Heal Pelvic Pain: The Proven Stretching, Strengthening, and Nutrition Program for Relieving Pain, Incontinence, I.B.S, and Other Symptoms Without Surgery

By Amy Stein

Bronze Medal Winner of a 2009 National Health Information Award

Stop your pelvic pain . . . naturally!

If you suffer from an agonizing and emotionally stressful pelvic floor disorder, including pelvic pain, irritable bowel syndrome, endometriosis, prostatitis, incontinence, or discomfort during sex, urination, or bowel movements, it's time to alleviate your symptoms and start healing--without drugs or surgery. Natural cures, in the form of exercise, nutrition, massage, and self-care therapy, focus on the underlying cause of your pain, heal your condition, and stop your pain forever.

The life-changing plan in this book gets to the root of your disorder with:

• A stretching, muscle-strengthening, and massage program you can do at home
• Guidelines on foods that will ease your discomfort
• Suggestions for stress- and pain-reducing home spa treatments
• Exercises for building core strength and enhancing sexual pleasure

• Language: English
• Publisher: McGraw-Hill Education
• Release date: Aug 31, 2008
• ISBN: 9780071546577

Book preview

Heal Pelvic Pain

Heal Pelvic Pain

A Proven Stretching, Strengthening,

and Nutrition Program for Relieving

Pain, Incontinence, IBS, and Other

Symptoms Without Surgery

AMY STEIN, M.P.T.

FOREWORD BY ANDREW GOLDSTEIN, M.D.

Copyright © 2009 by Amy Stein. All rights reserved. Manufactured in the United States of America. Except as permitted under the United States Copyright Act of 1976, no part of this publication may be reproduced or distributed in any form or by any means, or stored in a database or retrieval system, without the prior written permission of the publisher.

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DOI: 10.1036/0071546561

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CONTENTS

FOREWORD

Copyright © 2009 by Amy Stein. Click here for terms of use.

When I was in medical school back in the 1990s, physical therapy (PT) was regarded as something of an afterthought. Since physical therapists rarely published studies in journals read by physicians, the PT practice lacked scientific clout—at least as far as doctors were concerned. When physical therapy was considered, it was seen as useful mostly for damaged muscles and joints after injury or surgery. In other words, after doctors had done the real work, you might prescribe physical therapy for the mop-up.

Despite completing nearly 20,000 hours of internship and residency in obstetrics and gynecology, I heard only one hour-long lecture on vulvar pain and sexual dysfunction. I was taught that pain during sex was the result of vaginismus, an involuntary contraction of the vaginal muscles during attempted penetration. I was further taught that vaginismus was a psychological issue resulting from trauma or abuse, and that it was to be treated through psychotherapy and sex therapy. Physical therapy was never mentioned. Other types of vulvar pain were thought to be caused by nerve injury and were treated—as much as possible—with drugs. Again, physical therapy was never discussed as a treatment for women suffering this pain, nor was I ever taught anything about pelvic floor disorders in men!

After completing my residency, I joined the faculty of Johns Hopkins and became the director for the Center for Vulvovaginal Disorders. A great many of the patients with whom I dealt had suffered pain for a decade or more. Prescription drugs controlled the pain, but they did not cure it and often produced significant side effects—including heart palpitations, extreme lethargy, weight gain, dry mouth, and constipation. If it was a steep price for these women to pay for the relief of their pain, few people in the medical profession questioned the situation or challenged the assumptions on which this standard therapy was based—namely, that the chronic pain was solely due to nerve injury—neuropathy, in medical lingo.

The only problem with this wisdom was that it wasn't true. It took some forward-looking physical therapists like Amy Stein, the very folks we doctors had typically paid little attention to, to enlighten us on what was really at issue.

It's not too far-fetched to say that Amy and her colleagues had to beat down the doors of the medical establishment—figuratively, anyway—to be heard. They made their case with compelling logic, arguing that the cause of much of the pain we were treating with medication was not, in fact, neuropathic, but instead myofascial—that is, in the muscles and tissue. The pain, they explained, was a result of the muscles having tightened and shortened. The tightening had decreased the blood flow and therefore the supply of oxygen to the affected muscles; as a result, lactic acid built up, irritating the nerves that pass through the muscles. As the brain perceives pain as being located in the end organ reached by the affected nerve, the person felt vulvar pain. In addition, the irritation of the nerve typically gives rise to an inflammation that produces redness and swelling, and the redness and swelling, like the pain, show up in the endpoint organ reached by the irritated nerve—namely, the vulva.

Examining patients presenting with a complaint of pain in the vulva and with redness and swelling visible in the vulva, doctors would typically diagnose a vulvar infection, prescribing treatment that patients did not need for infections they did not have—treatments that were often irritating and sometimes harmful. Similarly, doctors often diagnosed prostatitis in men when the real issue was a pelvic floor disorder that could be addressed without drugs and without surgery.

As compelling as the arguments of these farsighted physical therapists were, what was really convincing was to see the profound and stunning results that Amy and the other physical therapists achieved when I began referring patients to them. I can describe those results in one simple but powerful word: cure. Through the modalities of physical therapy—manipulation, massage, and above all exercises that patients could do on their own—women who had suffered chronic pain for years stopped suffering.

This wasn't just temporary relief from pain. It wasn't a palliative. It was a cure. The women were able to give up the medications that had been controlling their pain, and they were able to return to normal functioning in every way—just by learning to relax and let go of the tension in their muscles, learning to lengthen their muscles, and learning to strengthen their muscles in the right way.

The impact on my practice of finding this natural cure has been phenomenal. I estimate that today I refer at least 50 percent of my patients to Amy Stein and other physical therapists who specialize in the disorders of the pelvic floor. I could not be a vulvar specialist without their very important specialty.

Many of the pain syndromes doctors and patients have struggled with for years now turn out to derive from myofascial disorders. For example, women are frequently diagnosed with irritable bowel syndrome or interstitial cystitis when in fact all of their pain may be myofascial in origin.

We live in a somewhat puritanical society, where the issues of pelvic floor disorder are not discussed openly, if at all. What's more, our culture's attitude toward health care often encourages the quick fix—make an appointment and get a prescription—and certainly, our current system of health-care insurance favors such efficiency. In France, however, it has long been the custom for every woman who goes through a vaginal delivery to see a physical therapist as part of her postpartum treatment. The muscles are massaged, lengthened, stretched, and strengthened prophylactically so as to prevent the weakness that can lead to incontinence or the tightness that can result from a tear or episiotomy and can lead to so much pain, discomfort, and limitations on functioning.

We also tend to believe that there's so much health-care information available—in newspapers and magazines and all over the Internet—that we should be in charge of our own medical treatment, even to the point of self-diagnosis and self-medication. Studies show, however, that when a woman diagnoses herself with a yeast infection based on the symptoms of itching, burning, and discharge—to take a common example—she is incorrect more than 50 percent of the time. The symptoms are just as likely to be a result of nerve irritation or tightened tissue. Yet far too many women head to the drugstore for creams to treat chronic itching and burning—often with dire consequences—when what they really should be doing is the exercise program in this book.

And that's precisely why this book is so important. It speaks openly and candidly to readers about the pain they are experiencing and the root causes of that pain. And it offers them simple, practical therapies for curing the pain so they can return to fully functioning lives. When the life-limiting pain and discomfort of pelvic floor disorder are at issue, Amy's program of exercises and self-care techniques is absolutely the best medicine.

Andrew T. Goldstein, M.D., FACOG

Director, The Centers for Vulvovaginal Disorders

Washington, D.C., and New York City

Coauthor, Reclaiming Desire: Four Keys to Finding

Your Lost Libido

ACKNOWLEDGMENTS

Copyright © 2009 by Amy Stein. Click here for terms of use.

My first thank-you is to my patients. They have been my biggest inspiration to learn more and to educate the public on pelvic pain and pelvic floor disorders. In addition, I'm grateful to those doctors and health-care providers who believe in these patients, and who understand the power of physical therapy to cure musculoskeletal pelvic floor disorders.

My agent, Sarah Jane Freymann, was really the progenitor of the idea for this book. I am grateful to her, McGraw-Hill editors Johanna Bowman and Craig Bolt, and copyeditor Alison Shurtz for understanding the importance of the book and for making it happen; to Susanna Margolis for helping get the book out of me; to Amy and Richard Hutchings of Hutchings Photography for the beautiful photos; and to Marie Dauenheimer for the great illustrations.

To everyone at Beyond Basics Physical Therapy who continues to help more than 5,000 sufferers each year, your success and passion are in this book; I couldn't have done it without you.

Finally, I am grateful to my entire support network—my family, my friends, and Travis—for their unconditional love and support.

CHAPTER 1

AT THE BODY'S CORE

Copyright © 2009 by Amy Stein. Click here for terms of use.

Say good-bye to your pelvic pain.

No matter how much it hurts, no matter how long you've suffered, no matter how many different pills you've taken or treatments you've undergone, the program in this book can help alleviate your pain or disorder and start the healing.

No drugs, no surgery. Instead, this is a program of natural healing—of exercises, massage, nutrition, and self-care therapies that will focus on the true underlying condition of your pain. Heal the condition, and your symptoms will go away—and that's just what the program in this book can help you achieve.

To start, I'll explain what pelvic floor disorder is, why doctors have trouble diagnosing it, why you may have had so much trouble treating it so far, and how you can feel better as quickly as possible.

The first thing you should know is that you are not alone. Of course, nobody likes to talk about bladder problems or painful sex or itching or burning in the genital region, so you may not hear or read much about pelvic floor disorders. But the truth is that millions of us suffer from these disorders—women and men, athletes and couch potatoes, young and old, even children.

Mostly, it's women who suffer. As I write this, 9.2 million women have pelvic floor disorder but don't know it because it has not been properly diagnosed. And the sad fact is that if you're a woman, you have at least a 5 percent chance of suffering chronic pelvic pain.

But your pain right now is what counts. That's why you're reading this book. You may be one of the more than 30 million women who have irritable bowel syndrome or one of the 700,000 with the urinary frequency, urgency, and pain that are collectively referred to as painful bladder syndrome or interstitial cystitis.

Maybe you suffer some form of incontinence, especially if you gave birth recently or exercise frequently.

Maybe you have some form of sexual dysfunction; 43 percent of women do. Pain during intercourse, performance problems, and declines in sexual response and enjoyment are all more common than you think. All can adversely affect your relationship with your partner. And all can be treated with the natural healing program in this book.

THE PELVIC FLOOR

What is the pelvic floor? Take a look at the figures. The pelvic floor is all the muscles, plus the nerves controlling the muscles, plus the tissues—called fascia—that connect everything together, plus the ligaments that link bone to bone and bone to organ that are attached to the front, back, and sides of the pelvis, from the pubic bone in the front of the body all the way back to the tailbone. These muscles, nerves, tissues, and ligaments sheathe the floor of the pelvis and together act like a sling or hammock to support the pelvic organs—the urinary tract, digestive tract, and reproductive