Today I am excited to share a guest post with you from Stephanie Prendergast, MPT, co-founder of the Pelvic Health and Rehabilitation Center, and co-author of the newly released book, Pelvic Pain Explained. (I just received my copy today!) Stephanie will be a guest expert in my upcoming Healing Female Pain program. Today she has some great information to share with us about why a diagnosis is not the key to recovering from pelvic pain. In my opinion this understanding is so important because it can help shift your focus and energy off of your diagnosis, or finding the correct one, and get it onto identifying and addressing the root causes of your symptoms – which is what will ultimately relieve them! Here’s what Stephanie has to say:
When symptoms of pelvic pain strike, it’s natural to want to know: What’s my diagnosis?
Every patient just beginning his/her journey to recovery from pelvic pain grapples with this question. But more often than not the quest to get that diagnosis leads to frustration and disappointment. On top of that, it can actually cause roadblocks to getting on the right treatment path.
For instance, so often patients come into our clinics either terrified of a “diagnosis” they’ve been labeled with (or given themselves) or so married to one diagnosis or another that it’s hard for them to think outside of that diagnosis box when it comes to putting together a treatment plan.
For the past few months we’ve been working to write a book about pelvic pain titled, Pelvic Pain Explained, and this is a topic that’s been on our minds a lot this week as we’ve worked to explain this concept in the book. In this blog post, I’m going to share the explanation that we composed for the book because I think it’s also a very blog-worthy topic!
Let me start the post by saying that I completely understand the desire for written in stone diagnosis. Not only does it validate a patient’s pain, especially if he/she has run up against a provider who’s dismissed his/her complaints or intimated that it’s “all in your head.”
But the fact is the treatment of pelvic pain widely diverges from the treatment of most other medical conditions.
Let me explain. Typically, when you have a medical problem, you go to the doctor, who perhaps runs a few tests, and then from there you get a diagnosis and treatment, usually some sort of medication.
Well, the diagnosis and treatment of pelvic pain simply does not work this way. When it comes to pelvic pain, a “diagnosis” does not dictate treatment.
For its part, pelvic pain ends up being a diagnosis of exclusion whereby other pathologies, such as an infection, must first be ruled out, and when symptoms persist, the patient is then given a descriptor diagnoses, such as “vulvodynia,” which simply means “pain in the vulva.” Indeed, oftentimes, the “diagnosis” simply is “pelvic pain.”
A second example is “interstitial cystitis/painful bladder syndrome” or “pudendal neuralgia,” meaning pain in the bladder or the pudendal nerve distribution respectively .
When a patient is given any one of these descriptor diagnoses they are often confused and frustrated mainly because there are no specific, one-size-fits-all treatment protocols for any one of them.
Understanding how a pelvic pain syndrome, whether it’s been tagged as “vulvodynia” or “pudendal neuralgia” is treated can restore hope.
So if a diagnosis does not dictate treatment, what does?
What does dictate treatment when it comes to pelvic pain are the specific neurological, musculoskeletal, and psychological impairments that are uncovered and determined to be involved in a patient’s symptoms.
As already mentioned, pelvic pain is rarely caused by just one issue, more often than not, it’s caused by a combination of factors, including impairments of the pelvic floor muscles, the central and peripheral nervous systems, and even behavioral issues, like poor posture or “holding in” one’s urine.
Therefore, a successful treatment approach involves identifying and treating all of the different impairments contributing to a patient’s symptoms.
These impairments might be found in the muscles, joints, nerves or connective tissue of the pelvic floor and/or the pelvic organs and the derma of the genitals. So we’re not just talking about that hammock of 14 muscles described above.
Therefore, the best course of action is to identify all of the impairments that contribute to a patient’s pelvic pain, and then treat each and every one of them individually while collectively treating the patient as a whole.
Is this an issue that you’ve faced in your recovery from pelvic pain? If so, please share your experiences in the comment section below.
Stephanie A. Prendergast, MPT is the co-founder of the Pelvic Health and Rehabilitation Center, which has locations in San Francisco, Berkeley, Los Gatos, Los Angeles, and Boston. She currently treats patients in the Los Angeles location.
Stephanie began serving on the International Pelvic Pain Society’s Board of Directors in 2002 and in 2013 was the first physical therapist to serve as President. As an acknowledged leader in the field, she was invited to become on of the founding Board members of the Society for Pudendal Neuralgia in 2005 and subsequently co-developed and teaches “De-mystifying Pudendal Neuralgia,” a continuing education course attended by doctors, physical therapists, and other allied health professionals around the world.
Stephanie served on the program committee for the World Congress on Abdominal and Pelvic Pain in 2013 and 2015 and is also Co-chair of the program committee for 2017. She is internationally recognized authority in the field of pelvic floor dysfunction, lectures regularly, and has numerous publications in medical textbooks, journals, and magazines. She co-authored the book Pelvic Pain Explained, released in January of 2016.