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Chronic Pelvic Pain - some media coverage at last!

Posted: Wednesday, December 18, 2013 at 12:22:26 PM EST by Alyssa Tait

ABC radio’s Health Matters show yesterday covered one of the most overlooked health problems in Australia: chronic pelvic pain.

One of my patients rang and let me know about it, for which I was very grateful. I downloaded the recording after work, and as I listened to it, I recognised in the stories things I am told over and over again in my clinic.

Despite the fact that everyone’s journey is unique, so many themes arise again and again: the physical suffering, the loneliness and social isolation, the despair at being made to feel like you’re crazy, malingering or exaggerating. The tendency to diagnose depression or anxiety when the symptoms don’t perfectly add up. The complete lack of awareness in a large majority of (otherwise capable) health professionals.

The symptoms that people mentioned echoed those of so many women and men I have seen over the years. To take just a handful of examples:

  • The constant burning pain
  • Being unable to sit down or find a comfortable position
  • The feeling of ‘’little cuts all over the vulva’’
  • The ‘’red hot poker up the backside’’ feeling

These symptoms are described to me every day by different patients, most of whom assume they are the only one who has them. But what I hear most commonly from my patients is

‘’Why did it take me so long to find you?’’

My patients have typically seen ten or more health professionals before me who either

  • Didn’t take the problem seriously
  • Didn’t recognise the symptoms
  • Didn’t refer appropriately
  • Wrote the symptoms off as caused by depression, anxiety, or a lack of sex life
  • Did not seem to care, and even seemed skeptical

It is a relief for people to finally find someone who understands chronic pelvic pain. To be frank, health professionals who really ‘’get it’’ are thin on the ground. The good news is that, because there are so few with good expertise in this area, those of us who understand it have good networks – so we know the people you need to see for the essential multi-disciplinary approach.

An important point raised during the broadcast as well as from listeners’ e-mails is that pelvic pain can have important identifiable medical causes, such as fractures and cancer.

However, when appropriate medical investigations have been done, and no clear cause has been found (and keep in mind a laparoscopy is required to definitively rule out endometriosis), then this is a case of chronic pelvic pain.

Chronic pelvic pain has many subtypes, some of which are diagnoses in themselves. There are also concepts that anyone with chronic pelvic pain will want to understand. You may want to investigate the following:

All of these are conditions I have successfully treated here at Equilibria for the past eight years.

I’m not sure how long the broadcast will be available for download, but it is thoroughly recommended listening.

Go to:

http://www.abc.net.au/radionational/programs/lifematters/pelvic-pain/4502250#comments

 If you are suffering from chronic pelvic pain, come in and get some help.

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About Alyssa Tait

Alyssa runs Equilibria Physiotherapy & Nutrition, a clinic focusing on integrative solutions for pelvic health issues including all types of pelvic pain, bladder and bowel control issues, fertility, and irritable bowel syndrome.

Alyssa’s website www.equilibriahealth.com.au is an information hub related to all things relating to the function of the female pelvis.

She aims to help as many people as possible restore balance to their pelvis through education, effective treatment and empowering lifestyle choices.

Alyssa enjoys playing the clarinet and rollerblading, though (much to the gratitude of her patients), not while she is consulting.

Connect with Alyssa  |  Facebook  |  Google Plus | linkedin | Twitter

Nutrients in Chronic Pain

Posted: Wednesday, December 18, 2013 at 12:12:00 PM EST by Alyssa Tait

Part 1: Magnesium

Chronic pain is complex; no one can deny that. Anyone who is experiencing chronic pain can think of their pain as a giant puzzle. There are many pieces that make up the picture, and an often-overlooked piece is the nutrition piece. Nutrients, which trigger certain (normal) physiological functions, are one part of this nutrition piece, and magnesium is a single one of these numerous nutrients that play a role in the process of persistent pain.

What is the role of magnesium in the body? Magnesium is a cation that plays numerous roles in various body compartments.

It helps maintain the internal “balance” (homeostasis) within the cell, so is imperative in cellular function. Magnesium has a “calcium channel blocking” action.

It is present in high amounts in the extracellular compartments, influencing excitability of nerves and nerve conduction. It has a role in skeletal, smooth and cardiac muscle function.

It is a cofactor for many enzymes, including those involved in the production of brain and gut neurotransmitters, thus influencing both gut and brain function.

Magnesium seems to be linked to various pain disorders and has some potential to help them:

One study showed a statistically significant link between low serum magnesium levels and myofascial pain syndrome. A 2012 study showed that magnesium supplementation helped to prevent migraine. Magnesium reduced pain in primary dysmenorrhea in a 1992 study. Furthermore, a 2007 systematic review of randomised trials found evidence for decreased postoperative analgesic requirements when magnesium was given.

Is there any evidence for the efficacy of magnesium administration in chronic or persistent pain?

One study showed that giving magnesium before surgery could help reduce both muscle fasciculations (twitching or spasms) and myalgia (muscle pain) experienced post-operatively.

Central sensitisation is a key process underlying chronic or persistent pain. An experiment was done with rats, whereby a drug called fentanyl was administered to produce delayed hyperalgesia (a sort of “exaggerated pain”). This was to try to create an animal model of central sensitisation.  Administering magnesium to the rats partially offset this process, resulting in less pain.

In chronic pain, we know there is abnormal processing of sensation. This is part of the “syndrome”, if you like, that is chronic pain (regardless of where in the body you feel it). Certain receptors called the NMDA (N-methyl-D-aspartate) are involved as “gates” that help process this sensation. Activation of the NMDA receptor leads to abnormal processing of sensation – therefore increased pain. This effect – part of what is known as “central sensitisation” – has effects in the spinal cord, in an area called the dorsal horn, as well as in the brain itself. Magnesium is involved in blocking the NMDA receptor, so that process cannot take place.  This was shown in an experiment with rats with in whom neuropathic pain was induced. The rats developed something called “allodynia” (where a stimulus that is not usually painful becomes painful) and mechanical hypersensitivity (where touch or pressure feels oversensitive). Giving magnesium to the rats “fixed” the allodynia (i.e. made them not feel this abnormal pain to normal stimulus) and delayed the onset of mechanical hypersensitivity, and stopped the change that takes place at the dorsal horn of the spinal cord. Hyperalgesia and allodynia are two aspects of the pain experience that we test in women who have vulvodynia and similar pelvic pain conditions. This makes these findings especially interesting to anyone experiencing these conditions.

Another group of rats was subjected to treatment that creates hyperalgesia. In this experiment, opioid agonists were used to try to resolve the pain (drugs like morphine). The morphine didn’t work – except when the group of rats were given magnesium first, which enhanced the analgesic effect of the morphine. Morphine works in the brain – so it seems that magnesium helps the “brain side” of chronic pain.

Finally, a 2013 study gives us some nice findings on magnesium in neuropathic pain. A 2-week intravenous magnesium infusion followed by 4 weeks of oral magnesium supplementation can reduce pain intensity and improve lumbar spine mobility during a 6-month period in patients with refractory chronic low back pain with a neuropathic component.

Ultimately, magnesium is cheap and fairly harmless as long as you don’t have a kidney disorder.  It’s certainly worth using if you experience persistent pain – and judge for yourself whether it helps. Clinicians working with people with pain should also consider giving magnesium early – before the pain becomes chronic. This might save a whole lot of grief. Not all magnesium supplements are the same, however; absorption (and therefore effectiveness) varies markedly across the different forms. For help in choosing an appropriate magnesium supplement, contact us at Equilibria.

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About Alyssa Tait

Alyssa runs Equilibria Physiotherapy & Nutrition, a clinic focusing on integrative solutions for pelvic health issues including all types of pelvic pain, bladder and bowel control issues, fertility, and irritable bowel syndrome.

Alyssa’s website www.equilibriahealth.com.au is an information hub related to all things relating to the function of the female pelvis.

She aims to help as many people as possible restore balance to their pelvis through education, effective treatment and empowering lifestyle choices.

Alyssa enjoys playing the clarinet and rollerblading, though (much to the gratitude of her patients), not while she is consulting.

Connect with Alyssa  |  Facebook  |  Google Plus | linkedin | Twitter

Adhesions: A Cry For Help From Your Episiotomy Scar

Posted: Saturday, August 16, 2014 at 5:27:31 PM EST by Alyssa Tait

I suspect we underrate the negative impact of episiotomy scars.

My last post was about scar tissue after surgery and how it can cause real problems, both in the short and long term. I used the examples of an orthopaedic surgery scar and a Caesarean scar. Both of these are considered major surgery, and when you really stop to think about it, it makes sense that they require some rehabilitation. (As an aside, nutrition has a big impact on healing of scars, and should be a major focus in the first three months after any surgery).

But what about perineal scars from childbirth injury? These include scars from episiotomy, OASIS (obstetric anal sphincter injuries), and all types of tears to the vagina and perineum, whether first-, second-, third- or fourth-degree. Won’t these types of scars benefit from rehabilitation too? Of course they will – in fact, I think we need to be much more proactive about this.

When the obstetrician gives you your six-week postnatal “clearance”, this is just the beginning. In fact, many women see their GP and have no perineal or vaginal examination at their six-week check-up. If they do have an examination, the aim is to ensure healing is adequate and there are no signs of infection. This quick check is not designed to confirm your tissue is back to its fighting best!

Many women I see, when they see their doctor for their six-week check, have not started having penetrative intercourse again yet. This is perfectly natural; not everyone feels ready by this point. However, when they are given the “all-clear” by the doctor, it comes as a rude shock when they first try to have intercourse two, four or six weeks later – to find that it’s horribly painful and not at all what they were expecting.

For some women, this initial pain with penetrative intercourse eases up quickly; for others it is mild or not significant in the first place. However, for a significant number of women, this pain is severe, persistent and very disruptive of their intimate relationships.

Pain with sex after childbirth is quite common, and in a way should come as no surprise. Think about this: you break your ankle and it is immobilised for six weeks in a cast or moonboot. Finally the day comes when it can be taken off. With joy and enthusiasm you throw your weight onto it – in fact, you don’t just try to walk, but jump off a high step and throw yourself into an exuberant set of dance moves. OUCH! It’s excruciatingly painful, isn’t it? Of course it is. Your body is not designed to go from zero to a hundred in the blink of an eye after a significant injury.

Well, an episiotomy or perineal tear is a significant injury to your vulva. While it might be mild and you get away with token, short-lived discomfort, you may be like many women I see for whom it is actually quite a hard road back to enjoyable, pain-free intercourse.  I often describe penetrative sex to women as being what a marathon run is to an ankle sprain. You wouldn’t jump straight into a marathon once your ankle sprain heals! But for some reason, women expect (or society expects us!) to be straight up for sex after the perineum heals postpartum. As I mentioned, some women have no ongoing problems. But if you find that the low-level discomfort (or strong pain) doesn’t get better and better each time you try, you need to get going with some perineal rehab!

The longer you leave this, the harder it is. A number of women I have seen with post-partum vulval pain and painful sex were so sensitive in the area of the scar they could barely stand light touch, let alone entry of their partner’s penis. This is more likely to occur the longer you leave it, and may involve sensitisation of the nervous system (where the brain, spinal cord and nerves become hypersensitive to touch and normal sensations become interpreted as pain: this is called central sensitisation).  The pelvic floor muscles become both tight/overactive and weak – not a good combination!

A good way to start to help this is some nice perineal massage daily with olive oil, apricot kernel oil or jojoba oil. You can do this yourself, and if you like, progress to allow your partner to do it. (You may need to have an agreement that nothing sexual proceeds from this, unless you yourself wish to initiate it.) If this does the trick, that’s fine. However, often more specific therapeutic input is required. A physiotherapist trained in connective tissue mobilisation and myofascial release can help your vulva and vagina restore its natural movement, flexibility and sensation. This requires specific training, and it’s worth enquiring of your physiotherapist whether they have this specific set of skills. With the right type of therapy, you can get back your good health in this area, get rid of pain, and restore the quality to your sexual experience. Contact me to get help for this.

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About Alyssa Tait

Alyssa runs Equilibria Physiotherapy & Nutrition, a clinic focusing on integrative solutions for pelvic health issues including all types of pelvic pain, bladder and bowel control issues, fertility, and irritable bowel syndrome.

Alyssa’s website www.equilibriahealth.com.au is an information hub related to all things relating to the function of the female pelvis.

She aims to help as many people as possible restore balance to their pelvis through education, effective treatment and empowering lifestyle choices.

Alyssa enjoys playing the clarinet and rollerblading, though (much to the gratitude of her patients), not while she is consulting.

Connect with Alyssa  |  Facebook  |  Google Plus | linkedin | Twitter

Pelvic Floor-Safe Exercise - The Ten Most Non-Boring Options!

Posted: Tuesday, January 27, 2015 at 2:08:01 PM EST by Alyssa Tait

We hear it over and over again: exercise that's safe for your pelvic floor is walking, cycling, and swimming.

And actually, cycling here probably means boring, easy cycling on flat (as we know that standing cycling puts enormous pressures on the pelvic floor). Or stationary cycling. Stationary cycling so predictable and unchanging that you could do it in your sleep (or that it puts you to sleep). Stationary cycling that may as well be stationary.

(Of course, I am exaggerating. Stationary cycling CAN be made challenging and interesting. But if you find it so, this post is not for you.)

So without a stationary bike, or in the absence of living on top of a plateau or a vast, unchanging plain, we are down to walking and swimming being our options for pelvic floor - safe exercise.

Boring!

Now, perhaps you love walking. Perhaps you find it stimulating and regenerating, and it fulfills both your physical and mental health requirements of exercise. But if that is the case, you will probably not be reading this blog post (or will stop reading it at this point).

So let's think laterally. What are some other options...

...for exercise that is a safer option for your pelvic floor, whether you have (or are at risk for) incontinence or prolapse? And/or, you have ever had a baby or been pregnant and actually want to exercise again? And (rather more self-indulgently) what is my favorite option?

Let's look at the requirements for pelvic floor safe exercise.

We are looking for

Low impact.

No excessively high intra-abdominal pressures generated.

This generally translates into no jumping, no running, no heavy weights, no sit-ups or crunches, and no uncontrolled/unexpected movements.

Sadly, this seems to rule out all forms of running, jogging, racing and fun-runs, virtually all team sports, most gym classes, most standard personal training sessions, boxing, and most styles of dancing, whether Latin, ballroom, modern, ballet or just leaping around the room to your favorite opera or hard rock album.

I would like to interject in my own blog post here. (That is one of the major benefits of blogging - that no one can stop you interjecting). I am not saying that all of these restrictions apply at all times for all women at risk of pelvic floor problems.

In fact, despite the excellent intentions and professional expertise behind these standard pelvic floor safe exercise recommendations, I believe that the best action any woman can take is to have an individualised assessement of her exercise "risk" via a pelvic floor examination with an experienced pelvic floor physiotherapist that offers this expertise.

(Ask your pelvic floor physiotherapist how specific they can be about your exercise risks upon having an assessment, and keep searching until you find one who will offer you more than the general recommendations). Individualised pelvic floor assessments have evolved in the last few years with pelvic floor physiotherapists undergoing further research-based training to give you much more individualised exercise advice than ever before. How, you ask? Ve have vays, my friend, ve have vays!

But until you have had an individual assessment, your safest non-walking, non-swimming options which are possibly the least boring, include:

Tai Chi.

Yoga.

Belly dancing.

Rock climbing.

Pole Fitness.

Scootering.

Skateboarding.

Surfing.

Rollerskating.

Rollerblading (i.e. inline skating).

Please don't take this list absolutely at face value. All return to exercise - and, especially, starting a new exercise regime - should ideally be advised upon by your pelvic floor physiotherapist and based on individualised assessment, that is, assessment of YOU.

More about these fantastic options for your new exercise life in a future blog post.

And I plan to play favourites here. The final option - rollerblading - being my favourite option, will have its own blog post devoted to it.

Prepare to kiss boring exercise goodbye!

Any other suggestions for fun pelvic floor-safe exercise? Let's have a conversation about it!

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About Alyssa Tait

Alyssa runs Equilibria Physiotherapy & Nutrition, a clinic focusing on integrative solutions for pelvic health issues including all types of pelvic pain, bladder and bowel control issues, fertility, and irritable bowel syndrome.

Alyssa’s website www.equilibriahealth.com.au is an information hub related to all things relating to the function of the female pelvis.

She aims to help as many people as possible restore balance to their pelvis through education, effective treatment and empowering lifestyle choices.

Alyssa enjoys playing the clarinet and rollerblading, though (much to the gratitude of her patients), not while she is consulting.

Connect with Alyssa  |  Facebook  |  Google Plus | linkedin | Twitter

An Interview with Alyssa Tait - Adhesions, Chronic Pain, and the Nervous System

Posted: Tuesday, September 13, 2016 at 1:14:04 PM EST by Alyssa Tait

It's not often someone gives me the floor for 45 minutes to talk about the web of connections linking adhesions, pain, visceral manipulation, the gut and the nervous system...

Stephen Anderson's questions were so thought-provoking, I just kept talking!

Here's the interview: Alyssa Tait on Pelvic Pain, Adhesions, and SIBO

This interview will either be a great cure for insomnia, or a useful insight into how my brain sees this broad and fascinating field.

We traversed the physical, the emotional and even the metaphysical!

Listen here.

We covered all sorts of topics...

...the curious pathway of my career and how it led me to visceral manipulation

...the emotions and your organs

...chronic abdominal and pelvic pain and visceral manipulation

...adhesions, and how they are more than just structural, but neurological as well

...endometriosis and how these adhesions differ from surgical adhesions

...central sensitisation in chronic pain and its links to visceral hypersensitivity in irritable bowel syndrome

....the power of the words "let's see" in therapy

Have a listen now!

Stephen's highlights and insights include...

....the power of the nervous system to increase neurological tone as a means of self-protection, and how this might impact the function of the organs

...the importance of engaging in fun, nurturing and nervous-system relaxing activities to take care of ourselves

....the need as practitioners to be careful with our language with our patients and not be "part of the problem".

Please listen, and give your rating or review on itunes!

 

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About Alyssa Tait

Alyssa runs Equilibria Physiotherapy & Nutrition, a clinic focusing on integrative solutions for pelvic health issues including all types of pelvic pain, bladder and bowel control issues, fertility, and irritable bowel syndrome.

Alyssa’s website www.equilibriahealth.com.au is an information hub related to all things relating to the function of the female pelvis.

She aims to help as many people as possible restore balance to their pelvis through education, effective treatment and empowering lifestyle choices.

Alyssa enjoys playing the clarinet and rollerblading, though (much to the gratitude of her patients), not while she is consulting.

Connect with Alyssa  |  Facebook  |  Google Plus | linkedin | Twitter
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