Pelvic Pain

Podcast Transcript

Dr. Scott Steele: Butts and Guts, a Cleveland Clinic podcast exploring your digestive and surgical health from end to end.

Hi again everyone, and welcome to another episode of Butts and Guts. I'm your host, Scott Steele, the Chair of Colorectal Surgery here at the Cleveland Clinic in beautiful Cleveland, Ohio. And today, we're super excited to have Dr. Ly Hoang Roberts, who's an associate staff in the Department of Urology here at the Cleveland Clinic. And we're going to talk about something that is all too common, but maybe not so commonly talked about, and that is pelvic pain. So, Dr. Hoang Roberts, thank you so much for joining us here on Butts and Guts.

Dr. Ly Hoang Roberts: Thank you for having me.

Dr. Scott Steele: So, let's start like I do every single episode, I need to know you a little bit better. And so, tell us a little bit about your background, where you're from, where'd you train, how'd it come to the point that you're here at the Cleveland Clinic?

Dr. Ly Hoang Roberts: Yeah, so a little bit about myself. I was born in Vietnam, actually. I'm a refugee from Vietnam. And so, we immigrated over to Texas where I did my training in residency medical school, and then went and did my fellowship in female reconstruction surgery up in Michigan at Beaumont Hospital. And then here I am, I'm one of the associate staff in urology specializing in female reconstruction.

Dr. Scott Steele: Well, that is an unbelievable story. I wish we could talk about that for all 15 minutes. So today, we're going to talk a little bit about pelvic pain. To start with, we're going to play a game that I like to call "truth or myth?" So, truth or myth: pelvic pain can happen in both men and women?

Dr. Ly Hoang Roberts: Truth. Anyone, both men and women, young or old can suffer from pelvic pain, unfortunately.

Dr. Scott Steele: So, can you explain a little bit more about what pelvic pain is to our listeners?

Dr. Ly Hoang Roberts: Yeah. So, pelvic pain is anytime you have any kind of pain or discomfort even in the pelvic region, and we say that ranges about from below the belly button down to the genital area. And it can wrap around even to the rectum and your lower back.

Dr. Scott Steele: So, what causes pelvic pain? It seems like it's a kind of a broad area of your body.

Dr. Ly Hoang Roberts: Yeah, and you're right. I mean, the pelvis houses many organs, muscle, nerves. So, really there's various causes to this pain so that any infection, injury or abnormalities to the bladder, reproductive organs, to the rectum, or even the muscles, such as the pelvic floor muscle, hip muscle, abdominal wall muscles, or even to the pudendal nerve can causes pain. So, really, our job as your physician is to investigate which of those is misbehaving.

Dr. Scott Steele: So, I take care of obvious patients as a colorectal surgeon who have pelvic floor disorders, and that can significantly affect mental health. So, how can pelvic pain affect mental health? What have you found?

Dr. Ly Hoang Roberts: Right. I like to remind all of my patients that the body and the mind are connected for sure. So, physical pain can cause mental stress and vice versa. For instance, if you're stressed out, you can tighten your pelvic floor muscles and that can cause them to be dysfunctional and cause pain. So, the best way to tackle pelvic pain is to do so comprehensively with a therapist or a psychiatrist as part of your treatment team.

Dr. Scott Steele: You talked a little bit about the mind and body connection, which I'm fully in agreement with. So, can pelvic pain actually extend beyond that to affect your relationships?

Dr. Ly Hoang Roberts: Of course. When you're not feeling your best, you may not be at your best. So, relationships with your friends and family can negatively be impacted. But especially if you're sexually active, that relationship with your partner can be affected.

Some patients may not want to voice their discomfort to their partners. But I think it's important to have an open discussion because your partner cannot only provide emotional support, they can also perhaps help with the treatment plan, such as encouraging you to do pelvic floor exercises at home.

I've also heard of partners who feel guilty that they are the cause of the pain and that it is just untrue and a really unfair burden on them. So, open communication about this condition is really beneficial for everyone.

Dr. Scott Steele: So, you mentioned a little bit earlier about treating pelvic pain at home. Can you tell us a little bit more about that?

Dr. Ly Hoang Roberts: Sure. So, as we mentioned earlier, the body and mind connection. So, anyone with pelvic pain can benefit from doing stress relieving exercises, such as meditation or yin yoga. And then depending on what the source of pain is, there may be additional home treatment options, such as pelvic floor exercises, vaginal or rectal suppositories, or even bladder installations. Because this is a chronic condition that may have flare-ups, we always work with our patients in developing a regimen that empowers them to treat their pain as needed at home.

Dr. Scott Steele: So, taking it to the next step, when should a patient or a listener on here contact a healthcare provider regarding pelvic pain?

Dr. Ly Hoang Roberts: At any time. I mean, pain is your body's way of telling you something is wrong. So anytime you have pain, please seek care from a healthcare professional.

Dr. Scott Steele: So, I'm a listener and I want to go in and see you. Walk me through how does this diagnosis work. What can I expect in a meeting with you?

Dr. Ly Hoang Roberts: Yeah. So, it begins with just a conversation. Have a nice chat to get more information about the location, severity, and possible sources of pain, as well as any relevant medical history.

Now, we do do a physical exam to better examine and evaluate specific areas. And though this part is important, please note that if you're not comfortable with it as it can involve sensitive areas, please feel encouraged to voice that. We will always work with you to make sure you're comfortable with whatever's going on.

Dr. Scott Steele: So, can you walk us through a little bit about what the prognosis is for someone experiencing pelvic pain? And if you want to just tell us a little bit more about what type of treatment options are out there for pelvic pain?

Dr. Ly Hoang Roberts: Sure. So, because of how complex pelvic pain is with multiple sources and possible lack of response for some patients to various treatment options, it may take some time to find the best personalized treatment plan for you. That said, there's been a lot of research into this condition, so we have tools in our toolbox. And as we continue to conduct research into this, we hope to expand treatment options. So, there is hope. Though we can't guarantee that the pain will go away 100 percent, our goal is to lessen it so you can have a better quality of life.

And you mentioned some of the treatments that we have. It depends on what the source is, but it can target either the pelvic muscles with physical therapy, we can do trigger point injections where we numb up the muscles, or it can be bladder installation or bladder-specific treatment options.

Some of the exciting work we're doing here is actually in pudendal neuromodulation or the implantation of a neurostimulator at the pudendal nerve to decrease pain for the conditions of pudendal neuralgia and pelvic floor dysfunction. This concept of using a neurostimulator is well established in the pain anesthesia literature, especially for back pain. But here, we're using it at the pudendal nerve for pelvic pain. There's already strong evidence spanning decades of research by giants in our field that showed that this is a promising treatment modality, especially for patients who are not responsive to standard treatments, such as medication or physical therapy. So, our research right now focuses on improving the surgical technique, making it easier for many others to do worldwide and to provide even more clinical data on outcomes.

Dr. Scott Steele: That's fantastic, and I can only imagine the wide variety of treatment options depending on what the source is. But if the pain doesn't go away, could it be a sign of something else, and what should we do?
Dr. Ly Hoang Roberts: Yes, the possible causes are plentiful. So, if you experience pain that doesn't go away, please see your healthcare provider so we can investigate what exactly is going on and proceed from there.

Dr. Scott Steele: So, now it's time to get to know you a little bit better with our quick hitters. So, first of all, what is your favorite food?

Dr. Ly Hoang Roberts: Oh, probably my mom's Vietnamese cooking, actually.

Dr. Scott Steele: What a great answer. What's your favorite sport, either to watch or play?

Dr. Ly Hoang Roberts: Oh, unfortunately, I might get in trouble here, but I don't “sports” very well.

Dr. Scott Steele: Nothing wrong with that.

Dr. Ly Hoang Roberts: But I used to play volleyball, so there's that.

Dr. Scott Steele: Fantastic. And so, a place that all of our listeners should visit that you've been to or a bucket list item for you?

Dr. Ly Hoang Roberts: I just took an amazing trip with my family to Vietnam. I would highly recommend people checking out Vietnam. It's very different from what it used to be.

Dr. Scott Steele: I heard the beaches are incredible. And finally, what do you like about living here in Northeast Ohio?

Dr. Ly Hoang Roberts: I love the spring, although today's dreary day isn't exactly a good representation of it. But I would have to say the spring and the summertime in Cleveland is just absolutely gorgeous, and I can't wait to get outdoors and do more of those activities.

Dr. Scott Steele: So, give us a final take home message about pelvic pain.

Dr. Ly Hoang Roberts: For all those listening to this podcast who are suffering from pelvic pain or know someone who is, know that you don't have to live like this forever. Just because something is chronic or common does not mean it's normal, and we can help you with that.

Dr. Scott Steele: That's fantastic advice. And to schedule an appointment with a Cleveland Clinic urologist, call 216-444-5600. That's 216-444-5600. You can also visit us on our website at my.clevelandclinic.org/urology. Again, that's my.clevelandclinic.org/urology. Dr. Hoang Roberts, thanks so much for joining us on Butts and Guts.

Dr. Ly Hoang Roberts: Thank you, Dr. Steele. Appreciate it.

Dr. Scott Steele: That wraps things up here at Cleveland Clinic. Until next time, thanks for listening to Butts and Guts.