Wednesday, February 27, 2013

Pelvic Pain, Bladder Disorders, Prostate Problems, Fibromyalgia, Chronic Fatigue Syndrome, and Other Female and Male Related troubles: Is it more than co-incidence?



The muscles in the pelvic girdle are what keep our organs from falling to the floor. These muscles make up the perineum, the urogenital triangle, and the anal triangle. They support the rectum, the vagina/penis, and the urethra, but they may not be the only muscles involved in your pain and dysfunction.


Causes

Pelvic pain can be from many causes such as, vulvodynia, irritable bladder or interstitial cystitis, infection, vaginal atrophy, prostate problems/pain, testicular and or pain in the penis, pain in the urethra (where your urine comes out), rectal pain, ovarian cysts, ectopic pregnancy, neuralgia, endometriosis, inflammatory bowel diseases, irritable bowel syndrome, diverticulitis, and myofascial trigger points (MTrPs), but for this blog we are looking specifically at the bladder and the perineum (area of the urethra, penis, vagina, and rectum).

Myofascial trigger points have been identified as the greatest aggravator of chronic pelvic pain, and pain is not the only symptom. Pelvic floor problems can also cause a decrease in urine flow in men and women, erectile dysfunction, urinary retention (setting the stage for infection), urgency (always feeling like you have to urinate), and constipation.

For more on myofascial trigger points and myofascial pain see “Myofascial Pain” at my website and
 my blog: Points That Need More Than Pondering: Defining Myofascial Trigger Points


Offending trigger points

Myofascial trigger points in adductor magnus (thigh), or internal oblique (abdomen), are capable of causing bladder pain and frequency, and MTrPs in the adductor magnus can cause a host of referred pain to groin and inner thigh, pelvic and pubic bones, rectum and vagina and can cause menstrual cramping (as can MTrPs in the rectus abdominus, abdomen), and trigger points in the internal oblique can also cause bladder difficulties. The muscles of the pelvis, and the multi-layered muscles of the pelvic floor can become tight, unforgiving and short due to MTrPs. Myofascial trigger points in pelvic related muscles can refer pain to the urethra, rectum, coccyx, or the crease of the buttocks.

This is speaking in generalities, but it’s important to understand that the source of your pain can be close by or well away from pelvis itself.  Treating MTrPs, whether active (painful without touching) or latent (only painful with touched) that refer pain to a specific region is just as important as treating those directly relatable. Often times, those who claim to know myofascial trigger points do not understand the complexity, this includes physicians, physical therapists, and body workers.


Chronic myofascial pain in fibromyalgia, chronic fatigue syndrome, and pelvic dysfunction

Myofascial pain syndrome often co-exists in fibromyalgia, and has been identified in some chronic fatigue syndrome (ME/CFS) patients, chronic pelvic and bowel disorders.  Myofascial trigger points are a peripheral nerve to muscle problem that lends to centralized (amplified) pain in fibromyalgia, interstitial cystitis, bladder difficulties, ME/CFS, IBS, and other overlapping conditions.  This hypersensitive state is also present in these disorders. Ignoring the obvious bloodies the diagnostic waters and most importantly delays appropriate treatments and leads to flawed research.


Therapies

It is important to identify perpetuating factors, such as, co-existing hip problems, piriformis syndrome, pudendal neuralgia, low back or sacroiliac joint dysfunction, and other overlapping conditions, bringing them under control when possible. Pay close attention to aggravating factors such as, sitting too long or on hard surfaces and chairs that can’t be adjusted to your body type, over activity, infection, poor posture, wearing pants that are too tight, consuming offending foods, etc.

There are a variety of therapies to help you, including intravaginal and pelvic floor trigger point injections, external and internal massage of the perineum and in women the vagina, biofeedback, bladder retraining, transcutaneous electrical nerve stimulation (TENS), tennis ball therapy (as discussed in our book),
acupuncture, dietary changes, over-the-counter probiotics for the bladder, stretching movements, topical analgesics (such as oragel), oral analgesics, and of course specific myofascial therapy by a trained specialist. Sometimes, all are necessary.

Seldom are doctors well informed about myofascial pain s and trigger points, so I am a firm believer that women should see a urogynecologist, that men should see a urologist and in both cases, the physician should understand the role of the myofascial in chronic pelvic pain.  The same is true for the physical therapist. Why? Those who do not understand the role of trigger points chronic pelvic pain and dysfunction may suggest traditional therapies, such as, Kegel exercise, which can worsen your symptoms, and when co-existing conditions such as piriformis syndrome, spinal disease, IBS, etc. are involved; a host of referral patterns are involved.  This is why identifying ALL your pain patterns (whether you feel a trigger point there or not) is important information for your specially trained healthcare provider.

Always discuss your symptoms with your doctor to make sure other causes are ruled out. If your pain and dysfunction is not found to be from another source, please look for those myofascial trigger points and a specialized therapist, they are treatable.

Resources for you:

IC and Irritable bladder
Blatman Pain Clinic
What Your OB/GYN Should Know About FMS and CMP by Devin J. Starlanyl
Pelvic Floor Myofascial Trigger Points: Manual Therapy for Interstitial Cystitis and the Urgency-Frequency Syndrome by Jerome Weiss
Fibro Care Center
National Association of Myofascial Trigger Point Therapists
ICA – Physical Therapy
ICA – Pelvic Floor Dysfunction
International Myopain Society
IC Network


All blogs, posts and answers are not meant to replace medical advice.

Want to know more about Celeste’s books?  (See the right side of this blog)






Thursday, February 14, 2013

Walk a mile in my shoes: : The FDA and opioid labeling and restrictions, where does the problem really reside?


It is important to set atop the sky scraper, looking down on both sides of the building, weighing concerns in either direction, with the wind or against it.  I have deliberated over the power of addiction from any source, whether it be food, drugs, gambling, smoking, video games, shopping, sex, alcohol.  As I look into the wind and away from it, I question, “Is addiction a behavioral choice or an illness?” “Does restricting opioid medication from chronic pain patients reduce risk or increase it?”

Pain trumps all other basic functions. We are facing a critical turning point in our culture, and the consequence of wrong choices could be devastating. Why aren't we concerned with pain related deaths in this country? Could it be because we are afraid to admit our system is failing?  Will banning or limiting opioids increase the epidemic of untreated, pain? Does the potential for addiction outweigh the risks of not treating pain?

Addiction is the illness not the substance or behavior that feeds it. Have we stopped selling alcohol even though we know it has the potential for abuse and can kill instantly or slowly over a period of time?  Aren't programs like Alcoholic Anonymous a better answer? Is banning certain foods going to stop the obesity epidemic?  Do we treat addictions to gambling, smoking, video games, shopping, or sex by making it illegal to participate in any of these activities? As I sit on this grandiose pentacle, I realize to restrict the use of opioids as a choice in management of chronic pain is not the answer. Relieving pain is necessary; the use of alcohol, playing video games, etc is not. That does not mean I am in favor of government regulation, it means I am in favor of protecting our freedoms to choose how to relieve our pain.

Gaining favor as an alternative to opioids is antidepressants or anti-convulsants which we know create suicidal ideation in some patients, and can cause diabetes and a host of other serious medical problems.  These medications, in the medicine cabinet of a great many homes across America, have the potential for abuse. But why would we deprive patients who need them to function on a daily basis or prevent a very serious seizure disorder? Then I question, why these would be prescribed for pain when many patients report they are only minimally helpful, if at all, or that they come with a laundry list of interactions and side effects, when we already have effective pain medication?  Here we are atop the skyscraper once again.

I ask each person to relive their experience with pain and imagine it on a continual basis with no interventions possible.  Then I ask, “How long could you endure this pain before wanting to end it all?”  Is there any doubt you would be emotionally distraught?  Many pain patients feel alone and abandoned, because they are. Should we not address the emotional, mental, and spiritual affects of chronic pain, and provide education on how to use opioid medications safely and effectively?

We are missing the core problem of any addiction, poor access to mental health programs, lack of funding, and cultural attitudes. I would argue that the epidemic is not the use of opioids to treat chronic pain; the problem resides in our perception.   The days of using words like crazy or addict in a demeaning way should be long gone. The social injustice of ignoring those in need of professional council is the real epidemic. 

Those who take opioid pain medication to improve their activities of daily life and use them responsibly should not be vilified, and neither should those fewer people with a genetic tendency toward addiction. We must ask, before we make the decision to stand into the wind or away from it, choose one side of the building or the other, “Is it fair to deny a basic human right to have our pain treated by restricting access to medications that will help?” Addiction is not a moral collapse, it is a disease, and isn't addiction best treated by professionals rather than withholding the tool of addiction? Can we withhold food, sex, video games, alcohol, tobacco, gambling from everyone, and will that really solve the problem? History tells us from our experience with prohibition, that it will not.

Have we turned into machines worried about numbers rather than human beings? I hope not.



Monday, February 4, 2013

February is Raynaud’s Syndrome Awareness Month: What does this mean to you?



“When [Raynaud’s] occurs by itself, it is called Raynaud’s disease, or primary Raynaud’s phenomenon. When it occurs along with other diseases, such as scleroderma, rheumatoid arthritis, systemic lupus erythematosus, polymyositis, dermatomyositis, Sjogren’s syndrome, or mixed connective tissue disease, it is called secondary Raynaud’s phenomenon.”
Cooper and Miller, 2010, pg. 106-107

The symptoms of Raynaud’s are common in fibromyalgia and chronic fatigue immunodysfunction, and may be present if you have thoracic outlet syndrome.  The symptoms should not be confused with feeling cold, which is often associated with FM and CFID (ME/CFS).  These symptoms could be due to an upset in neuro-endocrine system, and can be attributed to autonomic effects or hypothyroidism. 

The defining characteristic of Raynaud's is that it generally affects only the fingers, toes, and  sometimes nose, and most commonly occurs when exposed to cold. Changes in skin color occur from pale to blue, and turn red during re-warming.  Also associated is extreme numbness during the acute phase. Though the cause is unknown, it is suspected that the nerves to the blood vessels cause them to spasm depriving the skin of blood and oxygen.  When the arteries relax during re-warming, blood flow returns causing the redness, which is frequently associated with pain, stinging or a burning sensation.

Your doctor may order a cold stimulation test to confirm diagnosis or do a nail fold capillaroscopy  or vascular ultrasound if secondary Raynaud’s is suspected.

Myofascial trigger point (MTrP) nerve entrapment can worsen symptoms of Raynaud’s so check MTrPs associated with the referral patterns to the affected area. (Cooper and Miller, 2010).

Treatment goals:

  • Re-warm slowly.
  • Protect fingers, toes and nose from cold exposure to prevent frostbite and skin ulcers.
  • Avoid emotional stress.
  • Avoid alcohol, particularly when you know you will be exposed to cold.
  • Don’t smoke.
  • Avoid use of tools that vibrate the hands.
  • Vasodilator type medications may be indicated in severe cases.
  • There are certain medications to avoid if you have Raynaud’s, so be sure to consult with your physician or pharmacist.


Report any unusual symptoms or skin breakdown to your physician immediately.



All blogs, posts and answers are not meant to replace medical advice.

Celeste's Website

Celeste's Website
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