A 2016 study by Kaori et al examined the effect of self administered perineal stimulation for nocturia in elderly women. A prior study using rodents found a soft roller used decreased overactive bladder syndrome (OAB), but a hard roller did not produce the same results. Kaori et al performed a similar study for elderly women in a randomized, placebo controlled, double blind crossover. Participants were 79-89 years old women who applied simulation to perineal skin for 1 minute at bedtime, using either active (soft, sticky elastomer) roller or a placebo (hard polylestrene roller). Participants did a 3-day baseline, followed by 3-day stimulation, then 4 days rest, then other stimuli for 3 days. There were 24 participants, 22 completed the study: 9 with OAB, 13 without OAB. The placement of the roller was not on the skin of the perineal body, but rather on the general peri-anal area with the diagram from the study showing an area just medial to the gluteal crease—where one would find the ischial tuberosity-- and anterior and lateral to the anal sphincter.

Across the subjects with OAB, change with the elastomer roller (soft and sticky feel) was more statistically significant than with the hard roller. Baseline micturition for the participants was 3.2+/- 1.2 times per night, measured as the number of urination between going to bed and arising. The group as a whole did not have a statistically significant difference, measured by at least one less time arising per night. However, in the OAB group, the difference was significant. The researchers theorized that the soft and sticky texture may induce more firing of somatic afferents nerve fibers.

The most commonly prescribed treatment for overactive bladder is anticholinergic therapy, but the side effects, including cognitive changes and lack of significant difference from controls, as well as the drying effect of these drugs in a post-menopausal-low-estrogen-pelvis, bring up questions of whether this is the best option in the elderly.(6)

Our understanding of treating pelvic pain keeps growing as a profession. We have so many manual therapies such as visceral manipulation, strain counter strain, and positional release adding dimension to our treatment strategies for shortened and painful tissues. Pharmacologic interventions such as botox, valium, and antidepressants are becoming more popular and researched in the literature. We are beginning to work more collaboratively with vulvar dermatologists, urogynecologists, OB’s, family practitioners, urologists, and pain specialists.

Pelvic rehab providers are in a unique position of being able to offer more time with each patient and to see our patients for several visits. Frequently we are the ones being told stories about how a particular condition is really affecting our patient’s life and the emotional struggles around that. We are often the one who gets a clear picture of our patient’s emotional and mental disposition. A rehab provider may realize that a patient seems to exhibit mental patterns in their treatment. It can be anxiety from how the condition is changing their life, difficulty relaxing into a treatment, poor or shallow breathing patterns, frequently telling themselves they will never get better, or being able to perceive their body only as a source of pain or suffering, losing the subtlety of the other sensations within the body. Yet, aside from contacting a physician, who may offer a medication with side effects, or referring to a counselor or psychologist, our options and training may be limited. Patients may be resistant to seeing a mental health counselor, and we have to be careful to stay in our scope.

Research is showing us that meditation as an intervention can be very helpful in addressing these chronic pain issues.

Patients and practitioners alike can benefit from meditation and mindfulness training for the rehabilitation setting. Nari Clemons joined us today to discuss her upcoming Meditation for Patients and Practitioners course taking place in New York.

We all live in a fast paced world. Our smart phones are letting us know to get back to people with email or texts, we have busy practices with full days, and many of us also have care-giving to do when we get home. Many practitioners see chronic pain patients, sometimes with abuse history or a history of many years of failed medical care. Our patients come to us stressed out and ready to unload, and this happens all day long.

We know our pelvic patients would do better to calm their system. We go home at night so drained sometimes. We would do better to regulate our system. But how? We are all so busy. In Meditation for Patients and Practitioners, we focus on the therapist as well as the patient.

The following is a message from Nari Clemons, the instructor of Herman & Wallace's new Meditation for Patients and Providers course. You can join Nari at Touro College in New York this July 19-20 at Meditation for Patients and Practitioners - New York, NY!

What doesn’t meditation do? And why aren’t we meditating, already?

I’ve heard it said that if all the benefits of exercise could be placed in a pill, it would be the most powerful prescription. I’m thinking that the same could be said for meditation. We hear little snippets of it as we scroll through the news: meditation for heart disease, meditation for blood pressure, meditation for decreased anxiety. Well, here is yet another study:

Researchers used fMRI technology to examine the brain in 50 people who had been meditating for an average of 20 years and 50 non- meditators. Both groups had the same number of men and women, with ages ranging from 24 to 77. The participants’ brains were scanned, and while age did related to gray matter loss, it was better preserved in those who meditate. **