 20 minutes and so on until you are able to go 2-3 hours in between urination.

Physical Therapy

Physical therapy is considered a mainstay and top treatment for musculoskeletal causes of bladder disorders and bladder pain.  Expert pelvic floor physical therapists are clinicians who can find the cause of your bladder issues and provide you with a customized plan that will provide you with the best results possible. PT’s can work to relax spasmed muscles, treat constipation contributing to bladder issues, improve your toilet posture, reduce tightness around the bladder, abdominal and thigh region that can contribute to bladder dysfunction, as well as strengthen weak muscles. If you are experiencing bladder issues, please come see us.  There is so much we can do to help!

Sources:

Berghmans L, Hendriks H, Van Waalwijk, et al. Conservative treatment of urge urinary incontinence in women: a systematic review of randomized clinical trials. BJU Int. 2000; 85: 254-63

Chancellor, M, Yoshimura N. Neurophysiology of stress incontinence. Rev Urol. 2004; 6(Suppl3)S19-S28

Chang H, Lynm C, Glass R, et al. Urinary incontinence in older women. JAMA, 2010; 303(21): 2208

FitzGerald M, Brensinger C, Brubaker L, et al. What is the pain of interstitial cystitis like?. International Urogynecology Journal Including Pelvic Floor Dysfunction. 2005

Shafik A, Shafik I. Overactive bladder inhibition in response to pelvic floor muscle exercises. World J Urol. 2003 May; 20(6):347-7. Epib. Apr 4

PH101: Ladies Only Session

By: Fiona McMahon, DPT
Hey Ladies!!! In our next installment of our Pelvic Health 101 course, we are hosting a women’s only session to allow for a safe and non-threatening place to discuss many issues that can affect the health of your pelvic floor. This class one of Stephanie Stamas’s (the founder of PH101’s ) favorites and is definitely not to be missed. Join us at 7pm on October 25, 2017  Please register at pelvichealth101.eventbrite.com.

Location

110 East 42nd Street, Suite 1504

New York, NY

10017

Pelvic Health 101 Fall 2017

PH101: Pain and Sexuality: is it all in my head?

 

By Fiona McMahon, DPT

Sex should feel good… really, really good. But when it doesn’t, you may start to wonder, what’s wrong with me? Am I broken? Am I a prude? Am I frigid? Painful sex isn’t something we talk about. No one would look at you twice if you walked into work complaining of pain in your elbow, but if you walk into work complaining about pain in you vagina or penis, you may end up having a meeting with HR.

On October 18th, 2017 we at Beyond Basics are breaking down those taboos and having an educational seminar, followed by an optional question and answer session at the end. We will discuss the many causes of sexual pain and how physical therapy can help.  The event will be hosted by one of our therapists, Stephanie Stamas, DPT, ATC. Stephanie will give a detailed seminar about pelvic health and take time to clear up some common misconceptions many people have concerning their bodies and sexual function.

Please join us at our office at:

110 East 42nd Street, Suite 1504

New York, NY 10017
Register at: pelvichealth101.eventbrite.com

Here is our line up of this and future classes

Pelvic Health 101 Fall 2017

PH101: Does my Diet Really Matter?

Fiona McMahon, DPT

Gluten free, soy free, low FODMAP. It’s amazing how many diets there are out there that really can  provide people with symptom relief. If you are suffering with chronic pain you may be confused on where to start, or what is right for you. You also may have tried out a bunch of different ways of eating, not seen results and have gotten really frustrated. If this is the case for you, I highly encourage you to come to our next pelvic health seminar on October 4,  at 7pm, “Does my diet really matter”.

jessica-drummond-headshot-197x300This seminar will be hosted by a special guest speaker, nutritionist Jessica Drummond, MPT,CCN,CHC. Jessica Drummond is a former pelvic floor physical therapist who now specializes in nutrition for those suffering with pelvic floor dysfunction. This seminar has been a huge hit and is a great starting point for those considering adding nutrition as part of their healing journey.

Register at pelvichealth-101.eventbrite.com  today.

 

 

Location

110 East 42nd Street, Suite 1504

New York, NY

10017

Pelvic Health 101 Fall 2017

PH 101 Something’s Wrong with my What?

 

You’ve waited and waited, now finally Pelvic Health 101 is BACK!

On September 20th, 2017 at 7pm we will be kicking off our fall semester of pelvic health education classes. We have a lot planned this year, so get pumped. In our first class we will be introducing you to the pelvic floor muscles, where they are, what they do, and how they relate to the health as well as the function of your bowel, bladder, and sexual muscles and organs. We will also be covering how things such as alignment, posture, muscle tone, and nerves can affect your symptoms. This course is a great starting point to help you understand your pelvic floor and pelvic floor symptoms.

Please join us at our office at:

110 East 42nd Street, Suite 1504

New York, NY 10017
Register at: pelvichealth101.eventbrite.com

Here is our line up of this and future classes:

Pelvic Health 101 Fall 2017

Navigating Life with Chronic Pain: Part 1

cactus

Fiona McMahon, PT, DPT

Why Should Everyone Care About Chronic Pain

Chronic pain is the in vogue topic of the day. It is a subject that has pushed its way into American’s awareness for very good reason. According to the American Academy of Pain Medicine, chronic pain currently affects more than 1.5 billion Americans, affecting work, sleep, and quality of life. Most importantly chronic pain has become dangerous as the opioid crisis has come to a head. Out of the 28,000 people who died of accidental drug overdose, nearly 12,000 died from pain killers, three times as many in 1999, according to the American Academy of Pain Medicine.

What Is Chronic Pain

Chronic pain is classically defined as pain that persists more than 3 months, but it is so much more than that. When pain becomes chronic, it is actually processed in the brain differently than acute pain. This is one of the reasons chronic pain has proven to be so difficult to treat using traditional means.

Pain serves a vital function and is something we need to survive. Pain alerts us to danger like a hot stove or broken bone and compels you to take action. This “take action now” pain is acute pain. Chronic pain lingers and can be totally independent of what is actually going on in the tissue. In fact, the tissue may have healed completely and still pain persists. There are a lot of thoughts as to why pain becomes chronic. It can seem like there is nothing left to treat, and all we can do is blunt it with analgesics and painkillers. But there is more to do. All pain, whether it is acute or chronic is processed by pain receptors, the spinal cord, and finally the brain. By addressing pain at the level of the nervous systems, we can change the way stimuli are perceived in the brain, and hopefully reduce pain.

The book, Explain Pain, by David Butler and Lorimer Moseley does a really superb job explaining this concept. In the book, they explain chronic pain is the body’s response to prolonged exposure to noxious stimuli. (In non medical person terms: basically if you have pain for a long time, the body becomes much more sensitive to things that may or may not be painful or damaging). In states of chronic pain, your body can actually lower the threshold for something to become considered painful in the brain. Meaning, that simple stimuli like tight fitting clothing, or sitting can feel very painful. Your body is doing this, because it is on guard for anything that might hurt it. Chronic pain is your body’s way of looking out for you, but has gone way too far.

This blog is not long enough to dig into all of the varied nuances of how and why chronic pain occurs, but if your interest is peaked, I would highly recommend taking a look at Explain Pain or The Explain Pain Protectometer in order to dig down into the deep and fascinating science behind chronic pain.

False Leads and Dead Ends In Pain

Opiods, Addiction, and Efficacy

The nature of chronic pain has proven to be elusive for patients and healthcare practitioners alike. In the 1990’s, in an effort to finally address chronic pain, opiods became much more widely used. At the time, drugs like Oxycontin were marketed as a safe way to treat chronic pain. The manufacturer of Oxycotin, Purdue Pharmaceuticals, instructed their drug representatives to tell doctors that the rate of addiction for long term Oxycotin users was 1%, according to pharma who help fund these studies. Although one study did indeed find these numbers many other found addiction rates in excess of 40%.

Probably one of the most unfortunate aspects of the push by pharma to prescribe opioids more freely, is despite marketing to the contrary, there have been more and more studies supporting the theory that opioids may in fact be ineffective for the treatment of chronic pain. Studies of worker’s compensation patients being treated for chronic pain indicate that patients on higher opioid dose, return to work more slowly than those on lower doses. Additionally, patients with back pain, who are being treated with long term opiod therapy report greater disability than those who are not on opioids.

Opiods have their place, especially in the treatment of cancer, procedural, and end of life pain, however it is becoming more and more clear that opiods are not the miracle drug we once thought they were in the treatment of long term chronic pain. The increased risks of addiction, accidental overdose, falls and fractures, depression, and severe constipation (which can indeed worsen the pain for which the opiod was prescribed in the first place), make it clear that as a medical community, we need to find a safer and more effective way to reduce chronic pain symptoms.

First steps

If you can find a cause, but at the same time don’t get hung up on it.

This is easier said than done. Often times, by the time patients reach us here at Beyond Basics Physical Therapy, they have folders that are stuffed to the brim with expensive diagnostic tests that read “unremarkable”. This can be incredibly frustrating for someone suffering with very real pain. My first word of advice is, If something doesn’t feel right with your body, don’t stop looking for help, until you find someone who can truly help you. There are many pain conditions like, chronic prostatitis and endometriosis. Which are poorly understood by many providers, that require treatment and or consultation by a specialist. This isn’t to say that the clinicians that are unfamiliar with chronic pain conditions aren’t fabulous providers, but these chronic pain conditions often require a clinician who spends his or her career treating and managing these type of pain syndromes. Basically, don’t allow yourself to be written off by any clinician who tries to tell you your pain isn’t real. It is, but most importantly there are things to be done. At Beyond Basics, we have extensive training on chronic pain conditions, additionally we have multiple connections with physicians, nurse practitioners, and other clinicians who treat chronic pain, that we will often refer too if we feel additional intervention beyond physical therapy is necessary.

I am warning you, before you read this paragraph, I am about to say something that on its face will seem mind numbingly contradictory. Bear with me please, and read the entire passage. If you do get a diagnosis, do not expect an immediate cure of pain. Chronic pain has gone past the point of solely being about tissue damage. A chronic undiagnosed infection, muscle spasm, or injury should be treated to remove the fire or proximate cause of the pain. Just because the pain is gone, does not mean the nervous system will immediately calm down. In chronic pain, treating the proximate cause enables the nervous system to begin to down regulate (or less threat sensitive) with further treatment, but does not always guarantee immediate cure.

This brings me to the problem with imaging. Imaging is a great tool and advances in the ubiquity and affordability of imaging techniques like ultrasound and magnetic resonance imaging (MRI), are allowing more and more people glimpses inside their body. If you have ever looked at an MRI of yourself the feeling is profound. I have been fortunate enough to see both my brain and right hip in mind blowing detail on MRI. It’s amazing, but sometimes knowing where every tear, herniation, and bit of swelling is not only unhelpful, but downright dangerous to some patients.

I am not being hyperbolic simply to drive a point home. Early and unindicated MRI in cases of low back pain has been shown to result in increased time spent on disability and increased cost of care ranging between $8,000-13,000 according to the article by Webster, cited in the sources. The fact is with imaging as powerful as MRI, we get to see almost EVERYTHING and because MRIs are getting slightly cheaper and more common, we are identifying structural changes like disc herniation in people, who might not have had a reason to suspect that there was something wrong in their spine in the first place. Sometimes knowing there is a structural abnormality in your body can cause pain and hypervigilance, when prior to knowing, you may not have had the same quality or as much pain in the first place.. Reports indicate that disc herniation and narrowing of the spinal cord can be seen in up to 57% of people who have no symptoms at all. It’s not a far leap to imagine someone with pain hanging all of their problems on a slipped disc if the MRI shows it. What’s worse, is MRI results are alluring and can often lead practitioners down the wrong path of treatment, because it is an easy answer.

In physical therapy school, my professors drilled into us, with almost religious fervor, treat what you find. A fabulous Physician’s Assistant of mine also told me 90% of what you need to know is in a patient’s history of their present illness. It is so true. You can tell a lot about the origin of the pain by asking questions like, how long has it been around, what makes it worse, what makes it better, and what does it feel like. Imaging can sometimes be a bit of a red herring, rushing well intentioned clinicians towards what they think is a cure, while skipping some crucial information through gathering steps that would aid in a more accurate diagnosis.

MRI’s aren’t all bad. They can be life saving and life improving when they are used appropriately. There are many clinical practice guidelines that guide providers on when it may be beneficial to order MRI or other imaging, however, research has certainly borne out that early imaging is actually counter productive in the treatment of chronic pain.

 

If you find a cause, great. If you don’t, or still feel bad don’t despair

We place so much of our hopes on diagnosis. It seems logical that if there is a cause, there must be a cure. Unfortunately, it is not alway so simple. We went over in the opening paragraphs about how chronic pain is more than what’s going on in a specific body part, it also involves the brain. Sometimes simply curing the tissues is not enough. Sometimes we never know what the cause is. This can be so frustrating for patients. As a pelvic pain specialist, I treat a lot of patients with pelvic floor pain and spasm, who have not yet figured out what specific incident brought the pain on. Rarely, in these cases, is there the “oh, crap” moment, when you realize you have injured yourself. Sometimes the development of chronic pain is like having a water glass. We are all born with water glasses of different sizes. We pour a little water in for something like poor posture, genetics, injury, diet, stress, etc., and when our water glass has overflowed, we develop chronic pain. There is no one definitive cause in cases of the overflowing water glass. Many factors have contributed, and many factors must be addressed in order to treat it properly. That’s why the holistic, mind-body approach is really where it’s at, when we treat chronic pain.

Now that you have a grasp on pain science and how chronic pain can behave differently from acute pain, you can begin to approach treating and dealing with it in a different way. In part two of this blog we will discuss different treatments for chronic pain, including yoga, acupuncture, meditation, of course, physical therapy, and many more. Please stay tuned.

Sources:

AAPM Facts and Figures on Pain. The American Academy of Pain Medicine. http://www.painmed.org/patientcenter/facts_on_pain.aspx. [Accessed June 25, 2017]

Butler, David S, and G L. Moseley. Explain Pain. Adelaide: Noigroup Publications, 2003. Print.

Zee A. The Promotion and Marketing of Oxycotin: Commercial Triumph, Public Health Tragedy. Am J Public Health. 2009;99(2):221-227

Singh P, Chaturvedi A. Complementary and Alternative Medicine in Cancer Pain Management: A Systematic Review. Indian J Palliat Care. 2015. 21(1): 105-15

Von Korff M. Long-term use of opiods for complex chronic pain. Best Pract Clin Rheumatol. 2013 Oct 27(5):663-72

Webster B, Bauer A, Choi Y, et al. Iatrogenic Consequences of Early Magnetic Resonance Imaging in Acute, Work Related Low Back Pain. Spine. 2013. 38(22) 1939-46

September is Sexual Health Awareness Month!

pexels-photo-544917

Fiona McMahon DPT, PT

September is here and we at Beyond Basics are taking some time to observe sexual health awareness month. We take pride in our role of providing our patients with treatments to make sex comfortable and pleasurable as well as in our role as sexual health educators. Sexual health is comprised of many factors beyond just your ability to have sex. This article, by no means, exhausts all factors but is a good starting point to learn more about increasing your health as well as your enjoyment when it comes to sex. We will be expanding on some of the conditions featured in this blog in future posts, so stay tuned.

What is Sex

Sex is not a one-size fits all activity and can come in many different forms. Even between straight couples penetrative sex may not be the standard. In fact there are many couples that can not engage in penetrative intercourse for a variety of reasons. This may be because of an injury, medical condition, or simply because intercourse is not gratifying for the couple or there is some other act that is more gratifying. It’s really up to the couple’s choice and preference. A term for sexual activity that is not penetrative is called outercourse.  One type is not necessarily better than another. It’s all about what works for you and your partner’s bodies and desires.

Emotional Health and Sex

Sex is more than how it makes you feel physically, it is about how it makes you feel emotionally. Many things can influence how we feel about sex and how sex makes us feel about ourselves. If sex is making you feel unhappy or anxious it is important to get to the root of the cause, in order to maximize not only your pleasure but also, your well being. Common issues, to name a few, that can negatively affect sexual experiences are listed here:

 

  • Trauma
  • Mismatch between your sexuality and culture
  • Issues with your partner
  • Issues with consent: Consent is a hot button issue in today’s media and on college campuses. Although consent is a broad and important topic, it can be boiled down to a few key points:
  1. Consent can never be assumed, regardless of dating status or previous sexual activity. For consent to be given, it must be given with an affirmative “yes” answer.
  2. Consent can not be given if someone is high on drugs, underage, or drunk
  3. Consent must be given with every sexual encounter and can be withdrawn at any time.

If emotional issues are contributing to a lack of enjoyment with sex, it may be time to reach out to a certified sex therapist.

 

Sexually Transmitted Infections (STIs/STDs) and Safer Sex

Sexually transmitted infections also known as sexually transmitted diseases can have a huge impact on your well being. Up until recently, sexually transmitted infections (STI’s) have been known as sexually transmitted diseases. There was a change in the nomenclature of these infections, because many of them can be asymptomatic and a person may carry and transmit them without knowing they have been infected.

STI’s unfortunately sometimes carry a moral connotation, in that blame is often put on the person who has it. STIs are simply an infection with a bacterial, fungal, or viral pathogen and have absolutely no bearing on the moral character of those infected. They can be transmitted sexually but they can also be spread through the childbirth process, dirty needles, or a tainted blood infusion.

All STI’s are not created equal. For some there are excellent screening tests and treatment, yet for others, treatment or screening or both may not be fully effective yet. Some may be obvious to those infected, while others may go undetected for years. Common symptoms of symptomatic STI’s include:

  • Sores and bumps around the genital and rectal area
  • Painful urination
  • Penile discharge
  • Irregular vaginal bleeding
  • Foul vaginal odor
  • Painful sex
  • Fever
  • Swollen lymph nodes in and around the lower extremities, which may also be present in the upper body as well.
  • It is important to remember these symptoms are non-specific and can be related to a number of other conditions that are not solely related to STI.

STI Complications

  • Pelvic pain
  • Eye inflammation
  • Pregnancy complication
  • Infertility
  • Pelvic Inflammatory Disease
  • Certain types of cancers associated with Human Papilloma Virus (HPV)

Risk Reduction

Because not all STI’s can be cured, (although many can be effectively managed) and the impact to one’s health can be so large, it is imperative to safeguard your health and fertility. Steps you can take to reduce your risk of STI infection include:

  • Abstaining from sex: abstinence is the most effective way to reduce your risk of STI; however, with most adults, this is not an acceptable option.
  • Using a barrier to reduce contact with bodily fluids. Using condoms for penetrative sex (vaginal, oral, and anal) or a dental dam for vaginal oral sex, can help to reduce your risk.
  • Keeping your number of sexual partners low: long term monogamous coupling is associated with a lower incidence of STI
  • Regular screening: Because many STI’s can be asymptomatic, regular screening is key to catching an STI early, treating the infection, and preventing damage to your own body as well as transmission to others,
    • Herpes: Recommended for those at risk for herpes (people having unprotected sex, have had sex with someone who is infected, or people experiencing symptoms such as sores)
    • Chlamydia:  men who have sex with men, as well as women who are under 25 have a greater risk of contracting chlamydia and should be tested for it
    • Gonorrhea: men who have sex with men, as well as women who are under 25 have a greater risk of contracting gonnorrhea and should be tested for it
    • Human Immunodeficiency Virus (HIV): It is suggested that everyone between the ages of 13 and 64 be tested for HIV. If you do have HIV, it is imperative to be regularly screened for other STI’s as it is easier to contract them with an HIV infection
    • People born between 1945-1965: should be tested for hepatitis C as there is a high incidence in this population.
    • New Partners: Before having sex with a new partner, both people should be tested for STI to prevent transmission of new infections
    • HPV: Females should be screened for HPV at least every 3 years if they are 21 to 30.  It is recommended to be tested at least every 5 years for sexually active women over 30. There is currently no HPV screening for males.
      • Two vaccines are now available to help prevent two types of HPV associated cancer. The current recommendation is that both boys and girls receive the vaccine between the ages of 11 and 12 years old. Boys can receive that vaccine between 13 and 21 and girls between 13 and 26 as a catch up period.
    • Truvada: Truvada is a drug that is now available to help prevent transmission of HIV and indicated for use in high-risk populations.

 

When Genital Pain Limits Sex

Both men and women can have pain that is so severe that it limits their enjoyment of sex, or prevents sexual pleasure completely. There are many syndromes and diseases that can cause pain with sex. As we covered earlier, STI’s can influence pain, as well as other conditions such as non-bacterial prostatitis, vulvodynia, vaginismus, pudendal neuralgia, as well as many more. These diseases and conditions can be influenced by poorly functioning pelvic floor muscles and vice versa. Keep an eye out for future blog posts devoted entirely to these conditions.  It is possible to have tight and tender pelvic floor muscles as a result of an infective process, injury, or they may arise on their own idiopathically.

 

What to do if you have pain

First off, don’t panic.  Pelvic pain is relatively common, some studies estimate chronic pelvic pain rates being higher than 25%. You are not alone. It is important, though, to act swiftly to identify the culprit. The majority of pelvic pain is treatable, but the process is much easier when started earlier on in the pain cycle.

Go to your doctor to rule out any infective or disease process that may be causing your pain. The best case scenario is that a short course of treatment will do the trick. Unfortunately, often times the root cause is not identified on the first trip to the doctor and your results may come back negative for any infectious agent or systemic condition. This is common for many of the patients we see at Beyond Basics. If this happens to you, consider going to a pelvic pain specialist, whether physician or pelvic floor physical therapist, for more precise testing.

It is important to remember not all physicians are trained to recognize dysfunction of the musculoskeletal system, although the number of those who are trained is growing. Indications of musculoskeletal dysfunction are: pain that changes with changes in activity or position, pain that does not go away once the original disease or infection is treated or cured, or pain that can not be correlated to a specific systemic dysfunction. It is important to remember that musculoskeletal dysfunction in the pelvis can mimic, or be the cause of, bladder, bowel and sexual dysfunction.

If you believe your pain is musculoskeletal in nature or even think it might be, it is important to be examined by a skilled pelvic floor physical therapist and not all pelvic floor physical therapists are well trained. Pelvic floor physical therapists can determine if muscles and/or nerves are playing a role in your pain, and then treat the dysfunctional muscles and tissues to allow you to return to your old activities. When looking for a pelvic floor physical therapist, it is important to inquire whether or not they do internal work, both vaginally and rectally, and to ask about their training and experience.

At Beyond Basics we are experts at treating sexual pain as well as screening our patients and referring them on to the correct physicians to help treat any systemic causes of pain. We value a holistic approach to treating sexual pain, and strive to provide our patients with the best care possible. If you are in the New York area, another state, or even abroad and are suffering from sexual pain, please consider starting your healing journey with us.  We have an extensive ‘out of town’ program:  URL for program.

 

Resources:

STI Awareness and Counselling Services

American Sexual Health Association: http://www.ashasexualhealth.org/

Planned Parenthood: www.plannedparenthood.org

 

  • Services provided
    • STI screening/counseling
    • HPV vaccine
    • Male reproductive health exams
    • Pregnancy tests and counseling
    • Health insurance screening and enrollment

NYC STI Clinics and Services: http://www1.nyc.gov/site/doh/services/clinics.page

 

Sexual Assault Counseling:

 

RAINN: Rape Assault Incest National Network: https://centers.rainn.org/

-800.656.HOPE

  • Services provided (free or low cost):
    • Counseling
    • Medical Attention/ Hospital Accompaniment
    • Victim assistance/ advocacy
    • Legal/ Justice System advocacy
    • Emergency Shelter

Pelvic Pain Resources:

International Pelvic Pain Society: www.pelvicpain.org

 

International Society of the Study of Women’s Sexual Health: www.isswsh.org

www.pelvicpain.org

 

Heal Pelvic Pain

By: Amy Stein DPT

http://www.healpelvicpain.com/

Healing Pelvic and Abdominal Pain DVD

By: Amy Stein DPT

http://www.healingpelvicandabdominalpain.com/

 

Explain Pain

By: David Butler

https://www.amazon.com/Explain-Pain-David-Butler/dp/0987342665?ie=UTF8&hvadid=49868747328&hvdev=c&hvexid=&hvnetw=g&hvpone=&hvpos=1t1&hvptwo=&hvqmt=b&hvrand=9859257768995611935&ref=pd_sl_1tz644lwle_b&tag=googhydr-20

Healing Painful Sex

By:   Deborah Coady, MD and Nancy Fish, PhD

 

The Pain No One Wants to Talk About

https://beyondbasicsptblog.com/2015/05/13/the-pain-no-one-wants-to-talk-about/ When

When Sex Hurts

By: Andrew Goldstein, MD and Caroline Pukall, PhD

 

Sources:

 

International Pelvic Pain Society:  www.pelvicpain.org

 

International Society of the Study of Women’s Sexual Health:  www.isswsh.org (confirm url)

 

Ahangari A. Prevalence of Chronic Pelvic Pain Among Women: An Updated Review. Pain Physician. 2014;17(2) E141-7

 

Barrow R, Berkel C, Brooks L. Traditionally Sexually Transmitted Disease Prevention and Control Strategies: Tailoring for African American Communities.  Sex Transm Dis. 2008 Dec; 35 (12 sUPPL): s30-9

 

Katz A, Lee M, Wasserman G, et al. Sexually Transmitted Disease (STD): A Review of the CDC 2010 STD Treatment Guidlines and Epidemiologic Trends of Commone STDs in Hawai’i. Hawaii J Med Public Health. 2012 Mar; 71(3): 68-73

Mayo Clinci Staff. Sexually Transmitted Diseases (STDs). http://www.mayoclinic.org/diseases-conditions/sexually-transmitted-diseases-stds/home/ovc-20180594. [Accesses August 17, 2016]