Can Treating Your Pelvic Floor Beat the Bloat!?

time lapse photography of splash of water
Photo by Zoe Jane on Pexels.com

Fiona McMahon PT, DPT

Bloating is the worst. It hurts. It makes us feel uncomfortable in our clothes and can be super unpredictable. There is so much that can cause bloating and many times bloating can be caused by more than one thing: diet, gut flora balance (the ratio of good gut bacteria to bad), hormones, and your menstrual cycle/history, for those of us who menstruate. All these things can all play a part in bloating. Did you know the pelvic floor can contribute too? The truth is there are a lot of things that can contribute to bloating. In this blog we will give you a quick overview of where to start as well as explain how a tight pelvic floor can contribute to bloating.

Nothing fits and my belly really hurts! Help!

I’m so sorry! The first thing I would suggest at this point is get yourself an appointment with a trusted general practitioner. There really is a lot that can go into a rip roarin’ case of abdominal bloating, and having a good clinician to look through possible causes is worth their weight in gold. They are the first line to start sorting this stuff out. Go in prepared, if you notice any dietary contributors try and remember to tell your doc. Do you bloat at a specific time of day or after a specific activity? Does your bloating change based on your menstrual cycle, if you have one? Is there anything else amiss in your health, like fatigue, hair loss, overheating or feeling really cold? All of these details can be so helpful in the hands of the right clinician.

 

My Doctor did a bunch of tests, now what?

If your doctor found something on testing, hooray! You are closer than you were before, even if you have yet to see results. Samesies if your doctor didn’t find anything, because now you know the bloating isn’t caused by whatever they tested for. If you haven’t seen results OR didn’t receive a diagnosis at all, it’s time to look a bit deeper into your potential cause of bloating, the pelvic floor.

 

First of all, “The pelvic what?” and second of all, how can I tell if this is an avenue I want to go down?

Ah, the pelvic floor. If you are new to this blog, understand you are not alone if you have never heard of it. No one really talks about it, but it’s super important. The pelvic floor lives between the pubic bone in front and tail bone in back. No matter what anatomy you were born with, we all have one. The pelvic floor is a group of muscles that stabilizes the pelvis, regulates urination and defecation, and provides sexual function.

When people have pelvic floor dysfunction, many times the muscles are very tight and cannot move well to let stool out or keep urine in amongst other symptoms. A tight pelvic floor can affect your belly bloating by not moving down well to accommodate digestive gas. When we digest our food, the naturally occurring bacteria in our guts put off gas. In a healthy person, the pelvic floor will have some give to accommodate the bloat and allow you to expand like a balloon, up, down, side-to-side, and front to back. If you have a tight pelvic floor, much of the pressure is pushed out through your belly and you get that familiar and rather uncomfortable belly bulge. This is worsened if you have a weak transverse abdominis, which is the lovely little muscle that wraps around your belly and lies underneath to your six pack muscles. You may also find that you get heartburn along with the bloat which can be related to the pressure from the gas pushing up on your upper GI tract.

Signs the Pelvic Floor Could be Your Bloating Puzzle Missing Piece

Because the pelvic floor does so so so much for the body, we often see pelvic floor issues manifesting in many different aspects of our lives. Here are some symptoms that are caused by pelvic floor dysfunction. If you have these symptoms as well as bloating, pelvic floor physical therapy is very likely to be the right place to go.

  • Painful penetration
  • Painful orgasm/ejaculation
  • Painful sexual arousal
  • Urinary pain/burning
  • Urinary frequency (going to the bathroom more than once every 2 hours)
  • Urinary hesitancy
  • Urinary leakage
  • Urinary urgency
  • Bowel frequency (going more 3+ times a day)
  • Bowel urgency
  • Constipation
  • Bowel incontinence
  • Pelvic pain
  • Low back pain

How will Pelvic PT Help Me?

Pelvic floor physical therapy can help teach tight muscles contributing to bloating how to relax, normalize bowel movements, and strengthen the transversus abdominis, amongst many, many, other things. Learn more about how it can help, here.

There is so much that can be done to keep you from warring with your waistband and it may just start with pelvic floor PT.

Abraham S, Luscombe G, Kellow J. Pelvic floor dysfunction predicts abdominal bloating and distention in eating disorder patients. Scandinavian Journal of Gastroenterology. 2012. 12(6)

PH101: Ladies Session

By: Fiona McMahon, DPT
Hey Ladies!!! In the next installment of our Pelvic Health 101 course, we are hosting a ladies’ 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. Hear more about it in her video below! Join us at 7pm on October 30th . Please register at pelvichealth101.eventbrite.com

 

Location

110 East 42nd Street, Suite 1504

New York, NY

10017

Pelvic Health 101 Flyer-jpeg

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 9th at 7pm, “Does my diet really matter”.

jessica-drummond-headshot-197x300This seminar will be hosted by a special guest speaker, nutritionist Jessica Drummond. Jessica Drummond is a former pelvic floor physical therapist who now specializes in nutrition for those suffering with pelvic floor dysfunction. This seminar was a hit last year 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 Flyer-jpeg

Pelvic Floor Mythbusters: Endometriosis Edition

Fiona McMahon PT, DPT and Amy Stein PT, DPT

Featuring excerpts from Beating Endo by  Iris Kerin Orbuch, MD and Amy Stein D.P.T.

Welcome back to our Pelvic Floor Mythbusters series! We have explored the effects of prolonged sitting and pee holding and now it’s time to move on to endometriosis. With endo, there are so many different myths, concepts, and sorta truths, that we figured we would address them lightning round style so we can cover as much ground as possible.

Endometriosis (endo) comes with a lot of misconceptions and because of this, the time from symptom onset to official diagnosis and treatment is long. The diagnosis of endo can often take in excess of a full decade to get, which delays further intervention and prolongs suffering. It’s a huge deal and is the reason why Dr. Amy Stein, PT, DPT and Dr. Iris Orbuch, MD. set to the task of writing a book where they bust endo myths right, left, and sideways. Beating Endo goes into much more detail than we do here. If you wish to purchase it, you may here

So without further adieu, here is a list of myths and truths taken from Beating Endo:Beating Endo Cover!

 

Common Endo Myths

The abdominal and pelvic floor muscles are rarely affected by endometriosis.

False: Constipation, frequent urination or retention, Pain with vaginal penetration from endometriosis causes tightening of the abdominal and pelvic floor muscles; So too does assuming the fetal position which is our go to pose when we are in pain. Both contribute to tight abdominal and pelvic floor muscles which causes pain.

The pelvic floor and abdominal muscles do not cause bladder, bowel, sexual dysfunction or abdominal-pelvic pain in patients with endometriosis.

False: Tight pelvic floor muscles caused by years of straining or reflexive tightening due to pain, often cause a severe amount of pain which results in further tightening and shortening of the pelvic floor muscles. Good news is that pelvic floor physical therapy benefits most people who have been experiencing abdomino-pelvic or sexual pain and/or are straining due to ongoing bladder and bowel symptoms.

Hysterectomy is a cure for endometriosis.

False: Hysterectomy is neither a treatment nor a cure. By definition endometriosis consists of cells similar to those in the lining of the uterus but found outside the uterus. Only surgical ‘excision’ removes endometriosis cells.

Medical menopause is a cure for endometriosis.

False: Explanation: Just because your medicines give you hot flashes doesn’t mean your endometriosis is going away. The best treatment approach is to meet with an Endo specialist to discuss options, and in most cases PT management. As well surgical excision has much better results than ablation of Endometriosis.

There is no correlation between quantity of endometriosis and severity of disease.

Truth: Even if you have a minimal amount of endometriosis, you can be in debilitating pain with lots of symptoms and in most cases dietary changes, physical therapy and mindfulness practices can help manage a lot of your symptoms.

Teenagers are too young to have endometriosis.

False: Teenagers can have endometriosis and their endometriosis can cause debilitating symptoms.

Pregnancy is a cure for endometriosis.

False: Just plain no. Pregnancy does not cure endometriosis.

Ablation surgery is the same as excision surgery.

False: Not even close. Excision surgery is the proper treatment for endometriosis. Ablation surgery, burns the surface of the endometriosis lesion but leaves the bulk of endometrial implants behind.

Surprising Endo Facts:

Fact: Physical therapy (pelvic PT) can help many suffering from the many pains and symptoms of Endo, including back, abdominal and pelvic pain, bladder, bowel and sexual function.

Fact: The majority of patients with Endometriosis require pelvic floor physical therapy. Pelvic floor PT can be instrumental in the healing process and can help abdominal-pelvic pain, bladder and bowel urgency, frequency, retention, incomplete emptying, and any sexual pain related to the musculoskeletal system.

Truth: Painful bowel movements, constipation, diarrhea and bloating are symptoms of endometriosis as well as symptoms of pelvic floor dysfunction .

Truth: Painful sex is a symptom of endometriosis as well as a symptom of pelvic floor dysfunction.

Truth: 40 to 50% of women with unexplained infertility is caused by Endometriosis.

Truth: Teens with endometriosis often have acyclic pain, that is, pain at other times of the month rather than only during their period, in addition to cyclic pain.

Truth: Back pain is a symptom of endometriosis.

Truth: If your ultrasound is normal you can still have endometriosis.

Truth: roughly 10% of women have endometriosis. That’s close to 200 million women worldwide. Endometriosis is much more than just bad period pain. 1 in 4 women have pelvic floor dysfunction.

Truth: Endometriosis commonly affects the musculoskeletal system, and in many cases can be a primary contributor to one’s pain and symptoms..

March is Endometriosis Awareness Month

abstract-art-background-1020317Amy Stein BCB-PMD, IF (Pronouns: She, Her, Hers)

Fiona McMahon PT, DPT (Pronouns: She, Her, Hers)

 

We’ve written a lot of blogs over endometriosis (endo) over the years. It is a common diagnosis at Beyond Basics Physical Therapy, and frankly, out in the world. The current estimate is 1 in 10 people with female anatomy have endometriosis, and the average time for a proper diagnosis is 11 years. This number may be subject to change as currently laparoscopic surgery is the gold standard for diagnosis. We write extensively about what endometriosis is, and how it is thought to develop in this blog, But the cliff notes version is that endometriosis is the deposition of endometrial-like cells outside of the uterus. There actually was some degree of controversy about what the deposits actually are. It was originally thought that the deposits were endometrium (the lining of the uterus), but now the endo community is moving away from that thought. The deposits can cause a whole host of symptoms, or none at all. Symptoms severity is not related to the number/amount of endometrial deposits someone has.  We still don’t know why some people with large amounts of endometrial implants and or adhesions can experience little to no symptoms, while others who have a relatively small amount of endometrial deposits may experience debilitating pain.

For most people who know anything about endometriosis, they know it is associated with painful periods. Although this is true, if we look at painful periods, we may be missing a lot of other endometriosis-related symptoms.  Endo can affect the urinary system, resulting in urinary pain, hesitancy, frequency, urgency, and incomplete emptying. It can cause painful defecation and constipation, and it can affect your sex life causing pain with penetration and or orgasm. Endo can present itself in so many diverse ways and two people with endo may present completely differently.

For individuals with symptoms from endo, there is a lot that can be done to help minimize pain. But the same approach is not always effective for everyone. It is really important to look at your own goals when deciding on what to focus on so you can express them to your care team.

There is no magic pill or treatment that works on every endo patient. Oral medicines, surgery, physical therapy, nutrition, and lifestyle changes can all help with symptoms of endo. Often times treating endo requires some combination of all of these things and the frustrating part is what may have worked for someone else may not necessarily work for you. We will take a little look, (by no means exhaustive) at each one of these interventions with the intention of piquing your interest and hopefully facilitating a discussion about these options with your healthcare provider.

Endometriosis is thought to be an estrogen-driven condition. Some people with endo may find relief from medications that affect hormone levels. Oral contraceptive pills (OCPs)  are an example of medication used to affect hormone levels. There are other options beyond OCPs that work to alter hormone levels. For some people with endo, this approach can be helpful for symptom management, although hormone altering medication won’t cure endo.  You do have to consider the side effects of all the medication options however because some of the side effects can be worse than the medication’s positive effects.

Excision surgery is both treatment and the gold standard for diagnosis and treatment of endometriosis. Surgery works by cutting out the endometrial deposits. Performing biopsies on these deposits allows the practitioner to know if the deposit is Endo.  Ablation surgery has been shown to only clear part of the endometrial implants and is not nearly as comprehensive as excision surgery. As a result, repeat surgery is commonly required with ablation, and in many cases, multiple repeat surgeries.

So we’ve just explained to you that endo is an estrogen-dependent condition that causes deposits in the abdominal cavity. Logically it makes sense that getting rid of these deposits via surgery or slowing their growth with medication could help treat endo and the pain associated with it. But what does physical therapy have to do with the treatment of endometriosis? The answers range from simple to complex, with the complex delving into some pretty heady neuroscience. Why don’t we start with the simple first, and get more complex as we go.  

 

The deposits created in the abdominal cavity by endo can cause the tissues of the abdomen to get stuck and not slide and glide freely, we call those stuck areas, tissue restrictions or adhesions. The scars created by endo removal surgery cause adhesions. Sounds pretty bleak, but it’s not as bad as it sounds. Physical therapists have been treating scars for eons (actually since the start of the civil war, but we digress). Whether or not you have had surgery, chances are you will benefit from some myofascial release, which can help reduce endo and surgery related adhesions. Although most physical therapists know their way around scar massage, it is important to go to one who has been specially trained in pelvic floor conditions and ideally has been trained in visceral mobilization. This training will allow your PT to address adhesions of the viscera (your organs) as well as allow them to work on adhesions in the pelvic bowl by performing intravaginal and intrarectal release.

Here’s where it gets heady, bare with me. Let’s start with defining my subheading. Trigger points are taut bands of muscle that are extremely irritable. Trigger points can be described as “latent”, meaning they are painful when touched, or they may be an active myofascial trigger point, which is constantly angry and can refer pain elsewhere in the body. Trigger points in the abdominal-pelvic region can radiate to some funny places far away from where they actually are. Someone may feel the referred pain from a trigger point in their belly or back, near their bladder, or in their “ovary”, as well as other places.  Physical therapy can help relieve these trigger points by performing myofascial release as well as using techniques like biofeedback to help you learn how to relax your pelvic floor and prevent trigger points from reoccurring.

People who have been in pain for a long time may experience a phenomenon called central sensitization. What that means is the body, in an effort to protect you, starts perceiving things that wouldn’t necessarily be painful as painful. No one actively does this, and it is not in your head. It actually happens in the spinal cord and brain. This is what I mean by endo lowering pain thresholds. Physical therapy can be instrumental in improving pain thresholds through a process of desensitization.

What we just discussed are some of the most common things physical therapists address in patients with endometriosis. But let us not forget that everyone with endo experiences it differently. Pelvic floor physical therapists may address issues with urination, sex, and bowel movements directly as well as other issues like weakness, joint pain, and instability. It really is specific to the individual with endo.

Many people find relief in making adjustments to their lifestyle and diet. There have been numerous studies on the benefits of yoga on endo pain, as well as making changes in diet such as avoiding gluten, dairy, sugar, caffeine or committing to an IC and anti-inflammatory diet. In my experience, different things will work better for different people, but we have seen these changes be extremely helpful for some people. We write more about these changes in this blog.

We hope this blog was helpful to you. Having endo can really suck (we can’t think of a better word for it). If you think you may have endo, talk to a gyno who specializes in the treatment of endometriosis, because there is something you can do about your symptoms. Endo is a disease which requires much more research and awareness. Please take time this March to wear some yellow and do your part to spread endo awareness to physicians and other healthcare providers, to high schools and to your community.  

endo
This is the cover from Dr. Amy Stein and Iris Obruch’s latest book on endometriosis, available soon

 

Alimi Y, Iwanga J, Loukas M, et al. The clinical anatomy of endometriosis: A review. Cureus. 2108

 

Aredo J, Heyrana K, Karp B, et al. Relating chronic pelvic pain and endometriosis to signs of sensitization and myofascial pain and dysfunction. Semin Reprod Med. 2017; 35(1):88-97

 

Mayo Clinic. “Endometriosis”.

. Accessed on February 19, 2019  

 

Mehedintu C, Plotogea MN, Ionescu S. Endometriosis is still a challenge. Journal of Medicine and Life. 2014. 7(3); 349-57

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 got really frustrated. If this sounds like you, I highly encourage you to come to our next pelvic health seminar on October 4th  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 pelvichealth101.eventbrite.com today.

 

 

Location

110 East 42nd Street, Suite 1504

New York, NY

10017

Pelvic Health 101 Fall 2018

 

May is Pelvic Pain Awareness Month

Mayis PelvicPainAwarenessmonth

Fiona McMahon PT, DPT

May is Pelvic Pain Awareness Month: #PelvicPainAware. This is a big deal to us at Beyond Basics Physical Therapy, where we see it as our mission to spread awareness of pelvic pain and dysfunction to clinicians and patients alike. This month is spearheaded by the International Pelvic Pain Society (IPPS), of which, the founder of Beyond Basics, Amy Stein is the president. Amy took time to sit down with me to describe all of the fantastic things that are planned for this month so I can share them with you.

Before we get started, I want to share a little about IPPS, the organizer of Pelvic Pain Awareness Month. IPPS was founded in 1996. It is a society of healthcare clinicians who treat abdomino-pelvic pain conditions in men, women, and children. Their mission is twofold: “To educate healthcare professionals how to diagnose and manage chronic pelvic pain, thereby changing the lives of patients worldwide.” and “To bring hope to men and women who suffer from chronic pelvic pain by significantly raising public awareness and impacting individual lives.” Pelvic Pain Awareness month, is our opportunity to spread awareness among professionals and public alike in hopes of improving outcomes and demystifying pelvic pain.

Now let’s get started with Amy’s interview!

Fiona: Why did IPPS feel the need to start a pelvic pain awareness month?

  • Amy: I felt like it was needed. As president of IPPS, I wanted to make some changes to awareness, and I felt this was a great opportunity to get the word out and stop patients from having to suffer in silence. I wanted it to be abdomino-pelvic pain awareness month, but the phrase was too long.

 

Fiona: What activities does IPPS have planned this month to spread awareness of pelvic pain?

  • Amy: We created a pelvic pain awareness page on facebook and continue to tweet about it @intpelvicpain. We are also doing a blog talk radio interview with Lorimer Moseley, PhD, PT from Adelaide, Australia, on blogtalk radio/pelvic messenger on Thursday, May 18th at 7.30pm EST. Lorimer Moseley has written 270 articles and 6 books on pain. If you want to interview someone who is experienced in the study of pain and the brain, he is a good person to be interviewing. May 17th in New York City, we are doing a local fundraising/ networking event in the Green Room on 23rd street from 6:30-8:30pm to create more awareness locally. On may 25th, 9pm EST, 6pm PST we are doing a twitter journal club. An article on sexual health in women affected by cancer  will be featured, as well as one on vulvodynia, and prostatitis . [Click here to access the articles we will be discussing!] Each year we plan to add on more events for May is #PelvicPainAware both locally and internationally. 

 

 

Fiona: Why is it so important to build awareness of abdomino-pelvic pain conditions? What was the big driver for IPPS in doing this work?

  • Amy: Bringing awareness of abdomino-pelvic pain conditions is one of the main missions for IPPS, as well as Beyond Basics Physical Therapy and I believe it is a mission of many of other clinics, hospitals, etc, that treat pelvic pain. Again, it is such a common experience of many, many patients who visit us, to have gone to various well-known institutions throughout the country for pelvic pain, to be told it is all in there head and that they just need mental health therapy or a glass of wine. This infuriates me STILL (20 years later!), as well as the patients. Often times it will take just one session with an experienced pelvic health physical therapist or healthcare provider to have hope again. Many of our patients have been to 5 up to 10 physicians/healthcare providers and ended up being misdiagnosed, undiagnosed, or told to go home and relax; or even worse, have more sex or switch partners. Yes, pain is processed in your brain, but there is a physical component with most of these patients.

Fiona: Where would you suggest someone who is starting their journey? What resources would you recommend?

  • Amy: I would suggest to look at International Pelvic Pain Society, International Cystitis Association, IC-network, Endometriosis Association, National Vulvodynia Association, American Physical Therapy Association (APTA) or Herman and Wallace “ Find a provider”, for you to find physical therapists and physicians. Even taking that a step further, when you find a provider, do some research: ask how often your provider sees pelvic pain patients,, how long have they been treating in this area, because that can make a difference. If you go to someone who is not as experienced or is not trained, you might hit a roadblock or plateau in your progress.
  •  I would caution against looking up too much on patient-centered forums; however, here are a lot of great blogs out there that can help give you helpful information. There are some great books out there, like Heal Pelvic Pain, and Pelvic Pain Explained, Sex without Pain, and Pelvic Pain Management.  For providers, I want to add that IPPS is hosting the World Congress on Pelvic and Abdominal Pain in Washington D.C. at the Renaissance Hotel in October 11-15th. We have Lorimer Moseley and Paul Hodges flying in from Australia. They both have done extensive research in pain. This year we are doing 9 clusters on different topics with poster and abstract presentations, as well as a post conference on The Pain Revolution, with Paul Hodges, PhD and Lorimer Moseley, PhD, PT

Fiona: If you had to distill your message for May is Pelvic Pain Awareness month, what would you like the public, people with and without pelvic pain to get from this month?

  • Amy: I would like them to know there are resources and providers out there for abdomino-pelvic pain conditions. But remember to do your homework when deciding who and what is best for you. For providers, there are great resources too, including the International Pelvic Pain Society to help better your practice.

We also want everyone to know we are having a give away in honor of Pelvic Pain Awareness Month! Learn more info below!

For Everyone!

IPPS Facebook Page

Twitter: @IntPelvicPain #pelvicpainaware

IPPS

Blog Talk Radio/Pelvic Messenger

 

For Patients!

International Pelvic Pain Society: Find a provider

National Vulvodynia Association: Health Care Provider List

APTA Find a clinician

Herman and Wallace Find a Clinician

 

Give Away Information

Giveaway open internationally ). Must provide a mailing address within 48 hours of notification of winning, otherwise another winner will be selected at random. Click here for full details,
We have several generous donors lined up for the hour and will be randomly giving away the following items during the event:
1 Copy of Amy Stein’s Book “Heal Pelvic Pain” & DVD Healing Pelvic and Abdominal Pain”  (follow @beyondbasicspt @HealPelvicPain2)  (Open to International)
1 Copy of Heather Jeffcoat’s book “Sex Without Pain: A Self Treatment Guid to the Sex Life You Deserve” (follow @SexWithoutPain @TheLadyPartsPT) (Open to International)
1 Copy of Stephanie Prendergast and Elizabeth Rummer’s book “Pelvic Pain Explained”   (follow @PelvicPainExp @PelvicHealth) (Open to International)
1 Gift Card to Soul Source Dilators (link to soulsource.com)  (follow @SoulSourceTD) (Open to US only)
2 EndoFemm heating/cooling pads by Pelvic Pain Solutions (Open to US only)
2 CAPPS Travel Cushions by Pelvic Pain Solutions by Pelvic Pain Solutions  (follow @EndoFEMM) (Open to US only)
2 Multi-Comfort Therapy Pads by Pelvic Pain Solutions (Open to US only)
Official Rules: This giveaway is open to US only (except where specifically indicated as international above). The following guidelines must be followed to be eligible: Use the #PelvicPainAware hashtag during the twitter party from 6PM PST to 7PM PST to be entered into the random drawing. Must follow @IntPelvicPain @TheLadyPartsPT so we may contact you after the event regarding your winnings. Winners will have 48 hours from the time of notification to provide us with their eligible mailing address, or else a new winner will be randomly selected.
 
Twitter Party/Journal Club Disclaimer: Tweets during the 1 hour event are not to be taken as medical advice. We recommend following up with your team of providers to gain your most optimal care.