Interdisciplinary Pelvic Rehabilitation: Part 2

Last week in our blog, you learned about Susannah Britnell, a physiotherapist who works in a multidisciplinary pelvic pain treatment setting. I learned of her clinic when I came across this journal article) about developing an interdisciplinary clinic for patients with endometriosis and pelvic pain. Below is Part 2 of the questions that she was kind enough to answer for us so that we can hear more from her perspective!

What do you find rewarding as a therapist in working in this setting?

Working with people in pain can be challenging but also extremely rewarding. I really value being able to help women realize what they can do, how they can shape their current life experience and their future. We provide tools and strategies that they can put into practice successfully. I love being able to be a part of moments when there is a shift in thinking, an opening of opportunity, when women who have seen nothing but barriers and hopelessness realize that there could be the possibility of positive change. I really find satisfaction in helping women perform daily activities, manage bladder, bowel and sexual pain concerns and increase overall activity and participation in life.

What would you say is powerful for the patients in terms of having the team available?

Patients have a great sense of support being a part of this team. Gynecological, musculoskeletal and psychosocial components are addressed with a synergistic approach. Patients are searching for answers and once they receive a diagnosis, whether its endometriosis, pelvic girdle pain, sensitization or a combination, this does help them to move forward. More often than not, the diagnosis will be a combination of gynecological, musculoskeletal, and psychosocial components, with central sensitization. When they are aware that appropriate full medical management has taken place, a readiness for change and acceptance of the active role self- management can be fostered. Our patients learn self management tools in our workshop and then we support them as they practice these and integrate them into their lives.

Our team ensures that our language and message is consistent, supportive and empowering. We work hard to avoid any language that perpetuates confusion, fear or loss of hope and we clarify any misinformation or myths patients have encountered in the past. So many women have had negative past medical experiences and feel they have not been heard, or they have been told their pain is not real. This is obviously distressing for them, so to have a team that listens, supports and then helps to give strategies for change can be a big relief.

If a concern or question comes up during a session, we can usually address this with the appropriate team member before the patient leaves the clinic. This is important as it saves time for the patient and practitioner, but also helps to resolve those unanswered questions or worries that can lead to rumination and anxiety.

Our team has weekly meetings to communicate about treatment plans, discharge planning and for problem solving particular concerns. This is invaluable for communication and helps to give our team cohesion.

What do you sense are some barriers to others creating this type of environment?

Funding would be a big barrier. The reality is that these programs cost money to run. Many of these women have experienced pain and disability for years, which of course affects all facets of life, including being able to work. They often are unable to pay for private treatment and so without a publically funded program they go without. It is challenging to decide how best to use our limited resources so that we can try to meet the needs of so many patients.

Another barrier is that there are not enough physiotherapists and counsellors that have the experience or even the interest in working with women with chronic pelvic pain, so ongoing community support and follow-up in the patient’s communities can be difficult. We have a yearly Fellowship program for gynecologists who have an interest in this area. Part of our outreach plan is to help provide educational opportunities for physicians, physiotherapists and counsellors in BC.

A common perception from the medical side is that there is no hope for these patients and that nothing can be done for them. Isolated practitioners have a high burn out rate working in the area of chronic pelvic pain. However, with a supportive team, working in this area can be rewarding and exciting.

In an ideal world, are there some disciplines that you would love to see added to this group?

It would be fabulous to have a yoga Instructor and a dietician trained in biopsychosocial approach to chronic pain.

Are there any particular patient populations or conditions you love to work with or learn about?

I love working with women with chronic pelvic pain, in particular chronic pelvic girdle pain, dyspareunia, and bladder and bowel pain.

Thank you to Susannah for sharing her knowledge and experiences in our blog! If you would like to contact Susannah she can be reached via email at This email address is being protected from spambots. You need JavaScript enabled to view it., and her clinic website is www.womenspelvicpainendo.com. To discover more information about working with chronic female pelvic pain, you can attend one of our series courses such as Pelvic Floor Level 2B or our advanced course, Pelvic Floor Level 3. These courses always sell out, so sign up soon!