Continuing our Education: Treating Pain in Individuals with Male Anatomy

Fiona McMahon PT, DPT

One of the requirements for maintaining your license as a physical therapist, is to take continuing education classes. The amount of classes you are required to take will vary from state to state. Many physical therapists take the option to do the bare minimum required to maintain their license. This is not the case with the PTs at Beyond Basics Physical Therapy, whom also do a ton of in house training, in-services, case studies, and journal clubs in addition to formal classes. Many of our physical therapists exhaust their continuing education days and continuing education budget and chose to attend continuing ed on their own time and dollar, because they love it so much. Even though, they are well beyond satisfying their requirements for licensure. It is something that makes the physical therapists at Beyond Basics really special and in the top of their field.

As practicing pelvic floor physical therapists, we have extensive experience, but the truth of the matter is we can always know more. For many of us, before we arrived at Beyond Basics, we learned to treat pelvic pain on individuals with male anatomy by avoiding the penis all together. To be honest, we can get a lot of patient’s better by treating the muscles of the pelvic floor internally, but as a group, we were eager to be able to learn and treat issues of the penis directly. We just wanted to be able to get patients with issues like Peyronie’s disease (a bend in the penis, due to dysfunction in the fascia), erectile dysfunction and incomplete bladder emptying better on a much quicker time scale.

We were lucky to have Sara Sauder, PT, DPT and Kelli Wilson, PT, DPT, FAAOPPT, OCS come up to visit us in NYC one cold Saturday in January to help us expand our physical therapy tool boxes for individuals suffering from the following conditions, amongst others:

  • Erectile Dysfunction
  • Post Vasectomy Pain Syndrome
  • Prostatitis
  • Urinary Pain
  • Urinary incontinence
  • Pain following Hernia Surgery
  • Circumcision Scarring

In the class we covered a broad range of factors influencing the health and function of male reproductive anatomy, including the interplay of hormones, scar tissue from old surgery, restrictions in the fascia of the penis or scrotum, and hernia. We learned hands on techniques to improve the movement of tissues around and blood flow to the penis and scrotum.

Speaking for all of us, I would say, that Sara and Kelli helped us to better treat our male patients. It is clear as physical therapists, we continue to grow and learn long after physical therapy school. We at Beyond Basics Physical Therapy hold our continuing education close to our hearts and truly believe it is what sets us apart from other physical therapy clinics.

If you are interested in learning more about what we can do for pelvic floor conditions of the male anatomy, check out our other articles here!

All About Testicles

Prostatitis What it is and What to do About it

Also for more information on how manual physical therapy can help pain conditions of the male anatomy, check out this article:

Anderson R, Wise D, Sawyer T, et al. Integration of myofascial trigger point release and paradoxical relaxation training treatment of chronic pelvic pain in men. J Urol. 2005; 174(1): 155-60

 

You can read the full abstract here

BBPT Health Tip: Eat your Fiber

breakfast-1804457_1920

Fiona McMahon, DPT, PT

What is fiber?

Fiber, it’s the hot ticket. It is being marketed to us like crazy. But why is fiber is so important? What fiber is best? Should you get more fiber with supplements? Let’s take a closer look into the benefits of fiber in this edition of BBPT’s Health tips.

Fiber is the part of food that we cannot digest. It is separated into two types, soluble and insoluble. Both bulk up the contents of your stomach and colon, which can help you feel more full but after that, the similarities end.

As the name implies, soluble fiber dissolves in water but insoluble does not. Insoluble fiber increases the mass of the stool and helps to get things moving, in terms of passing feces. Soluble fiber absorbs water. The truth is, most people are not getting enough fiber. Less than half of people in the United States consume the recommended amount of fiber. Let’s discuss the benefits of fiber and how to make sure you are getting enough.

 

So what if you don’t have issues going number 2? What else can fiber help you with?

 

Fiber has been shown to help with reducing the risk of the following conditions:

  • Coronary artery disease
  • Stroke
  • High blood pressure
  • Diabetes
  • Obesity

Fiber has also been shown to:

  • Improve insulin sensitivity in people who have diabetes
  • Enhance weight loss
  • Improve GI conditions like acid reflux, duodenal ulcers, diverticulitis, constipation, and hemorrhoids
  • Enhance the function of the immune system

 

How much to eat and where to get it?

Men under 50 years and under should consume at least 38 grams of fiber daily, Women under 50 should consume at least 25 grams of fiber daily. Women over 50 should eat at least 21 grams and men over 50 should get 30. Those who suffer from constipation may add more to your diet. We suggest contacting a nutritionist for proper amounts of soluble versus insoluble in these cases and anyone with a history of GI issues. Also, please discuss with your doctor before making any drastic changes to your diet.

Adding fiber to your diet when you are not used to it can sometimes be a little difficult. If you add too much too quickly, you may experience gas and bloating. Start slow and work your way up. Also, drink plenty of water.

Start by adding in whole wheat items (unless you have a gluten sensitivity), legumes, fruits, and vegetables slowly to your diet. Check out the Mayo Clinic’s full list of fiber rich foods here http://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/high-fiber-foods/art-20050948

Sources

 

Anderson J, Baird P, Davis R, et al. Health benefits of dietary fiber. Nutr Rev. 2009. 67(4)188-205

Family Doctor.org Decermber 2010: http://familydoctor.org/familydoctor/en/prevention-wellness/food-nutrition/nutrients/fiber-how-to-increase-the-amount-in-your-diet.printerview.all.html. Accessed November 11, 2016.

Medlineplus. Soluble vs. insoluble fiber.https://medlineplus.gov/ency/article/002136.htm. Accessed November 17,2016.

The Scoop When Kids Have Trouble with Poop

 

Kiddo

Fiona McMahon PT, DPT

I spend a lot of my time at work talking about poop. In fact, poop discussions run in my family. My great grandmother, a nurse in the 1920’s, would always inquire about her charges and her children’s movements when they’d complain of any ailment. This scatological interest was passed to my grandfather, a civil engineer, designing and working in wastewater treatment plants, to my mother who was a nurse practitioner, who dealt with digestive issues and famously asked a guest at her parents’ dinner party when she was a child, “how are your bowel movements, lately?” This familial interest in the distal end of the alimentary canal was bequeathed unto me and I now spend much of my working life trying to help people of all ages with issues defecating to live more comfortable and full lives when it comes to bowel movements.

Anyone who has had any issues concerning their ability to poop, or to hold it, can attest to how much havoc issues with bowel movements can cause in one’s life. This is especially true when it comes to children. Children often have continence requirements to attend school, camp, and other activities. Not to mention other children may not always be very kind to another child who is experiencing difficulty with their bowels. Aside from the obvious issues of constipation and incontinence, kids with bowel issues can experience other symptoms like pain in their belly or with defecation, foul body odor, problems with their bladder, including incontinence, as well as skidmarks in their underwear or itchy bums. It really does all come down to poop.

The largest driver of bowel problems in kids is constipation. Constipation is surprisingly common and occurs in 4-36% of children. It accounts for 3% of visits to the pediatrician and 30% of visits to pediatric gastroenterologists. Constipation can be tricky to diagnose and many people who have children who are constipated, do not identify constipation as the culprit for issues like bowel and urinary incontinence, and pain. According to Afzar and colleagues, constipation would be missed nearly 50% of the time in children, if infrequent bowel movements was the only criteria used in assessing constipation in children.

So what criteria do we use to assess constipation in kiddos? We obviously look at how often a child is defecating. Two or less bowel movements a week is considered constipation, but it is important to keep in mind that a child with difficulty evacuating may move one or two small pellets multiple times a day and still be severely constipated.  Check out the Bristol Stool Chart here to determine if your child’s BM’s are normal. Types one and 2 indicated constipation. Bowel incontinence is also an indicator of constipation in children. In fact, 90% of children with constipation experience fecal soiling. Kiddos with large fecal masses felt in the rectum by a doctor or through the abdomen, those with history of painful bowel movements, and those who produce large toilet clogging poops are exhibiting symptoms of constipation. Children with constipation may also exhibit retentive posture in an effort to prevent painful bowel movements. They may go up on their toes, squeeze their butt cheeks and thighs together, cry, and rock back and forth. Retentive postures can trick parents into thinking their child is trying to defecate when in fact they are working hard to keep everything inside. If you see any of these symptoms in a child under 4 years lasting for a month, and over 2 months in kids over 4, you are dealing with constipation

Constipation can be divided into two different types, functional and constipation due to an organic or pathological cause. Around 95% of constipation in both adults and children is considered functional. Functional constipation can occur for a variety of different reasons in children. One of the most common reasons is that children can get in the habit of delaying or trying to prevent defecation. Children are often just as busy as the rest of us. They may simply be too busy in the morning to have a full bowel movement. Once they arrive at school, they are faced with bathrooms that have doors that may or may not lock, or they may have to contend with intimidating multi-stalled public toilets. Either way both are not conducive to pooping. After school is usually filled with activities and a mad dash to do homework. You can see that it may be very difficult to schedule in a good time to use the toilet. Kids also delay going to the bathroom because it hurts or may be uncomfortable to go. The more they delay their bowel movements, the more uncomfortable it can be to go. Thus creating a negative feedback loop that just feeds back on itself and worsens the constipation symptoms.

Weeks of delay whether it be secondary to pain, scheduling, or plain old distraction, can cause a big build up of poo in the very end of the digestive system, the rectum.  The accumulated fecal matter may be backed up through the  entire length of the colon. This big build up of feces in the rectum causes it to  stretch out.  A stretched out rectum is not good at holding feces in, or sensing that it is time to go to the bathroom, making the problem even worse. Furthermore, soft poo will easily slide by the hard fecal blockage and create smears or “skidmarks” in the underwear, or even more severe incontinence mistakenly labeled diarrhea. Chronic fecal impaction, and fecal withholding can alter how the muscles that control continence work (the pelvic floor), which may further worsen this constipation syndrome. Skidmarks, constipation and fecal incontinence are not anyone’s fault, especially the child’s, but it is a problem that can be solved.

So what to do about all of this? Is it too late if your child has been constipated for a long time? Tackling poo problems in kids is daunting for both parents/guardians alike. The first step is educating yourself, your doctor, and your child. My motto for the kiddos that I treat is, “Accidents are not your fault, but it is your problem to solve.” Letting children know what is happening in their body can help them further internalize this message and become more invested in the process to remedy their symptoms.

Next you have to tackle the poo situation inside of your child’s tummy, This is where a two pronged approach is key. Both physical therapy and your doctor will get you on the right track. Your doctor will screen your child for that 5% of constipation cases that are caused by organic causes like Hirshprung’s disease, thyroid issues, and notably cow’s milk allergies and gluten intolerance/ celiac disease. It is important to be screened for these allergies and food intolerance as they represent a large portion of organic constipation cases. Once organic causes are ruled out, your doctor will start medication to help clean out the bowels. Miralax (Polyethylene glycol), is a mainstay of pediatric constipation treatment and is generally best tolerated. Miralax may be first given in large amounts to clean out the bowel, and then followed with smaller maintenance and then slowly tapered off as the rectum reduces from it’s stretched out size. It is important to remember that when starting miralax, especially at “clean out”, doses will likely increase episodes of incontinence at first, so prepare both yourself and your child. Make sure to consult your doctor before attempting any sort of clean out on your own.

Next up is physical therapy. Our main goal is to keep poo moving and avoid buildups so your child’s body can heal. We will teach you ways to massage the colon through the belly to keep poo exiting and to reduce back ups and the need for laxatives. We also work to teach your child to sit on the toilet in a way that will help the poo as easily and painlessly as possible. More often than not, kiddos with constipation have pretty weak cores that make defecating difficult. As pediatric physical therapists, I humbly assert that we are the masters at dreaming up fun ways to gain a little core strength in session and at home to help make bathroom trips easier.

What Beyond Basics does that is truly unique from non pelvic floor physical therapists, is we train the muscles of the pelvic floor (the muscles that control both the the anal and urethral opening to better open and close). Kiddos with chronic constipation tend to have pelvic floors that are tight and uncoordinated. Paradoxical contraction occurs when a child tries to open their anal canal, and they truly believe they are doing so, however they are I n fact clamping it shut. We can treat this problem at Beyond Basics.

If your child would benefit from physical therapy, or an evaluation, to make pooping a bit easier, give us a call. Stay tuned for our next blog, where we will go over some practical at home tips for improving both you and your child’s pooping situation!

 

Sources

Afzal N, Tighe M, Thomson M. Constipation in Children. Ital J Pediatr. 2011; 37

 

Poddar U. Approach to constipation in children. Indian Pediatri. 2016;53(4) 319-27

 

 

All About Testicles

tennis ball isolated

By Fiona McMahon, PT, DPT

Testicles have long held a special place in our society.  In fact, the word testis means “witness of virility” in Latin. They help produce the hormones that spark puberty. They are responsible for body hair, the growth of the penis, and sex drive.

Testicles are gonads. Gonads are sex organs that produce sex cells.  People with male anatomy produce sperm and  people with female anatomy produce ova (eggs). Testicles also produce the hormone testosterone, which as stated earlier is responsible for people with male anatomy’s secondary sex characteristics, like body hair, muscle bulk, and sex drive.

Testicles are housed in the scrotum, a sack of skin just behind the penis. Within the scrotum, the testicles are covered by a fibrous sheath called the tunica vaginalis and tunica albuginea. The testicles are composed of many tightly bound tubules called the seminiferous tubules. These tubules give the testicles their uneven feel. Each testicle is held in the scrotum by the spermatic cord, which is composed of the vas deferens, blood vessels, and lymph vessels.

Anyone who has watched an Adam Sandler movie knows that testicles are delicate and sensitive creatures. Even just a jostle can be enough to double one over in pain. But sometimes your testicles may hurt for no apparent reason.  Acute scrotum is the technical name given to sudden onset testicular pain without swelling. There are many medical reasons your testicles may hurt.  Testicular pain can be a serious condition and should not be ignored.

Testicular torsion is a medical emergency that requires immediate treatment in order to save the testicle.  Testicular torsion is most common in people with male anatomy under the age of 25. It occurs when the spermatic cord twists cutting off blood supply to the testes. Usually testicular torsion is spontaneous and cause pain great enough to wake a one out of sleep and induce vomiting.

In some people testicular torsion is contributed to by what is known as a bell clapper deformity. A bell clapper deformity occurs when there is a lack of fixation in the tunica vaginalis. Because of this lack of fixation, the testis is free to rotate around on itself and obstruct blood flow. Bell clapper deformities are present in 12% of males and in males with bell clapper deformity 40% have bilateral derformity. In neonates, extravaginal torsion can occur when the tunica vaginalis and the testes both twist in the inguinal canal. Any case of sudden and severe testicular pain should be considered testicular torsion until proven otherwise and treated as a medical emergency.

Testicular cancer is usually painless but in 20% of cases pain can be a symptom. The pain caused by testicular cancer is typically due to hemorrhage. In the overall population testicular cancer is relatively rare, however it is the most common form of cancer in young males between the ages of 15 and 35. Signs of testicular cancer include a dull ache in the abdomen and groin, heaviness in the scrotum, lump in the testicle, enlargement of the breast tissue, or back pain. Any of these symptoms warrant a visit to your general practitioner.

So what about testicular pain that is not cancer or testicular torsion? Testicular pain can also be caused by other medical conditions like epididymitis, orchitis, urinary reflux, urinary tract infection, or sexually transmitted infection. Again as stated before, any acute testicular pain that occurs out of the blue warrants immediate medical attention.

There are some people however who suffer from acute and recurrent testicular pain for which a medical cause has not been established. For these people, not having concrete answers for what is going on can be especially distressing. In a paper by Anderson and colleagues, trigger points elsewhere in the body have been found to cause pain in the testicles, shaft of the penis, and other areas in the genital region.

Trigger points are defined as areas of hypersensitive and painful spots within the muscle that can be felt as a tough or tight band. In their study, Anderson and colleagues found that testicular pain could be elicited in 80% of men with testicular pain with no other medical cause, when trigger points in the external obliques were palpated. The study also found other trigger points referring to the shaft of the penis, and the perineum (the bicycle seat area of the body). Myofascial restrictions can refer pain to testicles as well as reduce blood flow to the genitals, making erections difficult or painful.

Irritated nerves can also be the cause of testicular and penile pain. The pudendal nerve is most commonly associated with male pelvic pain. The pudendal nerve supplies sensation to many of the pelvic structures including the penis, scrotum, and anorecatal region. This nerve can become inflamed or strained for a variety of different reasons. Straining with constipation, boney alignment that stresses the nerve, as well as tight ligaments and muscles that surround the area can all stress the pudendal nerve and cause scrotal, anal, or penile pain.

Other nerves such as the Iliohypogastric can cause suprapubic and gluteal pain. The inguinal nerve can cause pain in the inner thigh, and lateral scrotal skin. The genital femoral is also associated with the skin of the scrotum and thigh.

If you find yourself with testicular or penile pain that has not been resolved with medical intervention, it may be time to find your way to a licensed pelvic floor physical therapist. Physical therapists can work with you to break up your trigger points, provide postural education to correct alignment, reduce constipation with bowel training, and incorporate relaxation and postural changes to prevent your pain from coming back. At Beyond Basics, we have a great team of therapists who treat pelvic floor disorders who can help treat your testicular pain.

Sources:
Anatomy and physiology of the testicle. Canadian Cancer Society. http://www.cancer.ca/en/cancer-information/cancer-type/testicular/anatomy-and-physiology/?region=on. Accessed June 10, 2015
Anderson R, Sawyer T, Wise D, Morey A. Painful myofascial trigger points and pain sites in men with chronic prostatitis/ chronic pelvis pain syndrome. The Journal of Urology, 182;6 2753-58
Jefferies M, Cox A, Gupta A et al. The management of acute testicular pain in children and adolescents. BMJ. 2015
Mayo Clinic Staff. Testicle Pain. Accessed June 8, 2015. http://www.mayoclinic.org/symptoms/testicle-pain/basics/causes/sym-20050942
Mayo Clinic Staff. Testicular Cancer. http://www.mayoclinic.org/diseases-conditions/testicular-cancer/basics/definition/con-20043068. Accessed June 10, 2015

Demystifying Persistant Genital Arousal Disorder (PGAD)

PGAD photo

Fiona McMahon PT, DPT

Hello, everyone. Today I want to discuss a condition called Persistent Genital Arousal Disorder (PGAD). PGAD is an often sensationalized, painful, and disruptive condition that causes unwanted genital arousal, which doesn’t typically get better with orgasm and if it does, orgasm only brings relief for a short period of time. The key feature of this disorder is the genital arousal is unwanted and can cause deep psychological distress.

Typically when I write blogs, I will spend the lion’s share of my time sifting through scholarly articles, general health articles targeted at the general public, and maybe I will read one or two essays or editorials written by people with that particular condition. The process for writing this blog went a bit differently.

I was researching a condition that had only been first classified in 2001. There really was a small pool of articles from which to pull. I also had to sift through a lot of garbage. There were titles like “ Woman has 100 orgasms a day”, click bait, on click bait, on click bait. I thought of my patients and women and men, who are just starting their journey, not knowing where to start. Frankly, I was sad. I can’t think of a more eloquent way to say it: the web can be a real garbage pit sometimes. I can imagine how hopeless it might feel scouring the Internet for answers.

The good news is, I did not end my research sad. I ended up finding some great articles, but most importantly I listened to a fabulous Pelvic Messenger podcast with our very own Stephanie Stamas PT, DPT with guest Dr. Irwin Goldstein, MD, on PGAD. I ended my research feeling empowered, and it is my hope through this blog and additional resources I have provided, that you will too. If you have found your way here because you have or think you may have PGAD, please, do yourself a massive favor and give this podcast a listen. I will be breaking down so me of its points in this blog, but what the podcast does so well, is give hope.

Let’s go ahead and read on, and learn more about PGAD and how to manage it.

What Causes this Condition?

PGAD can affect people with both male and female anatomy. As Dr. Goldstein explains in the pelvic messenger podcast, It is more common in individuals with female anatomy, secondary to the fact the people with female anatomy have a shorter refractory period. The term refractory period refers to the interval of time that is required between an individual’s first orgasm and when they are able to become sexually aroused again. People with male anatomy tend to have longer refractory periods, allowing them some relief between bouts of arousal.

There are many factors that are thought to contribute to PGAD. It used to be considered more of a psychological disorder. Over the past 16 years, researchers have found that the development of PGAD can be influenced by stress, but there usually is some sort of anatomical or physiological factor contributing to the development of this condition.

The Role of the Brain

Like we discussed before, stress is a contributor and trigger to PGAD symptoms. Additionally, one of the criteria in diagnosing PGAD is that the genital arousal causes distress. Examining stress triggers and managing the stress of the disorder itself is paramount to effectively managing PGAD, especially if it is taking time to determine what physiological intervention will help treat the symptoms.

There also is some discussion that the sensations that trigger PGAD are processed differently in the brain. Disruptions in the vulvar, penile, or scrotal tissue, nerve compressions, pelvic congestion, etc may be processed in the “action” areas of the brain and may be interpreted as or cause arousal, when in fact, there is a physical condition irritating that delicate tissue that must be addressed.

Studies have also found a connection with PGAD suffers and individuals with restless leg syndrome. In a 2008 study PGAD and restless leg syndrome were found to be correlated. Restless leg syndrome bears some similarities to PGAD in that sufferers often feel they need to take action, like moving their legs, adjusting their position, and in individuals with PGAD, obtain orgasm for momentary relief. These findings amongst others support the theory that the brains of individuals with PGAD may interpret sensory signals differently that those without the condition.

Medication, Pearls, Back Problems, and Cysts

Now that we have talked about a potential explanation for persistent genital arousal as it relates to the brain, let’s talk about some of the physiologic contributors. The first factor found to be correlated with PGAD has to do with what we put in our mouths. There had been some evidence to support that increased soy intake may affect the development of PGAD. Also certain medications and withdrawal from them may also contribute to PGAD. Trazadone has been found to contribute to priapism (persistent and painful erection of the penis) in individuals with male anatomy and may also contribute to PGAD in individuals with female anatomy. There also has been a correlation with sudden withdrawal from selective serotonin reuptake inhibitors, (SSRI’s), a form of antidepressant, and the development of PGAD. We always have to remember the old adage that is familiar to anyone who has been taught to consume scientific literature that, “Correlation does not equal causation”. It’s really important to remember that phrase with PGAD, because there are many correctable physiological conditions that also contribute to PGAD.

Keratin pearls, sounds lovely, right? Not so much, and these bad boys are a big factor in the development of PGAD and other pelvic pain syndromes. Keratin pearls develop when the normal products of the vulvar tissue collect and harden under the clitoral hood. As you can imagine, having a keratin pearl is super irritating to this extremely sensitive tissue, not unlike having a piece of sand caught in your eye. This constant stimulation can certainly contribute to PGAD symptoms. Keratin pearls can be removed by an experienced doctor and bring relief for PGAD.

In pelvic floor physical therapy land we think a lot about the pudendal nerve. The pudendal nerve transmits sensory information from our genitals to our brain and gives our pelvic floor muscles instruction from the brain. The pudendal nerve comes off the sacral nerve roots, S2, S3, and S4, (remember this for later). This nerve can become compressed from tight muscles and fascia and can cause PGAD symptoms.

Physical therapists and other clinicians also think about the various “dynias”. Dynia is the Greek word for pain. In relation to PGAD we often think of clitorodynia, vulvodyina, and vestibulodynia referring to pain in the clitoris, vulva, and vestibule respectively. These “dynias” can be caused by irritated nerves, hormonal conditions and overactive pelvic floor muscles and should be addressed in order to help treat PGAD. Additionally, other pelvic syndromes like pelvic congestion can contribute to PGAD.

Do you remember the nerve roots for the pudendal nerve? It’s okay if you don’t. They are the sacral nerve roots S2, S3, S4. Your sacrum is part of your spine and problems in your back like a slipped disc, irritable facet joint, stenosis can all be culprits in irritating these very important nerve roots.

There are these things called Tarlov’s Cysts which recently have been found to be huge in the development of PGAD. Tarlov’s cysts are little sacs filled with cerebrospinal fluid and they can irritate those important nerve roots, S2, S3, and S4. In 2012, it was found that the rate of Tarlov’s cysts is exceptionally high in individuals with PGAD. Management of these cysts can help with this disorder.

Treatment Options and Finding the Correct Practitioner to Connect you to Those Options

So there is a lot of stuff to sort through when trying to figure out where your PGAD is coming from. It requires a skilled clinician to separate the signal from the noise. At Beyond Basics Physical Therapy, we are especially poised to help you get started on the correct treatment path.

Unlike many other clinicians, we are comfortable assessing things like the mobility of the clitoral hood, mobility of the structures surrounding the pudendal nerve and other pelvic nerves, as well as being able to treat issues involving the back and tailbone. We also have strong and robust connections to physicians who are pioneers in the treatment of PGAD and can help facilitate access to complementary medical treatment.

The most important part of treating PGAD is finding the cause, or the driver. Once the driver or drivers are found, you can begin the process of treating them and reducing PGAD symptoms. Dynias, clitoral adhesions, pelvic floor congestion, back issues and irritation to a pelvic nerve can be treated by physical therapy or a combination of physical therapy and medical intervention. Tarlov’s cysts may require surgery to correct. Additionally medication to reduce the symptoms, mental health therapy and relaxation techniques can be helpful.

PGAD used to be such a mystery and in some respects, it still is; however we are in a very exciting time, where knowledge about PGAD is growing as well as our ability to diagnose and treat this disorder. The internet is a very scary place to research PGAD and it can be hard to find almost anything hopeful or positive, but there is hope. Give the Pelvic Messenger Podcast a listen and make an appointment to see us here at BBPT today.

Charitable Giving Options to Support Research and Treatment

Like many pelvic pain conditions, PGAD is under researched. Research is an essential weapon to help us fight PGAD and improve individual’s lives. Please consider donating to the following organizations to fund the development of diagnosis and treatment protocols for PGAD and other pelvic conditions. Also, consider having your company or a friend’s company match you donation.

Donate to support pelvic pain research here:

International Pelvic Pain Society : IPPS https://wjweis.association-service.org/securesite/ipps/donations.aspx

International Society for the Study of Women’s Sexual Health ISSWSH; http://www.isswsh.org/about/endowment-fund

Sources

Aswath M. Pandit L, Kashyap K. et al. Persistent Genital Arousal Disorder. Indian J Pyschol Med. 2016; 38(4)

Jewell T, Legg T. What is persistent genital arousal disorder (PGAD?). Healthline. 2017 [Accessed: November 13, 2017]

Komisaruk B, Lee H. Prevalence of Sacral Spinal (Tarlov) Cysts in Persistent Genital Arousal Disorder. J Sex Med. 2012 Aug;9(8):2047-56.

Stamas, Stephanie. “ Dr. Irwin Goldstein: Treating Persistent Genital Arousal Disorder (PGAD).” Audio Blog Post. Pelvic Messenger Podcast. Blog Talk Radio. March 2017

Waldinger M, Schweitzer D. Persistent Genital Arousal Disorder in 18 Dutch Women: Part II- A Syndrome Clustered with Restless Legs and Overactive Bladder. J Sex Med. 2008

Ph101 Why is Pooping so Difficult?

toilet 2

Fiona McMahon, DPT

The number of Americans who deal with constipation issues is massive (4 million!)! It seems like every time I mention that I’m a pelvic floor physical therapist, another friend of a friend pulls me aside with bowel movement concerns. Why is it that so many people have issues? And more importantly – what can we do about it? This is the topic of our next Pelvic Health 101 seminar  on  October 11th at 7pm.

Not only will constipation be discussed but other bowel conditions, such as irritable bowel syndrome, fecal incontinence, bloating, and hemorrhoids will be addressed. The lecture will also go in depth on the role of fiber, water intake, toilet posture and pelvic floor muscles in having a successful bowel movement. You will even go home with easy techniques that you can implement immediately to help you get that smooth move! Don’t miss out on this FREE event – it’s a MUST for anyone who struggles on the porcelain throne. Seats are going fast!  Light snacks and refreshments will be served.

Register at pelvichealth101.eventbrite.com  today.

Location

110 East 42nd Street, Suite 1504

New York, NY

10017

Check out or upcoming courses!

Pelvic Health 101 Fall 2017

 

PH101: Running to the Bathroom Again?

toiletFiona McMahon PT, DPT

Do you find yourself with a full map of every public restroom along your daily commute in your head? Do you find yourself competing for the aisle seat at movies so you can sneak away to the bathroom? Does it hurt to go? Do you get up multiple times a night? If you answered yes to any of these questions, this week’s Pelvic Health 101 is for you.

On Wednesday, September 27, at 7pm, join Stephanie Stamas, physical therapist at Beyond Basics Physical Therapy, for all of the ins and outs of bladder health. Learn how the bladder works, common bladder disorders, and practical tips for helping your bladder symptoms. Light refreshments will be served.

Register at pelvichealth101.eventbrite.com  today.

Location

110 East 42nd Street, Suite 1504

New York, NY

10017

Pelvic Health 101 Fall 2017