Finding Pelvic Sanity Dr. Nicole Cozean and Jesse Cozean

For many people (almost 90% of those diagnosed with IC) tight muscles in the pelvic floor irritate the nerves running through the area.  One of the most important of these is the pudendal nerve.  
So what symptoms might be caused by pudendal nerve irritation?  One is urethral burning or pain.  One branch of the pudendal runs right to the urethra, so it is often responsible for urethral pain or burning.
The pudendal can also be the cause of urinary urgency and frequency.  It connects to the bladder.  Usually these nerves are ‘silent’, but with IC they are often activated and continue to send signals to the brain.  When the brain interprets these as the urgent need to urinate, we get urinary urgency and/or frequency.
(Just a note - Often when we hear ‘pudendal nerve’ we do a Google search and see information about pudendal neuralgia.  This is obviously a scary diagnosis.  But what we are talking about here is pudendal nerve irritation.  We actually compare it to something we’re more familiar with - sciatica)
So it’s definitely possible pudendal nerve irritation is driving symptoms.  There are many other nerves in the area which can be causing symptoms as well, so that’s where a pelvic PT can both figure out what is going on and work to address the issue.
This also explains why many people with IC-like symptoms are given bladder-focused treatments (bladder instillations, Elmiron, hydrodistensions, etc.) without benefit.

Finding Pelvic Sanity Facebook Group

If you haven't already, make sure you join the Finding Pelvic Sanity online support group (www.facebook.com/groups/findingpelvicsanity).  It's a supportive group and moderated by the PelvicSanity team, so you know you're getting high-quality information.

If you're local to Orange County (or can come here for treatment), we would love to work with you directly!



About Us

Dr. Nicole and Jesse Cozean are the founders of PelvicSanity Physical Therapy (www.pelvicsanity.com) in Southern California. The clinic has helped thousands of patients in the Orange County, CA area and hundreds from around the world with a remote consultation and Out of Town Program.

They co-authored The IC Solution and Nicole created The IC Roadmap online course to provide the most accurate, up-to-date information for those with interstitial cystitis. They run the Finding Pelvic Sanity Facebook group for a supportive online community for anyone dealing with pelvic health issues.

Nicole has also created courses and trained thousands of pelvic PTs to provide better care through her work with Pelvic PT Rising (www.pelvicptrising.com).
Subscribe to the podcast Follow @pelvicsanity for great info! Join the Finding PelvicSanity support group Check out www.pelvicsanity.com for additional help!
And as always, we hope this has helped you find just a bit of pelvic sanity!

Have you heard or been told you 'just need to Kegel'?  Here's why that's never the answer to pelvic health issues.

Kegels (or the voluntary squeezing of the pelvic floor muscles) are often one of the only areas of pelvic health we’ve heard about.  It’s often surprising to people to learn Kegels are often ineffective, antiquated and can cause flares or actually exacerbate symptoms.  Here’s why they are rarely used at all at PelvicSanity.
1)  The majority of people with pelvic floor symptoms already have overactive pelvic floor muscles. 

This means we want to be working to calm down the pelvic floor.  Help it to relax and stretch out.  Not adding a bunch more work for it to do! 

Not only are Kegels ineffective, but can often flare symptoms for those with an overactive pelvic floor.  This is why Kegels are never recommended for those dealing with pelvic pain.

2)  Even if you are weak, Kegels aren’t the best way to strengthen the pelvic floor.  
Even for the small subset of people who truly do have pelvic floor weakness, Kegels are only one small part of the pelvic floor.
If your goal is to run without leaking, how is laying on your back and staring at the ceiling the best way to train for that?  We need to get you up off the table and get your pelvic floor working in a functional manner again.
3)  Kegels don’t find or resolve the underlying ‘why’
At PelvicSanity we’re always about trying to find and address the root cause of your issue so it doesn’t return.
The underlying why is usually outside the pelvic floor - in how you’re moving, in your back, or glutes, or hips, or ankles.  Unless we find and resolve the underlying why, symptoms will either return or crop up in a different way in the future.
So if your pelvic PT was only doing Kegels or biofeedback, make sure you find a great pelvic PT for a second opinion.  And if you haven’t been to pelvic PT yet, let this be your call to action!

Local to Southern California?

Our expert team in Orange County would love to help resolve your pelvic floor issues for good - without a bunch of Kegels or biofeedback!  Give us a call or send us a message and we'll be happy to answer any questions and get you started!
About Us

Dr. Nicole and Jesse Cozean are the founders of PelvicSanity Physical Therapy (www.pelvicsanity.com) in Southern California. The clinic has helped thousands of patients in the Orange County, CA area and hundreds from around the world with a remote consultation and Out of Town Program.

They co-authored The IC Solution and Nicole created The IC Roadmap online course to provide the most accurate, up-to-date information for those with interstitial cystitis. They run the Finding Pelvic Sanity Facebook group for a supportive online community for anyone dealing with pelvic health issues.

Nicole has also created courses and trained thousands of pelvic PTs to provide better care through her work with Pelvic PT Rising (www.pelvicptrising.com).
Subscribe to the podcast Follow @pelvicsanity for great info! Join the Finding PelvicSanity support group Check out www.pelvicsanity.com for additional help!
And as always, we hope this has helped you find just a bit of pelvic sanity!

Why do most specialty pelvic health clinics see patients for a full hour, 1:1 with the therapist?
Ultimately it’s so we have time to ‘find the why’ for actual relief.  If you aren’t working with a qualified pelvic PT to ‘find the why’, one of three things happens:
You don’t improve at allYou see little, temporary improvements that don't 'stick' Symptoms do improve, but end up cropping up somewhere elseFor most patients in pelvic floor physical therapy, internal evaluation and treatment of the pelvic floor muscles is extremely important.  This takes time and can’t (or shouldn’t be) rushed.
Then we have to evaluate and treat the external contributing factors.  In fact, most of the time the ‘why’ is found outside the pelvic floor.  So we have to have time to treat externally in each session as well.  This could be treating the low back, mid-back, neck, hips, knees or ankles, depending on where the issue is coming from.
If your PT is only looking internally at the pelvic floor, or only looking externally at the orthopedic issues, they are missing half the picture.
The reason many physical therapy clinics don’t see you for a full hour is so they can make more money from the insurance company.  Financially, it doubles the clinic's revenue to have a PT seeing two (or more) patients per hour.  They do this by using aides, having someone watch you exercise or adding billable time with ice or e-stim at the end of your session.  
Most specialty clinics reject this model.  It might be helpful for simple orthopedic issues, but it certainly doesn’t benefit patients with complex pelvic floor dysfunction.  And even though it might be more lucrative to rush patients through the door every half hour, most experts aren’t willing to compromise on the quality of care.
So if you’ve been seen at a clinic for less than an hour, or had your PT seeing multiple patients at the same time, don’t give up on pelvic floor physical therapy!  

Local to Southern California?

If you're local to SoCal, give our team a call and let us help you find lasting relief!  And if you aren't, we offer a remote consultation program to get a second opinion on your case.
About Us

Dr. Nicole and Jesse Cozean are the founders of PelvicSanity Physical Therapy (www.pelvicsanity.com) in Southern California. The clinic has helped thousands of patients in the Orange County, CA area and hundreds from around the world with a remote consultation and Out of Town Program.

They co-authored The IC Solution and Nicole created The IC Roadmap online course to provide the most accurate, up-to-date information for those with interstitial cystitis. They run the Finding Pelvic Sanity Facebook group for a supportive online community for anyone dealing with pelvic health issues.

Nicole has also created courses and trained thousands of pelvic PTs to provide better care through her work with Pelvic PT Rising (www.pelvicptrising.com).
Subscribe to the podcast Follow @pelvicsanity for great info! Join the Finding PelvicSanity support group Check out www.pelvicsanity.com for additional help!
And as always, we hope this has helped you find just a bit of pelvic sanity!

If you (or someone you know) has had a C-section, make sure to listen to this full 'sode!  

As anyone who has had one will attest, a C-section is a major surgery.  And in the US, almost 1 in 3 give birth via a C-section.  But we are so cavalier about recovery!

After every other major surgery you are immediately referred to physical therapy to aid in the recovery.  Make sure the wound heals correctly.  Ensure the scar moves smoothly.  Get back your range of motion and strength in the area.

Except for C-sections (and other pelvic and abdominal surgeries).  There we just tell you to try and 'take it easy' (while dealing with a newborn) until it heals and hope it does well.

A C-section scar can be a major driving factor of pelvic floor and abdominal issues.  
It sits right above the bladder; if your scar is 'stuck' or adhered, it can make filling the bladder more difficult and contribute to urinary urgency/frequency.   
The muscles of the abdomen are intricately connected to the pelvic floor and the low back.  A history of a C-section can drive low back pain and ultimately pelvic pain.

We believe every person who has a C-section should be seen by a pelvic floor physical therapist to ensure they have a full and complete recovery.

The good news is that no matter how long it's been you can still get help!  If you have other symptoms, make sure your pelvic PT is checking your C-section scar.  It should move and feel almost identical to the tissue around it.  It shouldn't be painful to touch or move or numb.  And if you have an aversion to touching it (or even looking at it), definitely a sign to see a pelvic PT and get it moving freely again!

Remote Consultation

If you're struggling to get answers from your local practitioners or aren't sure what's next, PelvicSanity offers remote consultations to give you a concrete action plan going forward.  Our expert team will evaluate your entire case and give you our honest, clear recommendations going forward.  Check out our Remote Consultation program (www.pelvicsanity.com/remote) for all the details!


About Us

Dr. Nicole and Jesse Cozean are the founders of PelvicSanity Physical Therapy (www.pelvicsanity.com) in Southern California. The clinic has helped thousands of patients in the Orange County, CA area and hundreds from around the world with a remote consultation and Out of Town Program.

They co-authored The IC Solution and Nicole created The IC Roadmap online course to provide the most accurate, up-to-date information for those with interstitial cystitis. They run the Finding Pelvic Sanity Facebook group for a supportive online community for anyone dealing with pelvic health issues.

Nicole has also created courses and trained thousands of pelvic PTs to provide better care through her work with Pelvic PT Rising (www.pelvicptrising.com).
Subscribe to the podcast Follow @pelvicsanity for great info! Join the Finding PelvicSanity support group Check out www.pelvicsanity.com for additional help!
And as always, we hope this has helped you find just a bit of pelvic sanity!

With recent evidence Elmiron can cause long-term eye damage, many people with IC are reconsidering their use of the drug.  In this ‘sode we dive into the evidence for Elmiron’s efficacy and safety to help you make an informed decision.
Elmiron remains the only FDA-approved oral medication specifically for IC and many urologists prescribe it automatically because of this.
However, it’s unclear how much of a positive effect Elmiron has.  There have been five randomized, controlled trials with Elmiron.
Two showed a slight benefit (a 25% improvement) for a small percentage of patients (between 15-16% compared to placebo)Three showed no benefit at all compared to a placebo and the largest trial wsa stopped early because the drug wasn’t shown to be effective.From the data, we have to conclude either Elmiron has no benefit at all, or at best has a slight benefit from about 15% of people.  And we are left to weigh whether that upside is worth the risk.
Researchers have discovered Elmiron use is linked to eye damage (though it doesn’t happen for everyone on the drug).  This link gets stronger the longer you’ve taken the drug and the more of it you’ve taken.  The FDA has put a warning label on the drug and the company is being sued over it.  If you are on Elmiron, make sure to be getting your eyes examined by a retinal specialist.
Other side effects of Elmiron have been called ‘mild’, but for many patients are anything but.  Significant hair loss is common, as is GI upset and other issues.  
With questionable efficacy in question and significant safety concerns, it would be hard to recommend anyone starting Elmiron with what we know today.  
If you have been on the drug and find it helpful it’s often a more difficult decision and one to make in consultation with your physician.  As with any change in medication, always make sure you discuss thoroughly with your physician.

Remote Consultation

If you're struggling to get answers from your local practitioners or aren't sure what's next, PelvicSanity offers remote consultations to give you a concrete action plan going forward.  Our expert team will evaluate your entire case and give you our honest, clear recommendations going forward.  Check out our Remote Consultation program (www.pelvicsanity.com/remote) for all the details!
About Us

Dr. Nicole and Jesse Cozean are the founders of PelvicSanity Physical Therapy (www.pelvicsanity.com) in Southern California. The clinic has helped thousands of patients in the Orange County, CA area and hundreds from around the world with a remote consultation and Out of Town Program.

They co-authored The IC Solution and Nicole created The IC Roadmap online course to provide the most accurate, up-to-date information for those with interstitial cystitis. They run the Finding Pelvic Sanity Facebook group for a supportive online community for anyone dealing with pelvic health issues.

Nicole has also created courses and trained thousands of pelvic PTs to provide better care through her work with Pelvic PT Rising (www.pelvicptrising.com).
Subscribe to the podcast Follow @pelvicsanity for great info! Join the Finding PelvicSanity support group Check out www.pelvicsanity.com for additional help!
And as always, we hope this has helped you find just a bit of pelvic sanity!

In pelvic physical therapy you’re dealing with dysfunctional tissue, reduced blood flow, increased inflammation and in an area the body is wired to pay close attention to.  
But pelvic physical therapy should never hurt.  We can’t treat pain with more pain.  And the idea of ‘no pain, no gain’ not only isn’t true, it’s actively harmful.
Now, it can be uncomfortable, but there’s a major distinction.  You shouldn’t be trying to ‘bear’ treatment.  The discomfort should ease during the session as the PT works on the tissue.  And your pelvic PT should be checking in to see how you’re doing if they’re working on a tender area.
In this ‘sode we discuss how to communicate with your pelvic physical therapist if things are hurting or if you need to seek a second (or third) opinion.  Because there is a lot your physical therapist should be able to do if you are having pain in one area.
They can just work somewhere else (there’s plenty to do!).They can relax your nervous system first.They can use a different technique.They can postpone working on that area until a different day.They can help you find medical management to decrease pain before working there.You should never be in pain during pelvic floor physical therapy.  It’s counterproductive and harmful to the overall process.  If you are, make sure you say something to your pelvic PT.  And be prepared to get a second opinion if necessary!
Remote Consultations

If you're struggling to get answers from your local practitioners or aren't sure what's next, PelvicSanity offers remote consultations to give you a concrete action plan going forward.  Our expert team will evaluate your entire case and give you our honest, clear recommendations going forward.  Check out our Remote Consultation program (www.pelvicsanity.com/remote) for all the details!


About Us

Dr. Nicole and Jesse Cozean are the founders of PelvicSanity Physical Therapy (www.pelvicsanity.com) in Southern California. The clinic has helped thousands of patients in the Orange County, CA area and hundreds from around the world with a remote consultation and Out of Town Program.

They co-authored The IC Solution and Nicole created The IC Roadmap online course to provide the most accurate, up-to-date information for those with interstitial cystitis. They run the Finding Pelvic Sanity Facebook group for a supportive online community for anyone dealing with pelvic health issues.

Nicole has also created courses and trained thousands of pelvic PTs to provide better care through her work with Pelvic PT Rising (www.pelvicptrising.com).
Subscribe to the podcast Follow @pelvicsanity for great info! Join the Finding PelvicSanity support group Check out www.pelvicsanity.com for additional help!
And as always, we hope this has helped you find just a bit of pelvic sanity!