Beyond Basics is Visting Brooklyn!!!!

Brooklyn

 

Fiona McMahon PT, DPT

Have you got pelvic floor questions? Have you desperately wanted to go to one of our PH101 classes, but can’t swing 7pm in midtown in the middle of the week? Well, I have great news and GREATER news. I know, right… how much great news can you handle? The first bit of awesome, is that Beyond Basics’ Physical Therapists’, Dr. Fiona McMahon and Dr. Sarah Paplanus are hosting a forum and open discussion on pelvic floor health and treatment on Saturday, April 28th at The Floor on Atlantic (310 Atlantic Avenue in Brooklyn) at 12 noon. We will be there to explain the ins and outs of the pelvic floor, what can go wrong with it, and best yet, how you can heal it. It is a must go to event. RSVP here. Also, it’s FREE!

So what’s the other news, Fiona? Well, it’s that although we are not in Brooklyn, we have opened another office just across the river from Brooklyn, Beyond Basics Physical Therapy Downtown. In enlarging our footprint we hope to expand access and convenience to patients living downtown and in Brooklyn. We will be hosting a Grand Opening and 15 year anniversary celebration at our new location: 156 William St, Suite 800 New York, NY 10038 on Thursday, April, 26th from 4pm – 7pm. Come and enjoy food, drinks and meet our Physical Therapists. RSVP here.

 

 

Building a strong foundation – Treating the pelvic floor in individuals with multiple sclerosis

By: Kaitlyn Parrotte, PT, DPT, OCS, CFMT

MS

What is Multiple Sclerosis?

Multiple Sclerosis (MS) is an “immune-mediated” disease, in which the body’s immune system attacks the central nervous system (1).  The cause is unknown. MS is characterized by injuries (plaques) of the myelin, which is a fatty substance that surrounds and insulates the nerve fibers; nerve fibers themselves may also be attacked. The damaged myelin forms scar tissue that is called “sclerosis,” which is how the disease was named (1,2).  When the myelin, or nerve fibers, are damaged or destroyed at any point on the neural pathway, nerve impulses that are traveling between the brain, spinal cord and the body are interrupted, and as a result, can create a variety of symptoms.(1)

Symptoms:

The more common symptoms seen in individuals with MS are:

  • Fatigue
  • Numbness or tingling
  • Weakness
  • Dizziness or Vertigo
  • Sexual Problems
  • Pain
  • Emotional changes
  • Walking difficulties
  • Spasticity
  • Vision problems
  • Bladder problems
  • Bowel problems
  • Cognitive changes
  • Depression(1)

Types of MS:

There are four disease courses that have been identified in multiple sclerosis:

  • Clinically Isolated Syndrome (CIS) – a first episode of neurologic symptoms in the central nervous system, which lasts at least 24 hours.(1)
  • Relapsing-remitting MS (RMSS) – the most common form of the disease, that is characterized by clearly defined episodes of new or increasing neurologic symptoms (relapses), followed by periods of partial or complete recovery (remissions).(1)
  • Primary progressive MS (PPMS) – characterized by a gradual worsening of neurologic function, from the onset of symptoms, without any relapses or remissions.(1)
  • Secondary progressive MS (SPMS) – follows a course of MS that is initially relapsing-remitting. Most people with RMSS will eventually transition into a secondary progressive course, which is when their neurologic function will gradually worsen over time.(1)

Treatment of MS:

Because of the complex nature of this condition, and because it is not a curable disease, the management of MS requires comprehensive care. One component of that care is physical therapy. A physical therapist will evaluate and address the body’s ability to move and function. Common physical therapy interventions frequently address walking and mobility, strength, balance, posture, fatigue, and pain. However, did you know that physical therapy can also treat issues with bowel, bladder, and sexual dysfunction(1)? These dysfunctions are addressed through treating the pelvic floor musculature and surrounding tissues, which is performed by specially trained clinicians, such as the physical therapists at Beyond Basics Physical Therapy.

 

Bowel Dysfunction:

As previously noted, patients with MS can have various symptoms, including symptoms related to pelvic floor dysfunction, such as bladder, bowel, and/or sexual dysfunction. According to one study from 2016, individuals with MS can have lower anal sphincter pressure (which limits their ability to control stool flow), as well as higher rectal sensitivity (which makes it more difficult for a person to appropriately recognize when they need to defecate). These can increase the occurrence of fecal incontinence (involuntary leakage of stool), as adequate muscle strength and tone are needed to prevent leakage, and appropriate urge is required to ensure a person can get to the bathroom when they actually need to go (3) Even in the constipated individual with MS, there is a decrease in anal sphincter tone, which results in poor muscle coordination, making the release of stool more challenging (3) With these individuals, pelvic floor relaxation is typically needed to allow for easier and complete emptying and to decrease symptoms of bowel urgency.

Several studies from the late 1990s and early 2000s have looked at using biofeedback to help retrain muscle coordination. Biofeedback was applied in two ways: through stick-on electrodes that measured the response of muscles surrounding the anus, and with feedback applied internally in the rectum, with a finger, rental sensor or balloon. With stick-on electrodes, individuals are typically connected to a machine that allows them to see the electrical activity of their muscles, so they can work on controlling them (contract or relax). With internal feedback through a therapist’s gloved finger, with a rectal sensor or balloon, individuals can improve muscle control through gaining better awareness of their pelvic floor muscles. Researchers found that the use of biofeedback yielded some improvement in patient reported disability for those experiencing either constipation or fecal incontinence (4,5).  Physical therapy treatments to address muscle coordination and sensitivity can be helpful to treat those experiencing constipation or fecal incontinence related to MS; however, more research is needed to help enhance care.

Urinary Dysfunction:

As MS impacts the nerve signal transmission along nerve channels, urinary dysfunction frequently occurs (6) The most common urinary disorder seen in this population is urinary incontinence, which is involuntary leakage of urine. Urinary incontinence is related to fatigue and uncoordinated muscle recruitment, which are characteristic of MS, and can have a significant impact on an individual’s quality of life(2) Another common diagnosis is overactive bladder, which interrupts bladder function and causes a sudden need to urinate(6). This may occur, at least in part, due to hyperactive muscles in the pelvic floor that have become too short and tight over time.

Many groups have looked at the impact of physical therapy to directly address weaknesses that develop in the pelvic floor, and are related to urinary dysfunction (6,7) Two separate articles published in 2016 looked at groups of women with MS, and split them into groups to undergo pelvic floor muscle training with and without some form of electrical stimulation. The emphasis of this intervention was to train the pelvic floor muscles how to activate without compensation from surrounding muscles, over the course of several months (6,7) By the end of one study, women in both groups demonstrated increased pelvic floor strength and endurance, decreased symptoms of overactive bladder, and decreased anxiety and depression (6). In the other study, all three groups exhibited a decrease in pad weight, which measured the amount of urinary leakage, as well as decreased frequency of urgency and urge incontinence episodes(7). This research is showing that direct treatment to the pelvic floor muscles help to decrease urinary symptoms in people with MS, as muscle strength and endurance are increased.

Sexual Dysfunction:

Sexual dysfunction is also common in individuals with MS (affecting 40%-80%)(8). Sexual arousal begins in the nervous system with the brain sending signals through the spinal cord and nerves to the sexual organs. These pathways can become damaged due to the effects of MS on the nervous system, which in turn impacts a person’s sexual response or sensation. Symptoms of this may manifest as difficulty achieving orgasm or loss of libido, as well as erectile dysfunction in men, and altered clitoral/vaginal sensation or vaginal dryness in women (9). Other symptoms of MS, such as fatigue, muscle weakness, and spasticity also negatively impact sexual response in this population (8).

Pelvic floor muscles are responsible for rhythmical involuntary contractions during orgasm. These contractions occur when sensory information travels through nerves to these muscles. Continued, uninterrupted stimulation may allow for sexual arousal to progress and build up to a maximum point. Once this point is reached, the pelvic floor muscles, which have been gradually becoming tighter and tighter, get even tighter, hold this tension momentarily, and then release all tension; this is an orgasm (10). Through various research, it has been shown that weak pelvic floor muscles can lead to a decrease in orgasm and arousal (8) and specific pelvic floor muscle strengthening can help improve sexual function, especially in females (11,12,13).

One study that looks at MS-related sexual dysfunction is a 2014 article published in the Multiple Sclerosis Journal. This article took 20 women diagnosed with relapsing-remitting MS, and divided them into three treatment groups: pelvic floor muscle training alone, pelvic floor muscle training with intravaginal electrical stimulation, and pelvic floor muscle training with electrical stimulation applied over a nerve in the leg. The pelvic floor muscle training in each group consisted of teaching each participant how to contract her pelvic floor without using surrounding muscles as a compensation, and then performing both fast and slow contractions, over twelve weeks of treatments. After the twelve weeks of treatment, individuals in all three groups demonstrated significant improvements in muscle power, endurance, and fast contractions of the pelvic floor. They also reported an increase in the total score, as well as the arousal, lubrication, and satisfaction subscores, of the Female Sexual Function Index.8 What this study has shown is, in women with MS, physical therapy can help to treat sexual dysfunction by enhancing muscle response and activity in the pelvic floor.

Conclusion:

All bowel, bladder, and sexual function rely in part on strong and flexible muscles in the pelvic floor. With Multiple Sclerosis, these muscles tend to lose either mobility and then strength, and/or muscle tone and coordination. Either way, the loss of efficient tissue tension, coordination, and strength, makes the performance of these important functions much more challenging. While various medications or other interventions, may also be necessary to help individuals with MS manage their symptoms, physical therapy has been proven to be an important part of the healthcare team. Here at Beyond Basics Physical Therapy, all our clinicians have specialized training to evaluate and treat the pelvic floor, so each one of us is in a strong position to help you manage these symptoms and improve function! Feel free to contact our office at 212-354-2622, or visit our website (www.beyondbasicsphysicaltherapy.com) for more information!

Sources:

  1. National Multiple Sclerosis Society. https://www.nationalmssociety.org
  2. de Abreu Pereira CM, Castiglione M, Kasawara KT. “Effects of Physiotherapy Treatment for Urinary Incontinence in Patient with Multiple Sclerosis.” Journal of Physical Therapy Science 2017; 29(7): 1259–1263.
  3. Marola S, Ferrarese A, Gibin E, et al. “Anal Sphincter Dysfunction in Multiple Sclerosis: An Observation Manometric Study.” Open Medicine 2016; 11(1): 509–517.
  4. Chiotakakou-Faliakou E, Kamm MA, Roy AJ, et al. Biofeedback provides long-term benefit for patients with intractable, slow and normal transit constipation. Gut 1998;42:517–21.
  5. Wiesel PH, Norton C, Roy AJ, et al. Gut focused behavioural treatment (biofeedback) for constipation and faecal incontinence in multiple sclerosis. J Neurol Neurosurg Psychiatry 2000;69:240–243.
  6. Ferreira, Ana Paula Silva, et al. “Impact of a Pelvic Floor Training Program Among Women with Multiple Sclerosis.” American Journal of Physical Medicine & Rehabilitation 2016; 95(1): 1–8.
  7. Lúcio A, Dʼancona CA, Perissinotto MC, et al. “Pelvic Floor Muscle Training With and Without Electrical Stimulation in the Treatment of Lower Urinary Tract Symptoms in Women With Multiple Sclerosis.”Journal of Wound, Ostomy and Continence Nursing 2016; 43(4): 414–419.
  8. Lúcio AC, D’Ancona CA, Lopes MH, et al. “The Effect of Pelvic Floor Muscle Training Alone or in Combination with Electrostimulation in the Treatment of Sexual Dysfunction in Women with Multiple Sclerosis.” Multiple Sclerosis Journal 2014; 2 (13): 1761–1768.
  9. “Sexual Problems.” National Multiple Sclerosis Society, http://www.nationalmssociety.org/Symptoms-Diagnosis/MS-Symptoms/Sexual-Dysfunction.
  10. Lowentein L, Gruenwald I, Gartman I, et al. Can stronger pelvic muscle floor improve secual function? Int Urogynecol J 2010; 21: 553-556.
  11. Bo K, Talseth T, Vinsnes A (2000) Randomized controlled trial on the effect of pelvic floor muscle training on quality of life and sexual problems in genuine stress incontinent women. Acta Obstet Gynecol Scand 79(7):598–603
  12. Beji NK, Yalcin O, Erkan HA (2003) The effect of pelvic floor training on sexual function of treated patients. International urogynecology journal and pelvic floor dysfunction 14(4):234–238
  13. Zahariou AG, Karamouti MV, Papaioannou PD (2008) Pelvic floor muscle training improves sexual function of women with stress urinary incontinence. International urogynecology journal and pelvic floor dysfunction 19(3):401–406.

How a Birth Doula Can Help Make Labor a More Intimate Experience

affection-baby-birth-208189

Chantal Traub, CD, CCCE, LCCE,

Pregnant mothers may be unsure if they want to work with a doula because they would like their labor and birth to be an intimate experience between them and their partners and wonder whether having a doula would encroach on their intimacy.

The role of the doula is to help ensure a healthier, safe and positive birth experience for the whole family. She will provide emotional support, physical comfort and the information needed to make informed decisions as they arise in labor at home or at the hospital. She will present reassurance and perspective to the birthing woman and her partner, offering various positional ideas for relaxation and labor progression and hands-on comfort measures like touch, massage, counter pressure and breathing techniques.

One may wonder how an intimate experience can be enhanced with the presence of a doula and the medical staff. Intimacy refers to the feeling of being in a close personal association and belonging together. It is the familiar and very close affective connection with a bond that is formed through knowledge and experience of the other. This intimate experience can be created by having the partner taking a role in the birthing process. The experienced doula will include the partner.

The doula’s presence offers a great sense of relief for both of you, especially for your partner who may begin to feel concerned with the responsibility of supporting you and may not know what normal is in this situation. If you’re having an intimate moment with your partner, an experienced doula will know when to step in and when to step back. She will encourage and allow you both to have that moment. In fact, she will look out for and suggest opportunities for you to be together. She will gently pull your partner back if your partner is feeling overwhelmed or feels worried seeing you in pain and give your partner the tools to help support you. If your partner needs a break or a breath of fresh air, the doula will be there, so that the partner can take care of themselves knowing the doula will take care of you.

The role your partner takes depends on the two of you. If your partner would like to roll up their sleeves and offer physical support or prefers to remain emotionally present from a distance, your doula will guide you. The doula may suggest ways for your partner to hold you or breathe with you. She can show your partner ways to massage and apply pressure while you are laboring. If a partner cannot participate physically for various reasons, they may choose to assist in other ways like getting ice and water while the doula manages the physical part, or merely remain emotionally present in the room. The intimacy is in the experience, allowing your partner to remain confident and emotionally present with you.

Whether your birth is unmedicated or medically complex, every family can benefit from the guidance and support of a doula at this often vulnerable and overwhelming time in their lives.

Chantal is originally from Cape Town and after years of working in film she began teaching yoga in 1996 and in 2003 she became a Certified Doula and has been assisting women in labor ever since. She is also a Certified International Childbirth Educator and a Certified Pre/Postnatal Yoga teacher. Her Prenatal classes are informative and educational and are designed for Labor and Delivery. Chantal has been teaching and assisting families in the New York Metro area for over 15 years and she combines her wisdom and knowledge to help families prepare for a positive birth experience

Chantal Traub, CD, LCCE, CCCE

 www.chantaldoula.com

Certified Doula (CD)

Lamaze International Certified Childbirth Educator (LCCE)

Certified Cooperative Childbirth Educator (CCCE)

Chantal Traub is a certified doula with over 15 years of experience and is a board member for the Childbirth Education Association of Metro New York. Originally from Cape Town, South Africa, Chantal received her BA of Fine Arts and after working for many years in film as an art director, she began teaching Yoga in 1996. Chantal is a White Lotus Foundation Certified Yoga Teacher, Pre/Postnatal certified Yoga teacher and Certified Traditional Ayurvedic Bodyworker. Chantal started her Birth Doula practice in 2003 after receiving her certification from A.L.A.C.E. In 2007 She became a Certified Childbirth Educator by Lamaze International and by the Childbirth Education Association of Metropolitan NY. Chantal is trained with Kate Jordan Pregnancy and Postpartum Massage Therapy and with The Julie Tupler Maternal Fitness Technique. She’s also Certified Kangaroula by Dr Nils and Jill Bergman. She lives in Brooklyn with her husband and two children, Naomi and Noah.

Ph101 Men’s Only Seminar

Fiona McMahon PT, DPT

Guess what?! The next class in Beyond Basics Physical Therapy’s Pelvic Health 101 series is ALL NEW! On April 11th at 7pm we will be hosting our very first ever “Men’s Only Seminar”. Join Sarah Paplanus, DPT and Dr. Seth Cohen as they discuss how pelvic floor dysfunction affects the male pelvic floor. Learn how your sex life can be improved by pelvic floor treatment, how to regain function after a prostatectomy, and how to rid yourself of the pain of prostatitis, and avoid antibiotics for the most common type of prostatitis. This seminar is not to be missed!

For more reading on men’s pelvic health topics, check out:

All About Testicles

Navigating Life with Chronic Pain: Part 1

Navigating Life with Chronic Pain: Part II

Prostatitis What it is and What to do About it

Read more about our hosts here:

Sarah Paplanus PT, DPT

Sarah graduated with a Bachelor of Science in Exercise Science from Manhattan College and a Doctorate in Physical Therapy from Hunter College. Her clinical studies included advanced training in manual therapy at Functional Physical Therapy in Denver, Colorado. She has continued her training as a functional manual therapist with the Institute of Physical Art and is pursuing certification in Functional Manual Therapy (CFMT).

Prior to joining Beyond Basics, Sarah spent over five years specializing in orthopedics. Her interest in pelvic floor physical therapy grew through working alongside talented pelvic floor physical therapists and seeing the connections between orthopedics and pelvic floor dysfunction. Sarah has continued her training in pelvic health through the Herman and Wallace Pelvic Floor Rehabilitation Institute.

Sarah is a member of the International Pelvic Pain Society (IPPS).

Seth Cohen, MD, MPH 

Dr. Cohen treats erectile dysfunction, male sexual dysfunction, low testosterone, benign prostatic hyperplasia, enlarged prostate,  and kidney stones and other conditions including male and female pelvic pain. 

Credentials

Positions
  • Assistant Professor, Department of Urology
  • Assistant Professor, Department of Obstetrics and Gynecology
Board Certifications
  • American Board of Urology – Urology, 2016
Education and Training
  • Fellowship, Univ of CA San Diego Med Ctr, Sexual Medicine, 2014
  • Residency, Lenox Hill Hospital, Urology, 2012
  • MD from Tulane University, 2007
  • MPH from Tulane University, 2003
Departments
  • Urology, 
  • Obstetrics and Gynecology

Register here: pelvichealth101.eventbrite.com

Location:

110 East 42nd street

Suite 1504

NY NY

10017

Pelvic Health 101 Spring 2018 (2)

 

Endometriosis as a Feminist Issue

fist-bump-1195446_1280

Fiona McMahon PT, DPT

March is endometriosis awareness month. March is also women’s history month. It seemed like the perfect time to discuss how poor detection and treatment of the disease affects the welfare, social, economic health, physical health,  and quality of life of women. Endometriosis is a feminist issue.

Here, at this blog, we have extensively discussed treatment and various options for endometriosis. Although there are many treatments available for managing endometriosis, the time it often takes to get a proper diagnosis and referral to competent clinicians is often so long, that the disease may progress to a point where pain is a lot harder to treat and fertility is impacted. Endometriosis is a gynecological disorder, that according to the Women’sHealth.gov currently affects more than 11% of women in the United States.

Older material, in fact, posts on this page used to define endometriosis as a condition in which endometrium (the lining of your uterus) grows outside the uterus. Now, in most of the recent literature referring to the tissue growing outside the uterus, call it endometrium like, because the tissue bears some resemblance to endometrium but isn’t quite the same. Endometriosis can show up clinically in a whole host of ways. It is estimated that up to 59% never have symptoms and may only discover that they have endometriosis, if they have abdominal surgery and legions are spotted. Infertility may also be the only symptom. For those who do have pain symptoms, it can be really bad and debilitating. If you have heard of endometriosis before, you are probably aware that it can make periods intolerable, but that’s not the whole story. Endo, as it is called for short, can cause pain that extends well beyond menstruation, it can cause issues with constipation, low back pain, urination, bowel movements, and fertility. Pain with endo can be severe. It can keep you from work, and school, or even land you in the hospital. The time a woman spends trying to get a diagnosis for the pain caused by endometriosis can take up to 11 years according to the American College of Gynecology fact sheet cited below.

What Causes Endo?

As you may have gleaned from the intro to this story endo is poorly understood and frequently misdiagnosed. Up until recently, we weren’t even entirely sure what the deposits left by endometriosis were. The research community is divided on what causes endo and have offered many different theories to its origin, but the specific cause of endo is unknown.

We do know endometriosis is an estrogen dependent disease, which is why it affects mainly women. One common theory of how endometriosis is caused is the theory of retrograde menstruation. This theory posits that endometriosis is caused by shed endometrium that escapes the uterus and deposits itself in the abdomen. This theory is supported by animal studies that have produced endometriosis like legions when endometrial tissue was deposited in the abdominal cavity. The theory fails to explain cases in which endometriosis deposits are found far away from the uterus in tissues like the lung. It also fails to explain the rare cases of men who develop endometriosis with estrogen therapies. In many circles, this theory is falling out of favor and is completely disregarded by others. Another similar theory is the lymphatic vascular theory. This theory hypothesizes that endometrium travels to outside spots via the lymphatic system. Again, this theory doesn’t explain the rare cases of male endo nor does it explain that the tissue found in these outside sites. It also fails to explain that the tissue found outside the uterus is “endometrium like” and is different than normal endometrium within the uterus.

The theory of coelomic metaplasia is based on the fact the both endometrium and peritoneal tissue comes from the same embryonic ancestor, coelemic epithelium. The theory posits that certain immunologic or hormonal factors may transform this tissue into the implants we see in cases of endometriosis. The third theory is the embryonic rest theory. It purposes that endometriosis caused by stem cells derived from the embryonic müllerian system become transformed in endo deposits. This theory is supported by the rare cases of men with endo, as they, as embryos, have the same embryonic müllerian system, before it regresses as the male embryo develops.

What’s kind of crazy is the level of pain a women experiences is not directly related to the amount or size of the endo deposits she has. One theory of why a women with very little endo found surgically can have a lot of pain, is the concept of centralization, where the brain becomes more likely to perceive stimuli as painful. Read more about this process in our blogs  Navigating Life with Chronic Pain 1, and Navigating Life with Chronic Pain 2 here.

One, all, some, or none of these theories could explain how endo is formed and maintained. The truth is we don’t fully understand the pathogenesis of this disease, yet. We need to know the cause. If we know the cause we may be better able to design treatments to ease the pain of endo and optimize the fertility of its suffers. Knowing the cause of endo will at least, aid in diagnosing the disease earlier or possibly curing or preventing it all together, which brings us to our next section.

 

Why does it take so long to get an endo diagnosis?!

Here’s the deal. The gold standard for endometriosis diagnosis is laparoscopic exploratory surgery with pathological biopsy confirming a lesion. Before laparoscopic surgery was a mainstay of medical practice, it was often believed that endometriosis was a disease that did not affect adolescent girls, as it was only seen in laparotomy, a more invasive technique reserved for more severe symptoms and conditions. When laproscopy became widely available in the 1980’s the diagnosis of endometriosis grew rapidly in all women and especially adolescent girls.

There are other tools available to detect endo but they are not definitive like surgery and may miss cases. Even laparoscopic surgery can miss endo especially in adolescents, because the endo deposits may be better disguised because of its color, usually clear or red in younger girls. Endo is also not suspected often until after the start of a girl’s first menses, new recommendations suggest that abdominal and pelvic pain complaints in girls be investigated for endo at the start of breast bud development (Brosens) as endo was found in between 50- 62% of adolescent girls undergoing laparoscopy for chronic pelvic pain ( Agarwal and Chaichian).

Doctor’s need better, less invasive tools to detect endo and get women out of pain. Although laparoscopic surgery is considered non invasive, the recovery from it can be difficult, dissuading patient and physician alike from using it as a diagnostic procedure. There is emerging science working on less invasive ways to screen or even detect for endo. More research dollars should be spent to develop early diagnosis and treatment in order to save women the years, lost work and education secondary to pain, and infertility from prolonged endometriosis.

Conversely, women without true endo are undergoing surgery needlessly, sometimes sustain hysterectomies to “cure” endo that is in fact not even there (also hysterectomy does not cure endo, Endo by its definition is a disease that occurs outside of the uterus). 25% of 4000 women studied who underwent hysterectomy for suspected endometriosis pain, were found to not actually have endo, which is outrageous on so many levels. 1. Hysterectomies do not cure endo. 2. Infecting infertility and the risks of major surgery on a woman who does not need it, regardless of whether she has endo or not, is awful. 3. Those 25% of women who had their hysterectomy likely have more pain and were not given a proper diagnoses so they can pursue the proper intervention for their pain.

Why is Endo Such a Big Deal as Feminist Issue?

Endo is a disease the effects women and only in very rare cases, men. If you get 10 of your gal pals in a room, statistically 1 of them will have the condition. Before I start in with this next argument, I want to make clear, that a diagnosis of endo does not necessarily impair one’s success later on in life; however, it can make achieving life’s milestones a lot more challenging.

Girls with painful endo symptoms miss more school a month than girls without endo (Brosens), setting them up for a harder battle to succeed academically and potentially limiting college options. In the workforce, they may continue to miss more days limiting their chances for raises and advancement. These missed opportunities have the ability to compound and further place women with endo at an economic disadvantage.

As women, it is sometimes harder to have our pain taken seriously. In a shattering article in the Atlantic, Joe Fassler, describes the ordeal his wife had to go through to have her potentially life threatening ovarian torsion taken seriously. He recounts how many times his wife was told to buck up, while she was actually in the process of losing her ovary. He also sites the disturbing statistic that women wait approximately 25% longer than men in the ER for pain relief. There is evidence to support that if you are a woman of color, you are even less likely to be given an analgesic at all when you go to the ER for pain. The fact our pain, as women, is taken less seriously means that in order to get a timely diagnosis women may have to scream louder and longer just to be heard.

The longer women wait for diagnosis, the more likely the pain is likely to enter a centralized state in which stimuli that were previously not painful are perceived as pain. Centralized pain is a lot harder to treat and will take longer to resolve than non centralized pain, possibly leading to more time out of the workforce, and requiring more money spent on treatments. Women with endo must be taken seriously. Our financial independence and personal lives require it.

What Can I Do If I am In Pain?

So we talked about the larger systemic issues affecting women with endometriosis. But what are some realistic steps you can employ to help with your pain?

  • Get moving! A review by Bonocher and colleagues, found exercise may help women who are already suffering from endometriosis related pain. The pain caused by endometriosis is thought to occur because of inflammation caused by endometriosis implants outside of the uterus. Exercise has been shown in repeated studies to increase anti-inflammatory chemicals in the blood and therefore reduce pain caused by inflammatory processes.
  • Stretch it out. Zahra Rakhshaee, published a 2011 article that found yoga could ease painful periods and may be helpful in managing the symptoms of endometriosis. In this study, a yoga routine consisting of daily 20 minute sessions had a significant effect in reducing pain in the study participants.
  • Put a pin in it, or you! Acupuncture is an ancient Chinese healing practice and can be used to treat many conditions. In a review by Leong in 2014, acupuncture reduced painful periods in 92% of study participants. The review also cited an article in which 73% of participants reported an improvement in their symptoms versus 42% receiving a placebo (fake) treatment
  • Physical therapy treatment can be helpful in treating many of the issues associated with endometriosis. In a study by Wurn in 2011 , physical therapy was shown to have a significant effect on reducing pain and improving sexual function in women who have endometriosis. Physical therapists are trained healthcare practitioners who can guide you in strengthening and stretching programs to help ease your pain, apply hands-on techniques to restore mobility lost due to endometriosis and other conditions, as well as guide you through lifestyle modifications you can make to ease your pain symptoms.

If one or all of these methods of pain management strategies sounds like they will work for you, Beyond Basics Physical Therapy, as well as other specialized clinics can help guide you. We at Beyond Basics, have an excellent team of physical therapy practitioners who are experts in the field of pelvic health, who do one on one, hands on work, who can develop an appropriate exercise plan tailored to your needs, and can guide you through other lifestyle modifications to help reduce your pain. We also partner with acupuncture and yoga professionals who offer services on site at our Midtown clinic. We hope to see you soon as you begin your journey of healing.

For more on PT and how it can help endo pain, check out Amy’s Video

What do we do for everyone affected by endometriosis or pelvic pain?

Seems pretty bleak, doesn’t it? It’s not. Collectively women and endo specialists are working to advance the awareness, diagnosis, and multidisciplinary approach to treating endo. It is an exciting time with new discoveries being presented in the literature, and more women and doctors becoming outspoken about this condition. But we have a heck of a long way to go to help out our sisters with endo.

The first thing you can do is speak up. If you feel you have not been diagnosed correctly, seek a second opinion. Also feel free to share the articles below with your doctors in order to broaden their exposure to endometriosis, I particularly like Brosen’s article. Share this blog and others on endo so more women and practitioners know about it. For those of you with the resources to do so, consider donating to an organization like the Endometriosis Association or the International Pelvic Pain Society (IPPS). Both are organizations that study and advocate for effective diagnosis and treatment for people with pelvic pain, including those with endo, as well as advocate for a multidisciplinary approach to healing. Together, we can improve society’s awareness of this disease and reduce the challenges that endo has on women.

 

ACOG. Endometriosis Fact Sheet. https://www.acog.org/about_acog/news_room/~/media/newsroom/millionwomanmarchendometriosisfactsheet.pdf. Accessed March 12, 2018

Agarwal N, Subramanian A. Endometriosis- morphology, clinical presentations and molecular pathology. J Lab Physicians. 2010; 2(1)-19

Bonocher C, Montenegrow M, Rosa e Silva, et al. Endometriosis and physical exercises: a systematic review. Reproductive Biology and Endocrinology. 2014, 12:(4)

Brosens I, Gordts S, Benagiano G. Endometriosis in adolescents is a hidden, progressive and severe disease that deserves attention, not just compassion. Human Reproduction. 2013; 28(8) 2-26-31

Dickasen M, Chauhan V, Mor A, et al. Racial Differences in opiate administration for pain relief at an academic emergency department. Western Journal off Emergency Medicine. 2015; 16(3) 372-80

Chaichian S, Kabir A, Mehdizadehkashi A, et al. Comparing the efficacy of surgery and medical therapy for pain management in endometriosis: A systematic review. Pain Physician. 2017; 20 185-95

Fassler, Joe. How Doctor’s Take Women’s Pain Less Seriously. The Atlantic. October 15 2015

Leong F. Complementary and alternative medications for chronic pelvic pain. Obstetrics and Gynecology Clinics of North America. 2014, 41:(3): 503-10

Mowers EL, Lim CS, Skinner B, et al. Prevalence of endometriosis during abdominal or laparoscopic hysterectomy for chronic pelvic pain. Obstet Gynecol. 2016 Jun;127:1045–1053.

Rakhshaee Z. Effect of three yoga poses (cobra, cat and fish) in women with primary dysmenorrhea: A randomized clinical trial. Journal of Pediatric Adolescent Gynecology. 2011;24(4):192-6

Sasson I, Taylor H. Stem cells and the pathogenesis of endometriosis. Ann N Y Acad Sci. 2008; 1127: 106-15

Stratton P, Khachikyan I, Sinaii N, et al. Association of chronic pelvic pain and endometriosis with signs of sensitization and myofascial pain. Obset Gynecol. 2015; 125(3) 719-28

Womenshealth.gov. https://www.womenshealth.gov/a-z-topics/endometriosis . Page last updated: March 05, 2018. Accessed March 12 2018

Sources:

Wurn B, Wurn L, Patterson K. Decreasing dyspareunia and dysmenorrhea in women with endometriosis via a manual therapy: results from two independent studies. 2011;3(4)

Pelvic Health 101 is back and with BRAND NEW COURSES

Fiona McMahon PT, DPT

Our Pelvic Health 101 courses are back! For those of you not in the know about our courses, they are informational sessions provided by top experts in the field of pelvic pain and pelvic function. These courses allow you to dive more deeply into topics such as bowel, bladder and sexual function and dysfunction, pelvic and genital pain, childbirth, diet, issues with kiddos, and much more.

This year we added a Gent’s Only Session to be a companion to our Ladies only session to help answer some of the specific questions you may have about pelvic floor function as it relates to sexual health, bladder and bowel health, as well as pain.

Our first class is “PH101: Something’s Wrong with my What?”, where our own Stephanie Stamas,will be going through the basics of anatomy of the pelvic floor, what can go wrong and how we can fix it. Our first class is on March 7th at 7pm. Register here: pelvichealth101.eventbrite.com, to reserve your spot. Our classes are extremely popular so make sure you register well ahead of time.

Check out

Location:

110 East 42nd St, Suite 1504

New York, NY

10017

Check out all the upcoming classes here:

Pelvic Health 101 Spring 2018 (2)

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