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Pacing in Burnout - Welcome to 2020

In some ways being a pelvic health physio is very similar to being a counsellor – we have the same exposure to emotional trauma and provide emotional support. This article on burnout popped out at me the other day. Unlike counsellors we don’t get training and resources to tell you what to do, and it’s not spoken about.

When my Dad was dying I found myself completely overwhelmed by the needs of others. I love my job, I love the profession, but I was surviving one clinic to the next. I was head-down dug-in, just getting through each interaction and trying to stay alive, keep my Dad alive and support my family practically and emotionally. I was multitasking at an exponential rate; running clinic, running my business, running his medical situation. Working through emotional exhaustion I took everything personally, beating myself up for not ‘giving’ enough to support a patient and therefore taking their lack of progress, their hurt, their need for me to...

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I think I’ve got Vulvodynia or Vaginismus, what can I do?

Watch the video here.

Have you got Vulvodynia or Vaginismus?

Vaginismus is basically just tight pelvic floor muscles, which makes getting a tampon in or having penetrative sex painful or difficult. Your pelvic floor can be generally tight all the time (think about how tight your hamstrings get when you’ve been sat driving all day, the day after a run or you’ve never stretched them until that yoga class and down-dog was an experience..). Your pelvic floor muscles can also go into spasm when thinking about or having anything penetrate the vagina (like when your calf goes into cramp in the night). Both aren’t pleasant, and both are totally treatable. Treatment is exactly what you’d do with any other muscle – learn to relax them and give them a gentle (and regular) stretch. It shouldn’t hurt.

Vulvodynia is a pain in and on the vulva, where tests have shown there to be nothing ‘wrong’. I like to think of vulvodynia in these terms: your...

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Men have pelvic pain too. Let’s talk about it.

You can watch my interview with Karl Monahan here.

I’ve been wanting to talk about male pelvic pain. Men have pelvises and get pelvic pain. Why does it remain a taboo? This one is for both patients and clinicians.

Karl and I have been friends for a while. He’s a wonderful human, therapist, pain expert, collaborator… he generally defies labels. From a background in sports and advanced clinical massage therapy and specialist training in Arvigo Techniques of Maya Abdominal Therapy (ATMAT)  he’s built a wonderfully holistic clinic and practice that serves men with pelvic pain. You can find out about Karl here and his clinic here.

It speaks volumes that only in the last few years have we made the transition from “Women’s Health” physiotherapy (with physios who also treat men) to “Pelvic health physiotherapy” – a much more apt name for the treatment of pelvises, regardless of gender identity nor anatomy. It’s a...

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Guest blog: Recovering from urinary retention, Laura’s update

After delivering her first baby Laura went into Urinary Retention which caused an acute bladder injury. She was unable to pass urine and had no feeling that she needed to go. After an initial period of time with a catheter she has had to use Intermittent Self Catheterisation (ISC) to pass urine throughout the day.  If you haven’t read her last blog you can read it here.

We’ve been working together for a number of months and she’s making fabulous progress! I’ll let her tell you…

In my first ever blog post, I shared my story of retention post child birth. My journey of recovery is ongoing. I am still not completely ‘fixed’ yet but I am well on the way and now truly believe that I will get there in the end…whenever the end might be. There has been exciting highs but also really disheartening lows. Although I feel like it has been a lifetime since having a normal functioning bladder (when in reality, it’s only been 7 months),...

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Guest blog: Laura's childbirth and bladder injury story

Laura really wanted to share her story so that other women who have problems with rentention can know they’re not alone, and know how to find help. Reading her frank and at times devastating account of the first few weeks of her son’s life isn’t easy, especially as a health professional who can see where and when she’s been failed. I’ve been inspired by her resilience at a time where she should be enjoying motherhood. With persistence she’s making great progress, and I really do feel the future’s going to be fine.

Not being able to open your bladder, or going into “retention” can sometimes happen with childbirth. If it isn’t caught quickly the bladder can overfill, overstretch and become injured. Sometimes this leads to kidney injuries too. Not being able to go to the toilet at all can be quite dangerous for the bladder and kidneys, so people are often taught to drain their bladders with a small disposable catheter....

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Neurocentric approaches to treating pelvic pain with Dr Sandy Hilton

You can watch our chat here.

This is a Really exciting time in pelvic health where our understanding of the brain, pain and how we can change someone’s experience are all evolving. By this I don’t just mean in the psychological way, but in a true “pain experience” sense as well as thinking about how we can change biological markers and antecedents to pain, such as inflammation, with our words and how we approach people with chronic pain.

Sandy Hilton is a Doctor of Physical Therapy based in Chicago, America. She has contributed to multiple book chapters, papers, and co-authored “Why Pelvic Pain Hurts” and is an international instructor and speaker on treating pelvic pain for professionals and for public education. She’s also a regular contributor on health related podcasts, and is co-host of the Pain Science and Sensibility Podcast with Cory Blickenstaff, which I can wholly recommend as both a source of evidence and a great lesson in how...

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Practising fierce, compassionate self-care in 2019

You can watch our chat here.

I first met Katie Kettner at a Happy Bladder Course in 2018. I found her enthusiasm for our profession and passion for collating ways in which she can help people rehabilitate utterly inspiring. She is a Women’s Health Physiotherapist based in the North East of England with a diploma in counselling, is currently working towards a diploma is psychosexual Medicine and is studying a pastoral certificate via Loyola University in Chicago including the study of the psychology of human development and our quest for meaning.

She says of herself

“I have a deep and fierce passion for Women! Since working in this field, I have developed a huge compassion and empathy towards Women’s health and feel enthusiastic to not just help Women, but to celebrate them and honour them; and encourage them to do the same. This desire has led me to some fascinating discoveries from all sorts of fields, including neuroscience and psychology which is helping...

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Talking pelvic pain treatment with Dr Jessica Reale

Lots of clinical pearls of wisdom! You can watch our conversation here.

I just had the pleasure of an EPIC chat with Dr Jessica Reale (Doctor of Physical Therapy) all about our clinical interpretation of the latest methods of treating pelvic pain. How and why do we do what we do? There’s some great examples and pearls of wisdom I’ve taken from this, as well as being a good benchmarking that we are all approaching it in a similar way. I’ve linked to all the apps and references for the papers mentioned below. You can find out more about her on her website by clicking HERE, along with a great blog of resources

It fills my soul with joy to connect with other physios interested in understanding and treating pelvic pain. To borrow her phrase, at this point in time it really does feel like we’re “pioneers” in this work. I’d put it less eloquently but the meaning is the same; we have pain and dysfunction based research not specific to the pelvis...

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New metabolic markers for bladder pain syndrome/interstitial cystitis

New metabolic markers and histopathology findings for bladder pain syndrome/interstitial cystitis

As part of my recent “what else is out there?” literature review I came across two papers I thought you may be interested in. They look at potential new markers for BPS. What I find interesting is the numerous angles in which people are approaching this problem. It’s good to get out of our comfort zone, test our theories and be reminded of biologically plausible reasons for pain when we work in the emotionally and centrally driven world of pelvic pain so often…

I’d love to hear what you think!

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Graded motor imagery and sensory integration for pelvic pain + IC/BPS

Graded motor imagery for pelvic pain + IC/BPS – should we be incorporating other senses? Watch the vlog here.

It’s time to be honest. Working in pelvic health can sometimes be lonely, in the UK we’re often in tiny clinics away from our teams. I’m certainly someone who thrives on discussing, debating and being challenged. So here are some of the things I’ve been doing with Graded Motor Imagery, how I’m approaching it at the moment and the realities of how it’s going – it takes time!

If you’ve got any comments, are using GMI or are passionate about treating or researching BPS I’d love to hear from you! Only from sharing our knowledge do we all improve. At the end of the day, that’s my mission – getting better at getting people better. Enjoy!

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