Questions Regarding Physical Therapy

[PagesOfTime]

Well, I was lucky enough to find a PT in my area....more specifically, in the same office complex that I work in. My primary symptom I experience is urinary hesitancy. Then once it starts it often stops and starts again once or twice.

My questions are:

My insurance will not cover this, and at $100/session, the best I could possibly afford right now would be twice a month. In another 4 months my lease expires and I'm moving back in with my mother due to all this At that point, I'd be able to afford another 2 sessions/month. Being able to go only twice a month for the next 4 months and only once a week thereafter, will this be beneficial enough to me?

For those that have been helped by PT, how often do/did you go? Also, is this something that will be ongoing, or is it something that could be resolved in several months of therapy and then not have to go anymore? I want to get better, but I'm working at paying off some debts right now and I can't see when I'd ever be able to afford to go as often as some of you I read about on here.

[Sleeper Service]

I note you had an urodynamic evaluation. Your symptoms seem to be obstructive LUTS which your doctor has confirmed when she said your urinary sphincter is spasming. Valium is used to try and break this spasm whilst the Uroxatral she gave you is to help you pee better in the meantime. These medication should be your first line of therapy so I hope you've been taking them.

I also note that she referred to biofeedback which has been proven to help bladder neck spasms. How has this progressed?

I say this because whilst the SP has undoubtedly helped people you should ensure you have exhausted conventional treatments first before embarking on expensive and possibly unnecessary PT.

[PagesOfTime]

I could not tolerate the side effects of the valium and the uroxatral. The valium seemed to help minimally, but it causes me worst constipation I've ever had. If I take a low dosage of 2mg one night, I'm blocked up for several days. The uroxatral also had minimal benefits and horrible side effects.

Biofeedback I did not tolerate well. I was so uncomfortable when trying it that I could not focus on what it was telling me. It did show such high tension though that there really wasn't much of a difference when I was told to tense and when to relax.

On top of all that, I'm certain that the urodynamics catheter being jerked in the urethra has caused stricture formation.

However, before going though invasive procedures to get the stricture taken care of, I want to give PT a try to see if I can at least overcome the muscular part of the problem. I feel that although the external urethral sphincter is causing me not to be able to urinate properly, there are several surrounding muscles around there that may need to be worked on first to free up that one.

[Sleeper Service]

Then, forgive me for saying so, but you are your own worst enemy.

There are alternative drugs to Valium and Uroxatral and biofeedback requires patience and work. In addition you can take supplements for constipation as well as modifying diet. Do not fall into the trap of thinking a PT will solve your problems for you - if you have a physical obstruction it won't.

PT and the SP undoubtedly do help certain men with certain forms of this condition but Drs Wise and Anderson have never claimed that it is a panacea. If your doctors have prescribed a course of treatment then you need to try that first, not the other way round.

I'm sorry if I sound harsh here but you need to be aware of the reality of the situation - this is not a quick fix disease, it requires a lot of trial and error and work whilst you find things that work for you. The first step in doing so is to follow medical advice.

[SickofCP]

Sleeper Service.....your advice is terrible.

Biofeedback is a complete waste of time for those that have their pelvic muscles in spasm. Xatral and valium can give temporary relief of symptoms, but surely the goal is to just get better long term.

You say he should try conventional therapy first. In my opinion, the SP should be considered conventional therapy.

Go to the PT as much as you can. If the PT is good, he/she will help you learn how to do much of it yourself in between visits.

[Sleeper Service]

Sleeper Service.....your advice is terrible.

Biofeedback is a complete waste of time for those that have their pelvic muscles in spasm. Xatral and valium can give temporary relief of symptoms, but surely the goal is to just get better long term.

You say he should try conventional therapy first. In my opinion, the SP should be considered conventional therapy.

Go to the PT as much as you can. If the PT is good, he/she will help you learn how to do much of it yourself in between visits.

And you are familiar with his medical history, symptoms and an authority on this condition are you? Please note that I am not suggesting that he stops SP, merely that he follows the advice his doctor has given him as biofeedback actually has proven results for sphincter dyssynergia - admittedly in children but this is now being extended to adults. As for biofeedback being useless for CPPS, this article (which is published elsewhere on this site) seems to suggest otherwise.

PoT's symptoms seem to primarily LUTS, not pain related and it is quite wrong for us to say "Ignore your doctors and launch into the SP" because what may have worked for us might not be for him. It is utterly stupid to disregard the knowledge that the medical community has on voiding function - and that, as Kevin has pointed out, is something they do understand - in favour of an unproven methodology as the primary method of care.

Now let me be clear here: I am not discrediting SP as it shows results which Drs Wise and Anderson are now publishing in journals, however to ignore the existing repertoire of treatments would be folly indeed. Or would you not agree that a multi-modal approach is of benefit?

[PagesOfTime]

Allow me to intervene in my thread if I may...

Thank you both for your opinions. Both have given me a push on where I need to go next.

Sleeper, I think what you said about taking the uroxatral and valium are valid as advised by my urologist, and I am going to try them again with the addition of a stool softener to see if I can achieve tolerable results and then discuss with my urologist any alternatives if I can't. I don't feel that this alone is going to be a long term help, but I think as an addition to compliment the PT, it could be a valuable. As for the biofeedback, that is something that would be included in my PT sessions as she is who helped me through my previous sessions.

Sickof, I certainly agree after everything that I've read that PT seems to be the best way of tackling this as conventional therapy which is why I posted this in the first place. After my biofeedback sessions with my PT, and discussing my symptoms with her, she definitely feels I need some internal work which I agree is most likely the case.

I feel my best course is to have PT, while taking the valium and xatral for maximum benefits, but please, answer me this....if all I can afford is twice a month for the time being, is this going to be helpful, or just money waisted?

[carld]

You have to figure that any PT per month is better then none. I only do PT 2 times a month and I have found it helpful, although for example my last session a few days ago brought about my symptoms, so it feels like a few steps back. Learning from this forum that these set backs are part of the gig. You can study the diagrams in the "good book" and give it go yourself and get the Theracane, it seems to nail the external tightness. You can also have your partner learn to do internal work. I had my wife go with me to learn. My PT was more then happy to teach her. Trouble is, I have to make sure she's not pissed at me before I embark on that trip... That's our joke we share with each other. Sometimes you have to make light of your condition to help also. We have yet to try it...Regards, Carl...

[Sleeper Service]

Absolutely, PoT. Probably my misunderstanding that kicked this off. Multi modal is definitely the best way forward

On biofeedback you might find this interesting.