At the time of the patient's initial visit, Dr. Weiss spends a full hour or more taking a very thorough history and performing a meticulous physical examination to establish a diagnosis. Most patients are also scheduled for a subsequent evaluation by a staff physical therapist, after which Dr. Weiss and the therapist meet to develop the patient's individualized treatment program. This program is reviewed regularly and modified as needed.
When taking the history, Dr. Weiss is looking for information needed to understand how and why the chronic pelvic pain and/or dysfunction began. He asks questions related to:
• Childhood activities (such as ballet or gymnastics) or incidents of sexual, emotional, or physical abuse that might have led to repetitive tightening or straining of the pelvic-floor muscles
• The health of the organs within the abdomen (intestines, bladder, uterus, ovaries)
• Whether increased physical or emotional stress was present prior to the onset of symptoms
• Systemic issues that could lower pain thresholds and prolong symptoms, including diet.
• Prescribed medications and nutritional supplements the patient has been taking
When examining the patient, Dr. Weiss is looking for the cause(s) of the pelvic muscle and/or nerve trauma that created the symptoms. He focuses on:
• Obvious abnormalities in foot or hip mechanics that may be affecting the pelvis
• Mechanical abnormalities of the spine, sacrum, pelvis and/or attaching muscles
• Tenderness in the coccyx or abnormalities in its position or mobility
• External and internal muscle imbalances
• External trigger points in the muscles of the abdomen, inner thighs, pubic region, buttocks, and/or lower back
• Internal pelvic floor trigger points and/or pudendal nerve sensitivity or entrapment
• Painful scars in the tissues of the lower body that might relate to the symptoms
• Sensitive skin in the abdominal wall, inner thighs, pubis, lower back, buttocks, scrotum, penis, vulva, or vaginal opening
• Inflammation or skin lesions in the external genitalia
An internal examination is performed by Dr.Weiss in order to make many of the above assessments. This is performed anally in men and vaginally and/or anally, as appropriate, in woman. In men, the prostate is massaged to obtain prostatic fluid for microscopic examination if a prostate infection is suspected.