Kenneth M. Peters, MD, affectionately known as “Doctor Ken” by many patients, stands as a beacon of hope for individuals grappling with the debilitating effects of Interstitial Cystitis (IC), chronic prostatitis, and chronic pelvic pain. As the Chairman of the Department of Urology at Beaumont Hospital in Royal Oak, Michigan, Doctor Ken isn’t just a leading figure in urology; he’s a compassionate clinician and an NIH-funded researcher dedicated to unraveling the complexities of pelvic pain disorders. His encouraging bedside manner, coupled with his progressive point of view, has made him one of the most sought-after specialists in the USA. This article delves into a candid conversation with Doctor Ken, exploring the evolving landscape of IC research and his patient-centered approach to care.
The Exciting Frontier of IC Research, According to Doctor Ken
“The progress of IC research is truly exciting!” Doctor Ken exclaims, highlighting a significant shift in understanding. He points out that earlier hopes for certain IC treatments have not materialized, leading to a crucial realization: phenotyping is key. Many patients diagnosed with IC and referred to his clinic experience pain in the pelvic region, but Doctor Ken emphasizes that “in many cases, it’s not really their bladder that’s the problem. It’s often their muscles, nerves or perhaps bowel issues.”
For Doctor Ken, the success of clinical trials hinges on precise patient selection. He explains that patients with classic Interstitial Cystitis, specifically those with Hunner’s lesions (visible ulcers in the bladder), are ideal candidates for bladder-specific treatment trials. “You can measure the results, such as the size and the appearance of the ulcer. So, if you’re studying a bladder specific treatment, Hunner’s patients are a good way to measure its effectiveness.” He enthusiastically mentions the LiRIS study focusing on Hunner’s lesions, noting clear improvements and anticipation for upcoming clinical trials. “That’s the easy IC. No one can dispute that this is a bladder disease.”
Doctor Ken Peters in a thoughtful pose during an interview
However, Doctor Ken underscores that Hunner’s lesions represent a minority of IC patients. A much larger group experiences pain, urgency, and frequency originating from sources outside the bladder, such as pelvic floor muscles. He cautions against enrolling pelvic floor patients in bladder treatment trials, stating, “If I put a pelvic floor patient in a “bladder treatment” trial, the chance of me being successful is zero.”
Doctor Ken expresses optimism about the advancements in the field, “My sense is that we’ve become smarter in the last ten years and that the companies trying to develop new treatments and do clinical trials are trying to target them more effectively.” He contrasts current approaches with older NIH trials where patient selection was less refined. He emphasizes the importance of targeting “bladder centric patient rather than pelvic floor or a systemic hypersensitivity disorder patients,” as seen in the LiRIS® and Lipella studies.
The Prevalence of Pelvic Floor Dysfunction: Doctor Ken’s Clinical Observations
When asked about the prevalence of pelvic floor dysfunction in his clinic, Doctor Ken’s response is striking: “Eighty percent of the patients we see who have been on traditional bladder treatments jump off the table if you put your finger on their pelvic floor muscles.” This highlights a significant issue: many patients diagnosed with IC may actually be suffering from pelvic floor dysfunction.
Doctor Ken details his clinic’s approach to addressing this: “We’ll use pelvic floor physical therapy, vaginal valium, trigger point injections and, if necessary, nerve blocks to reduce that muscle tension.” He emphasizes a sequential treatment strategy: “If at the end of the treatment their pelvic floor has improved, but they are still having bladder problems, then we’ll treat them with bladder specific therapies.”
He expresses concern over the common diagnostic pathway many patients experience. “Most of these patients have never had a pelvic floor exam. They’ve been given Elmiron® and other therapies and labeled with “interstitial cystitis.” I don’t think that does patients any good.” Doctor Ken advocates for a comprehensive, multidisciplinary evaluation: “When a patient visits our clinic, we evaluate them using a multidisciplinary approach, identify their triggers and treat each one to improve their overall symptoms.”
Overcoming Patient Misconceptions About Pelvic Floor Dysfunction, According to Doctor Ken
Doctor Ken acknowledges the challenge in convincing patients that their muscles could be the source of their pain. “Patients are often resistant to the idea. They’ve been invested in the label of “interstitial cystitis,” often for years and have gone to multiple clinicians who has reinforced this diagnosis.” He explains that patients struggle to understand “that the pelvic floor muscles can trigger many of the symptoms that they think of as IC.”
However, Doctor Ken finds immense satisfaction in patient transformations: “Once you convince them to be treated, it is gratifying to see how much they improve.” This underscores the importance of patient education and open communication in effective treatment.
Addressing the Diagnostic Gap: Why Doctors Miss Pelvic Floor Dysfunction, Explains Doctor Ken
Doctor Ken points to a significant gap in medical training as a primary reason for underdiagnosis of pelvic floor dysfunction. “Doctors don’t know about it. Our medical training did not include the role of the pelvic floor and how it influences the other organs in the pelvis.” He describes the positive impact of educating clinicians: “When we give talks about pelvic pain to clinicians and we explain how to do an appropriate pelvic floor exam, you can see the lightbulbs go off. When you see them in the future they’ll say, ‘You’ve really changed our practice.'”
He reiterates the common misdiagnosis issue, stating, “I think many doctors who see patients with pelvic pain are quick to label them with IC and begin bladder treatments. The same is true for chronic prostatitis.” Doctor Ken advocates for a more thorough examination, even in cases of chronic prostatitis: “When doing a prostate exam, I tell doctors to swing their finger off the prostate and to the pelvic sidewall to check the muscles. That’s where the problem usually is for men diagnosed with chronic prostatitis who don’t respond to traditional prostate treatments.”
Doctor Ken’s Holistic Approach to IC and Related Conditions
Doctor Ken broadens the discussion to include patients with IC and co-existing conditions like IBS and vulvodynia, viewing them through the lens of “hypersensitivity disorder.” He explains, “Everything is sensitive, including the bowel, skin, vulva, etc. In these patients, their nervous system is “wound up” and our job is to unwind it.”
His treatment philosophy centers on identifying and addressing all pain triggers through a multidisciplinary approach: “We try to identify every pain trigger and then work to reduce them. A multidisciplinary approach with specialists dedicated to improving these triggers is key to successfully treating the symptoms.”
Realistic expectations are crucial in Doctor Ken’s patient communication. “I tell every patient that our goal is to obtain a meaningful improvement in their symptoms, but as with any chronic pain disorder, making them pain free is usually not achievable. With chronic pain disorders, everyone has good days and bad days. We hope they have many more good days than bad ones.”
Doctor Ken Peters in a thoughtful pose during an interview
Integrative medicine plays a vital role in Doctor Ken’s treatment plans. “Integrative medicine has become an important mainstay in the treatment of these patients. I’m a big fan of Reiki therapy, acupuncture, guided imagery, Yin yoga and meditation.” He acknowledges the significant impact of stress on these conditions, noting, “Many of these patients find stress as a major trigger of their symptoms. Their pain disorder has impacted relationships with their family and friends, led to social isolation and often depression. Referral to a pain psychologist skilled in cognitive behavioral therapy can improve their coping skills and significantly enhance their quality of life.”
Doctor Ken echoes the caution advised by Dr. Chris Payne regarding aggressive interventions, “I do agree with Chris Payne MD who said that you have to be very careful with these patients. The worst thing you can do is something aggressive and/or invasive that could “wind up” their nervous system and cause more pain.”
He expresses frustration with the patient journey many endure before receiving proper care. “It is frustrating that after all these years, patients still see 5 or 6 doctors and are given multiple ineffective treatments, without getting a comprehensive evaluation of their pain disorder. As a medical profession, we need to do a better job.” Doctor Ken emphasizes the need for a broader perspective: “In these complex patients, we must think outside the bladder and identify and chip away at all the pain triggers. At Beaumont, we are pretty good at being able to think outside the box. Helping patients that no one else has been able to help is very gratifying.”
Doctor Ken’s Expertise in Pudendal Neuropathy
Doctor Ken reports an increase in patients presenting with pudendal neuropathy, a condition causing severe pain, urgency, frequency, and sexual dysfunction due to pudendal nerve damage. “I’ve been seeing so many more patients recently. Damage to the pudendal nerve can cause terrible pain, urgency, frequency, bowel and sexual dysfunction.” He notes various triggers, from bike riding to trauma, but also cases where it “just seems to happen.” He also mentions the associated and debilitating PGAD (persistent genital arousal disorder).
Diagnosis and treatment strategies for pudendal neuropathy are areas of focus for Doctor Ken. “We’re doing a good job of identifying the pudendal nerve as the trigger. A pudendal nerve block can be both diagnostic and therapeutic.” Treatment approaches include “pudendal nerve blocks, trigger point injections and pelvic floor physical therapy with intravaginal myofascial release.” For patients needing further intervention, “For patients not having a sustained improvement in symptoms, we will offer pudendal neuromodulation with an implantable stimulator. Many patients (80%) will see a marked improvement in their symptoms.” While acknowledging that neuromodulation isn’t universally effective, he highlights its potential for significant relief. Doctor Ken expresses reservations about pudendal nerve entrapment surgery, favoring stimulation over surgery due to the invasiveness and limited success data.
Addressing the Cost of Therapy: Doctor Ken’s Practical Advice
Doctor Ken acknowledges the significant financial burden of treatment for many patients. “The biggest challenge confronting patients today is simply the cost of therapy. Many patients simply cannot afford medications and/or treatments.” He circles back to the importance of phenotyping as a cost-effective strategy: “This is where phenotyping is so helpful. Identifying the triggers of pain and focusing the resources on these triggers will give the biggest bang for the buck. Labeling someone with interstitial cystitis and giving Elmiron®, a drug with limited efficacy and high cost, will not help a patient if their pain is driven by pelvic floor dysfunction or pudendal neuropathy.” He also points to clinical trials as an accessible avenue for underinsured patients to receive novel treatments while contributing to research.
Doctor Ken champions self-help strategies and cost-effective home therapies. “If the pelvic floor is triggering the pain, rather than a prolonged physical therapy treatment regimen, we will communicate with our physical therapists and ask them to evaluate the pain triggers and educate the patients early on to do home therapy including internal myofascial release using a crystal wand.” He also recommends “Pudendal nerve blocks and trigger point injections performed in the office are usually well tolerated and relatively costeffective.” Doctor Ken is a strong advocate for “self-help” strategies” including “YIN Yoga,” “Meditation, relaxation techniques, dietary changes, heat, vaginal valium and other home strategies” for “welleducated and motivated patient.”
Ultimately, Doctor Ken emphasizes the crucial role of patient engagement and a collaborative doctor-patient relationship. “One of the key factors to success in treating patients with IC or chronic pelvic pain is to have an engaged and motivated patient. I tell patients that we must work together as a team and that I cannot fix the problem on my own. We must set expectations and achievable goals, They must understand that there is no “magic wand” to cure them, but I promise every patient they will be better. I truly believe this.”
Learn More About Doctor Ken Peters and Beaumont Urology
Doctor Kenneth M. Peters, MD, continues to transform the landscape of urology and pelvic pain management through his research, clinical expertise, and unwavering commitment to his patients. For those seeking advanced care and a second opinion, Beaumont Urology, under the leadership of Doctor Ken, offers a multidisciplinary approach to diagnosis and treatment.
To learn more about Doctor Ken and Beaumont Urology, please visit http://www.beaumont.edu/urology or call: 800-633-7377.
This article is based on insights originally published in the Summer/Fall 2015 IC Optimist.
