(646) 355-8777

Herman & Wallace Blog

Supporting Medical Providers Who Care for Patients with Pelvic Pain

A recent on-line survey queried fourty-four Obstetrician-Gynecologists (OB-GYNs) in British Columbia to learn more about the needs of physicians who treat women who have endometriosis and chronic pelvic pain (CPP). Physicians reported that women who present with endometroisis or chronic pelvic pain usually require more visits than other patients, for reasons including medical and pain management, lack of a clear diagnosis, and lack of improvement in condition. Evaluation techniques utilized by the physicians often included laparoscopy and ultrasound, and despite these practices, the OB-GYNS reported challenges in making a diagnosis or successfully treating their patients with CPP. In fact, survey results indicated that 5% of the respondents were able to diagnose a patient for a cause of pelvic pain in > 70% of patients. Most of the physicians reported that less than half of the women treated had a good response to interventions. Although the highest rate of referral for these providers was to another OB-GYN specializing in pelvic pain, nearly 60% of the time a referral to physical therapy was reported.

Although some of the narrative comments encountered in this survey were positive, including one physician's report of having "…good success with physiotherapy…", more often the providers expressed frustration and annoyance when faced with not only the challenges of diagnosis and treatment, but also the poor compensation and the longer visits required for counseling and teaching of patients. In addition to wanting more clear guidelines on diagnosis and management of female CPP, physicians expressed interest in having group educational sessions for patients, and more resources such as educational brochures on self-management for patients.

How can pelvic rehabilitation providers fill in this knowledge gap? I recall asking a referring provider if he was pleased with his patients' rehabilitation outcomes, and he expressed such a relief that I was taking the "dregs of the practice." He meant nothing disparaging about the patients themselves, he explained, just that when these patients walked in the door he felt a sinking feeling because he did not know what to do for them. Now, he reported, these same patients were returning from a pelvic rehabilitation referral and excitedly reporting on progress they had made. So many physicians and other referring providers still do not understand the scope of the patient populations that we can treat in pelvic rehabilitation. We can provide a necessary bridge between the challenge of diagnosing and medically treating chronic pelvic pain and the rehabilitation approach that addresses the chronic pain issues. Differential diagnosis of chronic pelvic pain from a rehabilitation standpoint is a skill set that every therapist must continually improve upon. If you are interested in learning more about these skills, sign up for faculty member Peter Philip's continuing education course Differential Diagnostics of Chronic Pelvic Pain next month in Connecticut.

Can We Predict Who Benefits from Manual Lymph Drai...
Balloon-assisted Training in Dyssynergic Defecatio...

Upcoming Continuing Education Courses

Boundaries, Self-Care, and Meditation - Remote Course

Sep 12, 2020 - Oct 11, 2020
Location: Replacement Remote Course

Mobilization of Visceral Fascia: The Urinary System - Phoenix, AZ (Postponed)

Oct 2, 2020 - Oct 4, 2020
Location: Banner Physical Therapy and Rehabilitation

Mobilization of Visceral Fascia: The Urinary System - Medford, OR Satellite Location

Oct 2, 2020 - Oct 4, 2020
Location: Asante Rogue Valley Medical Center

Mobilization of Visceral Fascia: The Urinary System - Self-Hosted

Oct 2, 2020 - Oct 4, 2020
Location: Self-Hosted Course

Mobilization of Visceral Fascia: The Urinary System - San Diego, CA Satellite Location

Oct 2, 2020 - Oct 4, 2020
Location: FunctionSmart Physical Therapy

Mobilization of Visceral Fascia: The Urinary System - Colorado Springs, CO Satellite Location

Oct 2, 2020 - Oct 4, 2020
Location: Manual Edge Physiotherapy

Mobilization of Visceral Fascia: The Urinary System - Fairlawn, NJ Satellite Location

Oct 2, 2020 - Oct 4, 2020
Location: Bella Physical Therapy

Low Pressure Fitness for Pelvic Floor Care - Trenton, NJ (Postponed)

Oct 2, 2020 - Oct 4, 2020
Location: Robert Wood Johnson Medical Associates

Pelvic Floor Level 1 - Grandville, MI Satellite Location

Oct 3, 2020 - Oct 4, 2020
Location: Apogee Therapy Center

Pelvic Floor Level 1 - Ann Arbor, MI Satellite Location

Oct 3, 2020 - Oct 4, 2020
Location: Probility Physical Therapy

Pelvic Floor Level 1 - Lansing, MI (Postponed)

Oct 3, 2020 - Oct 4, 2020
Location: Physical Therapy Services of Lansing

Pelvic Floor Level 1- Canton, OH (POSTPONED)

Oct 3, 2020 - Oct 4, 2020
Location: Aultman Hospital

Pudendal Neuralgia and Nerve Entrapment - Minneapolis, MN (Postponed)

Oct 3, 2020 - Oct 4, 2020
Location: Viverant

Yoga for Pelvic Pain - Remote Course

Oct 3, 2020 - Oct 4, 2020
Location: Replacement Remote Course

Male Pelvic Floor - Colorado Springs, CO

Oct 3, 2020 - Oct 4, 2020
Location: St. Francis Medical Center

Oncology of the Pelvic Floor Level 2A - Chicago, IL (Postponed)

Oct 3, 2020 - Oct 4, 2020
Location: Advocate Illinois Masonic Medical Center

Yoga for Pelvic Pain - Albany, NY (Postponed)

Oct 3, 2020 - Oct 4, 2020
Location: The Sage Colleges

Pelvic Floor Level 1 - Satellite Lab Course

Oct 3, 2020 - Oct 4, 2020
Location: Replacement Remote Course

Pelvic Floor Level 1 - Self-Hosted

Oct 3, 2020 - Oct 4, 2020
Location: Self-Hosted Course

Pelvic Floor Level 1 - Canton, OH Satellite Location (SOLD OUT)

Oct 3, 2020 - Oct 4, 2020
Location: Aultman Hospital

Boundaries, Self-Care, and Meditation - Princeton, NJ

Oct 9, 2020 - Oct 11, 2020
Location: Princeton Healthcare System

Pelvic Floor Level 2A - Self-Hosted

Oct 10, 2020 - Oct 11, 2020
Location: Self-Hosted Course

Pelvic Floor Level 1 - Boston, MA (Postponed)

Oct 10, 2020 - Oct 11, 2020
Location: Northeastern University

Pelvic Floor Level 1 - San Diego, CA Satellite Location

Oct 10, 2020 - Oct 11, 2020
Location: Water and Sports Physical Therapy Clinics

Pelvic Floor Level 2A - Kansas City, MO (Postponed)

Oct 10, 2020 - Oct 11, 2020
Location: Centerpoint Medical Center

Pelvic Floor Level 1 - Appleton, WI Satellite Location

Oct 10, 2020 - Oct 11, 2020
Location: Orthopedic & Spine Therapy

Pelvic Floor Level 1 - San Diego, CA (Postponed)

Oct 10, 2020 - Oct 11, 2020
Location: Water and Sports Physical Therapy Clinics

Osteoporosis Management - Remote Course (Rescheduled)

Oct 10, 2020 - Oct 11, 2020
Location: Replacement Remote Course

Pregnancy Rehabilitation - Remote Course

Oct 10, 2020 - Oct 11, 2020
Location: Replacement Remote Course