Treating Survivors

This morning, Dr. Patricia Young of Restore Physical Therapy and Wellness published a post on treating survivors of trauma on her new site, Peace in the Pelvis. The Post is reblogged below. Let us know what you think and learn more about Peace in the Pelvis here.

Pelvic pain is rarely an isolated phenomenon. Whether it appears during elimination, sex, or after birth, pain often follows underlying events from a patient’s past. Too often, these past events are disregarded as being unrelated to the physical pain or impairment that led a woman to seek treatment in the first place. When a woman is confronting a history of constipation, irritable bowels, interstitial cystitis, or pain of an unknown source, we need to look deeper at what her body is telling us.

According to a 2014 report by the Centers for Disease Control (CDC), 19.3% of women have been victims of sexual assault at some point in their lifetimes. Across the United States, this comprises more than 23 million women. Among these women, 12% were under the age of 12 when they were assaulted, while another 28% were between the ages of 11 and 17.  

These statistics, though appalling, don’t account for other forms of sexual transgressions against women. Stalking, intimate partner violence, and unwanted sexual attention are other traumatic events that can leave women in a state of extreme stress.  This stress, left unresolved, can be a significant contributing factor to pain and dysfunction in the pelvis.

It is our duty to empower women to heal and to surround them with physical therapists and other providers who will acknowledge their past and present challenges.

It is part of our job as physical therapists – clinicians who touch their clients as part of their treatment plan – to understand the prevalence and enduring effects of sexual trauma. As practitioners who treat the body, we must be aware of and sensitive to histories of sexual violence, as well as any other traumatic event that may result in a woman feeling unsafe in her body. We must also recognize that trauma can manifest as myriad symptoms, which are very real, but which require us to listen to our patients in order to understand and successfully treat. It is our duty to empower women to heal and to surround them with physical therapists and other providers who will acknowledge their past and present challenges.

In treating women with pelvic pain, the psychological and emotional well-being of the patient must be considered. While our focus as physical therapists is the body, we must be mindful of our patients’ overall wellbeing as individual people; collaborating with a psychotherapist trained in trauma is an excellent place to start. Because of the sexual and overall personal nature of the pelvic floor, the mind-body connection is especially poignant for persons with pelvic pain and dysfunction.

Our patients cannot afford for us to overlook the physical effects of psychological trauma. It is currently common practice for dozens of pain-related diagnoses to be grouped together and treated with a single set of drugs that not only carry potential side effects, but that treat only symptoms while ignoring the underlying cause of pain. If our patients are to move forward in their lives, we need to start directly addressing the physical dysfunctions and psychological traumas that are preventing them from doing so. Pain-relieving drugs are not a viable long-term solution.

Poor physical health as a result of abuse or psychological trauma is a real concern, and the correlation of abuse to adverse health outcomes is already established.  The Adverse Childhood Experiences Study looks at abuse, neglect and household dysfunction in people before the age of 18.  The higher the score a person receives, the greater the health risk for that individual.  Yes, there are those who stay healthy even with a high score thanks to mitigating factors that diminish the effects of early negative events. The point remains, however, that instances of abuse, neglect, or other dysfunction, though intangible, do produce negative physical health consequences. Their psychological nature does not make them any less real.

Now it is time for pelvic floor physical therapists to advocate on behalf of our patients in their treatment.

Our society is now beginning to recognize the prevalence of sexual assault. Because pelvic floor physical therapists are on the front lines of treating the survivors of assault, we have an opportunity and a responsibility to lead the discussion on the holistic and trauma-informed treatment of sexual assault survivors. Much the same can be said of treating women who have not survived sexual assault, but who have overcome birth trauma, painful surgeries, or other negative events that have brought pelvic pain and dysfunction.

The public conversation has begun. Now it is time for pelvic floor physical therapists to advocate on behalf of our patients in their treatment. We can serve as their primary point of contact, cooperating with and sharing information with their psychotherapists and other providers to whatever extent they wish. We can reassure clients and validate their concerns. We can confirm for them that their experiences do have an impact on their physical wellbeing. Most crucially, we can listen to our patients. They need to be heard.

This post originally appeared at peaceinthepelvis.com.