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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...

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...

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...

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!

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!

What is Bladder Pain Syndrome?

The first thing to say about Bladder Pain Syndrome is what it’s Not….

Initially people went to their doctors with the symptoms of a chronic infection – a urinary tract infection or cystitis. They had an urgent need to pass urine, felt like they needed to go often and it would be accompanied by pain in the bladder region, perineum (between the legs) or in the urethra (tube from the bladder). However this went on much longer than an infection should, and often after taking antibiotics. The lining of the bladder is called the interstitium and so it was thought that when people presented with this group of symptoms they had a chronic infection of the bladder lining. This is how the name Interstitial Cystitis came around.

It’s now understood that Interstitial Cystitis/Bladder Pain Syndrome is much more complex, and many people do not have a chronic infection of the bladder or urethral lining. Even If they do have a chronic...

Watch the vlog here.

Katie and I got chatting online as we both have an interest in graded motor imagery in pelvic pain. Katie works on the East coast of Canada as a pelvic health physiotherapist and is researching graded motor imagery in women with pelvic pain with  Mount Allison Univeristy and Dalhousie University. She’s just completed a Phase 1 trial looking at how women with pelvic pain perceive images, and was kind enough to sit down and chat with me about her research and experience of what works for her in clinic.

It was really interesting to hear what kinds of images they’ve been using, the difficulties in finding images to represent motor and sensory activities for the pelvis, and what tools she uses in clinic.

Apologies for the sound quality, I’m working on it…

There was such deluge of important research presented at the recent World Congress on Abdominal and Pelvic pain that I’m taking time to digest it and translate it into practice. Here’s my second instalment.

If you didn’t see Part 1 click here.

There’s much more discussion in the vlog above, here are my brief notes. Starting with the end of the BPS cluster, Mr Kenneth Peters MD presented the role of peripheral nervous system on development and management of pelvic pain.

He believes there’s clearly two distinct populations in BPS: those with active Hunner’s Ulcers and those without. Those with Hunner’s Ulcers and pain/urgency symptoms (the more Type 3c, small stenotic bladder, passing small volumes at a high frequency) are the “active” Hunner’s ulcer phenotype, who tend to have less systemic pain, occur in post-menopausal women, and patients respond more readily to intensive surgical treatment....

I had an absolutely inspiring time at the World Congress on Abdominal and Pelvic Pain in Washington recently. I was given the opportunity thanks to the Dame Josephine Barnes award from the POGP and the EPIC Scholarship from Entropy Physiotherapy in Chicago and Lorimer Moseley. I can’t thank them enough for supporting the education and development of clinicians who wouldn’t otherwise be able to attend world-leading conferences such as this one. It truly was EPIC.

I’ve gone back through my notes and pulled together some of the things I think are important and have great clinical translation. It helped me to gather and retain the information and I really wanted to share what I learned. Better informed clinicians providing up to date evidence-based therapy are going to be the best for our patients, and at the end of the day this is why we do what we do. Apologies to any of the researchers for inaccuracies, these are just a few teeny pearls of wisdom I took/understood...

“It’s like having the worst urine infection, but all the time. I can’t work, I can’t sleep, my relationship is suffering because its too painful to have sex so I don’t want him near me, and I feel ratty all the time. I’m not being a good mum, I shout at the kids. I’ve had enough.”

I first came across Bladder Pain Syndrome (previously known as Interstitial Cystitis) 10 years ago when one woman’s story really hit home. A young mum who’d had to stop working as her trips to the toilet every 15 minutes were annoying her boss, and her colleagues made jokes about her bladder. It was initially something she handled well, but as she tried to hold off from going to the toilet her symptoms worsened and she retreated inside herself. Medications didn’t help the pain and quickly her world became smaller and smaller.

Her bladder was ruling her life and she was miserable. She was at the end of her tether and I was her last hope.

I...