For nearly a decade, Dr. Sonia Bahlani has been treating pelvic pain patients. During her ob/gyn residency, she noticed how many women were suffering with pelvic pain — many of whom had been suffering in silence for years. Her passion ignited, Bahlani decided to specialize in treating people with pelvic pain. After her residency, she moved on to a fellowship in urology with well-known IC expert, Dr. Robert Moldwin at the Smith Institute for Urology in New Hyde Park, New York.
Now, Bahlani has her own practice treating pelvic pain. She works with patients from throughout the country, utilizing a holistic approach. In fact, she is now referred to as the “pelvic pain doctor” and has an internet platform to help patients and other medical professionals treat pelvic pain more effectively. Bahlani has been published in a variety of national and international journals. She’s also appeared in various mainstream media, including an appearance on Dr. Oz. In 2022, she received the New York Super Doctors award, which is given to leaders in medical excellence.
Combining her knowledge of obstetrics, gynecology and urology, Bahlani treats a variety of conditions that contribute to pelvic pain: vulvodynia, pelvic floor dysfunction, IC, vulva dermatoses and female sexual dysfunction. Recently, she took time to talk with us about her work, what she wishes more women knew, what she’s excited about for the future and general advice for IC patients.
What are some common misconceptions women have about pelvic pain?
Bahlani said women have four common misconceptions about pelvic pain, starting with how many women have pelvic pain.
“I think due to the stigmatization of pelvic pain, [women] often are unaware how common it actually is,” she said, pointing out that she’s thinks the number is much higher than the estimated 4 to 22% of patients. “We don’t talk about [pelvic pain] much.”
In fact, many women who see Bahlani assume they are the only ones struggling with pelvic pain. They’re often shocked that others have pelvic pain, too. And speaking of pain, the second misconception is about the pain itself, which can include frequency, urgency, heightened sensation of the area, pressure and more.
“It doesn’t have to be excruciating pain,” Bahlani said. “It can actually be anything that is bothersome. If it’s affecting your quality of life, it needs to be addressed.”
A third common misconception is that pelvic pain is a women’s problem. Bahlani treats both genders, which often surprises men. Male and female anatomy are similar enough that symptoms often present in the same ways. Treatment is available for both genders to help ease pelvic pain symptoms.
The fourth and final misconception is getting a confusing diagnosis. For example, many of Bahlani’s patients have been diagnosed with IC, but bladder-centric treatments haven’t helped them. Often she discovers they have untreated pelvic floor dysfunction causing at least some of their symptoms.
“You can have more than one diagnosis, and that’s pretty common,” Bahlani said, mentioning that about 80% of IC patients also have pelvic floor dysfunction.
Treating for other conditions that are present leads to better outcomes. While pelvic floor physical therapy is a well-known treatment for pelvic floor dysfunction, Botox, trigger point injections and medication can help accelerate the healing process.
What treatments are you utilizing most right now?
First of all, Bahlani said she tends to avoid medications like amitriptilyne that just mask symptoms rather than address the root cause of them. Instead, she tries to discover what percentage of her patients’ discomfort is coming from what parts of their body. Then she works from there. Patients with Hunners lesions (about 10% of the IC population) are treated differently. However, the vast majority of her patients benefit from addressing areas outside the bladder, like the pelvic floor.
“I really like figuring out how much of it is coming from the bladder and how much is coming from the pelvic floor,” Bahlani said.
One of her go-to treatments for pelvic floor dysfunction right now is Botox, because it has more longevity than other numbing pelvic floor injections. She doesn’t want to do pelvic floor injections more than absolutely necessary. But, Botox has its challenges. While the FDA approved it for similar conditions like migraines and TMJ, Botox is not yet FDA approved for pelvic floor dysfunction. As a result, insurance companies don’t often cover Botox. Bahlani is advocating for change.
Bahlani pointed out her overall philosophy in treatment is less is better, so she uses the lowest amount of Botox (or any medication) to get the best impact. For example, she said 100 units of Botox usually treats pelvic floor dysfunction well. When a medical professional injects too much Botox into the pelvic floor, fecal incontinence is a side effect. Bahlani hasn’t had that happen with any of her patients.
What advice do you have for women about pelvic health and pelvic pain?
“There’s so much advice,” Bahlani said. “I think that trusting our bodies is key. Every patient who walks into my office has always known there was something that was not right. Trust yourself, because, in general, you’re right.”
She encourages patients to keep seeking help until they find the right medical professional to help them and believe them. Bahlani said many of her patients come to her after seeing multiple doctors who say nothing is wrong with them. She’s working to help change this by educating patients and medical professionals. Bahlani has a book coming out along with online patient courses to give patients a good, everyday ideas on how to manage their symptoms. And she will connect with medical professionals throughout the country to help them in treating patients
“It’s hard for patients to find specialists,” Bahlani said. “Not a lot of people are going into this field.”
For that reason, she’s happy to talk with medical professionals treating their patients and also sees patients virtually.
What do you wish more IC patients understood?
“I have many patients who come to me thinking [IC] is somewhat of a death sentence,” Bahlani said. “The vast majority — over 90% — of my patients live very normal lives. It’s not an end all, be all. There are so many things that we can do given the opportunity.”
Find more about Dr. Sonia Bahlani and her practice on her site, Pelvic Pain Doc.
