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Amy Stein. This is a podcast where practitioners as well as patients gather to discuss natural strategies for healing chronic pain of all types.

This week, I have a really exciting guest. My guest is Dr. She lectures both nationally and internationally on television, has been featured on shows such as Dr. Amy Stein, welcome to the Healing Pain Podcast. Thank you so much for having me. Obviously you have a great thriving practice here in New York City that treats pelvic pain. I always like to go back a little bit with professionals and ask them about their journey and their discovery as to how they became a specialist in pelvic health. My story goes back to the very beginning.

When I was in grad school, I had a friend, she had a hysterectomy and she ended up with severe pelvic pain. They ruled out urinary tract infection.

She was having pain in the genital region. She ended up with bowel issues. A couple of years later, she ended up with diverticulitis. But it all started with the hysterectomy. I opened up my textbooks. I went to my professors. She did go through pelvic floor physical therapy, as well as other relaxation techniques. It was definitely a full body approach for her.

She was out of work for a couple of years because of this. It took some nutrition, meditation, mindfulness meditation, eventually going back to yoga class and also the pelvic floor physical therapy. Then it just started from there and it just kept going. I was so interested and realized there was such a need for this field and this area, that I was really intrigued by learning more and I still am.

What year was this? What year was this when you had this initial patient and this discovery? When I first started out of school, all the training is post graduate. In school, we went over an hour of incontinence and incontinence is the other spectrum of what my friend was experiencing.

All we did was an hour. Now they have post graduate classes. Prior to that, when I was learning, there was one class and I just went to various parts of the country. I trained with a physician. Then I went to other PTs that were the pioneers of pelvic pain. We still have a long way to go, but it still is wonderful to see.

She said that pelvic floor physical therapy has helped her significantly. I have many patients that have and are willing to speak publicly about their condition, male and female. I want to put my practitioner hat on for a minute. You said something earlier in our discussion that this initial patient, your friend who had pelvic pain, initially they were looking at her lumbar spine. They were looking for musculoskeletal pain in the lumbar spine area. But now we see that obviously men have pelvic health as well.

Does it actually belong in the realm of orthopedic physical therapy since we know that the pelvic floor has so many different functions throughout respiration, through stability and pelvic pain, through GI dysfunction?

There are so many different areas it relates to, so maybe you can talk to that for a couple of moments. I do know that now there are different certifications.

We see children in our practice, typically more with bladder, bowel issues, not so much the pain aspect. They do get the abdominal pain from constipation, but we do see them as young as four, sometimes even younger, the babies with the constipation.

If you address that sooner in life rather than later, then I think it helps to not have so many issues when they are older. We have chiropractors, we have massage therapists. That may or may not be an internal treatment approach.

Obviously, sometimes you can treat things externally, which have an impact on the pelvic floor. I have very high standards for our patient care because we do have a lot of chronic pain patients.

There are definitely some techniques that you could do externally for sure. One thing that they said coming here to work here was that they now feel like they can treat the patient as a whole, meaning that they may need to do some internal work with a gloved hand, with lubrication when needed.

It is definitely in the musculoskeletal realm. A lot have been suffering for a long, long time, decades. I think the statistics show that most of the chronic pelvic pain patients see seven or so practitioners prior to coming to a final diagnosis.

Even this actress that had all of this exposure and everything at her fingertips, she was misdiagnosed and mistreated many times and for many years. Tell us what exactly is pelvic floor dysfunction? I have a model here. If you tilt the pelvis this way, all of this pink or red, whatever you want to call it, is all muscle. There are a lot of muscles going on. Again, some of them you can address externally, but most of them you do have to address internally.

This is obviously the female version. The male version, they have the same muscles. They have the urogenital triangle, which has the three more superficial muscles, men and women have it. Bulbo and ischiocavernosus in the transverse perineum, which is down here. Then you have the deeper levator ani muscles, which is the deeper muscles that connect to the bowel and the rectum.

But you can have dysfunction in one of these muscles. You can have dysfunction in all of these muscles. My friend that I mentioned earlier, she had nerve irritation which caused her to have bladder, bowel and sexual dysfunction, as well as pain in the whole area.

The pudendal nerve comes from S2, S3 and S4 nerve roots. When I was new to the field, it was all pudendal nerve. Just to go back to the pudendal nerve, basically almost everyone is familiar with the sciatic nerve. They basically come out like this, so sciatic is more lateral. The posterior femoral cutaneous nerve comes right next to and in between the sciatic, and then the pudendal nerve.

The posterior femoral cutaneous nerve can have some of the same symptoms as the pudendal nerve, such as burning, itching, sharp shooting pain that goes into the perineum area. The posterior femoral cutaneous can go a little bit down the legs, so then you get confused, is this sciatica or is it posterior femoral cutaneous pain?

Not just from the pelvic floor physical therapy standpoint, there are a lot of mental health challenges that these patients that are experiencing, as well as nutrition. Then they start getting constipation, irritable bowel syndrome. It can cause a cascade of symptoms. It can be complicated, but we are learning more and more from our patients and as a community, a pelvic health community.

That all you have to do is just do some Kegel exercises and squeeze your pelvic floor and retain the flow of urine for about five seconds. Repeat that ten times a day and your pelvic floor will just be fine and healthy.

But when you start mentioning that nerves have a motor function, nerves have a sensory function and there are nerves that have an autonomic function. Tell us about the muscles down there. Generally, what are their functions? Do they always need tightening? Or is it something else that is needed for someone to heal? A while ago, it was called hypertonic pelvic floor muscles, which meant more tightening, shortening of the muscle, more restrictions, trigger points, connective tissue restrictions, etc.

Now, they are calling that overactive pelvic floor dysfunction, so hypertonic and overactive are really meaning the same thing. For the men, the non-bacterial prostatitis is very common. These are all more of the overactive syndromes and symptoms. There are two different types of muscle fibers, which are also throughout the body.

When you are doing pelvic floor exercises, you do need to focus on both strengthening the slow twitch and the fast twitch. When you have bicep weakness, you want to strengthen the muscles but you want to go through the full range of motion. Then the underactive is more the diagnosis of incontinence, prolapse.

Prolapse is when the organ is actually starting to descend. That could be strictly from weakness, it could also be from connective tissue laxity. Every time I go on Amazon and I look, your book is always up there on the top five or top ten. We need it.


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