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PELVIC PAIN THERAPIES AND INTERVENTIONS

THE INFORMATION CONTAINED ON THIS PAGE IS FOR INFORMATION ONLY AND DOES NOT REPLACE THE RECOMMENDATIONS OR TREATMENT INVENTIONS OF YOUR HEALTH CARE PROVIDER.

CONTENTS:

BOTOX INJECTIONS INTO THE BLADDER FOR INTERSTITIAL CYSTITIS
CHRONIC PELVIC HEALTH SUPPORT GROUPS AND ORGANIZATIONS

DIETARY CHANGES FOR INTERSTITIAL CYSTITIS
DIETARY CHANGES FOR IRRITABLE BOWEL SYNDROME
ELMIRON FOR INTERSTITIAL CYSTITIS

HYDRODISTENTION
PHYSICAL THERAPY FOR PELVIC PAIN

ARTICLES:

BOTOX INJECTIONS INTO THE BLADDER FOR INTERSTITIAL CYSTITIS - By Christopher P. Smith, M.D.

Indication: non-FDA approved for urologic indications. Trials underway to evaluate its effect in Overactive Bladder and Benign Prostatic Hyperplasia (BPH)

What is Botox: neurotoxin that prevents nerves from releasing chemicals (neurotransmitters) that stimulate surrounding tissue (for example, Botox will reduce release of chemicals that cause bladder muscle to contract so it can reduce bladder overactivity)

How is it done: Botox is injected into the bladder either under local anesthesia in the office or under general anesthesia as an outpatient hospital procedure. It is injected into multiple areas in the bladder through a small needle inserted in a cystoscope (an instrument that is passed through the urethra, the channel that one urinates out of).

How long does it work: For Overactive bladder results last approximately 6 months. It also has documented positive results in some patients with interstitial cystitis with results usually lasting approximately 4-6 months.

What can I expect as my result for this therapy: Reduction in frequency, urgency, and incontinence of urine that is related to overactive bladder. In some cases, perhaps, a reduction in pain, particularly if pain related to bladder frequency or urgency.

Side effects: Besides potential risks of bleeding and infection, the most common adverse event (approx 5%) is impaired emptying of urine that in severe cases would require a patient to drain their bladder with a catheter for a temporary period of time (usually a couple of weeks).

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CHRONIC PELVIC HEALTH SUPPORT GROUPS AND ORGANIZATIONS - By Cindy Sinclair, President of PURE-HOPE

Who makes up these support groups and organizations: Patients affected by one or more of these conditions, health care providers that have an interest in treating these conditions, and community members such as your neighbor, housewives, students, school teachers, accountants, attorneys.....

What kinds of backgrounds do members of these support groups and organizations have:These conditions are nondiscrimatory, anybody can be affected by one or more of these conditions in any part of the world, age, ethnic origins, social classes, and religious preferences.

How do I find out if there are any groups or organizations where I live:By searching the web for a group in your area or by contacting a national or international organizations such as PURE HOPE at www.pure-hope.org. Individuals that make up these organizations are always ready to assist in any matter possible to help patients with their needs.

What do I expect to get out of a meeting from a support group or organization:An individual can expect to obtain educational information pertaining to their conditions, emotional support to help cope with their diagnosis, and referrals to the health care community that treats their conditions.

How often do they meet:Every organization has different meeting formats. PURE HOPE has an annual national patient conference to bring help and support to the patients affected by chronic pelvic health related conditions. We also have two to four regional meetings annually for the Southeast Texas region.

Do I have to go to the meetings if I just want to talk to someone:No one is expected to attend a meeting to obtain support. Most organizations including PURE HOPE have patient advocates that can offer support by email and/or by telephone.

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DIETARY CHANGES FOR INTERSTITIAL CYSTITIS - By Fred S. Emmite, R.Ph., CDM

Who is this for: Males and Females with Interstitial Cystitis

What can I expect to get out of it: With the help of your physician and following dietary and lifestyle changes you can expect to have noticeable relief of pain and discomfort from Interstitial Cystitis symptoms.

What are the down sides to doing a "diet": None

How long do I have to do this diet: Many patients will need to follow this as a lifelong plan.

Who do I see to help me with this: A Nutritional consultant and/or nutritionist knowledgeable in inflammation caused by food and/or lifestyle issues.

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DIETARY CHANGES FOR IRRITABLE BOWEL SYNDROME - By Fred S. Emmite, R.Ph., CDM

Who is this for: Males and Females with Interstitial Cystitis

What can I expect to get out of it: With the help of your physician and following dietary and lifestyle changes you can expect to have noticeable relief of symptoms of Irritable Bowel Syndrome.

What are the down sides to doing a "diet": None

How long do I have to do this diet: Many patients will need to follow this as a lifelong plan.

Who do I see to help me with this: A Nutritional consultant and/or nutritionist knowledgeable in inflammation caused by food and/or lifestyle issues.

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ELMIRON FOR INTERSTITIAL CYSTITIS - By Christopher Jayne, M.D.

ELMIRON: Pentosan Polysufate Sodium

Purpose: The only oral drug approved by the Food and Drug Administration for the treatment of bladder pain associated with Interstitial Cystitis.

Dosing: The manufacturer recommends taking one 100mg capsule three times a day on an empty stomach. Many experts however recommend a dosing schedule twice a day while maintaining the 300mg total daily dose.

Mechanism of action: The mechanism of action is unknown. However Elmiron is a low molecular weight heparin-like compound that adheres to the surface of the bladder (bladder wall mucosal membrane). It is thought that this then decreases bladder sensitivity by keeping irritants in the urine from contacting the inflamed bladder surface (i.e.,  reduces bladder mucosal permeability preventing irritating solutes from entering the bladder interstitium).

Side effects: In the clinical trials involving over 2400 patients 1-4% of patients had side effects with the most common being nausea, diarrhea, and head ache. However one should be aware of the potential for hair loss (alopecia) and rectal bleeding. All side effects usually resolve shortly after discontinuation of Elmiron.

How effective is it: Used alone roughly 25% of patients the first month and 60% by three months will have improvement in their symptoms. Many experts however have seen enhanced symptom improvement with the addition of other medications such as Hydroxyzine and Amitriptyline, as well as patient adherence to a strict Interstitial Cystitis Diet.

How long do I take it: Elmiron should be taken for at least three months before abandoning its use due to the lack of symptom improvement. For those who do have symptom relief on Elmiron, its use should be considered long term with the potential to reduce the dose after six months of symptom improvement has been identified.

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HYDRODISTENTION - by Karen Delhey, M.D.

Background:Cystoscopy with hydrodistention is a procedure done under anesthesia which can both aid in diagnosing interstitial cystitis, along with also relieving symptoms.

 cystoscope  glomerulations

IC bladders are very sensitive and commonly develop superficial tears during the filling procedure resulting in bloody urine and bleeding points in the bladder which can help with establishing the diagnosis.

In addition, 30-60% of IC patients will have improvement in their symptoms, but initially everyone has worsening of their symptoms for a few days.

Dosing/Frequency:If a patients IC symptoms recur in 3-6 months it can be repeated, but may not be as successful the second or third time.

Advantages: In addition to relieving IC symptoms, the bladder is examined and any abnormal areas can be biopsied and the anesthetic bladder capacity is obtained which can help with determining which therapy to utilize. The normal bladder capacity ranges from 800-1200cc whereas IC bladders can have normal capacity, but can be as low as 200cc.

Disadvantages: Hydrodistention requires anesthesia and there is a slight risk of injury to the bladder. In addition, the patientís symptoms will worsen initially before improving or returning to baseline.

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PHYSICAL THERAPY FOR PELVIC PAIN - By Lyne Stewart, P.T.

What kinds of pelvic pain are treated by P.T.?: Vulvar pain, Menstrual pain, Scar pain from episiotomy, Vaginal muscle spasm, Male pelvic pain, Pudendal nerve entrapment, Constipation, Groin, Pubic bone and Sacro-iliac pain, Interstitial Cystitis, Endometriosis, Sexual pain.

What is a Physical Therapist?A Physical Therapist (is a wonderful human being with a compassionate touch!) will assess your symptoms, muscle, joints and other tissue restrictions. The therapist will develop a personalized plan of care that fits the client's needs and goals. Through various modalities, our goals will target the management of pain, the release of soft tissue body restrictions and the attainment of a greater functional level (such as improved walking and sitting tolerance, resuming Intercourse, etc...).

Don't most PT's work in gym setting, helping people with broken bones and other ailments?There are a variety of specialties in physical therapy. Woman's Health Physical Therapy is a specific area where clients suffering from pelvic floor dysfunction are evaluated and treated. All of our clients are treated in individualized treatment rooms, where privacy is respected and valued. Treatment options include manual therapy to soften muscle tension and scar tissue, bladder retraining, biofeedback to strengthen and/or relax and coordinate the pelvic floor muscles. Modalities to help manage pain are also available. Personalized exercises are given to help strengthen core muscle such as pelvic floor, abdominals and glutes. Those exercises will also improve sacro-iliac and lumbar stability.

When should I start seeing a P.T.? The sooner the better. Once a physician has established a diagnosis and following their assessment and testing, he/she will write a prescription and refer their client to physical therapy. We will then schedule an initial evaluation to assess pain and limitations.

How often would I go to P.T.?The frequency of treatment will be decided once an evaluation has been completed and the treatment to follow will be individualized to the client. You usually can expect to be seen for treatment 1-2 times/week for 6 weeks up to 3 months. If after 3 months signs of progress are still shown, physical therapy may be continued. Frequent reevaluations will be performed to ensure progress.

When should I stop going?Treatment should be discontinued once the set goals have been reached, or if maximum rehabilitation potential has been attained. Completion of physical therapy should be discussed between the client, the physical therapist and the physician.

What could I expect to get out of it?Our goal in physical therapy is to help you achieve greater quality of life through management and relief of pain and other symptoms, increased comfort level during activities of daily living (activities you perform everyday) and learn how to help yourself through comfort measures and exercises.

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Disclaimer Statement:br> All information on the P.U.R.E. H.O.P.E. Web site is provided with the understanding that the P.U.R.E. H.O.P.E. does not engage in the practice of medicine.  The members of P.U.R.E. H.O.P.E. cannot and do not give medical advice.  No information on this Web site should be considered medical advice.  Only your personal physician can do this for you.

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