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Lindsey Thompson and her husband were elated to learn they were pregnant with their first child. Lindsey, a WakeMed Children's Hospital pediatric emergency nurse and her husband, an EPIC Games employee, began preparing for the arrival of their son. 

However, within a few short weeks of pregnancy, Lindsey began to experience challenging pregnancy symptoms. Around her 27th week of pregnancy, she was forced to pause her career and adjust to life as a homemaker. 

Lindsey Welcomes Her Son

Her labor and delivery went swiftly and in February 2022, Lindsey and her family were taking their seven-pound and four-ounce, perfectly healthy newborn son home. 

"He came out with a conehead from dropping early and then going through the vaginal canal quickly. The labor, itself, was fine. I had some pelvic issues present throughout the entirety of the pregnancy. I had not realized pelvic issues could be exacerbated by delivery."

Lindsey felt good after delivery and began nursing right away. For the next six months, all went well. 

The Emergence of Pelvic Pain

Around the time her son was turning seven-months old, she began weaning him, and she noticed she had alarming pelvic floor pain and constipation. Her body traversed between waves of dull aches to sharp pains and cramps. She also felt chronic pressure deep within her pelvis.

"Near the end of my breastfeeding journey, when my hormones started to shift and my milk supply started to drop, the pelvic pain started up."

Before long, Lindsey felt like a prisoner in her own body. Pain accompanied her every move. 

"The pain would shift throughout the month, and when it was at its worst, it was hard for me to do normal activities of daily living, such as standing up to wash the dishes, cooking meals, caring for my son and going on long walks. Activities I normally enjoyed became almost impossible, and that was scary because I didn't understand what was going on. It caused me a lot of heartache because it was debilitating."

A Diagnosis of Endometriosis

Lindsey scheduled an appointment with her obstetrics and gynecology doctor to get to the root of the problem. She shared her symptoms, and the doctor determined it was endometriosis. The treatment for endometriosis required surgery, so Lindsey underwent surgery, but sadly, she found her pelvic pain was unabated.

"I was referred to a urogynecologist who told me my pelvic floor was really tight. I was then sent to WakeMed Outpatient Rehab, where I originally saw Alison beginning in October 2022. I also was receiving hip rehabilitation since the pelvic floor muscles wrap around from the front and back into the hips. My providers wanted me to work on every aspect of my pelvic floor."

During hip physical therapy, Lindsey was introduced to dry needling. It was the first time she'd experienced any real relief from her pain. During her next visit with WakeMed therapist Alison, Lindsey informed her about dry needling, and Alison graciously informed her that Anjali Shelke was the only pelvic dry needling therapist in the area. She encouraged her to schedule her next appointment with her colleague at Outpatient Specialty Rehab – Cary.

Dry Needling

Dry needling is a minimally invasive treatment employed by health care professionals to alleviate pain and restore movement in areas affected by myofascial trigger points. This technique involves the insertion of fine needles into or close to trigger points. These needles trigger muscle contractions, stimulating and releasing the tension that causes discomfort, increasing range of motion and relieving pain.

"I switched my care over to Anjali in the beginning of 2023, and she was able to do the dry needling on my pelvic floor. My doctors were blown away that I found someone with that certification because it's so hard to find. After each dry needling session, the next day I had so much relief, but it lasted for only about 24 hours."

Chronic Pain Proves to be a Bigger Issue

In time, Lindsey and Shelke reviewed the chronic nature of her symptoms, and Shelke deduced that Lindsey was not only dealing with pelvic floor dysfunction, but it was secondary to other pelvic conditions, such as pelvic conduct and pelvic congestion syndrome.

"I learned that because I had pain in my pelvis due to an underlying issue, I was guarding my pelvis by clinching those muscles. It's a similar action to grinding teeth or clenching the jaw without realizing. I was holding the stress in my pelvis."

This caused Lindsey's muscles to overwork and become weak and uncoordinated. To test this theory, along with Kegel exercises and biofeedback, Shelke had Lindsey hold her legs up to see if that helped blood flow. She also encouraged Lindsey to try icing her pelvis instead of using heat.

Encouraged by what she observed, Shelke informed Lindsey that she should return to her obstetrics and gynecological provider to share the probable pelvic congestion syndrome diagnosis. 

Anjali Shelke

According to Anjali Shelke, PT, WCS, CLT, DN-Cert, "Lindsey was referred for pelvic physical therapy to address chronic pelvic pain. The pain was significantly impacting her quality of life. We navigated her pain management from a neuromotor point of view. It was as if something was not letting her pain alarm shut off. The clinical interventions we used were manual therapy. She responded well to traditional manual techniques but found most and immediate relief with dry needling for the pelvic floor muscles and manual techniques to facilitate her lymphatic drainage. We progressed to resolving her muscle spasm and coordination issues with exercises focused on improving awareness and control, so she could sustain a functional resting tone for optimal function. It was clear that we needed to discover the cause of her pelvic inflammation, as she presented more with symptoms of pelvic floor congestion syndrome. Lindsey is very patient and resilient and very compliant with her program. Our goal is to educate and train Lindsey, providing all the tools to sustain the progress she has made, so she can return to enjoying her time with her family and doing things she loves."

Pelvic Congestion Syndrome

Pelvic congestion syndrome, a medical condition characterized by persistent pelvic pain, is believed to stem from abnormalities in the enlarged veins within the pelvic region. Those most susceptible to this syndrome are women in the childbearing age range or those with a history of multiple pregnancies.

Lindsey shares, "It's essentially varicose veins within the pelvic cavity, but they aren't visible in my pelvis. I think being pregnant, carrying the weight in my pelvis and then giving birth quickly exacerbated my pelvic floor muscle issues. I had to advocate for myself to get testing for this."

The diagnosis was confirmed, and on May 15, 2024, Lindsey will have ovarian vein embolization treatment for pelvic varices. 

For this procedure, the patient receives conscious sedation, and a vascular surgeon inserts a coil through the neck or groin to view the pelvic varices. The surgeon then dissolves the veins and redirects blood flow. This is proven to offer significant relief in 85 to 95 percent of cases.

Reflecting on this long journey toward a diagnosis and treatment, Lindsey says, "There were times I felt no one believed the level of my disability. I wanted to give up, but Anjali wouldn't let me. She was just so wonderful. She would say, 'Don't you dare give up.' She helped me walk through this journey and was so invested in my story. I felt heard by her."

Plans for an Active Future

With new resolve for a bright future and a more fulfilled life, Lindsey urges other women to advocate for themselves and not feel embarrassed to share their concerns with their medical team. 

"We shouldn't be embarrassed about the problems or think it's an isolated situation. It's not normal to sneeze and need to change underwear, to have a swollen pelvis or to have pain after sitting for a long time or standing for a long time."

Lindsey anticipates that in time she will be able to return to her nursing career and spend more time with her son. She wants to be able to play with him more freely and feel empowered to be the best mom version of herself.

"I've been really lucky to have a good support system in my husband and my mom. They've been wonderful. I'm ready to get over having mom guilt for not being able to be the mom I envisioned I would be. I want to be able to stand and run at the park for long periods of time, travel by car for a long ride, sit on the floor and read a book to my son as well as crawl around with him in his toddler phase." 

Therapy with Shelke restored Lindsey's ability to engage in activities of daily living, such as cleaning and cooking. Now, she hopes to once again lead an active life — thanks to Anjali Shelke!

About Anjali Shelke, PT, WCS, CLT, DN-Cert

Anjali Shelke is an experienced pelvic health and certified sexual health physical therapist. She helps patients regain quality of life by learning to manage symptoms of pelvic floor dysfunction, including urinary incontinence, urinary urgency, urinary frequency, pain with urination (dysuria), urinary retention, pelvic organ prolapse, fecal incontinence, constipation in female, male and transgender patients as well as pediatric patients. She also works with expectant and new moms who experience pain during pregnancy, pain with bowel movements, pelvic pain secondary to conditions like IC, endometriosis, pelvic congestion, levator spasm, vulvodynia, coccydynia, vestibulodynia, allodynia, pudendal neuralgia and sciatica.

Shelke earned her bachelor’s degree at Pune University in India. “I truly want to give the control back to my patients who trust me to share their story with me,” she says. “I continue to gather tools and skills adding to my current tool box, to provide the best care to my patients and I am humbled by the gratification I feel whenever I am able to help my patient achieve their goals!”

About WakeMed Pelvic Health Physical Therapy

Pelvic floor muscle tone can change for many reasons. Pregnancy and childbirth, genetics, the aging process or chronic constipation are some of the most common causes, and it can affect men, women and children. This may result in the muscles becoming too stretched and loose, weakened, or too tight and restricted. Both decreased and increased muscle tone can lead to pelvic floor dysfunction.

Pelvic floor dysfunction such as urinary incontinence and pelvic pain associated with such issues as endometriosis or pelvic organ prolapse are very common. But that doesn’t mean you have to live with it.

Today, WakeMed Pelvic Health Physical Therapy offers a wide variety of treatments for pelvic floor dysfunction exist to help you get back to living the life you want. Many of these treatments are available through a physical therapist. Our physical therapists can coordinate your treatment and work with your physician to ensure your success.

WakeMed Rehab & Physical Therapy