Restore Motion physical therapists Carrie Cothran, Patrick Wenning, and Reshma Rathod attended The International Pelvic Pain Society Conference held in Washington DC October 11-15th. When asked to summarize her “take home discovery” from the IPPS Conference, Carrie Cothran replied, “Pain can be viewed as a neuro-immune response. Structures within the body that aren’t injured may still undergo an inflammatory reaction due to the tissue changes associated with pain. This in turn contributes to long-term protectiveresponses that affect resting muscle tension and ability to do work. The protective responses that occur with pain make the body more vulnerable to injury.”
Patrick Wenning remarked, “At the conference,there was such enthusiasm for better understanding scientific knowledge of the pelvic floor. Most of the time, pelvic floor rehabilitation is new to people and to other PTs mainly because it is an area of the body that people don’t want to talk about. Discussion with fellow participants was frank and enlightening. They made me feel that I had something to contribute and that I made the right decision to pursue this specialty. I still have a lot to learn as the science continues to uncover more useful information!”
Reshma Rathod added, “Opioids don’t work with Fibromyalgia or chronic pain since the endogenous opioid receptors are already occupied due to changes associated with chronic pain. When opioids are given for acute pain, they interfere with mood, sleep patterns and contribute to headaches. Ironically, patients may want to continue on the opioid medication to address their depression, difficulty sleeping and headaches. The body’s dependence opioid medications ‘stick’ with the person making it more difficult to discontinue and cause more problems in the long run.”
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.
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