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ProTouch Physical Therapy helps patients with many different conditions. Please see the diagram below for information on common conditions we treat and how physical therapy can help you.

Anal pain — pain in and around your anus or rectum (perianal region) — is a common complaint. Although most causes of anal pain are benign, the pain itself can be severe because of the many nerve endings in the perianal region.

Many conditions that cause anal pain may also cause rectal bleeding, which is usually more frightening than serious.

The causes of anal pain usually can be easily diagnosed. Anal pain usually can be treated with over-the-counter pain relievers and hot water soaks (sitz baths).

Causes of anal pain include:

  • Anal cancer
  • Anal fissure (a small tear in the lining of the anal canal)
  • Anal itching (pruritus ani)
  • Anal sex
  • Anorectal fistula (an abnormal channel between the anus or rectum usually to the skin near the anus)
  • Coccydynia or coccygodynia (tailbone pain)
  • Constipation
  • Crohn’s disease
  • Diarrhea causing anal irritation
  • Fecal impaction (a mass of hardened stool in the rectum due to chronic constipation)
  • Hemorrhoids (swollen and inflamed veins in your anus or rectum)
  • Levator ani syndrome (spasm in the muscles that surround the anus)
  • Perianal abscess (pus in the deep tissue around the anus)
  • Perianal hematoma (a collection of blood in the perianal tissue caused by a ruptured vein, sometimes called an external hemorrhoid)
  • Proctalgia fugax (fleeting pain due to rectal muscle spasm)
  • Proctitis (inflammation of the lining of the rectum)
  • Solitary rectal ulcer syndrome (ulcer of the rectum)
  • Thrombosed hemorrhoid (blood clot in a hemorrhoid)
  • Trauma
  • Ulcerative colitis (a type of inflammatory bowel disease)
  • Ulcerative proctitis (a type of inflammatory bowel disease


What is an anal fissure?

An anal fissure is a small tear in the thin, moist tissue (mucosa) that lines the anus. An anal fissure may occur when you pass hard or large stools during a bowel movement. Anal fissures typically cause pain and bleeding with bowel movements. You also may experience spasms in the ring of muscle at the end of your anus (anal sphincter).

Anal fissures are very common in young infants but can affect people of any age. Most anal fissures get better with simple treatments, such as increased fiber intake or sitz baths. Some people with anal fissures may need medication or, occasionally, surgery.

Signs and symptoms of an anal fissure include:

  • Pain, sometimes severe, during bowel movements
  • Pain after bowel movements that can last up to several hours
  • Bright red blood on the stool or toilet paper after a bowel movement
  • A visible crack in the skin around the anus
  • A small lump or skin tag on the skin near the anal fissure

What is abdominal pain?

Abdominal pain is pain that you feel anywhere between your chest and groin. This is often referred to as the stomach region or belly.

Ways to Describe Abdominal Pain:

  • Generalized pain — This means that you feel it in more than half of your belly. This type of pain is more typical for a stomach virus, indigestion, or gas. If the pain becomes more severe, it may be caused by a blockage of the intestines.
  • Localized pain — This is pain found in only one area of your belly. It is more likely to be a sign of a problem in an organ, such as the appendix, gallbladder, or stomach.
  • Cramp-like pain — This type of pain is not serious most of the time. It is likely to be due to gas and bloating, and is often followed by diarrhea. More worrisome signs include pain that occurs more often, lasts more than 24 hours, or occurs with a fever.
  • Colicky pain — This type of pain comes in waves. It very often starts and ends suddenly, and is often severe. Kidney stones and gallstones are common causes of this type of belly pain.

Pelvic pain is pain felt in the lower abdomen, pelvis, sacrum, hips or perineum. It has many possible causes and affects up to 20% of the population in the United States, including women and men. Pelvic Floor Physical therapists help people experiencing pelvic pain restore strength and flexibility to the muscles and joints in the pelvic region, and reduce their pain through internal pelvic floor intervention.

Signs and Symptoms:

  • Inability to sit for normal periods of time.
  • Reduced ability to move your hips or low back.
  • Difficulty walking, sleeping, or performing daily activities.
  • Pain, pressure or numbness in the pelvic region with exercise or recreational activities.
  • Pain during sexual activity.
  • Urinary frequency, urgency, or incontinence, or pain during urination.
  • Constipation or straining with bowel movements, or pain during bowel movements.
  • Difficulty using tampons

How can a Physical Therapist help?

Based on the evaluation results, your Pelvic Floor Physical Therapist will individualize treatment to strengthen your Pelvic Floor muscles and to improve their function. You will also gain control over your symptoms and reduce your dysfunctions. Your physical therapist will discuss diet and nutrition, change in behavior, postural training, and develop a plan to return you to your previous level of function.

Dr. Scott Kelly in Clinics in Colon and Rectal Surgery, Sept, 2014 published an article Pelvic Floor Rehab in the treatment of incontinence stated that Pelvic Floor Physical Therapy is an important first-line treatment for patients with incontinence.

What to Expect During Your First Evaluation:

Your physical therapist will complete a thorough review of your medical history, and perform a physical examination to identify the causes of your pelvic pain and any joint issues, muscle tightness or weakness, or nerve involvement.

The exam may include:

Pelvic girdle screening, Soft tissue assessment, Visual inspection of the tissues, Reflex testing, Sensation testing, Internal assessment of pelvic floor muscles.

Your physical therapist also will determine whether you should be referred to a physician to assist in your interdisciplinary plan of care.

What is Coccygodynia?

Coccyx pain or tailbone pain (coccydynia) makes it painful to sit down. There are effective treatments available, and the great majority of sufferers can be cured. You’re not alone, and you’re not going mad!

Coccyx pain can follow after falls, childbirth, repetitive strain or surgery. In some cases the cause is unknown.

Chronic constipation is infrequent bowel movements or difficult passage of stools that persists for several days, weeks or longer.

Types of Constipation:

Primary Constipation

  • Slow-transit constipation. In this type of constipation, motility (gut movement) is decreased causing bloating, abdominal pain and hard stool
  • Outlet constipation. In this type of constipation, discoordination of the musculature of the pelvic floor results in either inappropriate anal contraction.
  • Normal-transit constipation. In this type of constipation you may have daily bowel movements but show the following symptoms: hard stools and abdominal bloating and discomfort

Secondary constipation

  • Secondary constipation can be caused by metabolic disturbances like hypothyroidism; neurological problems like Parkinson’s disease, multiple sclerosis, and spinal cord injuries; celiac disease; and diseases of the large intestine such as colon cancer

Signs and symptoms of chronic constipation:

  • Passing fewer than three stools a week
  • Having lumpy or hard stools
  • Straining to have bowel movements
  • Feeling as though there’s a blockage in your rectum that prevents bowel movements
  • Feeling as though you can’t completely empty the stool from your rectum
  • Needing help to empty your rectum, such as using your hands to press on your abdomen and using a finger to remove stool from your rectum or splinting
  • Increased bloating and gas formation

Difficulty with the muscles involved in elimination

Problems with the pelvic muscles involved in having a bowel movement may cause chronic constipation. These problems may include:

  • Inability to relax the pelvic muscles to allow for a bowel movement (anismus)
  • Pelvic muscles don’t coordinate relaxation and contraction correctly (dyssynergia)
  • Weakened pelvic muscles
  • Pudendal nerve involvement causing muscles to act inappropriately

What is Diastasis Rectus Abdominis?

DRA is a common condition that affects many women during the childbearing years. As a fetus grows within the uterus, the uterus expands, which places stress across the structures surrounding it, specifically the muscles. The primary abdominal muscle on the front side of the body is called the rectus abdominis. This muscle is divided into a left and right half by a thick band of connective tissue called the linea alba. You may hear people talk about “6-pack abs”; this is referring to the rectus abdominis. As the uterus expands, stretching across the rectus abdominis potentially could occur. In some cases, the weakening and stretching of the linea alba connective tissue creates a separation between the right and left sides of the muscle, or diastasis.

DRA may affect women during and after pregnancy. Typically, DRA develops in the second or third trimester. It is during this time that the fetus is growing most rapidly, and can result in the greatest increase in distance between the 2 sides of the muscle.

There are several factors that may make a woman more susceptible to developing DRA. These include age, being pregnant with multiple children (multiparity), and having many pregnancies. The abdominal muscles have many important functions within the body, including postural support, movement, breathing, and protection of the internal organs. Therefore, if their structure is affected by DRA, a woman may have difficulty controlling her posture, which may put her at an increased risk for injury. Additionally, for a woman juggling the many stresses of having a new baby, the discomfort, weakness, and changes to postural control that may result from DRA can negatively affect her quality of life.

During your DRA evaluation we will be educating you on postural training, myofascial release, spinal mobilization, stretching and bracing to reverse your DRA symptoms.

At ProTouch Physical Therapy we developed a 7 step protocol that has been 98% successful with addressing all of the dysfunctions of DRA.

What is painful ejaculation?

Painful ejaculation, or Odynorgasmia, is a physical syndrome described by pain or burning sensation of the urethra or perineum during or following ejaculation. Some men may only experience pain after having sex with a partner, but when they masturbate.

There are many causes that can create painful ejactulation and is usualy due to a medical condition such as infections associated with urethritis, prostatitis, or

epididymitis. Sometimes, doctors are unable to find a medical cause.

Symptoms may include the following:

  • pain during or immediately following ejaculation
  • pain in or around the penis, bladder, or rectum
  • pain that begins shortly before or after ejaculation
  • pain during urination, especially immediately after ejaculating
  • The pain may last only a few minutes or for up to 24 hours following ejaculation. It can be mild or very intense.

What is premature ejaculation?

Premature ejaculation (PE) is when ejaculation happens sooner than a man or his partner would like during sex. Occasional PE is also known as rapid ejaculation, premature climax or early ejaculation. PE might not be a cause for worry. It can be frustrating if it makes sex less enjoyable and impacts relationships. But it happens often and causes problems, your health care provider can help.

How does ejaculation work?

Ejaculation is controlled by the central nervous system. When men are sexually stimulated, signals are sent to your spinal cord and brain. When men reach a certain level of excitement, signals are then sent from your brain to your reproductive organs. This causes semen to be released through the penis (ejaculation).

Ejaculation has 2 phases: emission and expulsion.

Phase 1: Emission

Emission is when sperm moves from the testicles to the prostate and mixes with seminal fluid to make semen. The vasa deferentia are tubes that help move the sperm from the testicles through the prostate to the base of the penis. (When you are talking about just 1 of these tubes, it is called a vas deferens.)

Phase 2: Expulsion

Expulsion is when the muscles at the base of the penis contract. This forces semen out of the penis. Usually, ejaculation and orgasm (climax) happen at the same time. Some men climax without ejaculating. In most cases, erections go away after this step.

Though the exact cause of PE is unknown, there are possible causes associated with it such as serotonin levels and psychological issues.

What is Endometriosis?

Endometriosis, sometimes called “endo,” is a common health problem in women. It gets its name from the word endometrium, the tissue that normally lines the uterus or womb. Endometriosis happens when tissue similar to the lining of the uterus grows outside of your uterus and on other areas in your body where it doesn’t belong.

Most often, endometriosis is found on the:

  • Ovaries
  • Fallopian tubes
  • Tissues that hold the uterus in place
  • Outer surface of the uterus
  • Mainly rectum
  • Sometimes thorax

Symptoms:

  • Pain is the most common symptom. Women with endometriosis may have many different kinds of pain. These include:
    • Very painful menstrual cramps. (The pain may get worse over time.)
    • Chronic (long-term) pain in the lower back and pelvis
    • Pain during or after sex. This is usually described as a “deep” pain and is different from pain felt at the entrance to the vagina when penetration begins.
    • Intestinal pain/abdominal pain
    • Painful bowel movements or pain when urinating during menstrual periods. In rare cases, you may also find blood in your stool or urine.
  • Bleeding or spotting between menstrual periods.
  • Infertility, or not being able to get pregnant.
  • Stomach (digestive) problems. These include diarrhea, constipation, bloating, or nausea, especially during menstrual periods.

At ProTouch we are certified in Visceral Mobilization and Arvigo Abdominal Massage to address the mobility of the abdominal organs, address the mobility or abdominal organs, increase blood supply, decrease bloating inflammation, sar mobilization after surgery, myofascial release as well as internal pelvic floor therapy.

ED is defined as trouble getting or keeping an erection that is firm enough for sexual activities .

Though it’s not rare for a man to have some problems with erections from time to time, ED that is progressive or happens routinely with sex is not normal, and it should be treated.

ED can happen:

  • Most often when blood flow in the penis is limited or nerves are harmed
  • With stress or emotional reasons
  • As an early warning of a more serious illness, like: atherosclerosis (hardening or blocked arteries), heart disease, high blood pressure or high blood sugar from Diabetes

ED can result from health problems, emotional issues, or from both. Some known risk factors are:

  • Being over age 50
  • Having high blood sugar (Diabetes)
  • Having high blood pressure
  • Having cardiovascular disease
  • Having high cholesterol
  • Smoking
  • Using drugs or drinking too much alcohol
  • Being obese
  • Lacking exercise

It is normal to experience a little bit of pain from time to time. You may feel sore from exercising too much, or you may stub your toe on a piece of furniture. Most of the time, you’re able to shake it off or take ibuprofen and go about your day. However, sometimes people can experience pain that’s widespread and chronic, failing to diminish despite their best efforts. This can cause a large impact on one’s life that anti-inflammatory drugs simply will not fix.

If you are suffering from chronic pain that is accompanied by fatigue, changes in mood, or irregular sleep patterns, you may be dealing with a more serious physiological condition, such as fibromyalgia. If you identify with these symptoms, contact ProTouch Physical Therapy today to set up a consultation with one of our Cranford physical therapists.

What exactly is fibromyalgia?

Fibromyalgia is somewhat of an umbrella term used to describe someone who is experiencing a certain combination of symptoms. The exact causes of fibromyalgia are still unclear, although some medical experts believe it may be caused by an overactive sympathetic nervous system – the part of your body that elicits “fight or flight” responses. This theory makes sense, as people tend to develop their first symptoms of fibromyalgia after experiencing a physically or emotionally traumatic event, though it has never been scientifically proven.

Fibromyalgia also tends to affect more women than men, and your likelihood of developing it increases if you have a family member with the same condition. Some people who develop fibromyalgia begin with chronic bouts of stress or depression, while other symptoms build over time. The most common symptoms of fibromyalgia include:

  • Chronic and/or sharp muscle pains
  • Fatigue
  • Tender areas of the body
  • Disrupted sleep cycles/irregular sleep schedules
  • Fluctuations in mood
  • Forgetfulness or disorientation
  • Sensitivity to touch/numbness
  • Nausea

How do we treat fibromyalgia?

Since fibromyalgia is not a disease, but rather a range of symptoms, there is no single, surefire treatment for the condition. Primary physicians will typically prescribe some sort of pain medication or an anti-depressant to manage symptoms; however, those medications do not address the chronic nature of the condition or the loss of function that chronic pain and distress typically bring.

At ProTouch Physical Therapy, we can provide effective treatments for both managing symptoms in the long-term and regaining optimum function to your body. Our Cranford physical therapists will examine your physical abilities, analyze your medical history, and discuss your current symptoms, in order to design a treatment plan that will fit your unique needs.

Treatments will typically begin with pain-relieving modalities to provide relief and promote healing. This may include the use of ice and heat therapies, trigger point therapy, massage, stretching, electrical stimulation, or other therapeutic tools that our physical therapist believes could be beneficial to your recovery. After this, your treatments will shift toward active therapies, such as muscle strengthening, range-of-motion activities, and cardiovascular exercises.

Studies have shown that cardiovascular exercise paired with postural strengthening activities not only relieves widespread pain, but also increase energy levels, improves sleep, and elevates mood. Regardless of where you are on your journey, it is possible to find relief from even your worst fibromyalgia symptoms, through our Cranford physical therapy services. Contact ProTouch Physical Therapy today for more information, or to schedule your evaluation and find out how we can get you started on the road to recovery.

What is Vulvodynia?

Pain that affects the external female genital area, called the vulva. Vulvodynia is pain that lasts for 3 months or longer and is not caused by an infection, skin disorder, or other medical condition. Patients tend to have a hard time with intercourse, personal hygiene, tight clothes, sitting and bowel movement due to pain.

What are some of the possible causes of vulvodynia?

Vulvodynic is likely caused by many factors working together. Some of these factors include:

  • Damage or irritation of the nerves of the vulva or surrounding regions
  • Inflammation of the vulva
  • Long-term reactions to certain infections (yeast or UTI)
  • Certain genetic disorders
  • Sensitivity to certain foods
  • Dysfunction of the muscles of the pelvic floor
  • Conditions that affect nearby muscles or bones
  • Chronic constipation
  • IBS

What is groin pain?

The groin area is the area where the upper thigh meets the lower abdomen. Pain is this area is referred to as “groin pain” and can affect both women and men for a variety of reasons.

These reasons may include musculoskeletal pain, trauma or injury (muscle strains, bursitis, or fractures), infections, tumors, or hernias to name a few. Groin pain can also originate in other parts of the body such as the leg, known as “referring pain”.

In males, inflammation of the testicles or other conditions affecting the testicles and scrotum can cause groin pain such as epididymitis, hydrocele, orchitis, scrotal masses, spermatocele, testicular torsion, varicocele, and testicular cancer.

In females, groin pain can also be caused by certain medical conditions such as inguinal hernias, bacterial infections, swollen lymph nodes, STDs, kidney stones, urinary tract infections, ovarian cysts, yeast infections, and cellulitis.

What are hemorrhoids?

Hemorrhoids, also called piles, are swollen veins in your anus and lower rectum, similar to varicose veins. Hemorrhoids have a number of causes, although often the cause is unknown. They may result from straining during bowel movements or from the increased pressure on these veins during pregnancy. Hemorrhoids may be located inside the rectum (internal hemorrhoids), or they may develop under the skin around the anus (external hemorrhoids).

Hemorrhoids are very common. Nearly three out of four adults will have hemorrhoids from time to time. Sometimes they don’t cause symptoms but at other times they cause itching, discomfort and bleeding.

Signs and symptoms of hemorrhoids may include:

Painless bleeding during bowel movements — you might notice small amounts of bright red blood on your toilet tissue or in the toilet
Itching or irritation in your anal region
Pain or discomfort
Swelling around your anus
A lump near your anus, which may be sensitive or painful (may be a thrombosed hemorrhoid)

What is a hernia?

A hernia is a weakness or tear in the abdominal muscle wall, which normally holds the inner lining of the abdomen and internal organs in place (i.e. inside, where they belong). The weakness or tear allows the inner lining to protrude and form a pouch. The bulge you might see is usually a loop of intestine protruding through the tear in the muscle and into that pouch.

Contrary to popular myth (about lifting heavy objects), you didn’t cause your hernia. Most people are born with a weakness in the muscle, which eventually gives way, or an opening that didn’t close up (as it usually does) before birth.

Symptoms of a hernia can be any of the following:

  • A sudden, sharp pain in the groin area or a sensation as if something has “torn” even if you experience no other symptoms.
  • A dull ache, feeling of weakness, heaviness, pressure, tingling, or a burning sensation in your abdomen, groin, or scrotum that may get worse when you stand for long periods. The pain may also get worse if you strain your abdominal muscles when coughing, lifting heavy objects, play sports, or have a bowel movement. Rest may help.
  • A visible soft bulge in the groin area or scrotum that you can push back in with gentle pressure or that gets smaller or disappears when you lie down. The bulge may get bigger over the course of the day or when you cough, bend, lift, or strain.

*If you have a bulge that cannot be pushed back inside, that is red, purple, or dark, or have pain with fever, chills, and/or vomiting, go to your hospital emergency room or call 911. Don’t wait — this may indicate an emergency that can become life-threatening.

What is vaginismus?

Vaginismus is a spasm or contraction of the muscles around the vagina. This can happen during sexual intercourse. It can also happen when you try to insert a tampon into the vagina, or during a Pap test.

What are the causes of vaginismus?

  • Psychological conditions such as; Fear of ses, Anxiety, Past sexual abuse or trauma, Negative emotions towards sex
  • Physical conditions involving:
    • Scar tissue
    • Tight pelvic floor muscles
    • Tight connective tissue
    • Chronic constipation
    • Digestive dysfunction
    • What are the symptoms of vaginismus?

The main symptom of vaginismus is painful, and sometimes impossible, vaginal penetration.

15 Million adults in the U.S. suffer from some form of Incontinence. This frustrating and embarrassing condition can easily be addressed by strengthening the pelvic floor and improving function of the pelvis.

There are multiple kinds of incontinence:

  • Frequency
  • Urgency
  • Mixed
  • Stress
  • Post Prostatectomy
  • Overactive Bladder
  • Fecal

Causes of Incontinence

  • Most causes of Incontinence are caused due to:
  • Pregnancy
  • Childbirth
  • Menopause
  • Surgery
  • Chronic Constipation

How can a Physical Therapist help?

Based on the evaluation results, your Pelvic Floor Physical Therapist will individualize treatment to strengthen your Pelvic Floor muscles and to improve their function. You will also gain control over your symptoms and reduce your dysfunctions. Your physical therapist will discuss diet and nutrition, change in behavior, postural training, and develop a plan to return you to your previous level of function.

Dr. Scott Kelly in Clinics in Colon and Rectal Surgery, Sept, 2014 published an article Pelvic Floor Rehab in the treatment of incontinence stated that Pelvic Floor Physical Therapy is an important first-line treatment for patients with incontinence.

During Your First Evaluation:

Your physical therapist will complete a thorough review of your medical history, and perform a physical examination to identify the causes of your pelvic pain and any joint issues, muscle tightness or weakness, or nerve involvement.

The exam may include:

Pelvic girdle screening, Soft tissue assessment, Visual inspection of the tissues, Reflex testing, Sensation testing, Internal assessment of pelvic floor muscles.

Your physical therapist also will determine whether you should be referred to a physician to assist in your interdisciplinary plan of care.

What is Interstitial Cystitis?

Interstitial cystitis (IC)/bladder pain syndrome (BPS)/ Hypersensitive bladder syndrome (HBS)/Painful bladder syndrome (PBS) is a chronic bladder health issue. It is a feeling of pain, soreness and pressure in the bladder area. Along with this pain are lower urinary tract symptoms which have lasted for more than 6 weeks, without having an infection or other clear causes.

Currently there are two recognized subtypes of IC: non-ulcerative and ulcerative.

  • Non-ulcerative: 90% of IC patients have the non-ulcerative form of IC. Non-ulcerative IC presents with pinpoint hemorrhages, also known as glomerulations, in the bladder wall. However, these are not specific for IC and any inflammation of the bladder can give that appearance.

These patients have true pelvic floor dysfunction (Kenneth Peters, MD)

  • Ulcerative: 5 to 10% of IC patients have the ulcerative form of IC. These patients usually have Hunner’s ulcers or patches, which are red, bleeding areas on the bladder wall. Diagnosed via Cystoscopy by a Urologist.

Signs and Symptoms:

  • Bladder pain with urination
  • Frequency and Urgency
  • Suprapubic pain
  • Lower abdominal pain
  • Painful intercourse
  • Nocturia with sleep disturbance
  • Hesitancy and decrease urine flow
  • Incomplete bladder voiding
  • Recurrent UTI

Special Techniques along with traditional pelvic floor therapy

  • Arvigo technique
  • Visceral mobilization
  • Cold laser
  • Real time ultrasound (to view bladder function)

What is Irritable Bowel Syndrome?

Irritable bowel syndrome (IBS) is a common disorder, affecting an estimated 15% of the population. It is one of the several conditions known as functional gastrointestinal disorders. This means the bowel may function abnormally, but tests are normal and there are no detectable structural defects.

Symptoms

Symptoms vary from person to person and can range from mild to severe. IBS is a long-term condition, so symptoms may come and go and change over time.

IBS symptoms include:

  • Abdominal pain/rectal pain or pressure
  • Fullness
  • Gas and bloating
  • Change in bowel habits
  • Alternating diarrhea or constipation or both

Causes of IBS:

  • Muscle contractions in the intestine
  • Nervous system
  • Inflammation in the intestines
  • Severe infection
  • Changes in bacteria in the gut (microflora)

What is Urinary Dysfunction Post-surgery?

Urinary dysfunction post-surgery can either be urinary retention, also known as POUR (Postoperative Urinary Retention), or urinary incontinence.

  • Postoperative Urinary Retention (POUR)

Urinary retention is the inability to empty the bladder completely. Urinary retention is a common complication of post-surgery and anaesthesia and is commonly known as Postoperative Urinary Retention (POUR). The risk of retention is especially high following anorectal surgery, hernia repair, and orthopedic surgery and increases with advancing age of the patient. Many factors are thought to contribute to the development of POUR including traumatic catheterization, pre-existing urologic pathology, and increased fluid requirements of surgery combined with the use of analgesics, opiates and components of anaesthesia

  • Postoperative Urinary Incontinence

Urinary incontinence is the loss of the ability to control urination. Urinary incontinence is common in men who have had surgery for prostate cancer. Most men regain their bladder control over time and are fully recovered within 6 to 12 months. However, it is important to get professional advice to help cope with bladder weakness during this time.

What is nerve pain?

Nerve pain, or neuropathic pain, is usually due to damaged nerves that send false signals that result in chronic pain. Also, the signals may not function to register the pain associated with an injury normally. In a case like this, the person may lack a pain response indicating injury. Sometimes, no reasons can be found for nerve pain. In other instances, there are many reasons for nerve pain from diabetes and shingles to cancer.

Symptoms of nerve pain can vary from patient to patient and may encompass the following:

  • Stabbing pain
  • Prickling pain
  • Burning pain
  • Tingling pain
  • Loss of feeling or numbness
  • The above descriptions of pain that can get worse at night and cause difficulty sleeping
  • The above descriptions of pain that worsens over time or becomes progressive

What is SIBO?

Small intestinal bacterial overgrowth (SIBO), defined as excessive bacteria in the small intestine, remains a poorly understood disease. Initially thought to occur in only a small number of patients, it is now apparent that this disorder is more prevalent than previously thought. Patients with SIBO vary in presentation, from being only mildly symptomatic to suffering from chronic diarrhea, weight loss, severe dehydration, malnutrition, excessive gas, and indigestion. Recently there has been renewed interest in SIBO and its putative association with irritable bowel syndrome.

Causes:

  • your small bowel has anatomic abnormalities
  • decrease stomach acidity
  • decrease flora in the gut
  • the pH changes in your small bowel
  • your immune system isn’t working properly
  • the muscular activity of the small intestine malfunctions, which means that food and bacteria aren’t removed from the organ

Symptoms:

  • bloating and increased passing of gas (flatulence)
  • diarrhea or constipation
  • abdominal pain
  • nausea
  • fatigue

What is penile pain?

Penile pain is any pain associated with the base, head, or shaft of the penis. It can also affect the foreskin. An itching, burning, or throbbing sensation may accompany the pain. The pain can vary depending on what underlying condition or disease is causing it. If you have an injury, the pain may be severe and occur suddenly. If you have a disease or condition, the pain may be mild and may gradually get worse.

Any type of pain in the penis is a cause for concern, particularly if it occurs during an erection, prevents urination, or occurs along with discharge, sores, redness, or swelling.

There are a variety of causes for penile pain including peyronie’s disease, priapism, balanitis, STIs, UTIs, injuries, phimosis & paraphimosis, or cancer.

Painful urination (dysuria) is discomfort or burning with urination, usually felt in the tube that carries urine out of your bladder (urethra) or the area surrounding your genitals (perineum).

A number of conditions can cause painful urination. In women, urinary tract infections are a common cause of painful urination. In men, urethritis and certain prostate conditions are frequent causes of painful urination.

FACT: Patients with painful urination that have no blood present in urine with testing are misdiagnosed. These patients potentially have either interstitial cystitis (10%) or pelvic floor dysfunction (90%)

  • Medical conditions and external factors that can cause painful urination include:
  • Bladder stones
  • Chlamydia trachomatis
  • Cystitis (bladder inflammation)
  • Drugs, such as those used in cancer treatment, that have bladder irritation as a side effect
  • Genital herpes
  • Gonorrhea
  • Having a recent urinary tract procedure performed, including use of urologic instruments for testing or treatment
  • Kidney infection (pyelonephritis)
  • Kidney stones
  • Prostatitis (infection or inflammation of the prostate)
  • Sexually transmitted diseases (STDs)
  • Soaps, perfumes and other personal care products
  • Urethral stricture (narrowing of the urethra)
  • Urethritis (infection of the urethra)
  • Urinary tract infection (UTI)
  • Vaginitis
  • Yeast infection (vaginal)

What is sexual dysfunction?

Sexual dysfunction refers to a problem occurring during any phase of the sexual response cycle that prevents the individual or couple from experiencing satisfaction from the sexual activity. The sexual response cycle traditionally includes excitement, plateau, orgasm, and resolution. Desire and arousal are both part of the excitement phase of the sexual response.

What are the types of sexual dysfunction?

  • Desire disorders —lack of sexual desire or interest in sex
  • Arousal disorders —inability to become physically aroused or excited during sexual activity
  • Orgasm disorders —delay or absence of orgasm (climax)
  • Pain disorders — pain during or after intercourse

In men:

  • Inability to achieve or maintain an erection suitable for intercourse (erectile dysfunction)
  • Absent or delayed ejaculation despite adequate sexual stimulation (retarded ejaculation)
  • Inability to control the timing of ejaculation (early or premature ejaculation)

In women:

  • Inability to achieve orgasm
  • Inability to relax the vaginal muscles enough to allow intercourse

Pain in the scrotum and testicles can be caused by multiple factors. When caused by testicular torsion, it is important to see urgent care immediately as this condition is considered a medical emergency.

Other factors leading to testicular pain can include orchitis, epididymitis, prostatitis, kidney stones, mumps, chronic prostatitis, chronic nonbacterial prostatitis, and polyarteritis nodosa.

What are scars?

Scars are a natural part of the body’s healing process. A scar results from the biologic process of wound repair in the skin and other tissues. Most wounds, except for very minor ones, result in some degree of scarring.

Scars can develop both externally and internally (known as scar tissue or adhesions).  When scars develop internally, multiple areas of the body can be affected from the organs and the muscle to the connective tissue.

There are multiple reasons scars that affect pelvic pain can develop:

  • Episiotomy
  • Perineal/vaginal tears (due to childbirth)
  • Cancer
  • Post-op
  • C-section
  • Endometriosis
  • Hysterectomy
  • Tummy tuck
  • Hernia
  • Infection

What is Sacroiliac Joint Dysfunction?

The sacroiliac joint is a joint between the sacrum and the ilium, or pelvic bone. The 2 sides of the sacroiliac joint normally work together. If 1 side becomes stiff, they will not move together and this causes pain or muscle stiffness in the area. Pain is often made worse with walking and bending activities. It is also possible that 1 side may become too loose (lax) as well, resulting in SIJ dysfunction. This may occur during the menstrual cycle or pregnancy due to hormonal changes that cause the ligaments to become more lax. SIJ dysfunction can occur with injury, such as when a person falls and lands on 1 side of the body and alters the position of the joint, or when an athlete overtrains. Muscle imbalances and hip problems, such as hypermobility or dysplasia, may also lead to SIJ dysfunction. Sacroiliac pain is also related to some types of arthritis, such as ankylosing spondylitis, an inflammatory process most often affects the lower back, which may cause the vertebrae to fuse.

How Does it Feel?

People with SIJ dysfunction may experience:

  • Pain that may be sharp, stabbing or dull, localized to 1 side of the pelvis/low back, groin, or tailbone.
  • Pain that may radiate down to the knee.
  • Pain with movements, such as standing up from a sitting position, turning in bed, or bending/twisting.
  • Muscle tightness and tenderness in the hip/buttock region.
  • Pain with walking, standing, and prolonged sitting.
  • Pain that is worse when standing and walking, and eases when sitting or lying down.

What is Pudendal Neuralgia?

Pudendal neuralgia is a type of pelvic dysfunction that originates from damage, irritation or entrapment of the pudendal nerve as it courses through the pelvis.

The pudendal nerve is one of the main nerves in the pelvis, supplying areas such as the:

  • lower buttocks
  • area between the buttocks and genitals (perineum)
  • area around the rectum
  • vulva, labia, and clitoris in women
  • scrotum and penis in men

Pudendal neuralgia can be very uncomfortable and distressing, but help is available and there are several unique treatments that can be implemented into our treatment plan. 

Signs and Symptoms:

You usually feel pudendal neuralgia symptoms in your lower body, genitals, or perineum (the area between your genitals and anus). These may include:

  • A sharp or burning pain
  • Increased sensitivity
  • Numbness or a pins-and-needles feeling
  • A swollen feeling

These feelings might be worse when you sit down or use the toilet. You may have symptoms on one or both sides of your body, and they might go into your belly, buttocks, or legs.

You also may have problems such as:

  • A sudden or frequent need to go to the bathroom (urination or defecation)
  • Trouble or pain during sex
  • For men, problems getting an erection, ejaculation, post-ejaculation

What is Prostatitis?

Prostatitis is swelling and inflammation of the prostate gland, a walnut-sized gland situated directly below the bladder in men. The prostate gland produces fluid (semen) that nourishes and transports sperm.

Prostatitis often causes painful or difficult urination (initiating stream, weak stream, dribbling). Other symptoms include pain in the groin, pelvic area or genitals and sometimes flu-like symptoms, fatigue.

Prostatitis affects men of all ages but tends to be more common in men 50 or younger. The condition has a number of causes. Sometimes the cause isn’t identified. Depending on the cause, prostatitis can come on gradually or suddenly. It might improve quickly, either on its own or with treatment. Some types of prostatitis last for months or keep recurring (chronic prostatitis).If prostatitis is caused by a bacterial infection, it can usually be treated with antibiotics.

Signs and symptoms can include:

  • Pain or burning sensation when urinating (dysuria)
  • Difficulty urinating, such as dribbling or hesitant urination
  • Frequent urination, particularly at night (nocturia)
  • Urgent need to urinate
  • Cloudy urine
  • Blood in the urine
  • Pain in the abdomen, groin or lower back
  • Pain in the area between the scrotum and rectum (perineum)
  • Pain or discomfort of the penis or testicles
  • Painful ejaculation
  • Flu-like signs and symptoms (with bacterial prostatitis)

Keynote: Non-bacterial Prostatitis is usually diagnosed as Pelvic Floor Dysfunction (PFD/CPPD). It may or may not present with pelvic pain/pressure, erectile dysfunction, difficulty initiating urinary stream, constipation, rectal pain/pressure, penile pain/pressure, testicular/groin pain. These conditions can all be addressed by a pelvic floor physical therapist.

According to research, more than 50% of women suffer from some form of prolapse. Pelvic Floor Physical Therapy is the most efficient, non-invasive method of treatment available with an 80-90% success rate.

Causes of POP

Pelvic Organ prolapse can involve dropping of the uterus, bladder, and/or rectum. The prolapse may be due to:

  • Childbirth
  • Aging
  • Chronic Coughing
  • Chronic Constipation
  • Weak Pelvic Floor
  • Heavy Lifting
  • Surgery
  • Patients with POP may experience:
  • Pelvic Pressure/Pain
  • Low Back Pain
  • Discomfort with Intercourse
  • Difficulty using personal hygiene products
  • Organ protruding out of the vaginal opening
  • Urinary frequency/incontinence or inability to empty bladder
  • Fecal incontinence or constipation

During Your First Evaluation:

Your physical therapist will complete a thorough review of your medical history, and perform a physical examination to identify the causes of your pelvic pain and any joint issues, muscle tightness or weakness, or nerve involvement

The exam may include:

Pelvic girdle screening, Soft tissue assessment, Visual inspection of the tissues, Reflex testing, Sensation testing, Internal assessment of pelvic floor muscles.

Your physical therapist also will determine whether you should be referred to a physician to assist in your interdisciplinary plan of care.

Our pelvic floor physical therapists are specially trained to treat patients who are planning to become pregnant or who are currently pregnant. Pregnancy and the associated hormonal changes cause significant stress to the entire body, particularly the spine, pelvis and pelvic floor. Our therapists will educate you on proper movement patterns, positioning, exercises, and stretches to make your pre-natal body as strong, flexible, and pain free as possible.

Common Prepartum Symptoms:

  • Sacroiliac joint (SIJ) pain and instability
  • Low back pain
  • Sciatic nerve pain and irritation (Sciatica)
  • Diastasis recti
  • Urinary incontinence
  • Fecal incontinence
  • Dyspareunia (painful sex)
  • Pelvic organ prolapse
  • Pelvic floor pain
  • Swelling
  • Neck pain and headaches
  • Pubic symphysis pain
  • Tailbone pain

JOIN OUR PRENATAL PROGRAM

The Prenatal Program at ProTouch Physical Therapy was designed to treat any pregnancy pain & discomfort as well as optimize your delivery and prevent perineal tearing, and all other postpartum dysfunctions. This program includes partner training to handle labor & delivery as a team.

Mommy to be includes the following:

  • Educated on proper preparation, relaxation and strengthening of pelvic floor muscles for childbirth.
  • Taught proper self alignment of the pelvis to keep pelvic floor intact.
  • Educated on proper strengthening of the core muscles.
  • Educated on proper stretching and strengthening of the low back muscles.
  • Taught trigger point release.
  • How to prevent DRA formation

Pelvic Floor Physical Therapy will individually exam each muscle externally & internally to address each impairment with manual therapy. Each program will be uniquely designed to meet each mom’s individual needs.

How can a Physical Therapist help?

Based on the evaluation results, your Pelvic Floor Physical Therapist will individualize treatment to strengthen your Pelvic Floor muscles and to improve their function. You will also gain control over your symptoms and reduce your dysfunctions. Your physical therapist will discuss diet and nutrition, change in behavior, postural training, and develop a plan to return you to your previous level of function.

During Your First Evaluation:

Your physical therapist will complete a thorough review of your medical history, and perform a physical examination to identify the causes of your pelvic pain and any joint issues, muscle tightness or weakness, or nerve involvement.

The exam may include:

  • Pelvic girdle screening, Soft tissue assessment, Joint mobility assessment, Visual inspection of the tissues, Reflex testing, Sensation testing, Internal assessment of pelvic floor muscles.

The woman who has just given birth is adjusting to motherhood, but her body is adjusting to new physical dysfunctions. We quickly forget that our vital organs have been out of place for months, the muscles have weakened, pelvic widened, pelvic floor became tight or weak and potentially scarred down.

It is very important to return to your pre pregnancy physical state in order to avoid long-term dysfunctions. Breastfeeding new moms have a bigger “mountain” to climb because of increased hormone levels, but there is an easy and comfortable way to address most postpartum dysfunctions with our newly developed postpartum program.

Common Postpartum Symptoms

  • Urinary Difficulties and Leakage
  • Anal Incontinence
  • Pelvic Organ Prolapse
  • Constipation
  • Pelvic Floor Pain/Pressure
  • Scar Pain
  • Weak Core Muscles (Diastasis Recti)
  • Low Back Pain
  • General Body Weakness

JOIN OUR POSTPARTUM PROGRAM

It is very important for all new moms to be educated in the following:

  • Breathing and Rib Mobility
  • Bladder/Uterus/Rectum Mobility
  • Visceral mobilization of vital organs to be placed back to pre-pregnancy state
  • Assessment for Diastasis Recti
  • Strengthening of core, lower abs and back muscles
  • Correcting pelvic joint alignments
  • Scar mobilization after vaginal birth and C-section
  • Manually releasing Pelvic Floor spasticity and trigger points
  • Pelvic floor stretching
  • Proper lifting techniques
  • Progressing into advanced core strengthening
  • Return to gym program
  • How can a Physical Therapist help?

Based on the evaluation results, your Pelvic Floor Physical Therapist will individualize treatment to strengthen your Pelvic Floor muscles and to improve their function. You will also gain control over your symptoms and reduce your dysfunctions. Your physical therapist will discuss diet and nutrition, change in behavior, postural training, and develop a plan to return you to your previous level of function.

Dr. Scott Kelly in Clinics in Colon and Rectal Surgery, Sept, 2014 published an article Pelvic Floor Rehab in the treatment of incontinence stated that Pelvic Floor Physical Therapy is an important first-line treatment for patients with incontinence.

During Your First Evaluation:

Your physical therapist will complete a thorough review of your medical history, and perform a physical examination to identify the causes of your pelvic pain and any joint issues, muscle tightness or weakness, or nerve involvement.

The exam may include:

  • Pelvic girdle screening, Soft tissue assessment, Pelvic girdle assessment, spinal assessment, Visual inspection of the tissues, Reflex testing, Sensation testing, Internal assessment of pelvic floor muscles.

Pelvic pain is pain felt in the lower abdomen, pelvis, sacrum, hips or perineum. It has many possible causes and affects up to 20% of the population in the United States, including women and men. Pelvic Floor Physical therapists help people experiencing pelvic pain restore strength and flexibility to the muscles and joints in the pelvic region, and reduce their pain through internal pelvic floor intervention.

Signs and Symptoms:

  • Inability to sit for normal periods of time.
  • Reduced ability to move your hips or low back.
  • Difficulty walking, sleeping, or performing daily activities.
  • Pain, pressure or numbness in the pelvic region with exercise or recreational activities.
  • Pain during sexual activity.
  • Urinary frequency, urgency, or incontinence, or pain during urination.
  • Constipation or straining with bowel movements, or pain during bowel movements.
  • Difficulty using tampons

How can a Physical Therapist help?

Based on the evaluation results, your Pelvic Floor Physical Therapist will individualize treatment to strengthen your Pelvic Floor muscles and to improve their function. You will also gain control over your symptoms and reduce your dysfunctions. Your physical therapist will discuss diet and nutrition, change in behavior, postural training, and develop a plan to return you to your previous level of function.

Dr. Scott Kelly in Clinics in Colon and Rectal Surgery, Sept, 2014 published an article Pelvic Floor Rehab in the treatment of incontinence stated that Pelvic Floor Physical Therapy is an important first-line treatment for patients with incontinence.

What to Expect During Your First Evaluation:

Your physical therapist will complete a thorough review of your medical history, and perform a physical examination to identify the causes of your pelvic pain and any joint issues, muscle tightness or weakness, or nerve involvement.

The exam may include:

Pelvic girdle screening, Soft tissue assessment, Visual inspection of the tissues, Reflex testing, Sensation testing, Internal assessment of pelvic floor muscles.

Your physical therapist also will determine whether you should be referred to a physician to assist in your interdisciplinary plan of care.

The pelvic floor muscles are located between the tailbone (coccyx) and the pubic bone within the pelvis, and support the bowel and bladder in males along with the uterus and vagina in females.

Muscular bands (sphincters) encircle the urethra, vagina and anus as they pass through the pelvic floor. When the pelvic floor muscles are contracted, the internal organs are lifted and the sphincters tighten the openings of the vagina, anus and urethra. Relaxing the pelvic floor allows passage of urine and faeces.

If the muscles are weakened, the internal organs are no longer fully supported and you may not be able to control your urine, faeces or gas.

Common causes of a weakened pelvic floor include pregnancy, childbirth, prostate cancer treatment (in males), obesity and the associated straining of chronic constipation/IBS.

Pelvic floor exercises are individually designed to improve muscle tone and prevent the need for corrective surgery.

Symptoms of a weak pelvic floor

The symptoms of a weakened pelvic floor include:

  • leaking small amounts of urine when coughing, sneezing, laughing or running (urinary incontinence)
  • failing to reach the toilet in time (fecal incontinence)
  • Uncontrollably passing gas from either the anus or vagina when bending over or lifting
  • reduced sensation sensation in the vagina
  • tampons that dislodge or fall out
  • a distinct bulge at the vaginal opening
  • a sensation of heaviness in the vagina.
  • Low back pain/sacral pain/tailbone pain

Prostatectomy includes a number of surgical procedures to remove part or all of the prostate gland. The prostate gland is situated in the male pelvis, below the urinary bladder. It surrounds the urethra, which carries urine from the bladder to the penis.

Post-Prostatectomy Complications:

  • A frequent, urgent need to urinate
  • Urinary Incontinence
  • Difficulty starting urination
  • Slow (prolonged) urination
  • Increased urination frequency at night (nocturia)
  • Stopping and starting again while urinating
  • The feeling you can’t completely empty your bladder
  • Urinary tract infections
  • Inability to urinate
  • Erectile dysfunction

Pelvic floor physical therapy works on releasing the use of sphincters, strengthening pelvic floor muscles, strengthening the core and pelvis, as well as re-educating urinary systems to properly fill the bladder and initiate urinary reflux.

A hysterectomy is a surgery to remove a woman’s uterus. During the surgery the whole uterus is usually removed. Your doctor may also remove your fallopian tubes and ovaries. After a hysterectomy, you no longer have menstrual periods and cannot become pregnant.

Post Hysterectomy Complications:

  • Abdominal bloating
  • Abdominal pain
  • Scar tissue
  • Hip pain
  • Sacral pain
  • Decreased hip mobility
  • Low back pain
  • Pelvic floor pain

Pelvic floor physical therapy can address all of the above dysfunctions and teach the patient how to strengthen the surrounding structures to compensate for the newly created “space” within the abdominal cavity.

What is Persistent Genital Arousal Disorder?

In PGAD, a person’s genitals become physically overstimulated due to nerve or vascular involvement. For many, it feels like their brains and bodies have become disconnected from one another; and often, a flare-up feels intrusive, uncomfortable and embarrassing. In other words, this condition interferes with a person’s ability to live a normal life. Most physicians are not sure how to treat these patients.

The emotional distress that PGAD causes can be so severe that one may develop symptoms of anxiety, and depression. Despite this, many people can and do find effective ways to cope; often this is simply a matter of empowering yourself to reach out for support.

PGAD s a top of the iceberg as Dr. Echenberg, who recommends to find the real reason of nerve/vesicle overstimulation.

At ProTouch we have a unique approach in treating this complex condition.

Signs and Symptoms of PGAD

  • Unwanted physiological feelings of overstimulation in the genitals that are not linked to sexual desire.
  • Symptoms may happen spontaneously, or they may be triggered by manual stimulation of a non-sexual nature.
  • Symptoms are experienced as intrusive and result in feelings of emotional distress.
  • Pain in the lower abdomen, bladder soreness, genital/rectal pain or overstimulation.

Pelvic pain is pain felt in the lower abdomen, pelvis, sacrum, hips or perineum. It has many possible causes and affects up to 20% of the population in the United States, including women and men. Pelvic Floor Physical therapists help people experiencing pelvic pain restore strength and flexibility to the muscles and joints in the pelvic region, and reduce their pain through internal pelvic floor intervention.

Signs and Symptoms:

  • Inability to sit for normal periods of time.
  • Reduced ability to move your hips or low back.
  • Difficulty walking, sleeping, or performing daily activities.
  • Pain, pressure or numbness in the pelvic region with exercise or recreational activities.
  • Pain during sexual activity.
  • Urinary frequency, urgency, or incontinence, or pain during urination.
  • Constipation or straining with bowel movements, or pain during bowel movements.
  • Difficulty using tampons

How can a Physical Therapist help?

Based on the evaluation results, your Pelvic Floor Physical Therapist will individualize treatment to strengthen your Pelvic Floor muscles and to improve their function. You will also gain control over your symptoms and reduce your dysfunctions. Your physical therapist will discuss diet and nutrition, change in behavior, postural training, and develop a plan to return you to your previous level of function.

Dr. Scott Kelly in Clinics in Colon and Rectal Surgery, Sept, 2014 published an article Pelvic Floor Rehab in the treatment of incontinence stated that Pelvic Floor Physical Therapy is an important first-line treatment for patients with incontinence.