Testing One- Two, Testing....

Pain or discomfort in your pelvic or abdomen region can feel extremely unfamiliar due to the nature and location of the issues. To complicate things a bit more, your doctors and specialists may want to perform certain testing to find the root of the problem. At first, some of these may seem intimidating, invasive or uncomfortable. It is important that you get an idea as to what these tests are trying to determine and how they can guide your future therapy.

Urodynamics

If your health care provider has recommended a Urodynamic Test, they want to assess how well your bladder, sphincter and urethra are working together to store and release urine. Certainissues might seem familiar to you such as leakage, frequent urge, initiating or emptying as it relates to urination, making you a candidate for this testing. Your lower urinary tract (LUT) works like this:

  • Bladder fills (and relaxes) whiles your sphincters contrac
  • t to prevent leakage
  • When your brain tells your bladder it is ready to release, your bladder contracts and your sphincters relax to allow the flow of urine out through your urethra

    This testing can help to determine if there is any dysfunction within the system, whether it is at the level of the pelvic floor or at the bladder.

Cystoscopy

If you’re experiencing urinarytrack problems such as frequent UTIs, blood in your urine, urgency, incomplete emptying or painful urination, youmight be scheduled for a cystoscopy. Similarly, to the urodynamics test, a cystoscopy looks at your LUT. During this test, the urologist is looking specifically at the lining of your bladder and urethra to check if any of the tissue is abnormal.

 

Defecography

Have you been experiencing constipation, fecal incontinence or perhapsdiscoordination during bowel movements? During a defecography test, an X- Ray visible substance is introduced to the rectum. You will then be instructed to squeeze & defecate the substance out into a commode while X- Ray imaging is taken. With these images, the doctor will be able to get a better idea as to what the underlying issue is, whether it be a pelvic floor or sphincter issue.

The SmartPill

True to its name, the SmartPill is an ingestible “data collecting” capsule that travels throughout your entire gastrointestinal tract, tracking certain measures.The pill is able to determine the rate at which your stomach empties, how quickly and effectively your colon transp orts food, as well as pressure patternsthroughout. This is extremely helpful for someone experiencing symptoms such as constant bloating, constipation, or chronic abdominal pain. The SmartPill helps clinicians rule out other problems throughout your GI system and does it all in a fairly noninvasive manner.

Anorectal Mammography

An anorectal mammography is another (and slightly less vulnerable) test for the anal sphincters. This looks primarily at their role in keeping stool in the rectum when it is supposed to be there and releasing it when your brain says its ready. You might be having complaints of constipation, so it is important for your doctor to know whether you have an issue with the stool moving through your system, or if it’s your sphincters that aren’t appropriately relaxing when you bear down for a bowel movement. In the same realm of fecal incontinence (leaky stool), this test can tell your doctor if it is weak anal sphincter muscles that is leading to this issue.

True to its name, the SmartPill is an ingestible “data collecting” capsule that travels throughout your entire gastrointestinal tract, tracking certain measures. The pill is able to determine the rate at which your stomach empties, how quickly and effectively your colon transp orts food, as well as pressure patterns throughout. This is extremely helpful for someone experiencing symptoms such as constant bloating, constipation, or chronic abdominal pain. The SmartPill helps clinicians rule out other problems throughout your GI system and does it all in a fairly noninvasive manner.

Pelvic MRI

A MRI of the pelvis will usually be a test that is done later in the course of diagnosis. A MRI is indicated if you’re complaining of pain in your pelvic or hip region that can’t be explained by any other mechanism. The hope of this is that it will further investigate the presence of unexplained difficulties urinating or defecating, injury or trauma (possible herniations) or specifically for women, lumps or masses in the area.

Nerve Block

Chronic pelvic pain is classified as unexplained pain that has persist ed for at least 6 months. For individuals who are experiencing this, a possible mechanism for the pain is a neuropathy. If this is likely, your doctor may recommend a nerve block to a culprit (frequently the Pudendal Nerve) that innervates your pelvic floor muscles. The nerve block is diagnosticas well as treatment. The nerve block will quite literally “block” the pain source, inducing an anesthetic effect. If the nerve block relieves your pain, it can then be further used as a treatment. The block will be used as a temporary relief, however it can also be used as a time for the damaged nerves to heal.

The Good News

So, you have taken the advice of your doctor and performed the tests that they recommended. Now what?! Many (almost all) of these issues can be addressed with pelvic floor physical therapy. Your pelvic floor, just like any other muscles in the body, respond very well to manual therapy and some re- training. Let these invasive, and sometimes uncomfortable, tests be put to good use and help gear your therapy sessions to make sure your issues are directly addressed.

References:
Chronic Pelvic Pain – More Options for Treatment Than You Think | Nebraska Medicine Omaha, NE.

Gastroparesis: “Smart” Pill Uncovers This Mysterious Stomach Condition. Health Essentials from Cleveland Clinic. January 2017. BJU International. 2014;114(S1):22-28.

Raz O, Tse V, Chan L. Urodynamic testing: physiological background, setting-up, calibration and artifacts. Urodynamic Testing | NIDDK. National Institute of Diabetes and Digestive and Kidney Diseases. Urodynamic Testing | Urology Services | Virginia Mason, Seattle.
What does urodynamic testing for incontinence involve? Ask Doctor K. February 2013.

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