Category Archives: Pelvic Health

What comes after the PSA (Prostate-Specific Antigen)? The next steps

I had a conversation with Dr. Harold Frazier ( http://www.gwdocs.com/physicians/hal-frazier ) the other day about some alternative testing when Prostate Cancer is suspect.  This would be the next step after the initial screening with the PSA if it shows an elevated level.  In the past, a biopsy would be the next step.  This however can pose a number of risks to the patient, infection, bleeding, and just being plain unpleasant.

We talked first about a blood test that I had heard about from the Cleveland Clinic called the 4Kscore test.  This one combines four prostate-specific results with clinical information into an algorithm that calculates the individual’s risk for aggressive prostate cancer.  It has good clinical confirmation behind it.  

He also talked about another test that was not a blood test, but a urine test called SelectMDX.  It measures the mRNA levels of two biomarkers and helps determine if the possibility of a more aggressive form of cancer is likely and if a biopsy is therefore warranted.  Good news if you don’t want to go through another blood draw!

The downside is the expense of the test and the possibility that insurance may not cover the tests.  The upside is that there are more options to help detect prostate cancer and the options are simpler and more effective than ever before.

As with all methods of prostate screening, a good dialogue with your doctor, your risk factors, and age should always be taken into consideration before proceeding.

 

 

By: Patrick Wenning, PT

Photo Credit: https://pixabay.com/en/what-s-next-yellow-sticker-note-1462747/

New Prostate Screening Recommendations 2018: Rethinking the use of the Prostate-Specific Antigen (PSA) test

Men need to be proactive about their health.  Cardiovascular fitness and blood pressure screening are often part of the regular check ups with their primary care physician.  In the last few years, Prostate Cancer screening is becoming part of this proactive approach.

There has been some controversy over the past few years about when and how to screen for prostate cancer.  What age do I start? What type of tests are there? Am I more at risk? Do I have to have an “uncomfortable” manual exam?

In the past, there were concerns about “over diagnosing”, “false positive” tests, and unnecessarily scaring men about the threat of prostate cancer; and as a result, the PSA (Prostate-specific antigen)-based test was not part of the proactive strategy.  But there are now newer guidelines for men to follow about the PSA-based test to help men determine their risk factor.

The US Preventative Service Task Force (Independent volunteer experts in evidence based and preventative medicine who work to make recommendations about prevention.) https://www.uspreventiveservicestaskforce.org/  have set forth the following guidelines for use of the PSA by men:

  • Men age 55-69: individual decision on Prostate-specific antigen (PSA) based screening test. Need to discuss potential benefits and harms with their clinician.
  • Men age 70 – older: No PSA-based screening.
  • African American Men: Unable to make a recommendation.
  • Men with family history: Unable to make a recommendation.

There is a similar point of view now from the Prostate Cancer Foundation https://www.pcf.org/  on when to begin screening and if the test is appropriate for you:

  • 40 ➣ If family history
  • 45 ➣ If African American
  • 50 ➣ If no history and not African American
  • 55-69 ➣ Discuss with your Doctor
  • Over 70 ➣ Not recommended

Often, Men start thinking about how their health is changing somewhere in their early 50s.  This is when prostate cancer screening should be considered.  Something simple to keep in mind when considering those long term health choices.

 

By: Patrick Wenning, PT

Photo Credit: https://www.freepik.com/free-vector/person-completing-a-test_1064134.htm

Playing for Two

There are moments in an athlete’s career that are life changing; winning your first title, becoming world number 1, or finding out you are going to be a mother.  For some female athletes, motherhood can be an exciting time; for others finding out you’re with child can leave more questions than answers.  How will this impact my professional career? My lifestyle? Or even my training? Can I still compete while pregnant? For a long time, the American College of Obstetrics and Gynecology (ACOG) has recognized the importance of exercise during pregnancy.  Unlike old beliefs, exercise is now known… For more information, click on PhysicallySpeaking-Playing for two

 

Written by: Reshma Rathod, PT and Thu Tran, MD for WTA (Women’s Tennis Association)

MAPP: Multi-Disciplinary Approach to the Study of Chronic Pelvic Pain


Malassezia spp. Skin Microbiome.  https://skinmicrobiome.wordpress.com/tag/malassezia/

MAPP (Multi-Disciplinary Approach to the Study of Chronic Pelvic Pain) Finds That Fungus In Urine Might Be Linked to Urgency and Pain.

One of the most promising lines of research in urology today is the study of the biome, the diverse population of bacteria and fungi that live harmoniously in the human body. In previous MAPP Research Network studies, IC patients were found to have high levels of candida/fungi in their urine during flares (1). Another found that IC patients are deficient in some important bacteria in our bowel while having higher levels of other harmful bacteria (2). This latest MAPP Research Network study now links changes in fungal communities with the symptoms of urinary urgency and pain (3).

Researchers obtained urine specimens from 12 IC patients, 17 Over Active Bladder (OAB) patients and 14 patients without urinary symptoms. DNA was extracted, deep sequenced and compared to multiple fungal sequence databases. They found that patients with more severe symptoms, regardless of the symptom type, had decreased fungal diversity. Individual symptoms were associated with distinctive species of fungi. Patients with severe bladder pain had altered levels of Malassezia spp. composition while patients struggling with incontinence were inversely correlated with Wickerhamomyces spp.

The researchers concluded that the urinary microbiome is altered inpatients struggling with lower urinary tract symptoms, and that the loss of diversity in the microbiome correlated with worsening symptoms. Specific fungal patterns were found in patients with the symptoms of bladder pain and urinary urgency but interestingly this did not correlate with a diagnosis or medical condition. The researchers concluded, “These results suggest the intriguing possibility that particular microbial patterns maybe associated with specific symptoms, not necessarily diagnoses. This could lead to new diagnostic and treatment algorithms for patients struggling with lower urinary tract symptoms.” Clearly, there is a need for greater testing for fungi in urine screening.   Bacteria may not be the root problem in some patients. It is time to consider the roll of fungus in bladder dysfunction.

Adapted from Jill Osborne 8/10/17 Interstitial Cystitis Network Blog, Research https://www.ic-network.com/mapp-research-network-study-finds-fungus-urine-might-linked-urinary-urgency-pain/

 

References:

  1.  Osborne J. Could IC Flares Be Caused By Candida – New research study finds higher rates of candida rather than bacteria during IC flares. IC Optimist Winter 2016.
    https://www.ic-network.com/could-flares-be-caused-by-candida/
  2. Osborne J. The DIPP Mystery – Why are IC patients deficient in some good bacteria. IC Optimist Summer 2016.
    https://www.ic-network.com/dipp-mystery-ic-patients-deficient-bacteria-gut/
  3. Journal of Urology, April 2017 Abstract MP29-10 Alterations in the Urinary Fungal Mycobiome in Patients with Bladder Pain and Urinary Urgency
    https://www.ic-network.com/mapp-research-network-study-finds-fungus-urine-might-linked-urinary-urgency-pain/

Postpartum Pelvic Health: Vol. 1.

During pregnancy and delivery, natural changes occur that impact your pelvic floor and abdominal wall. These changes can cause pain and discomfort for many women during pregnancy and/or after delivery. Childbirth takes a toll on our bodies regardless of the method of delivery.

The toll of postural changes and weight gain on the body can lead to conditions such has back pain, abdominal separation (diastasis recti abdominis), urinary urgency and leakage. It is a misconstrued notion that these symptoms are normal because they are common. Common is not the same as normal. Many women need assistance treating these symptoms so they do not deal with life-long consequences. The good news is therapists at Restore Motion are skilled in treating both pre and postpartum symptoms.

Physical therapy can help pregnant women be strong and fit while decreasing complications during delivery and improving the birth experience. Physical Therapy can also assist postpartum women in regaining their pre-pregnancy body.

 

Constipation: What is it and how can physical therapy help?

 

According to the National Digestive Diseases Information Clearinghouse, someone is constipated if they have a bowel movement less than 3 times a week. This leaves a large range for what is considered “normal” frequency of defecation, from going three times a day (after every meal) to three times a week.

All of us will likely experience constipation at one time or another in our lives. Constipation just means that our food has spent too long in our colon, so more water than usual has been absorbed from the stool leaving it dry and hard to pass. This can be a frustrating symptom, leading to abdominal bloating, gas, increased pressure on the pelvic floor and surrounding organs and back pain. The best treatment is to be aware of the contributing factors and make daily lifestyle changes as needed.

What can lead to constipation?: Factors that may lead to constipation:

  • An imbalance in soluble and insoluble fiber intake, or lack of fiber in your diet
  • Not drinking enough water
  • Not enough physical activity
  • Changes in routine (irregular meal intake, traveling, unusual stress)
  • Ignoring the urge to go to the bathroom
  • Overuse of laxatives
  • Pelvic floor muscle dysfunction (we’ll come back to this later in the post)
  • Sometimes, constipation is a symptom associated with a specific condition such as from suffering a stroke, rectal prolapse, and irritable Bowel Syndrome or IBS. Constipation is common during pregnancy as the abdominal contents must shift and compress to accommodate a growing baby.

Physical therapy for Constipation

  • Help your pelvic floor muscles relax during defecation

When you go to the bathroom, your pelvic floor muscles should relax to “open the gates” and allow passage of stool and urine. Some people lose this normal coordination if they hold tension in their pelvic floor from life stress, or if they’ve had trauma to the pelvis, back, abdominals, or hips (childbirth and surgery). A pelvic floor physical therapist can help your body re-learn proper pelvic floor muscle coordination with biofeedback, manual therapy, and postural education.

  • Perform and teach you manual techniques to stimulate movement through your Intestines

In some cases, performing an abdominal massage can stimulate a bowel movement. Your physical therapist can teach you the massage sequence and appropriate amount of pressure. He/she can also perform visceral manipulation, techniques to restore normal movement in your abdominal organs.

  • Help you become more physically active

Your physical therapist can prescribe exercises to improve your flexibility and strength so that you can be physically active in the community without pain. Establishing a daily exercise routine is an important step in reducing constipation.

 

Photo: http://static.businessinsider.com/image/550b24a46da8115622cd5ecd/image.jpg

 

Written by: Claire Agrawal, PT
Edited by: Miriam Graham, PT