Transcript of the Prendergast Interview on Pelvic Pain

[Guest guest]

francesca, one of the women on the group 'Happy Pelvis', was gracious enough to type out the entire Interview with Prendergast. So, if you couldn't get the link to work here is the transcript... ~Chelle ----------------------------------------------------------------------------------------------------------------------------------- Hi,I typed up a transcript of the Prendergast radio interviewthat Chelle emailed us about. It was a much larger endeavor than Iexpected but I'm glad I now have a written copy of the interview sinceI haven't figured out how to download it. (Anyone have that softwarethat "records" streaming audio?)Please write me back if you find any errors!!I never want to type the words "pelvic" or "muscle" or "unfortunately"again!francescaSo I'm copying the text in the body of this email and I'm attaching a.txt

file in case it gets reformatted or something:--------------------------------------------http://www.kvta.com/dyn_page.php?id=13 - , thank you for joining us.Pelvic Health and Rehabilitation Center, Masters of Physical Therapy.And , this is probably on a subject matter that isn'tdiscussed very much in public, about pelvic health and pelvic pain,and do you want to let our listeners know what that is and who'saffected by it? Prendergast - Absolutely. So the pelvic pain syndromes wedeal with typically affect men and women in their 20s, 30s, 40s, and50s. And it basically is a musculoskeletal injury, so inside of thepelvis, just like anywhere else in the body, you have muscles,connective tissue, and nerves.And when

these muscles start to get tight, unfortunately, they canproduce the symptoms of genital pain, pain with intercourse,aorgasmia* or pain with orgasm, post-ejaculatory pain in men, scrotalpain in men, rectal pain or tailbone pain in both men and women.MS - I didn't realize that this applied to both genders! For somereason when we talk ...SP - Most people don't.MS - Yeah, when we talk about the pelvis, or pelvic exams even for uswomen, that involves the ob/gyn.SP - Exactly.MS - And I'm glad that you shared that, because obviously this is ahuge segment of our listeners.SP - It is, in fact, recent studies show that this actually affects 1in 4 people and that the problem is actually as prevalent as low backpain.It's commonly misdiagnosed as other things: Younger men are typicallymisdiagnosed with chronic prostatitis where in fact they don't havebacteria upon examination. Women are

often misdiagnosed with yeast orurinary tract infections, and unfortunately those treatments aren'teffective because they don't in fact have yeast or bacteria... but thesymptoms sound very very much the same.MS - And so one of the first things that one should do is... for awoman, I would imagine, she goes to her OB, right?SP - That's correct.MS - And a man would go to a prostate urologist...?SP - Men tend to go to primary care first, and then urology second.The most important thing is to not erroneously treat all of thesesymptoms just to what I'm describing here. So of course it's veryimportant for a patient to go to their doctor and get all other causesexamined. And if their cultures come back negative, their tests arenot positive, what then happens is patients tend to experience a lotof anxiety because the doctors may not be sure where to turn, when infact this is something that could be

looked at as well.MS - And when you said things like, the symptoms could be low backpain, so I imagine people might then go to their chiropractor.SP - That's correct.MS - And how do you know when you're supposed to take it to the nextlevel without being an alarmist, or a hypochondriac?SP - A good physical therapist that is specially trained in pelvicfloor dysfunction should be able to help a patient discern what'sactually causing their problem if the other causes are negative. Andhow that works is, basically, per vagina or rectum, the physicaltherapist will do a manual exam to palpate the nerves, the muscle andthe tissue to try to explain to the patient what's happening.Typically patients with pelvic pain do often have low back pain or hippain as well, so chiropractic treatments and standard physical therapymay be helpful for some of the symptoms, but not for all of thesymptoms.MS - And

can you describe it? I mean, is it isolated? Is it chronic?Does it have heat generating from it, is their something we could knowthat Ahh! - this might be...SP - Yes, typical symptoms (I'll just run through a list), becausethere're four main categories and patients may experience one or anycombination of the above.So simple symptoms, starting with the bladder: patients may experienceurinary urgency, frequency, or burning when they go to the bathroom.Some of my patients unfortunately feel like they actually need to voidup to 60 times a day. In less severe cases, it may start out as peoplesaying, "Oh I just have a small bladder" or a "shy bladder" but inactuality patients should not urinate more than 6-8 times in a 24 hourperiod. And if patients are under the age of 35-40 they should notwake up during the night to void. And if they are, it's a sign thatthe muscles around the bladder may in fact be short and

tight, whichis creating the sensation that they have to go the bathroom when theyin fact, don't.Moving on to the other side of that, a lot of patients experienceconstipation for many reasons. One of the reasons could be becauseagain, these pelvic floor muscles are tight, and they're actually notable to relax the muscles sufficiently to allow a bowel movement. Sowhat happens as a result of that is the patients end up straining andthey're really struggling to have a bowel movement. And normal bowelmovement should occur 5 to 7 times per week.MS - If someone is experiencing that and then they augment with fiber,say or Metamucil or something like that, does that help it?SP - If they have a gastrointestinal problem, and not a muscleproblem, things like fiber may help. But the patients that I'm talkingabout are those who are taking fiber who have a good diet and yet theystill are having trouble, and

trouble in the way that they really haveto strain, versus if you take fiber and you can easily have a bowelmovement, that's probably not a musculoskeletal issue.And so continuing, the next level is the pain with intercourse, whichobviously can be very distressing. So a lot of women may not be ableto tolerate wearing a tampon, or tolerate penetration because theyeither feel pain or burning either at the entryway or deep in thevagina. Or they actually will describe a feeling of extreme tightness,actually unable to tolerate penetration because the muscles arecircular andin fact can get so tight that I've had trouble doing digital exams onsome of our patients.And with men, in terms of sexual side effects, they may experienceerectile dysfunction, penile pain, or post-ejaculatory pain, either inthe tip of the penis or in the area right above the penis called thesuper-pubic region. That's one of our most common

symptoms among men.MS - Now , if somebody didn't have pain before and then theydo have pain now, that's obvious, right? But if somebody has issueswith their pelvic floor is that something that gets exacerbated overtime or would that be their experience *always* and therefore theymight not know that that's not normal to have penile pain, orpost-ejaculatory pain?SP - We see both cases, that's a very very good point, because we dosee both. Some patients may have a particular initiating event, like ayeast infection that seemingly didn't go away because they're stillitchy. Itching without infection is another one of the symptoms thatwe see.Whereas other patients may experience a life-long history of urgencyand frequency.They say, since the minute they were born, they always had troublewith going to the bathroom, or bowel movements, or urinary frequency.So for some it may start later, other

patients it may start earlier.And typically if it's not treated or if it's treated incorrectly,unfortunately the symptoms do get worse, and while they may havedysfunction it often will progress into pain, burning... it can bevery problematic.MS - Now tell me though, how is it that a pelvic floor issue wouldcome about, did you say at the beginning of our conversation, it mightbe due to an injury?SP - It could be. So athletic injuries that we see all the time,particularly around this time of year, are falls on the tailbone fromsnowboarding or skiing. Cyclists' syndrome is another common thingbecause a bike seat will compress some very important nerves andvessels in the pelvic floor.Patients with back pain and any type of lower extremity issue that maycause their pelvis to be slightly crooked, if you will, can lead totension on one side, compression on another, the pelvic floor is inthe middle. So it

can develop into a situation such as that.The other major area we see are, a lot of our patients, who doexcessive exercises in the gym -- I've had patients report doing 500sit-ups a day, things that are beyond what would be considered normalexercise -- can start to develop trigger points or tight points in themuscle. That can create a lot of what I just described.MS - And with the men, since we haven't left that yet, is the PSA** areflection of any of these issues?SP - Not at all. And if the PSA is elevated and they are havingsymptoms, that is definitely something that needs to be examined bythe urologist. But it's not definitely... it's not typicallyassociated with prostate cancer or in fact any type of prostateproblem. Most of our male patients are diagnosed with prostatitis butthat in fact is not the issue, and they are put on years and years ofantibiotics trying to treat it.MS

- Oh my gosh! You must see some horror stories that have happenedover time...SP - We do. And we treat this and specifically this all day long,which makes our office a little bit different than most practices. Andit's unfortunate, but you know, knowing that there is something thatcan be done and the situation *can* improve with proper therapy is themost important thing for patients to understand.MS - And did I interrupt you? You were talking about the issues,bladder, constipation, pain with intercourse, itchy withoutinfection...SP - Those are the key things, and with that may come things such asclothing intolerance, because the whole skin in the area can becomevery sensitive, so women may not be able to wear jeans, or underwear,or have trouble sitting down (both sexes).Those are the primary subsets that we see, so again clitoral pain,vaginal pain, and rectal pain can accompany any of the urinary,

bowel,or sexual dysfunction symptoms that I described.MS - And we're finishing this very fascinating discussion about pelvicpain and pelvic health and pelvic dysfunction. And as hasbeen sharing with us, it doesn't discriminate between genders. Weusually hear about pelvic issues with women, but before the break was telling us about how it can affect men and women, 20s,30s, 40s, and 50s, typically, with bladder, constipation, pain withintercourse, itchy without infection, and clothing intolerance.And , if somebody's listening and they're identifying thatthey may be a candidate for this, if you will, you said: first you goto your healthcare provider, and then you see somebody who is a pelvicdysfunction expert?SP - That's correct. So of course you want to start with your standardgynecologist, urologist, primary care physician to rule out anypotential infections or anything

that may be going on in thoseparticular organ systems. Your physician may or may not be aware ofthe things that we're talking about today. This is a relatively newfield, and as you and I were discussing, it's not completelyunderstood by all practitioners.So there is an organization, called the International Pelvic PainSociety, which has a list of practitioners, physicians, physicaltherapists around the country and in other areas, and hopefully you'llbe able to find a provider on that site in your area who is familiarwith the types of things that we've been discussing today.MS - And we have Craig from ?? ; you're on Newstalk 1520 KVTA, goodafternoon Craig. You had a question for ?Craig - Yeah a little bit. I had an experience since I've been in myearly 20s and I was diagnosed just like she said, with having chronicprostatitis. And I've been through this, that, and the other thing andI still

have all these symptoms. And so I was really fascinated tohear about this condition, because it sounds like something that mightbe an answer to what I've been going through.MS - Wouldn't *that* be something, Craig?Craig - Yeah it would, because no matter what, the antibiotics andthis and that and I still have constant pain and several of thesymptoms that she indicated, so it peaked my interest; I've beenputting up with this for thirty years.MS - Whoa!SP - That's not uncommon, unfortunately.Craig - You know I never got an answer from any urologist, orwhatever, you know?MS - So , since Craig lives here in ??, he should consultthat web address that you gave us, about the organization?SP - I would recommend that first. And unfortunately there are notthat many people in our country who are skilled at evaluating andtreating this, so it's not uncommon for patients to

have to travel alittle bit of distant to get to the closest person to you. Which maybe me because I'm in San Francisco and the Bay Area. And again, youwant to start, typically with the urologist, the primary carephysician...Craig - I'm going back, for like, my 19th PSA deal.MS - Oh boy.SP - If you haven't yet been evaluated by a pelvic floor physicaltherapist, that's the next reasonable step.MS - And so , we also we're going to be speaking about howthis can effect, or not, orgasms. And you want to address that too?SP - Absolutely. So one of the situations that can occur with thepelvic floor muscles is an orgasm is a rapid muscle contraction. Andin cases where patients have pelvic floor muscle tightness, they'reunable to rapidly contract the muscles at the rate that is

required toexperience an orgasm. Or as patients start to develop this they maystart to notice, maybe prior to any urinary pain or bowel symptom,that their intensity or their ability to have an orgasm has decreased,if they were able to at all. And it seems to be the case that a lot ofmy patients that eventually develop pain syndromes later on, alwayshave had difficulty with orgasm or reporting that they just have neverbeen able to achieve one, which in fact may be a musculoskeletalreason that preceded the pain syndrome that may develop later on.The situation is similar in men with both, difficulty with ejaculationand erectile dysfunction. A lot of the vessels surrounding the penisthat are responsible for erection can get compressed when tissues andmuscles get tight, and therefore will not allow that to happen. Sothis particular subset of patients will be non-responsive to thetypical Viagra and Cialis that they may

be prescribed, because in factit's a tissue issue, and not necessarily something that will respondto a medication.MS - And quickly , what is the therapy like?SP - So the typical physical therapy appointments are about an hour,and it's manual therapy, so the physical therapist should have theirhands on their patient during most of the time. Historically peoplewho treat pelvic dysfunction may be trained onbiofeedback devices, which can be somewhat effective in alleviatingmuscle issuesbut really that's meant for patients who are weak. Patients who aretight actually need to be stretched and the tissue needs to belengthened.So we do a combination of techniques internally and externally thatinvolve lengthening the muscles that attach to the pelvis as well asthe muscles inside the pelvis, either per vagina or per rectum. Inaddition to that we work with myofascial trigger points,

connectivetissue restrictions, and basically trying to normalize any structuralchanges that the patients may have undergone.MS - Well I cannot thank you enough for the information, and lettingus know about how chronic and prevalent this could be, and that peopledon't have to live in fear or in pain or without pleasure!SP - Absolutely. , thank you for bringing attention to this topic.MS - You're welcome, and of course we will post your information,, on our website as we do, as well as the organization thatyou referred to. Prendergast, she is one of the leaders inthe Pelvic Health and Rehabilitation Center, and as she said, it'slargely unknown.* Same as "anorgasmia" i.e. inability to achieve orgasm.** PSA: Prostrate Specific Antigen:http://men.webmd.com/prostate-specific-antigen-psaPelvic Health and Rehabilitation Center:http://www.pelvicpainrehab.com/International Pelvic Pain Society: http://www.pelvicpain.org/

[Guest guest]

HI Chelle,

Hon thank you SO much for that interview.. I was one who couldn't

download it either.

Tell your friend thank you as well. Great job.

big hugs

Dee

[Guest guest]

To record streaming audio:

1. Download and install Audacity, a free audio recording program

2. Set your computer to record itself. Go to Start>all

programs>accessories>entertainment>volume control. Go to

Options>Properties. then click the button for recording. Make sure

What U Hear is selected. Press ok and make sure What U Hear is

selected as the recording input.

3. Record in audacity. (Just press red circle)

That's how I do it on my computer. This is my field!

shannon

pletchsr@...

>

> francesca, one of the women on the group 'Happy Pelvis', was

gracious enough to type out the entire Interview with

Prendergast. So, if you couldn't get the link to work here is the

transcript... ~Chelle

> -----------------------------------------------------------------

------------------------------------------------------------------

>

> Hi,

>

> I typed up a transcript of the Prendergast radio

interview

> that Chelle emailed us about. It was a much larger endeavor than I

> expected but I'm glad I now have a written copy of the interview

since

> I haven't figured out how to download it. (Anyone have that

software

> that " records " streaming audio?)

>

> Please write me back if you find any errors!!

>

> I never want to type the words " pelvic " or " muscle "

or " unfortunately "

> again!

>

> francesca

>

>

> So I'm copying the text in the body of this email and I'm

attaching a

> .txt file in case it gets reformatted or something:

>

> --------------------------------------------

>

> http://www.kvta.com/dyn_page.php?id=13

>

>

> - , thank you for joining us.

> Pelvic Health and Rehabilitation Center, Masters of Physical

Therapy.

>

> And , this is probably on a subject matter that isn't

> discussed very much in public, about pelvic health and pelvic pain,

> and do you want to let our listeners know what that is and who's

> affected by it?

>

> Prendergast - Absolutely. So the pelvic pain syndromes we

> deal with typically affect men and women in their 20s, 30s, 40s,

and

> 50s. And it basically is a musculoskeletal injury, so inside of the

> pelvis, just like anywhere else in the body, you have muscles,

> connective tissue, and nerves.

>

> And when these muscles start to get tight, unfortunately, they can

> produce the symptoms of genital pain, pain with intercourse,

> aorgasmia* or pain with orgasm, post-ejaculatory pain in men,

scrotal

> pain in men, rectal pain or tailbone pain in both men and women.

>

> MS - I didn't realize that this applied to both genders! For some

> reason when we talk ...

>

> SP - Most people don't.

>

> MS - Yeah, when we talk about the pelvis, or pelvic exams even for

us

> women, that involves the ob/gyn.

>

> SP - Exactly.

>

> MS - And I'm glad that you shared that, because obviously this is a

> huge segment of our listeners.

>

> SP - It is, in fact, recent studies show that this actually

affects 1

> in 4 people and that the problem is actually as prevalent as low

back

> pain.

>

> It's commonly misdiagnosed as other things: Younger men are

typically

> misdiagnosed with chronic prostatitis where in fact they don't have

> bacteria upon examination. Women are often misdiagnosed with yeast

or

> urinary tract infections, and unfortunately those treatments aren't

> effective because they don't in fact have yeast or bacteria... but

the

> symptoms sound very very much the same.

>

> MS - And so one of the first things that one should do is... for a

> woman, I would imagine, she goes to her OB, right?

>

> SP - That's correct.

>

> MS - And a man would go to a prostate urologist...?

>

> SP - Men tend to go to primary care first, and then urology second.

> The most important thing is to not erroneously treat all of these

> symptoms just to what I'm describing here. So of course it's very

> important for a patient to go to their doctor and get all other

causes

> examined. And if their cultures come back negative, their tests are

> not positive, what then happens is patients tend to experience a

lot

> of anxiety because the doctors may not be sure where to turn, when

in

> fact this is something that could be looked at as well.

>

> MS - And when you said things like, the symptoms could be low back

> pain, so I imagine people might then go to their chiropractor.

>

> SP - That's correct.

>

> MS - And how do you know when you're supposed to take it to the

next

> level without being an alarmist, or a hypochondriac?

>

> SP - A good physical therapist that is specially trained in pelvic

> floor dysfunction should be able to help a patient discern what's

> actually causing their problem if the other causes are negative.

And

> how that works is, basically, per vagina or rectum, the physical

> therapist will do a manual exam to palpate the nerves, the muscle

and

> the tissue to try to explain to the patient what's happening.

>

> Typically patients with pelvic pain do often have low back pain or

hip

> pain as well, so chiropractic treatments and standard physical

therapy

> may be helpful for some of the symptoms, but not for all of the

> symptoms.

>

> MS - And can you describe it? I mean, is it isolated? Is it

chronic?

> Does it have heat generating from it, is their something we could

know

> that Ahh! - this might be...

>

> SP - Yes, typical symptoms (I'll just run through a list), because

> there're four main categories and patients may experience one or

any

> combination of the above.

>

> So simple symptoms, starting with the bladder: patients may

experience

> urinary urgency, frequency, or burning when they go to the

bathroom.

> Some of my patients unfortunately feel like they actually need to

void

> up to 60 times a day. In less severe cases, it may start out as

people

> saying, " Oh I just have a small bladder " or a " shy bladder " but in

> actuality patients should not urinate more than 6-8 times in a 24

hour

> period. And if patients are under the age of 35-40 they should not

> wake up during the night to void. And if they are, it's a sign that

> the muscles around the bladder may in fact be short and tight,

which

> is creating the sensation that they have to go the bathroom when

they

> in fact, don't.

>

> Moving on to the other side of that, a lot of patients experience

> constipation for many reasons. One of the reasons could be because

> again, these pelvic floor muscles are tight, and they're actually

not

> able to relax the muscles sufficiently to allow a bowel movement.

So

> what happens as a result of that is the patients end up straining

and

> they're really struggling to have a bowel movement. And normal

bowel

> movement should occur 5 to 7 times per week.

>

> MS - If someone is experiencing that and then they augment with

fiber,

> say or Metamucil or something like that, does that help it?

>

> SP - If they have a gastrointestinal problem, and not a muscle

> problem, things like fiber may help. But the patients that I'm

talking

> about are those who are taking fiber who have a good diet and yet

they

> still are having trouble, and trouble in the way that they really

have

> to strain, versus if you take fiber and you can easily have a bowel

> movement, that's probably not a musculoskeletal issue.

>

> And so continuing, the next level is the pain with intercourse,

which

> obviously can be very distressing. So a lot of women may not be

able

> to tolerate wearing a tampon, or tolerate penetration because they

> either feel pain or burning either at the entryway or deep in the

> vagina. Or they actually will describe a feeling of extreme

tightness,

> actually unable to tolerate penetration because the muscles are

> circular and

> in fact can get so tight that I've had trouble doing digital exams

on

> some of our patients.

>

> And with men, in terms of sexual side effects, they may experience

> erectile dysfunction, penile pain, or post-ejaculatory pain,

either in

> the tip of the penis or in the area right above the penis called

the

> super-pubic region. That's one of our most common symptoms among

men.

>

> MS - Now , if somebody didn't have pain before and then

they

> do have pain now, that's obvious, right? But if somebody has issues

> with their pelvic floor is that something that gets exacerbated

over

> time or would that be their experience *always* and therefore they

> might not know that that's not normal to have penile pain, or

> post-ejaculatory pain?

>

> SP - We see both cases, that's a very very good point, because we

do

> see both. Some patients may have a particular initiating event,

like a

> yeast infection that seemingly didn't go away because they're still

> itchy. Itching without infection is another one of the symptoms

that

> we see.

>

> Whereas other patients may experience a life-long history of

urgency

> and frequency.

> They say, since the minute they were born, they always had trouble

> with going to the bathroom, or bowel movements, or urinary

frequency.

> So for some it may start later, other patients it may start

earlier.

> And typically if it's not treated or if it's treated incorrectly,

> unfortunately the symptoms do get worse, and while they may have

> dysfunction it often will progress into pain, burning... it can be

> very problematic.

>

> MS - Now tell me though, how is it that a pelvic floor issue would

> come about, did you say at the beginning of our conversation, it

might

> be due to an injury?

>

> SP - It could be. So athletic injuries that we see all the time,

> particularly around this time of year, are falls on the tailbone

from

> snowboarding or skiing. Cyclists' syndrome is another common thing

> because a bike seat will compress some very important nerves and

> vessels in the pelvic floor.

>

> Patients with back pain and any type of lower extremity issue that

may

> cause their pelvis to be slightly crooked, if you will, can lead to

> tension on one side, compression on another, the pelvic floor is in

> the middle. So it can develop into a situation such as that.

>

> The other major area we see are, a lot of our patients, who do

> excessive exercises in the gym -- I've had patients report doing

500

> sit-ups a day, things that are beyond what would be considered

normal

> exercise -- can start to develop trigger points or tight points in

the

> muscle. That can create a lot of what I just described.

>

> MS - And with the men, since we haven't left that yet, is the

PSA** a

> reflection of any of these issues?

>

> SP - Not at all. And if the PSA is elevated and they are having

> symptoms, that is definitely something that needs to be examined by

> the urologist. But it's not definitely... it's not typically

> associated with prostate cancer or in fact any type of prostate

> problem. Most of our male patients are diagnosed with prostatitis

but

> that in fact is not the issue, and they are put on years and years

of

> antibiotics trying to treat it.

>

> MS - Oh my gosh! You must see some horror stories that have

happened

> over time...

>

> SP - We do. And we treat this and specifically this all day long,

> which makes our office a little bit different than most practices.

And

> it's unfortunate, but you know, knowing that there is something

that

> can be done and the situation *can* improve with proper therapy is

the

> most important thing for patients to understand.

>

> MS - And did I interrupt you? You were talking about the issues,

> bladder, constipation, pain with intercourse, itchy without

> infection...

>

> SP - Those are the key things, and with that may come things such

as

> clothing intolerance, because the whole skin in the area can become

> very sensitive, so women may not be able to wear jeans, or

underwear,

> or have trouble sitting down (both sexes).

>

> Those are the primary subsets that we see, so again clitoral pain,

> vaginal pain, and rectal pain can accompany any of the urinary,

bowel,

> or sexual dysfunction symptoms that I described.

>

>

> MS - And we're finishing this very fascinating discussion about

pelvic

> pain and pelvic health and pelvic dysfunction. And as has

> been sharing with us, it doesn't discriminate between genders. We

> usually hear about pelvic issues with women, but before the break

> was telling us about how it can affect men and women,

20s,

> 30s, 40s, and 50s, typically, with bladder, constipation, pain with

> intercourse, itchy without infection, and clothing intolerance.

>

> And , if somebody's listening and they're identifying that

> they may be a candidate for this, if you will, you said: first you

go

> to your healthcare provider, and then you see somebody who is a

pelvic

> dysfunction expert?

>

> SP - That's correct. So of course you want to start with your

standard

> gynecologist, urologist, primary care physician to rule out any

> potential infections or anything that may be going on in those

> particular organ systems. Your physician may or may not be aware of

> the things that we're talking about today. This is a relatively new

> field, and as you and I were discussing, it's not completely

> understood by all practitioners.

>

> So there is an organization, called the International Pelvic Pain

> Society, which has a list of practitioners, physicians, physical

> therapists around the country and in other areas, and hopefully

you'll

> be able to find a provider on that site in your area who is

familiar

> with the types of things that we've been discussing today.

>

> MS - And we have Craig from ?? ; you're on Newstalk 1520 KVTA, good

> afternoon Craig. You had a question for ?

>

> Craig - Yeah a little bit. I had an experience since I've been in

my

> early 20s and I was diagnosed just like she said, with having

chronic

> prostatitis. And I've been through this, that, and the other thing

and

> I still have all these symptoms. And so I was really fascinated to

> hear about this condition, because it sounds like something that

might

> be an answer to what I've been going through.

>

> MS - Wouldn't *that* be something, Craig?

>

> Craig - Yeah it would, because no matter what, the antibiotics and

> this and that and I still have constant pain and several of the

> symptoms that she indicated, so it peaked my interest; I've been

> putting up with this for thirty years.

>

> MS - Whoa!

>

> SP - That's not uncommon, unfortunately.

>

> Craig - You know I never got an answer from any urologist, or

> whatever, you know?

>

> MS - So , since Craig lives here in ??, he should consult

> that web address that you gave us, about the organization?

>

> SP - I would recommend that first. And unfortunately there are not

> that many people in our country who are skilled at evaluating and

> treating this, so it's not uncommon for patients to have to travel

a

> little bit of distant to get to the closest person to you. Which

may

> be me because I'm in San Francisco and the Bay Area. And again, you

> want to start, typically with the urologist, the primary care

> physician...

>

> Craig - I'm going back, for like, my 19th PSA deal.

>

> MS - Oh boy.

>

> SP - If you haven't yet been evaluated by a pelvic floor physical

> therapist, that's the next reasonable step.

>

> MS - And so , we also we're going to be speaking about how

> this can effect, or not, orgasms. And you want to address that

too?

>

> SP - Absolutely. So one of the situations that can occur with the

> pelvic floor muscles is an orgasm is a rapid muscle contraction.

And

> in cases where patients have pelvic floor muscle tightness, they're

> unable to rapidly contract the muscles at the rate that is

required to

> experience an orgasm. Or as patients start to develop this they may

> start to notice, maybe prior to any urinary pain or bowel symptom,

> that their intensity or their ability to have an orgasm has

decreased,

> if they were able to at all. And it seems to be the case that a

lot of

> my patients that eventually develop pain syndromes later on, always

> have had difficulty with orgasm or reporting that they just have

never

> been able to achieve one, which in fact may be a musculoskeletal

> reason that preceded the pain syndrome that may develop later on.

>

> The situation is similar in men with both, difficulty with

ejaculation

> and erectile dysfunction. A lot of the vessels surrounding the

penis

> that are responsible for erection can get compressed when tissues

and

> muscles get tight, and therefore will not allow that to happen. So

> this particular subset of patients will be non-responsive to the

> typical Viagra and Cialis that they may be prescribed, because in

fact

> it's a tissue issue, and not necessarily something that will

respond

> to a medication.

>

> MS - And quickly , what is the therapy like?

>

> SP - So the typical physical therapy appointments are about an

hour,

> and it's manual therapy, so the physical therapist should have

their

> hands on their patient during most of the time. Historically people

> who treat pelvic dysfunction may be trained on

> biofeedback devices, which can be somewhat effective in alleviating

> muscle issues

> but really that's meant for patients who are weak. Patients who are

> tight actually need to be stretched and the tissue needs to be

> lengthened.

>

> So we do a combination of techniques internally and externally that

> involve lengthening the muscles that attach to the pelvis as well

as

> the muscles inside the pelvis, either per vagina or per rectum. In

> addition to that we work with myofascial trigger points, connective

> tissue restrictions, and basically trying to normalize any

structural

> changes that the patients may have undergone.

>

> MS - Well I cannot thank you enough for the information, and

letting

> us know about how chronic and prevalent this could be, and that

people

> don't have to live in fear or in pain or without pleasure!

>

> SP - Absolutely. , thank you for bringing attention to this

topic.

>

> MS - You're welcome, and of course we will post your information,

> , on our website as we do, as well as the organization

that

> you referred to. Prendergast, she is one of the leaders

in

> the Pelvic Health and Rehabilitation Center, and as she said, it's

> largely unknown.

>

>

>

> * Same as " anorgasmia " i.e. inability to achieve orgasm.

> ** PSA: Prostrate Specific Antigen:

> http://men.webmd.com/prostate-specific-antigen-psa

>

>

> Pelvic Health and Rehabilitation Center:

> http://www.pelvicpainrehab.com/

> International Pelvic Pain Society: http://www.pelvicpain.org/

>