Tuesday, June 18, 2013

Adhesions and Myofascial Release

One of the big concerns with endometriosis (and with multiple surgeries) is adhesions. Those nasty little bands of scar tissue that can reduce mobility, cause muscles to not contract well, pull on tissue and nerves causing pain, even cause bowel obstructions...need I go on? Here's a good rundown on adhesions in general: http://www.nlm.nih.gov/medlineplus/ency/article/001493.htm

So. What can we do about them? Obviously, the first line of defense is prevention. Like what? Adhesion barriers? Good surgical technique (like getting all the blood out before closing)? Getting all the endo out of our bodies as much as possible? Here's a nice article about adhesion prevention:  http://www.centerforendo.com/articles/adhesionsupdate.htm

Okay, so what about the ones you already have? Is there a way to improve mobility, possibly help with pain? One thought is the use of myofascial release. What's that? I'm glad you asked.
"Myofascial therapy can be defined as "the facilitation of mechanical, neural and psycho physiological adaptive potential as interfaced by the myofascial system" with the "purpose of deep myofascial release is to release restrictions (barriers) within the deeper layers of fascia. This is accomplished by a stretching of the muscular elastic components of the fascia, along with the crosslinks, and changing the viscosity of the ground substance of fascia."

Anyone else hear the crickets chirp after that? In short, it's a technique to loosen or break up scar tissue to help with mobility & pain. (Here's a more simple explanation:  http://www.peaksportschiropractic.com/treatments/myofascial-release-technique)   It requires special training. It is often used as a part of pelvic physical therapy. As far as studies that show it to be effective in chronic pelvic pain, the very limited ones I've found state that it helps temporarily and is best used as part of a multi disciplined approach. (see
http://link.springer.com/article/10.1007/s11916-004-0066-0 and the article below*).

*No link for this one, so I had to copy and paste it all.

Prevalence of Pelvic Floor Dysfunction in

Patients with Interstitial Cystitis
Kenneth M. Peters, Donna J. Carrico, Scott E. Kalinowski, Ibrahim A. Ibrahim,

and Ananias C. Diokno
OBJECTIVES To evaluate the prevalence of pelvic floor dysfunction in women with interstitial cystitis (IC).

METHODS Women with IC and pelvic pain were referred to the Beaumont Women’s Initiative for Pelvic

Pain and Sexual Health program. A comprehensive patient history and pelvic examination were

completed by a certified women’s health nurse practitioner.
RESULTS Seventy women with a mean age of 45 years were evaluated. Of these 70 women 87% had levator

pain consistent with pelvic floor dysfunction. The mean levator pain score was 4.48 out of 10.

Nearly two thirds of these women (64%) had their pain for 5 years or more, whereas one quarter

(24%) had their pain for 1 to 3 years. Half of the women reported irritable bowel syndrome, and

more than one third (36%) reported urge urinary incontinence.
CONCLUSIONS Women with IC may have pelvic floor dysfunction, as noted in this population in which 87


had levator pain upon examination. If pelvic floor dysfunction is diagnosed in IC patients, then

therapy targeting the pelvic floor musculature may be considered as part of a multimodality
approach to treating IC. UROLOGY 70: 16–18, 2007. © 2007 Elsevier Inc.

Interstitial cystitis (IC) is a debilitating bladder syndrome

characterized by urinary urgency, frequency,

and pain. The National Institute of Diabetes and

Digestive and Kidney Diseases definition has been expanded

to include not only those with bladder ulcers or

glomerulations identified on cystoscopy and hydrodistention,

but also those with only symptoms of urinary urgency,

frequency, and pelvic pain who had identifiable

causes ruled out, such as urinary tract infections, bladder

cancer, and endometriosis. Currently medications, hydrodistention,

intravesical therapies, physical and behavioral

therapies, and neuromodulation are used to decrease

IC symptoms. Unfortunately, even in conjunction these

therapies are often suboptimal in alleviating these symptoms,

perhaps in part because the true cause of IC is
unknown.1 Many IC patients also suffer from pelvic floor

spasm, which causes pelvic pain, dyspareunia, and urinary

hesitancy. Myofascial pain and hypertonic pelvic floor

dysfunction are present in as many as 85% of patients
with IC and/or chronic pain syndromes.2 The purpose of

this article is to report clinical findings related to pelvic

floor dysfunction in women with IC.
Seventy women diagnosed with IC by cystoscopy and hydrodistention

and ongoing pelvic pain were referred to the Beaumont

Women’s Initiative for Pelvic Pain and Sexual Health

program. These women had been evaluated and treated by

gynecologists, gastroenterologists, and other medical specialists

without resolution of their pain. Our evaluation included a

comprehensive history and a pelvic examination performed by

a certified women’s health nurse practitioner. The pelvic examination

included assessment of levator pain on the right and

left sides at the ischial spines (as noted in the comment section).

Pain was quantified on a 10-point visual analogue scale

(VAS) by the patient. A retrospective chart review was done to

gather additional data. Descriptive statistics were used to describe

the sample and the distribution of the variables of interest,

such as demographics and pain levels.
Seventy women with IC and pelvic pain were evaluated.

The mean age was 45, with a standard deviation of 12

years. More than half of the women were married (65%),

had more than 12 years of education (54%), were not

working outside the home (52%), or were menopausal

(55%). Nearly two thirds (64%) had their pain for 5 years

or more, whereas one quarter (24%) had their pain for 1

to 3 years. The vast majority of the sample had levator

pain (87%) and dyspareunia (71%). The average levator

pain score 4.48 out of 10. Interestingly, the average score

on the left side was greater than on the right side (4.75

vs. 4.2). Eleven women (16%) had an Interstim device

(Medtronic, Minneapolis, Minn) and 1 had a bion mi-
K.M. Peters is a paid consultant and funded investigator for Medtronics and Advanced


From the Ministrelli Program for Urology Research and Education (MPURE),

Department of Urology, William Beaumont Hospital, Royal Oak, Michigan.

Reprint requests: Donna J. Carrico, N.P., M.S., Department of Urology, William

Beaumont Hospital, 3535 West 13 Mile Road, Suite 438, Royal Oak, MI 48073.

E-mail: dcarrico@beaumont.edu

Submitted: September 14, 2006; accepted (with revisions): February 28, 2007
16 © 2007 Elsevier Inc. 0090-4295/07/$32.00

All Rights Reserved doi:10.1016/j.urology.2007.02.067