By Amy Price, PT

This October, some of our practitioners from Proactive Pelvic Health Centre had the opportunity to attend the 2019 International Pelvic Pain Society (IPPS) conference, which was hosted right here in Toronto! IPPS raises awareness and promotes education about interdisciplinary approaches to treatment of chronic pelvic pain, and aims to support clients living with a number of pelvic pain conditions. This was all definitely reflected in the conference itself, which had a mix of presenters from different fields of healthcare, including gynaecologists, surgeons, physiotherapists, and researchers. The conference was centred around the latest and greatest research about evaluation and management for people suffering from pelvic pain. In this post I hope to share some of the highlights from the weekend.

A major theme at the conference was endometriosis; many of the speakers were presenting new and ongoing research related to this condition. Endometriosis occurs when endometrial tissue, which usually exists inside the uterus, is found abnormally outside the uterus within the pelvic cavity. Endometriosis is complex and can have varying presentations but common symptoms include pain, gastrointestinal symptoms, bladder dysfunction, fertility issues and fatigue. The efficacy of some medications and surgical approaches were presented – but one thing I found striking was the fact that severity of symptoms does not necessarily match surgical findings. This means that there are other factors at play in determining how a person with endometriosis feels other than the extent of pathology itself. Endometriosis is complicated and not necessarily well understood (hence all the research being done on it), but I personally found the greatest take home message to be about a proposal for an effective treatment approach. A protocol that has been tested in Vancouver, British Columbia was outlined that emphasized interdisciplinary care – provided by a gynaecologist, pelvic floor physiotherapist, and psychologist. A multi-faceted treatment program like the one described is a fantastic was to address the complex nature of this condition, and it was shown to be effective in the population studied.

Another condition that came up a lot in the research being presented was interstitial cystitis (IC) or bladder pain syndrome (BPS), which involves a combination of urinary symptoms like pain, urgency, and frequency that persists longer than 6 weeks. The new research is showing that IC is commonly present with other conditions like IBS, fibromyalgia, and chronic fatigue, which highlights the fact that people with IC can have complex symptom presentations that include more than just urinary symptoms. There was also research presented to show that people with IC can have higher than normal risk for depression and suicidal ideation. Similar to endometriosis, this data highlights a need for a well rounded treatment approach for these individuals, including not just treatment for the physical treatments, but addressing mental health and well being as well.

Lastly, there were a few talks that discussed how other factors can influence the presentation of pelvic pain. Firstly, gender and sex can play a  role in how pain presents. There is evidence to show that pain is not only more prevalent in females, but is also experienced at a greater subjective intensity in females. There are also hormonal influences to pain, which can be seen when fluctuations in pain are noted at different times of the menstrual cycle.

There was also some interesting insights about pain in the transgender population, and how pain is a possible side effect of both hormone therapy and gender affirmation surgery. More studies need to be done on these topics to understand them better and optimize treatment for all genders. Lastly, there is evidence to show that experiences that occur in childhood can affect pelvic pain in adulthood. There was preliminary evidence presented from a mouse study to suggest that early childhood trauma can increase pelvic pain and bladder symptoms in adulthood.

Overall, even though there were many different topics that were presented by researchers from a variety of professions, there were a few underlying take home messages. For one. it is clear to see that these pelvic pain conditions are complex in nature – and there can be lots of different factors that can play a role outside of just the physical symptoms. Between the high incidence of co-morbidities, psychological symptoms, and the influence of hormonal, gender, and life experience factors – the research is showing that there’s a reason why there isn’t a miracle drug for these conditions. The complexity and variability in symptoms means that it’s important to have a well rounded and multi-faceted treatment approach, with lots of different healthcare providers working together towards the same goal. I know all of us at Proactive Pelvic Health Centre can attest to this, as we see on a daily basis how important it is to use a team approach to care to maximize the outcomes for our clients!

Resources:

1) International Pelvic Pain Society – Mission Statement (https://www.pelvicpain.org/IPPS/About/Mission/IPPS/Content/About/Mission.aspx?hkey=f912cf86-2e92-48b5-87f3-7631789ab00a)

2) The Endometriosis Network of Canada – Understanding Endometriosis (https://endometriosisnetwork.com/information/understanding-endometriosis/)

3) IC Network – What is Interstitial Cystitis? (https://www.ic-network.com/interstitial-cystitis/what-is-ic/)

4) IPPS Research Presentations:

-Early trauma and its effect on chronic urogenital pain. Julie A. Christianson, Ph.D. Univeristy of Kansas Medical Centre

-Gender and sex influence in the clinical treatment of pain. Andrea L. Nicol, MD. University of Kansas School of Medicine.

-Breakthrough from the MAPP network. H. Henry Lai, MD. Washington University School of Medicine.

-Endometriosis and Adenomyosis. Sukhbir. S. Singh, MD. The Ottawa Hospital & University of Ottawa.

-Pain in the transgender population. Helena Frecker, MD. Michael Garron Hospital

-Endometriosis: Towards prevention of chronic pain. Catherine Allaire. MD. BC Women’s Centre for Pelvic Pain & Endometriosis.

-Suicidal ideation/risk in community and tertiary care patients with chronic pelvic pain syndromes. Dean A. Tripp, PhD. Queens University.