When “Pelvic Pain” is Something Else
Pelvic health physical therapy* includes many topics about which I could talk all day – issues
including pain, bladder dysfunction, bowel issues, sexual dysfunction, peri-natal care, abdominal
issues, post-surgical issues and pelvic girdle pain – among others! It’s a good thing there are
lots of blog posts available to fill!
I received a message this week that put me in a different direction: identifying when that issue,
whatever it is, is NOT actually a “pelvic PT” issue.
Clients come in with pelvic symptoms – leakage, constipation, various pains, etc. Many times
we are able to establish the contributing biopsychosocial* (yep, big word…for another blog…)
factors and help that person take appropriate action. However, there are times that may not be
the case – times when the symptoms are not directly tied to pelvic therapy.
Being able to accurately assess and treat (or refer) is a critical skill in your pelvic health
therapist. (We will use “she” for our example pelvic therapist for simplicity…most of us are
female, although many guys are starting to get involved too! Yay!)
First, she must be able to identify that it is not a local, physical therapy issue. It’s tempting to just
focus treatment locally to the pelvis or to a specific system (musculoskeletal) when something
as specific as say, leakage, is occurring. However, multiple factors can feed into the
dysfunction. Some potential triggers in this example include positional issues, neurologic
dysfunction, vaginal mucosal support, dietary influence, etc. But that’s yet another blog…
So when it’s not a straight-forward pelvic PT issue….now what? Then comes the differentiation
– is it due to another PT-related factor or is a deeper (medical, psychological, nutritional, etc)
issue involved? If it’s the latter, the therapist should be ready to refer appropriately to a provider
who will be able to help.
Here’s that message I received from one of my clients this week that started this whole blog:
“I’m so thankful for your help in finally figuring out the source of my pain. During my visit
with you I was able to determine, that as rare as it may be, my … was my pain center.
We never know what we may say to someone that may be life changing. You are a very
special lady with the gift of healing.”
It had nothing to do with my “gift of healing” (as much as I like the ring of that…) and everything
to do with being present and listening to him. In this client’s case, he had been referred for
abdominal and pelvic pain that had been going on for years. We completed one session. That’s
it. Most of that time was discussion and more importantly, listening…by me. Because you know
what? He described his path of multiple practitioners, medical treatments, pain management
strategies and even multiple surgeries. The tale did not add up to a physical therapy issue as
the primary driver. Sure, he had musculo-skeletal issues, but that wasn’t what was really leading
the charge. He needed referral to the right place for the right thing. This client came in telling me
what was going on – he just needed someone to help point him in the right direction.
So what happened with him? He’s received follow-up care to treat the specific neurologic trigger
and now reports:
“…that has reduced my pain to near nothing. It further helped to diagnose my pain as
‘deep organ pain’.”
[Yet another aside that will likely be a future blog post….ALL pain is from the brain*, interpreting
signals from the body. So the treatment that has resolved his ‘deep organ pain’ simply disrupted
those signals so his brain could develop a new strategy, and there are lots of ways to do this.
More later…now, back to this blog…]
So here is what I hope you take from this case….I didn’t do anything magical for him. I just
listened and helped to direct accordingly. Your therapist should spend a LOT of time listening to
you. Reach back into the history – even things you think don’t matter or were from way back in
the past, just might be critical in your recovery of function. So please, be as open and honest
and detailed as you can be!
Many urinary and bowel issues are just symptoms of other, underlying problems. It could be as
easy as changing the diet a little or a more serious matter. That’s where the clinical
differentiation comes in, and having a great therapist on your side can do wonders to get you
going in the right direction.
There are many times pelvic PT is the best course of action. I’ve seen the amazing changes
that people can create in their lives through pelvic therapy. (Not that I’m biased….) I firmly
believe (and research supports) that pelvic therapy should be a first-line, treatment of choice for
many of the issues discussed here. I just also believe in being diligently aware of the many
other layers and factors – recognizing them assures that each person is treated exactly how he
or she needs to be in order to return to their own best function!
*For anyone who likes to geek out on this stuff as much as I do, here are a few resources:
What is considered Pelvic Physical Therapy
A brief intro to the biopsychosocial concept