November 2019 Newsletter
Cyclist Syndrome
Cyclist's Syndrome, or Pudendal Neuralgia, is a diagnosis involving pain or sensory changes (numbness, tingling) around the pudendal nerve distribution. Women are not the only ones that can be affected with pelvic pain, as this can involve regions around the penis, testicles or anal opening in men. It can no doubt effect a person’s quality of life, impacting bladder, bowel, and sexual function as well as someone’s ability to sit for extended periods of time. Pudendal nerve pain can be exacerbated by sitting, driving, exercise, bowel elimination or having a full bladder, and can be alleviated by lying down, sitting on a toilet seat, or standing.
PN is commonly referred to as Cyclist’s syndrome due to the amount of time spent in a bike saddle, which can compress or irritate braches along the path of the pudendal nerve with repetitive compression or irritation from the repetitive nature of hip flexion required from cycling. Prolonged cycling on an ill fitting bike seat in this position can cause those nerve branches to become irritated.
As we described above, pain is not the only identifier of pudendal neuralgia. It can also present with bladder dysfunction such as urinary urgency, frequency, pain with bladder filling, burning with voids, or sensation of incomplete emptying. Bowel symptoms can include anything from pain, to difficulty eliminating, or even incontinence. Sexual function can be affected including pain with erection, ejaculation or orgasm, erectile dysfunction or persistent arousal. With the amount of symptoms pudendal neuralgia can present with, it’s easy to see how PN can be quite challenging to receive an accurate diagnosis.
PN can be challenging to treat, but not impossible to manage. Pelvic floor PT can be one tool to assist in normalizing muscle tone or reducing nerve irritation on the pudendal nerve, as it has a close relationship to the pelvic floor. Having a team of providers focusing on a multidisciplinary approach is essential for thorough treatment of PN. Medical management with medication, suppositories, nerve blocks, surgical decompression or ablation are some options in addition to pelvic floor PT. Dry needling can also be a tool utilized during PT visits to reset the pudendal nerve and assist with reduction in symptoms.
PN is commonly referred to as Cyclist’s syndrome due to the amount of time spent in a bike saddle, which can compress or irritate braches along the path of the pudendal nerve with repetitive compression or irritation from the repetitive nature of hip flexion required from cycling. Prolonged cycling on an ill fitting bike seat in this position can cause those nerve branches to become irritated.
As we described above, pain is not the only identifier of pudendal neuralgia. It can also present with bladder dysfunction such as urinary urgency, frequency, pain with bladder filling, burning with voids, or sensation of incomplete emptying. Bowel symptoms can include anything from pain, to difficulty eliminating, or even incontinence. Sexual function can be affected including pain with erection, ejaculation or orgasm, erectile dysfunction or persistent arousal. With the amount of symptoms pudendal neuralgia can present with, it’s easy to see how PN can be quite challenging to receive an accurate diagnosis.
PN can be challenging to treat, but not impossible to manage. Pelvic floor PT can be one tool to assist in normalizing muscle tone or reducing nerve irritation on the pudendal nerve, as it has a close relationship to the pelvic floor. Having a team of providers focusing on a multidisciplinary approach is essential for thorough treatment of PN. Medical management with medication, suppositories, nerve blocks, surgical decompression or ablation are some options in addition to pelvic floor PT. Dry needling can also be a tool utilized during PT visits to reset the pudendal nerve and assist with reduction in symptoms.
SPT Spotlight
Christina McGee
Physical Therapist
Physical Therapist
Christina McGee earned a Bachelor of Science in Athletic Training from the University of Iowa and Doctorate in Physical Therapy from the University of Delaware. She has been with Sullivan Physical Therapy since graduating in 2013. Christina is the head of Sullivan Physical Therapy's pediatric bowel and bladder program as well as the coordinator of clinical education. She has particular interests in the areas of sexual health, trauma, and pregnancy/postpartum recovery. Christina helped to start a collaboration between Austin Area Birthing Center and Sullivan Physical Therapy with a vision of postpartum physical therapy for all and treats at the South location weekly.
Christina is passionate about empowering patients through information, helping them to understand what is going on in their bodies and steps they can take to help alleviate symptoms. She enjoys sharing information with the public through speaking engagements on topics of pelvic health, especially in regards to prevention and recognition of symptoms.
Christina is a member of the American Physical Therapy Association.
Christina is originally from Chicago and lives in South Austin with her husband, daughters, and dog. She enjoys cooking, yoga, and trying new things.
Christina is passionate about empowering patients through information, helping them to understand what is going on in their bodies and steps they can take to help alleviate symptoms. She enjoys sharing information with the public through speaking engagements on topics of pelvic health, especially in regards to prevention and recognition of symptoms.
Christina is a member of the American Physical Therapy Association.
Christina is originally from Chicago and lives in South Austin with her husband, daughters, and dog. She enjoys cooking, yoga, and trying new things.
Research Roundup
Study: Hyperbaric oxygen therapy may reduce incontinence in patients with cancer
Patients who had radiotherapy to treat cancer in the pelvic region had improved urinary incontinence symptoms after hyperbaric oxygen therapy, according to a study in The Lancet Oncology. Patients also reported less pain and bleeding, researchers found.
Study: Low testosterone tied to urinary incontinence in older women
Older women who experienced urinary incontinence had decreased serum testosterone compared with women who experienced less frequent urinary leakage, according to a study presented at the American Urological Association's annual meeting. The study included 3,075 men and women ages 70 to 79.
Study: Physical therapy patients less likely to be prescribed opioids
Seeing a physical therapist or chiropractor first, before a primary care doctor, made it less likely that patients with low back pain would get an opioid prescription, according to a study in BMJ Open. "To reduce the risks of short- and long-term opioid use, insurers should incentivize patients to see physical therapists or chiropractors first or early on following a bout of low back pain, before seeing PCPs," said study lead author Dr. Lewis Kazis.
Report: US continues to see drop in breast cancer deaths
The breast cancer-related mortality rate in the US declined 40% in the US from 1989 to 2017 even as the rate of new cases rose 0.3% each year from 2012 to 2016, according to a study in CA: A Cancer Journal for Clinicians. The pace of the decline in mortality, however, has slowed in recent years.
Patients who had radiotherapy to treat cancer in the pelvic region had improved urinary incontinence symptoms after hyperbaric oxygen therapy, according to a study in The Lancet Oncology. Patients also reported less pain and bleeding, researchers found.
Study: Low testosterone tied to urinary incontinence in older women
Older women who experienced urinary incontinence had decreased serum testosterone compared with women who experienced less frequent urinary leakage, according to a study presented at the American Urological Association's annual meeting. The study included 3,075 men and women ages 70 to 79.
Study: Physical therapy patients less likely to be prescribed opioids
Seeing a physical therapist or chiropractor first, before a primary care doctor, made it less likely that patients with low back pain would get an opioid prescription, according to a study in BMJ Open. "To reduce the risks of short- and long-term opioid use, insurers should incentivize patients to see physical therapists or chiropractors first or early on following a bout of low back pain, before seeing PCPs," said study lead author Dr. Lewis Kazis.
Report: US continues to see drop in breast cancer deaths
The breast cancer-related mortality rate in the US declined 40% in the US from 1989 to 2017 even as the rate of new cases rose 0.3% each year from 2012 to 2016, according to a study in CA: A Cancer Journal for Clinicians. The pace of the decline in mortality, however, has slowed in recent years.
Updates from the Physical Therapy Team
On October 4, Anissa Akrout spoke at the North Austin Mom's Club discussing incontinence, preventing prolpase, enjoying sex after baby and general health tips.
On October 7, The physical therapists had an inservice with Dr. Jennifer Aranda where they will learned more about dermatological concerns regarding the pelvic floor.
On October 7, Jamille Niewiara and Jessica Chastka presented an introduction to pelvic floor physical therapy lecture to the second year PTA students at Austin Community College.
On October 24, Kimberlee Sullivan was a guest lecturer at Texas Woman's University on Women's Health Physical Therapy to the first year physical therapy students.
Please watch this video about pelvic floor physical therapy featuring Anissa Akrout and Lauren Steele.
On October 7, The physical therapists had an inservice with Dr. Jennifer Aranda where they will learned more about dermatological concerns regarding the pelvic floor.
On October 7, Jamille Niewiara and Jessica Chastka presented an introduction to pelvic floor physical therapy lecture to the second year PTA students at Austin Community College.
On October 24, Kimberlee Sullivan was a guest lecturer at Texas Woman's University on Women's Health Physical Therapy to the first year physical therapy students.
Please watch this video about pelvic floor physical therapy featuring Anissa Akrout and Lauren Steele.
Upcoming Dates
November 5
UsToo Prostate Support Group: Mike Jones Memorial Chapter will be
at 7pm to 8:30 pm at St.David's South Austin Medical Center.
November 9
Christina McGee will be speaking at Prostate Cancer Support Group for Gay, Bisexual and Transgender Individuals dealing with prostate cancer.
November 9
Pelvic Pain Support Group 10 to 11:15 am 4131 Spicewood Springs Road Suite M-1 Austin, Texas 78759
RSVP prior to joining the group: brittanyneece@gmail.com or 512-814-6027
November 28 and 29
Sullivan Physical Therapy will be closed for the Thanksgiving Holiday.
December 2
Our schedules will be open for appointments in February, March, April and May.
Currently your physical therapist's schedule is now open through the end of January. Please connect with one of our Patient Care Coordinators if you need to schedule more appointments.
If you are unsure what frequency you should schedule, just ask your physical therapist.
UsToo Prostate Support Group: Mike Jones Memorial Chapter will be
at 7pm to 8:30 pm at St.David's South Austin Medical Center.
November 9
Christina McGee will be speaking at Prostate Cancer Support Group for Gay, Bisexual and Transgender Individuals dealing with prostate cancer.
November 9
Pelvic Pain Support Group 10 to 11:15 am 4131 Spicewood Springs Road Suite M-1 Austin, Texas 78759
RSVP prior to joining the group: brittanyneece@gmail.com or 512-814-6027
November 28 and 29
Sullivan Physical Therapy will be closed for the Thanksgiving Holiday.
December 2
Our schedules will be open for appointments in February, March, April and May.
Currently your physical therapist's schedule is now open through the end of January. Please connect with one of our Patient Care Coordinators if you need to schedule more appointments.
If you are unsure what frequency you should schedule, just ask your physical therapist.
PT Below the Waist
Jamille Niewiara and Jessica Chastka are co-hosts of Sullivan Physical Therapy's podcast called "PT: Below the Waist", a patient oriented podcast discussing topics related to pelvic floor physical therapy and how it addresses bladder, bowel, and sexual function issues. The podcast features two pelvic floor physical therapists casually conversing about their experiences and thoughts towards pelvic floor related issues.
Every few weeks, they will be posting podcasts about different diagnoses, tips/recommendations to address symptoms, and interviews with medical professionals. Subscribe to their podcast on iTunes, follow them on Twitter @PTBelowTheWaist, and like them on FaceBook. Leave comments and questions on their email: PTBelowTheWaist@gmail.com.
Sullivan Physical Therapy encourages you to listen to their podcasts and get enlightened about "Better Pee, Better Poo, Better Sex".
To listen to our latest podcast please click here.
Every few weeks, they will be posting podcasts about different diagnoses, tips/recommendations to address symptoms, and interviews with medical professionals. Subscribe to their podcast on iTunes, follow them on Twitter @PTBelowTheWaist, and like them on FaceBook. Leave comments and questions on their email: PTBelowTheWaist@gmail.com.
Sullivan Physical Therapy encourages you to listen to their podcasts and get enlightened about "Better Pee, Better Poo, Better Sex".
To listen to our latest podcast please click here.
Sullivan Physical Therapy & Austin Area Birthing Center
Postpartum pelvic floor physical therapy is standard in some other countries, with health systems recognizing that preventative care during the crucial healing period following delivery can save women from future suffering and save the system hundreds of thousands of dollars in medications and surgeries farther down the line. Problems such as incontinence, prolapse, scar pain, diastasis recti, back or hip pain, and pain with intercourse can be addressed and eliminated or even prevented all together with a post partum evaluation and recommendations or exercises from a pelvic floor physical therapist trained in postpartum health. To this point, these services are rarely offered in the United States.
Sullivan Physical Therapy is excited to partner with Austin Area Birthing Center in creating this type of whole- person care for clients. Christina McGee PT, DPT, will be on site at Austin Area Birthing Center South Thursdays to provide physical therapy evaluations and treatments to pregnant and postpartum AABC clients to maximize health and healing and allow patients to get back to activities safely following delivery. At this time, the only insurance accepted at AABC is Blue Cross Blue Shield, however we will give you a receipt for you to submit to your insurance companies.
Please contact Sullivan Physical Therapy to learn more about this service and schedule an appointment or email christina@sullivanphysicaltherapy.com.
Sullivan Physical Therapy is excited to partner with Austin Area Birthing Center in creating this type of whole- person care for clients. Christina McGee PT, DPT, will be on site at Austin Area Birthing Center South Thursdays to provide physical therapy evaluations and treatments to pregnant and postpartum AABC clients to maximize health and healing and allow patients to get back to activities safely following delivery. At this time, the only insurance accepted at AABC is Blue Cross Blue Shield, however we will give you a receipt for you to submit to your insurance companies.
Please contact Sullivan Physical Therapy to learn more about this service and schedule an appointment or email christina@sullivanphysicaltherapy.com.
