In Your Pants with Dr. Susie G - Treating Complex Pelvic Pain w/ Maria Elliot

Episode Date: November 22, 2018

Pelvic pain is complex. It's often a mystery for many patients and practitioners alike but it isn't all doom and gloom in your undercarriage. There's hope. On today's episode, I chat with one of UK's leading Female Health specialists and Pelvic and Abdominal Physiotherapists specializing in Post-Natal Rehab and Complex Pelvic Pain Recovery.

You're listening to In Your Pants with Dr. Susie G, the physiotherapist for your private, helping you get in the know down below. Hey guys, it's Dr. Susie G here and welcome to the In Your Pants podcast, a show where we talk about the issues in your undercarriage so that you can keep embarrassing search histories off your web browser. On today's show, I've invited pelvic pain expert Maria Elliott to help answer the complexities surrounding pelvic pain, because let's face it, life is better without pain in your pants. Here's a little background about Maria. Maria Elliott is one of the UK's leading female health

specialists and pelvic and abdominal physiotherapists specializing in postnatal rehab and complex pelvic pain recovery. She is the owner and founder of Maria Elliott Physiotherapy Services, which compromises the Mummy Moth, a unique comprehensive postnatal assessment and treatment plan to help women's bodies recover after giving birth simply women's health which provides physiotherapy and rehab for women of all ages specializing in pelvic pain abdominal trauma prenatal well-being and postnatal recovery and simply pelvic health which focuses on physiotherapy rehab and treatment for complex pelvic pain in women and men and most recently the pelvic power Clinic, the first specialist assessment equipment for treatment of complex pelvic pain in women and

men in the UK. Maria has worked extensively in the field of women's health for over 25 years, training in France to specialize in prenatal and postnatal physiotherapy, and in the US to treat and coach women with complex pelvic pain. She is also an experienced clinical Pilates teacher and works closely with leading London pain consultants, functional gut clinicians, and experts in the field of biomechanics and functional rehab to provide integrative recovery programs for both men and women. What a beautiful and very impressive bio, Maria. Thank you so much for being on the show today with us. Oh, you're welcome. Yes, I'm sounding quite busy. I'm going to die. So yeah, and actually being away at the moment on holidays is giving me a chance to look

at then where my energy goes uh once i get back and start again for the next year so yeah so thank you um for asking me to be with you today and discuss uh complex pelvic pain and and maybe you know you said the mummy mott isn't it in america it's mummy holly herman often says what's that mott and whereas here mummy mummy mot is when the moms come for a check and they get checked for their posture their diastasis pelvic floor and then we come up with a you know a rehab program specific for that particular mum and it's more of a screening assessment actually for you know urinary incontinence pelvic organ prolapse and any abdominal pelvic issues and that the mum might be concerned about and that's one side that's about 30 percent of my clinical work and then presently

70% is probably still seeing men and women with complex pelvic pain. And I've been doing that since 2004. And how did you get into pelvic health? I got into pelvic health when I worked in Paris in the late 90s. And that was, I trained in women's health and that's where I did my training. And there the women were all being assessed postnatally at six to eight weeks. and we checked the mums and there it was more of a pelvic floor assessment rather than a full abdominal imposter and we checked them with biofeedback and then some had electrical stimulation when required so that's where it started and my journey then continued when I moved to London and trained in clinical Pilates for postnatal mums and I thought that

would be the field that I would remain in and then in 2004 I had a patient come to clinic with a um overactive pelvic floor um and she presented just clicking on her she presented um yeah with bladder symptoms and voiding problems and pain uh and i hadn't really come across that because i'd been mainly focused on strengthening and rehab um physiotherapy rather than any manual therapy and pelvic floor release work so she was my first patient and she had the book a headache in the pelvis with her and she'd come back from having treatment in america and asked me would i read the book and um and treat her and so that's where the journey started i read the book um treated her got good results and since then her consultant who's a eminent urologist in london

has been sending me his um overactive hypertonic pelvic floor patients um more related to urology um conditions and then i some of my patients were having treatment in america and i went over and shadowed them so i went over to ronda in chicago and stephanie and elizabeth at the pelvic health rehab center and just kept learning and learning and learning and um i think that's it over time what i've learned with treating the patients and whether they're men or women often a you know a multi-integrated team needs to be involved especially if the pain has been present for a significant time and often we assess in clinic and then often i say to the patients i'll try four to six sessions of manual therapy and alongside that we'll get you to build your own recovery

toolkit and like one person at this point is probably going to be able to help you when you need a combination of people and a combination of recovery strategies and tools and so that's the way i work for me that's great and i know in one of your videos on your website you delineate between complex pelvic pain versus chronic pelvic pain can you talk a little bit about that? Yeah I don't usually use the word chronic and I know the guidelines and all the guidelines and the pain management documents they're all defined but I suppose just I learn on the job and I learn in clinic and often before I say it's complex and then we look at okay what are the drivers and is it more biomechanical is it a low-grade infection with the bladder is it

hormonal so it's often complex so I like to think that it's complex and like a mystery but then you know with the right treatment and the right brains in the room people get better so and you know I'd work with you know Holly Herman said years ago she'd work with I think a veterinary clinician if she could help her patients you know I work with anybody who I think can help and over the years I think you did a podcast with Lorraine didn't you one of the pelvic pain coaches correct yeah so I've worked with the pelvic pain coaches um over the years and I work with cognitive hypnotherapist trauma therapist and then also always always work with um consultants so pain clinic urologist gynecologist hypermobility rheumatologist so I'm blessed now I suppose

because of the years of working in the area to sometimes do a blink and say oh okay that patient presents in that complex way but i've seen that many times before and i know what worked for that particular type of presentation so let's try that first i suppose that's the way i yeah work and recently we've added over the last three or four years a lot of the visceral mobilization and scar manipulation um through some of the visceral work that we've learned um so yeah often a combination of you know a very good assessment the initial assessment takes 90 minutes and then um come up with a recovery plan and move forwards and then see what's working and then also i was thinking earlier when people are better then and they're you know they haven't got pain so they're away

from that kind of tipping point of the pelvis, they certainly need to maintain, don't they, to stay well often. So I get patients to open a folder on their desktop and to have all their breathing apps, their stretches, any advice and guidance that they've been given and that has helped for them to continue that then afterwards. So self-efficacy, you're teaching them to essentially know what to do when something may come up in the future and that way they're just dependent on

themselves to get themselves out of trouble it sounds like yeah exactly yeah getting them to have their own toolkit and their yeah their go-to quick go-to so then they need to maybe calm down a flare or you know a lot of people be you know anxiety driven or trying to teach the patient how to be less hypervigilant and I often say you know just when they're getting better you often know and and then they start to do new activities and they don't come in and always say do you think my gut do you think I have an infection they're like well do you think I should go back to art or dancing and then I know we're on a good uh you know we're on the next stage and if they get back to some of those activities that they loved doing before then they'll be producing good chemicals in

their body whereas if they're always anxious and worrying and um yeah just hyper vigilant of the area why so just get bored get bored of the pain that's right it's exhausting yeah it's exhausting isn't it yeah it is it really is what's the difference do is if there's a difference this is a question i get asked a lot as well is is there a difference treating male pelvic pain versus female pelvic pain and i'm curious to know what your thoughts are on that um yeah being honest with you i suppose my in my uh clinic population probably 10 on men so obviously i have more experience with women and i was going to say often our men in the uk travel up and down the country they might go up to bill and edinburgh and gerard and birmingham so they have to move around a little

bit and sometimes that's not a bad thing um because i find that you know from a treatment point of view i find it quite easy actually to treat the men from a you know connective tissue manipulation trigger point work getting them doing all their stretching and but then when they've got more kind of guy on guy things to talk about i send them off to the guys i'm afraid um i mean i i screen them and talk to them about everything but um yeah then i let them talk to the guys as well i found them easier in some ways um maybe they i found them very good at doing their exercises at home they're breathing they're stretching and they've been very good at you know following dusty and millers i suppose what i do is i give them lots of resources alongside

my manual therapy so i find that the guys in my clinic get better quicker but um a lot of the guys that i see would be more musculoskeletal biomechanically driven pelvic pain they might have had a you know an l5s1 disc or they might have had a fall on their coccyx or we've seen one or two young guys with leg length discrepancy and then they cycle from london to paris and end up with tendons and neuralgia so if we sort their biomechanics out and then it's quite easy to reduce pain and the manual therapy is very useful and very effective and then as long as they come away from the pain and they get well then again getting them to maintain that at home and maybe then I say to them come back once a month once every three months for a checkup and a treatment

following and giving them all the tools like you're saying well and i know and i'm not sure how much you're into what happens on maybe twitter and all these things that are you know don't do this do that what's happening in physiotherapy land you know what are these research saying but you mentioned a couple things that are kind of controversial from what i've been listening to actually uh about like leg length discrepancy and structure and posture and um there are certain clinicians out there that will that are strongly believe that that's not you know that has nothing to do with with pain in itself as an experience or what what are your thoughts on that you know i'm just curious not not to bring up a very

controversial topic but you know i really like to know what other people think about it um so that's okay yeah i'd be called one of the old dinosaurs or something like that wouldn't i and depends on who you're talking to I think they're a little I'm not evolving um so yeah I suppose it's a bit like I know you know often the patient also don't they they come whether that's a guy or a girl and they have you know they're going over and over in their head is it this is it that is it this if they come in and I as I said I feel that there's lots of biomechanical issues going on and drivers we start with that if that then didn't get success within four to six treatments of manual therapy and them doing what we ask them to do at home which will always involve

then also the um as i said the breathing the stretching the calming of the nervous system and getting them so i think i kind of cover all ends and find out you know i suggest different people that they can listen to to calm down that central sensitization and and i get them to feed back to me who they like and um who they don't and so that they then know themselves who to continue listening to so as i said my my practice and clinic is based on what i'm finding in clinic and what works for for me um and i know yes some people would say and in london there's a big pain clinic and like there's no manual therapy so it's all yeah you know cbt act acceptance pacing and i do that alongside the manual therapy but i am you know at heart a hands-on person right

you know and when i'm treating i feel i'm treating the skin the fascia the muscles and down to what's happening internally and then also shifting them from that you know autonomic nervous system fight flight freeze into you know rest digest and yeah I just kind of let it go so I'm you know I've always been that way and um I suppose the other thing is I had pelvic pain myself as you do after treating pelvic pain for four years no resentments there but and I had my own 18 month journey and um and that's where I had to have everything you know manual therapy pelvic pain coaching a bit of cognitive hypnotherapy and then you know off to a healing um center for a week or two yeah to kind of um yeah to heal on all levels so yeah i don't really

i kind of know what you're talking about but i avoid it being honest i don't i don't blame you it's kind of like, don't, don't get into the fire. Don't get burned. Okay. I mean, it's certainly challenging, but it, you know, it just, which is fine. You know, if you, if you can keep equanimity between all that and, and you know, at your heart, what your intention is and what your intent is, obviously no one is out there trying to be malicious towards their patient or that sort of thing. And I love what you said about you use your touch. It sounds like you're using your touch and your manual therapy skills to tap into somebody's nervous system because we know that does ultimately change the the brain's interpretation of a threat versus a

safety right yeah exactly and that's what I'm good at and you know I will have started my physiotherapy treatment of pelvic pain by doing you know trigger point therapy connective tissue manipulation you know from the ribs to the knees but over time over the years that I'm doing it now I very much um you know start with the abdominal area and get the breathing everything to slow down so I often wouldn't do internal pelvic floor release or feel massage or external until I've done two or three sessions and the patients got to know me and often I end up you know doing a lot of work on those hip rotators piriformis obturator internus but then uh yeah it's all you know i'm a good manual therapist and now i have you know beside me i'm lucky i've got good rehab therapists

who do which is fantastic which then yeah train the patients because they get deconditioned don't they especially the hypermobile patients so they then need the you know the strong arms the strong legs and they need somebody who doesn't want to talk to them about the pain and doesn't want to talk about inflammation and mast cells which i can do with the patient but then say the rehab team then they'll be talking about you know pink cardigans and what shoes to wear and at the same time as making them sweat and strengthen them globally um so i feel at the moment i've got a really good team so the patients are getting better quicker and i probably did protect the pelvic pain patients a little bit too much and now um based on what we're doing in clinic

and we got the pelvic power chair obviously which is fantastic and that has been great for kind of urinary incontinence and and for the men post-prostectomy however we're now using it to um yeah help fire up the glutes and get rid of back pain so that then patients can train and uh so we can get some of those internal holding patterns to release but we need to strengthen the more global bracers so yeah so i'm the kind of the you know assess the manual therapy and then as i said blessed with a team who deal with nutrition trauma rehab um around me so patients are doing well great so you're healing on all levels like you said yeah yeah and actually i'd say it's funny isn't it when you said

where i was like today i was on a beautiful beach in dorset and this is total chance today and with two people from portugal who are setting up a healing center and one of the ladies taught me meditation years ago when i had pelvic pain and i thought that's a bit strange that they're here now and and yeah so you know what we'll probably do with them is when our patients are doing pretty well or they're 90 there and they're keen to go off to portugal and do a week or two of either working helping with the healing center or go for a pelvic um recovery you know retreat you know

that final that 10 that final 10 when i had pelvic pain i found difficult to get rid of completely I suppose because I had 18 months and because my pain was pretty bad and I couldn't fit and I couldn't do lots of other things, you know, and I got completely better. I believe that for most of the patients that come through my door. Now, obviously, they don't all get better, but I start with the idea and the hope. Yes, if we this is complex, but if with the right people and the right setting, you can recover. so that's very much my message right right so that sounds like that was the pivotal turning point for your recovery was was this culmination of events and having the right people and giving yourself some time to reflect on your life and actually heal and down regulate the

nervous system was it actually the retreat that you were on that kind of tipped the scale for you or what would you say that was I would say um the the retreat was definitely the last bit because it was a bit I was still kind of hanging on to to my pain I feel and and in some ways I felt well it's good that I can still feel it a bit because now when the patients come in and they say you know I've got vaginal burning I can't sit down can't have sex you know my my partnership my relationships are in trouble I've got no money all those things you know I resonated with me so I kind of felt in a mad way that I kind of needed to to keep that but then I had a great teacher over there and he was like no let it go you know leave it here and go back and help other people

that you can help and um just so that letting go um yeah is really really important and I felt it you know, I left and, you know, I have gut pain now. And I know it's not as simple as that. And some people, isn't it? It is that there is a hormonal imbalance. Some people, it's endometriosis, you know, so it can be often very complicated. And then with the bladder and the bowel and the gut, the gut is so important, isn't it? You know, and I think often the people that are talking about the brain and central sensitization, really the problems back in the gut, if I was to be honest um so that's why we joined the functional gut clinic so that we can you know work with them around you know constipation ibs anything that might put extra pressure or irritation

into the pelvic area and upset the organs right right there's a lot of cross talk you're very right the you can't we can't eliminate the impact that our gut has on our pelvic floor function and the visceral structures that cross talk right there's a lot of cross talk that goes on down there and i think if the gut isn't happy isn't it then the it's keeping it very simple but then the brain chemicals aren't happy so people feel their pain more they don't sleep as well so there's all that and then you can have a flare in the gut which gives say bladder pain and then people are put on antibiotics for the bladder when actually it was the gut so i like all that and i like all the yeah yeah you know working with other consultants and seeing what new research

is out there and and even we're involved a little bit with the fecal transplants for some of the hypermobile patients you know to get the good bacteria back in there so that they um decrease their inflammation and stabilize their cellular membrane so i know a lot about that but i has a set of steered away from reading you know getting too involved in the physio of the brain you're better off Maria it is quite challenging but you're better off like I said not in the line of fire yeah what happens is you know if when the patients come in and they're presented with that as the main driver and they do what that clinician or physiotherapist gets them to do and they get better well that works as well doesn't it you

know so right right we have to do whatever we are good at and no works yeah absolutely i'm with you 100 definitely um awesome well what are some of briefly what do you think some of the what are some of the common myths around pelvic pain in your in your experience and again i'm going to say i only hear it from the patients because i don't spend an awful lot of time reading you know as i said i go to the conferences i learn lots of conferences i love going to conferences networking and listening to the other consultants and discussing there the common myths you know when patients come in to me is oh i've been diagnosed with um baldodinia or dyspareunia or interstitial cystitis pretend neuralgia so they've already you know associated themselves

with that diagnosis so unless i feel that is the primary diagnosis i i try to to shift them and then by the time the patients have come to me usually they've been tested for everything you know they've had their scoloscopies they've had their multiple antibiotics so then we have to work with what's current reality and I think that you know the patients it's really difficult isn't it because they can find lots of very very useful resources online but then they can get very scared very anxious with some of the other forms that they're on so it's trying to do okay what is current reality for the patient so i suppose the common myths would be i have interstitial cystitis you know got holes in my bladder i'm never going to get better

and the pre-dental neuralgia i've got pre-dental neuralgia and and then i might examine them and feel that's not their you know clinical diagnosis you know unless it's post-surgery as well unless it presents as very unilateral and they have pain when they sit and all the symptoms so I think often the patients come in possibly with an incorrect diagnosis and then we have to kind of untangle that and unwind that and unwind the patient you know from head to toe so that they can kind of release and relax and often the muscles and the pain that's there um whether it's neuropathic or muscles or you know lack of blood flow everything's often so tight and tense isn't it that um the tissue is is tender to touch which it shouldn't be so i kind of go okay we're

going to relax everything we're going to release everything we're going to improve the blood flow and then after that we're going to strengthen you up and um yeah um and see how we go that's beautiful so you really debunk a lot of the things that they come in with holding on so tightly to like you mentioned these labels quote-unquote diagnoses that scared them because you're right everything is on the internet and i always tell my patients to take a google holiday stop googling your diagnosis because algorithms are are meant and i tell them i said did you know that google algorithms are specifically meant to give you the top rated the most drastic catastrophized um thing out there and i said it's not always true and everything you read on

facebook isn't always true exactly so that's what i say okay so let's look at the reality of you know how you've been right in the last three months and then the next time they commit i might cut that down to three weeks and then the next time I say okay the last three days how are we doing and then and I explain to them that they will get better often and then reach a plateau and then we need to think okay what can we do next and then all of the time we're trying to keep them drop them far from that you know as I said that tipping point then with respect to to pain and then get them once they're pain-free get them to know what are the triggers is it right when they go to watch the sun on stage and they have to sit on a seat that that's going to be the trigger and

to be prepared in advance and have their their toolkit uh you know start 48 hours beforehand and it's the same with you know getting back to being comfortable with intimacy and intercourse you know talking them through that and preparing them for it and trying to make that as you know pain-free or easy I'm not one for you know just try it and have pain and continue on I'm not a big fan of the dilators I do get people to use them but when the dilators are in place then I get them to breathe and move and so yeah and you know and if a patient says I'm using an ice pack and the dilators and they're really helping i say great let's keep them in the toolkit and now what can we can we add and i've only i've just been blessed i suppose with you know patients over

the years that have recovered well and stayed well and some you know you often know some recover quite quickly um and we've had a big shift with six sessions and others it can take six months nine months so there's you know 18 months so there's no really one um recovery kit book for everybody so right right a lot of patients will ask me that too or new or prospective patients they'll ask well how long do you think it will take and that's a tough one for me to answer just like you said for those reasons we don't know there's no time frame on healing yeah uh it's hard to determine that like you said some people do really well quickly others take longer and it's all about trusting the process rather than the destination in my opinion exactly yeah

but the more tricky ones are the ones you know post um gyne surgery that wake or you know with pudendal nerve pain and um they can be trickier but generally again we do everything we can to try to help them and keep in contact with the consultant and uh yeah and partner them up on that journey but they can in my opinion in clinic at the moment they're the patient caseload that are the more difficult and that could be the men as well you know the men that have had hemorrhoidectomies or surgery for hemorrhoids and then they're they can be a little bit more difficult so require I would say more manual therapy internally externally more support really grateful to as I said some of the visceral work and to be able to start you know in the abdominal area

and work my way to the pelvis that's right creating safety slowly and surely exactly yeah and being you know we had we had a guy on uh nine o'clock on last friday myself and martha and you know he came in and he was just so anxious and an hour later he was like god this is great i didn't know any of them and you know he bounced out of the clinic and and he himself you know we couldn't actually find that much wrong with him but um he's been on google he's read everything he's got some symptoms but you know he's like can i come back next friday and we said yeah come next friday nine o'clock for the next six weeks and and he's my trainer and we were like yeah we'll talk to your trainer yeah and um so so yeah it's it's good and um and now as i said

that we you know because treating complex pelvic pain can be isn't it it's a challenge obviously it can be tiring for the clinician and it's important to to look after ourselves as well so we can help those patients and now having kind of the rehab side and the pelvic power in clinic you know when people are getting better then we go okay you know what this week do we need to look at is it like physical emotional sexual financial spiritual you know how can we now you know move you on or what needs your attention and our attention this week and then as I said because I'm not a you know a straight thinker I've got my think outside the box I think okay can I do that what resources do I have and if not who can help me and and that's I suppose the way I work

beautiful very comprehensive very individualized so yeah I love it so yeah so it's great I love it I love I love my work I love you know watching people recover and and then you know inspiring them to go on and lead and enjoy their life you know sometimes you even say you could have a better life now because yes you were just look what was happening beforehand remind you yeah I mean that's part of our job isn't it to reflect on the progress that someone has made because oftentimes they're living when we're living in a rut it's very hard for us to see any positivity out of what we're struggling through until somebody actually says hey you know what i noticed that you don't you don't see your your shoulders are only up to your ears when we're

talking or you're talking more softly or you're out and about more you know so sometimes it does take you know a third party to come in or and just reflect on the changes that have already been made the life skills i think i think what we do is give our patients more life skills than anything to be honest yeah right exactly and it's difficult for some patients then my my second patient actually she was a lawyer and then she headed off to Chicago for treatment and you know she ended up training in relaxation therapy and taking a total shift she got rid of her pelvic pain she went back to work you know so they there are it's kind of opening doors as well for the patients rather than that's where their you know their impression of pelvic pain is oh I'm now stuck

I'm here I've got this forever so we would say no let's look at all the options let's try them let's see what works and then with some patients it's it's useful isn't it to get them to journal daily and bring everything and then some patients it isn't and some patients we do that initially and then we take the journal away and yeah and as I said once you start to hear them you know talking about their their kids or their partner or a new job creative program that they're keen to do i kind of feel they're on the we're on the road on the road to recovery as opposed to yeah catastrophizing and you know over and over again what's wrong with me what's wrong with me um right right and the body heals you know i believe i do honestly believe that the body heals

and yes I know there are as I said you know one in ten women in the UK have endometriosis and so therefore you know can physiotherapy help those patients but we we help their symptoms we can't get rid of the disease or anything but by helping their symptoms by changing again the way they breathe and I have a few clever patients at the moment getting involved in artificial artificial intelligence around endometriosis. I'd quite like to end up there, actually, when I retire in a couple of years. But, you know, so in the meantime, we can do everything. We can help them, you know, get pregnant, help them with deliveries. You know, I get lovely photos of some of my patients with their babies. And you think, wow, you know, one who'd had a

bowel resection stage four endo and she's two little boys now so and she coached actually with Lorraine many years ago back in 2010 so yeah I'm just one of those old dinosaurs who thinks you know everything's possible with the right people places and things that's right and and there's nothing dinosaur about that that's just being human oh my gosh well that leads me to my lap my my final question here is what are some actionable steps you know for all the listeners who are struggling through pelvic pain or pain in general what are some items that they can do right now to help them start their you know recovery process so i suppose i would always say go and see you know a good pelvic health physiotherapist

to pt if you're over there or physio here who specializes in if it is pelvic pain who specializes in complex pelvic pain and then um resources wise you know if somebody contacts us and they're looking for information i send them the resources that i have and i can send you that on a pdf if you like and that would be you know the books that people have read amy stein's book you know sarno peter levine's and then the different breath work and breathing to start with as i said i've now started sending them your videos so it's yeah yeah just see a pt first get a full assessment and then follow those guidelines and to avoid yeah too much googling and too many forums until they actually know what might be driving their their pain yeah it's so individualized

you know what works one for one person might not work for the other because we are we're just like our thumbprints no one has the same thumbprint so individualized and it's exactly and as the patients come in this is isn't it then back to collagen and connective tissue and some things come in and they're like really hyper mobile and the here's back to the biomechanics and the pelvis is tilted forwards and the bladder hasn't got much space at the front and then others come in and they've got like really stiff stiff fascia that doesn't move and hips that don't open so you know the management even manual therapy of those two different presentations in clinic would be different for for me so therefore as you say every patient is different and everybody's a snowflake

or it's a different blueprint and it's yeah trying to help them work out and you know if I give them different i don't like the word homework but different um you know different things to practice during the day and i try not to be too i don't i try not to put too much stress and say you have to do this at nine o'clock i kind of i would suggest you do these things then let me know what works what doesn't and right you know everybody's busy aren't they and then the food is a big one isn't it in pelvic pain people come in and they're on the antihistamine diet or the FODMAP diet or um and I have found over time as patients have got well um often you know the diets aren't that important but other people might disagree with me um you know some people are

going to be always gluten and dairy intolerant and that's that's okay um and they will you know have a degree of acceptance around that but I do have a lot of patients that come in and they're only eating five foods and but as they get better and as they're because of the urology patients i see you know if there has been a low-grade infection and they have been treated with systemic mast cell stabilizers and i see a lot of patients like that and the inflammation descends and drops then they can slowly reintroduce um their foods and just start kind of living life again and get back to whatever if they were doing yoga before go back to yoga if they were doing tennis skiing get back to what the body did beforehand

and enjoy it get back to life that's right back to life yeah with your additional you know with additional tools now you're breathing and you're new what would you call them your new gurus or mentors that you listen to yeah that's right i love it i think i think what you're doing is fabulous and i so appreciate you sharing your wisdom with all of us and um just having an open an honest conversation and if you if you don't mind i will definitely link those resources for for others um in the podcast show notes you know if you don't if you don't mind that'd be awesome and um how can listeners connect with you in your clinic and um well i've got our website now maria elliott physiotherapy services so that involves myself but then you know the other practitioners

that I work with and then we have an ultimate guide to pelvic pain recovery and online that everybody can do and I can give you the pre-code for that and that is myself you know talking about pelvic pain and the drivers but then moving on to what they can do at home with the breathing and the stretching and strengthening work but also it has Bevis Nathan's videos and audios all around Peter Levine's work Awaken the Tiger and that's all to do with you know calming the vagus nerve and so the combination of those two where there's been trauma and often it's traumatic isn't it to be living with pain over a long period of time and is is very useful the patients seem very happy with that we haven't really advertised it that much but yeah I can send you all that

wonderful yeah we'll link in the show notes for everyone all you listeners so you'll have all this yummy information and quality resources because there's a lot of garbage out there so make sure you whatever you're reading that you're getting it from a trustworthy resource yeah yeah it really calms everything down um don't overwhelm yourself let let someone do the research for you so yeah wonderful well thank you maria for taking the time out of your vacation to again shed some light wisdom and hope for others who are struggling with pain and it's just been wonderful thank you so much oh you're very welcome and yeah lovely talking to you too i'll keep in touch yeah yes absolutely and guys listeners thank you so much for listening to the

show and as always in loving wellness for your pelvis this is dr suzy g until next time my friends. I'll see you later. Thanks for listening to today's episode. Be sure to head on over to drsusieg.com where you can get more information, show notes, and related articles on today's topic. Also, if you like what you're hearing, head on over to iTunes, subscribe to the podcast, and leave us a rating and review. We'd love to hear feedback. Thanks again.