His and Her Health

I was recently diagnosed with vestibulitis and suggested that I use lidocaine and go to pt, why was there nothing prescibed to address nerve issues. Am I missing something? I read that vestibulitis is nerve damage so why pt? why no nerve pain meds, but just lidocaine?

thanks
Annie

I have the same question as Levatorani. I was also diagnosed with a Lichen issue. Either Sclerosis or Planus or both. Actually, I am very interested in PT, but it only came up because I asked about it. I am also wondering why I was only given Lidocaine for the pain (and clobetasol for the lichen). Why no antidepressants or other meds to help the nerves potentially learn to shut off?

levatorani (love the name!)
PT can help in both muscular and neuromuscular issues. Commonly we see pelvic floor dysfuinction in the form of tension (and weakness) in women with vestibulitis. PT can help in this issue. Also we commonly see postural issues and muscle incoordination in these women again can be helped with PT.

In regards to the meds, I don't want to get involved bc it is out of my scope, but perhaps the physicians are trying to see if the least invasive way can help first?

niva

Thanks Niva,

But I read Dr Goldsteins article "lumper" and he suggests one category as neural proliferation and suggests nerve pain meds, how do I know that the doc did not misdiagnose me and mine is more of a "nerve" issue ( my levator muscles are spasming- but I read that it could be a secondary response to vestibulitis or the proliferation of nerve endings- so I guess I am still confused:(

The best suggestion would be to see a PT to evaluate your muscles. The lidocaine is to help address the senstivity in the nerve endings in the "loca;"" area, the vestibule. This does not however address the muscular component to your problem. That is where physical therapy is important. A PT may also be able to suggest whether you need to go back to your Md for a nerve pain medication. There is a chance that you don't need this though. I would suggest finding a PT that specializes in pelvic floor dysfunction.

Amy,
I started seeing a pelvic floor PT a few weeks ago. but she has not done an internal exam due to the pain levels. the appointments are only half an hour and i feel like hardly anything gets done. so i still don't have an evaluation of my pelvic floor muscles. i tried to get into another PT, Raquel Perliss, but can't get in until may 19th. i've tried calling holly herman, but have not heard back. I live about 1 hr from boston, do you have any other suggestions? i am having trouble with the lidocaine, as i might be having a reaction to it. I'd love to come to Beyond Basics, but live too far away. I do have an appointment to see Dr G but it's not until april. thanks for the help!
Jana

Cassiesmom...try Marathon physical therapy-I used to work there and there are some great therapists there! Raquel is good too and off course Holly, but may be a while to see her too.
niva

I have pain with urination and in trying to decipher whether its when the urine contacts the skin or whether its from the urethra- I used vaseline and I think that it is coming from the urethra. I do notice, however, a reduction in pain when I drink more water- so perhaps it is when the urine contacts the skin-
Do levator spasms cause painful urination????

I have been seeing my pt for 8 times now, she has not yet evaluated my muscles internally. I have been complaining about lower back pain and she thinks we should address external issues first so we have been doing only electro stim and heat to sacrum area. She also does like a massage to sacrum, but that area is still painful - it is fine when I leave her office, then next day (afternoon) it ususally returns. Also, she does cold laser therapy externally. Do you think electro stim is beneficial and/or should I be doing internal work after 8 visits

btw, she does do the elect stim internally but not yet any myofascial work internally, does this sound ok?

Levatorani,
PTs may have different techniques. I personally do not use e-stim internally in my office. If anything, I have patients rent the unit as it is needed more than 1x/week. I prefer working with my hands when I see the patients in the clinic. Now, if there is no obvious inflammation, infection, guarding and obviously there is consent, the internal work should be included. I evaluate the pelvic muscles internally during the evaluation (if the above mentioned is clear). I have not used laser therapy, but have heard from other PTs of its benefits. I do agree with your PT to focus also on the low back pain. I find that when patients complain of painful urination, there is decreased connective tissue mobility in the periurethral area (anterior vaginal wall).
You can always ask why the internal part has not been done.
Hope this helps
niva

Niva

She said to me that its pointless to do internal work until the external area is addressed, that internal work may be less effective and cause me to flare easily.(However, my sacral area- does not seem to be getting any better after 8 visits- its fine in the a.m. normally, but by the end of the day the pain is bad:( So at this rate, not sure when she will get to the internal muscles. Does the levator issues cause the sacrum pain or vica versa?
The decreased connective tissue
mobility you mentioned is of interest to me as my gynecologist pressed the paraurethral muscles and they were so burny. Is there anything I can do on my own to reach that area??
thank you

A

I have pain with urination and cannot tell if it is coming from urethra or when urine touches the skin- is either way - the connective tissue mobility in anterior vaginal wall?

Sarah1-not sure if I understand your question?

Levatorani: I usually am a big promoter od patients doing their own internal work in addition to the PT. But I don't have them work on the anterior wall bc many cause themselves more pain by not knowing they are moving the urethra around. On the other hand, you can do some work on the lower abdominals and over the pubic area which will also help this process. Does the PT do the myofascial work in this area...if yes, ask her to teach you how to do this at home too! You can "roll" the tissue in this area. As for the sacrum pain, i think it can be both ways. Some people have an injury in the sacral region and then begin having pelvic muscle issues...others begin with pelvic muscle spasms which then irritate the sacral area. Another question for you: does what you drink or eat make a difference with the burning w/urination? Is your Vestibule very irritated and red? If you don't know ask the PT...if it is not inflamed she can do and should do connective tissue mobilization in that area too (and that is external!).
Hope this helps a little more:)

Hi Niva

No my pt does not do myofascial work to abdomen or pubic area. Im thinking perhaps I am with the wrong pt:( Im so weary. Can you explain how one does connective tissue work to the vestibule area?
Do you know any good pts around Hagerstown MD?

ty