Friday, 24 August 2018

Stress and Pelvic Pain


If you read my previous blog “Why my pelvic floor spasms with sex, PAP’s and tampons,” I talked about a study from 2001 that revealed women tense their muscles in response to a threat, even if just watching a video. When women feel stressed or threatened, they sub-consciously contract their muscles as a defense response. Sustained stress and tense muscles can lead to pain. The stress can be emotional, mental or physical.

Many old traditions of healing treat people from a holistic perspective, because they understand the mind-body connection. These traditions, such as Chinese Medicine, Ayurveda and Native Indigenous medicine understand that thoughts, emotions and spiritual connection/purpose impacts physical health(1). The mind-body connection approach that is missing in western medicine but is slowly changing as we have mounting scientific studies showing that our thoughts and emotions do in fact impact our nervous, immune and endocrine systems as well as our pain pathways and the level of tension we carry in our bodies (1).

One of the challenges physiotherapists face when using a mind-body connection model of care is that not all healthcare providers have adopted this model and as such other providers may not be educating their patients this way. Another challenge is when patients themselves cannot see the connection between mind, body and spirit.

There is a lot of cultural and societal stigma surrounding mental and emotional health because people don’t understand it. Spirituality is an overused concept that is subjective, misunderstood and often times seen as in conflict with religion.

If you ever feel dismissed, hopeless, frustrated or blamed whether by yourself or others, do not give up. Do not feel ashamed and know that it is not your fault. Find therapists that understand and value a holistic approach.

A resource I like to start with for education on the stress-relaxation response.

There is a fantastic documentary called “The Connection” which explores the stress and relaxation response on the body while following the lives of seven people. You can access it at theconnection.tv(2).

There are five components for reducing stress.

  1.  Diet: What we eat impacts the function of our cells. Ever heard the saying, “you are what you eat?” We need a healthy diet consisting of whole foods, protein, veggies, fruit and healthy carbs. How can our bodies heal when our cells don’t get the fuel they need?
  2.  Exercise: Walking to increase our heart rate (even better if done out in nature) for 30 minutes has profound effects on our bodies. Do not overlook the importance of exercise, it has been shown that exercise affects us not just physically but mentally and emotionally as well.
  3.  Evoking the Relaxation Response: Whether yoga, meditation, tai chi, body connection/body awareness movements, it also impacts stress on our body. We workout but how much do we work “in”, connecting with ourselves.
  4. Social interaction: Humans are social beings and we need to interact with others in meaningful ways, healthy ways. Being social allows us to see different perspectives, feel heard, appreciated and cared for. People can impact our moods and help keep us hopeful.
  5. Believing we can be well: It’s totally okay to have doubts and be skeptical. This is why you need other people and healthcare providers to help you build belief in yourself. The belief you can be well impacts self-efficacy, which means the belief you will succeed.


I highly recommend watching the documentary as it will help you understand the science behind the mind/body approach.

The Pelvic Health Lady

References:
  1. Faehndrich, Lorraine. 2018. “Is there a connection between Stress and Pelvic Pain?”. Accessed on June 14, 2018 from https://radiantlifedesign.com/is-there-a-connection-between-stress-and-pelvic-pain/
  2. The Connection Documentary. www.theconnection.tv 



Wednesday, 8 August 2018

Is Pelvic Floor Physiotherapy Effective in Treating Pelvic Organ Prolapse?


Is Pelvic Floor Physiotherapy Effective in Treating Pelvic Organ Prolapse?

Prolapse is defined as a symptomatic descent of the vaginal wall or vault from the anatomical position. Symptoms might include some or all of the following: bladder, bowel, vaginal, back, abdominal or sexual abnormalities or dysfunction(1). My clients that come in with symptoms will often say that it feels like something wants to fall out. They report feeling heaviness and pressure at the end of the day, or they say that they can see/feel something at the opening.

So what causes prolapse?

Some risk factors include pregnancy, vaginal delivery, increased age, family history, obesity, heavy lifting, and constipation(1).

Is pelvic floor physio effective in reducing symptoms?

Yes, pelvic floor physiotherapy helps decrease symptoms greater than just daily lifestyle changes.
Let’s examine a study.

477 women of varying ages were randomly separated into two groups. Each group consisted of women with varying stages of prolapse, number of children, etc. The control group only received a pamphlet outlining lifestyle changes, such as advice on weight loss, constipation, avoiding heavy lifting, coughing and high-impact exercise. This group was not provided any information on pelvic floor anatomy or function.

The second group (pelvic floor muscle training group) had 5 one-to-one sessions with a women’s health physiotherapist over the course of 16 weeks. They got education about pelvic floor muscles and function, as well as, all the tips the other group received. Additionally, the second group got individualized pelvic floor exercises which included slow endurance contraction and fast contractions.

Throughout the study, they tracked patient progress with self-reported questionnaires about symptoms such as bowels, bladder, pain and sexual function but also the women’s ability to do activities and impact on their quality of life. The participants were also separately assessed by an OBGyn that followed a specific objective measure 6 months into the study and again at 12 months.
Here are the results.
  • Those in the pelvic floor muscle training (PFMT) group had fewer symptoms than the control group at 6 and 12 months. They were less likely to report prolapsed symptoms.
  • 52% of participants in the PFMT group reported feeling better at 6 months compared to 17% in the control group.
  • 50% of women in the control group went in for additional treatment after the 12 months compared to 24% in the exercise group.
  • Women going for surgery after 12 months was 11% in the PFMT group and 10% in the control group likely because there was an even distribution of women who were set on surgery anyway.
  • Interestingly, 27% of women in the control group were referred for physiotherapy compared to 1% of the PFMT group that needed additional physio.
  • Also 80% of women in the exercise group continued their pelvic exercises after 12 months.
  • In terms of costs, this study was done in England so amounts were in pounds.
  • On average surgery costs: £1044, pessary £229.45, phsyio £170.24,
  • The average cost of treatment in physio group was £268.23 which is far less than surgery.  
I want to highlight that some women in the exercise group did need further treatment.
As mentioned 11% had surgery, 5% needed pessaries, 10% estrogen treatment. As pelvic floor therapists our job is to take a multidisciplinary approach and optimize other forms of treatment when needed.

In my practice I do see women after prolapse surgery because they have prolapsed again. Even if surgery is needed physiotherapy can help women prepare. I.e. get stronger muscles before surgery, educate on lifestyle and reduce risk factors, aid in recovery of muscles and take a prevention role.
I have also seen clients who couldn’t use pessaries because their muscles were too weak to hold the pessary. Pelvic floor Physiotherapists can help women strengthen for this.

What I want to say is that physio is a conservative therapy that should be our first line of defense. Thus if additional treatments are needed, we have optimized those treatments for success. With physiotherapy the patient is also an active participant in their health.

The Pelvic Health Lady

Reference:
Hagen et al. 2014. Individualized pelvic floor muscle training in women with pelvic organ prolapse (POPPY): a multicenter randomized controlled trial. The Lancet 383: 796-806.