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CASE REPORTSCase No. 7PPOD symptoms: pelvic pain; coccyxgeal pain; rectal pain; vaginal pain; genital pain; urinary frequency, urgency, sluggishness, dribbling and incontinence; loss of bladder sensory perception; bladder massage required to void; severe chronic constipation; pelvic pain with intercourse; loss of ability to achieve orgasm; loss of sexual desire; painful and irregular menstruation. A 41 year old female was seen for low back and left leg pain of many years duration. She reported that her back pain had started as a child and had been accompanied by lower abdominal pain. Medical evaluation at that time attributed her low back and abdominal pain to constipation. Despite the prescription of exercises and dietary modifications, these pains persisted and would frequently be accompanied by left leg pain radiating to the foot. Menstruation, which had its onset at about 16 years of age, had initially been pain free. However, shortly after a period of time during which her low back pain increased, menstruation became painful and irregular, with the greatest intensity being located in the inguinal (ovarian region) regions bilaterally. She had been pregnant four times, and each pregnancy was accompanied by severe back pain. The first three pregnancies were uneventful, resulting in the normal deliveries of healthy children. The last pregnancy however, resulted in the delivery, by cesarean section, of a baby boy two months pre-mature. Shortly thereafter she experienced the onset of left leg pain. Spinal manipulation at that time resulted in a gradual resolution of her back and leg pain. Several years later, about seven years before being seen by the author, low back and left leg pain returned. As a result, she again underwent spinal manipulation, however, this attempt did not improve her condition. Gradually, over time, her condition worsened. As a result, a few weeks prior to being seen by the author, she obtained an orthopedic evaluation and was given exercises for her condition. However, as these measures failed to provide relief, she consulted the author. Detailed historical review at that time however, revealed that about 20 years previously, during a time of increasingly painful low back pain, she experienced in the onset of urological disturbances consisting of urinary frequency, urgency, dribbling and incontinence. Over time, urological function continued to deteriorate with the development of sluggish micturition (urination) which required forceful straining to initiate and maintain bladder emptying. In addition, sharp pain would frequently accompanying micturition. During this same period of time, she also noted a change in the awareness of having to urinate, from the normal urge to void, to a suprapubic "fullness" or "pressure" sensation which was accompanied by pelvic distention. About two years prior to being seen by the author, bladder function had deteriorated so that micturition could only be initiated, maintained and completed by self administered deep bladder massage. During this time of progressive urological dysfunction, gynecological, sexual and enterologic (bowel) disorders also had their onset. Pelvic pain had become more frequent and severe, and would radiate to the inguinal regions, with its greatest intensity on the right side. Additionally, sharp pain would frequently radiate to the coccyx (tail bone), rectum, vagina, suprapubic and outer genital area, with it's maximum intensity being felt in the clitoris. Intercourse had become intensely painful, with pelvic pain being consistently experienced in the right inguinal and suprapubic regions. Genital sensitivity had decreased so that orgasm occurred less frequently, and was of a diminished intensity. Gradually, the ability to achieve orgasm completely disappeared, and, was accompanied by a total loss of sexual desire. The genital region had become exquisitely hypersensitive so that touch or contact of any type painful was intensely painful. She had developed a strong aversion to any sexual approach by her husband, and as a result, had not engaged in coitus for many months. Bowel function, which had been poor for many years, slowed to a single evacuation once every four-five days, and would not occur without the use of a laxative or suppository and forceful straining to achieve emptying. She had undergone several evaluations, however, no abnormalities could be found. Clinical examination by the author revealed the characteristic features of a Type II mechanically induced PPOD Syndrome with secondary bladder, bowel, gynecologic and sexual dysfunction as described above. Treatment following the Type II PPOD protocol resulted in progressive improvement of her back, leg and PPOD complaints. Following two weeks of care, she was aware of improved bladder and bowel function. Evacuation was occurring at 1-2 times per day without the use of a laxative or need to strain. Urinary frequency, urgency, dribbling, incontinence and pain had disappeared. She was initiating and maintaining micturition normally, without having to apply external pelvic compression. Bladder control improved so that coughing and sneezing did not result in incontinence. The awareness of having to urinate by suprapubic pressure and distention, was replaced by the normal desire to void. Pelvic pain progressively diminished, and genital sensitivity returned to normal. Intercourse became pain free and the ability to achieve normal orgasm returned. Menstruation, which occurred during the course of treatment, was without the sharp intense pelvic pain experienced previously. |
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