Why would someone see a women’s health or pelvic health physical therapist?
The pelvic floor is a group of muscles in your pelvic area. These muscles support the organs in your pelvis like a sling.
Pelvic floor dysfunction can cause incontinence, slow urine stream, vaginal or rectal pain, painful sex and constipation.
Pam Meyer, a Physical Therapist with Aspirus Outpatient Therapy Services, is here to help you better understand pelvic floor dysfunction and how physical therapy can help to relieve these symptoms.
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Specialized Physical Therapy Helps Women With Pelvic Health Issues
Featured Speaker:
Learn more about Pamela J Meyer, PT
Pam Meyer
Pamela J Meyer, PT, is a Physical Therapist with Aspirus Outpatient Therapy Services.Learn more about Pamela J Meyer, PT
Transcription:
Specialized Physical Therapy Helps Women With Pelvic Health Issues
Melanie Cole (Host): When you feel that something’s not right down there and it affects how you feel everywhere else but, fortunately, there’s a growing field of medicine devoted to treating these unique complications. My guest today is Pam Meyer. She’s a physical therapist with Aspirus Health System. Welcome to the show, Pam. Tell us a little bit about women’s health or pelvic health physical therapists. What are you there to do?
Pam Meyer (Guest): Thank you, Melanie. Primarily, the pelvic floor muscles, women would know it as when they are doing a Kegel. An old way of instructing a woman to do a Kegel would have been to, while you’re urinating, stop your urine flow. Those are the group of muscles that we use or we talk about as the pelvic floor muscles. For men, they also have pelvic floor muscles but they don’t understand the Kegel, usually, because they have not been talked to about that until they have prostate issues. For a man, it is usually when they have fully urinated and then they squeeze and they get the last few drops of urine out which is emptying the urethra which is in the penis. That’s when they’re using their pelvic floor muscles.
Melanie: So, you said in the old days they were taught to stop their urine stream. Is it different now?
Ms. Meyer: It’s very different. We do not instruct people to do that whatsoever because what that does is, is it helps then to train the bladder to want to empty or send the message to the patient to empty their bladder sooner than is needed. So, I may use that as an example. If someone is having difficulty understanding where the pelvic floor is, I may say, “Imagine that you’re urinating. Now stop your urine” and that can help but never do we have women do Kegels to stop their urine as part of their exercise program.
Melanie: So, what’s the most common condition women may seek physical therapy for for something with pelvic floor?
Ms. Meyer: Usually, people think about incontinence and that’s the leaking of urine. There’s different kinds of incontinence. There is incontinence called “urge incontinence” which means when you have the urge to urinate and you don’t get to the bathroom in time because you can’t hold it that’s urge incontinence. But there’s also stress incontinence. Stress is common as we age, per se, but it doesn’t have to be related to age nor does it have to be related to having children. Stress incontinence is when you cough, sneeze, laugh, or jump as if you’re working out, and then you leak.
Melanie: So, when somebody has these kinds of complications and for women it can be even difficult to discuss or bring up with their doctor, so then, when does it come to the point where they come to see you, Pam? What would bring them to see a physical therapist and how can you help them?
Ms. Meyer: Well, it’s pretty wonderful here at Aspirus in that I have a very nice relationship with urology associates and they have a very good understanding of what I do. So, oftentimes women are going to a urologist because of incontinence issues; they’re going to have pelvic pain, potentially; sex may be painful; they’re having issues like they’re frequently urinating and frequency is at least one time an hour. Normal is that we urinate anywhere from one time every two hours to five hours. If your water intake is good and high where it’s supposed to be, you may be going a little bit more than that but you should not be urinating two to three times an hour. We often times get referrals from urology and before, a woman, for example, was stress incontinent, they may want to do a sling where you pin up the urethra to help with the incontinence. But, these women are then sent to us. The first step is we do something called “biofeedback”. What that is, is just an assessment of the pelvic floor muscles. What I need to find out is, first of all is their issue even related to the pelvic floor? What I’m looking for is, are those muscles able to relax and when I have the person do a Kegel after instruction, can they do a Kegel, how long can they hold that contraction? After you do a Kegel, do your muscles relax? A lot of times, Kegels fail because the pelvic floor muscles are not relaxed. In other words, that’s what I’m seeing a lot of and it’s called “pelvic floor dysfunction” or myalgia or tension. You can’t strengthen a tight muscle. So, the first step, oftentimes, is to relax the muscle and once that relaxation occurs, then oftentimes the pain is gone with sex or urgency reduces, frequency reduces. Then, we go from there to strengthen. It is, again, much more than just Kegels. Kegels is the first step.
Melanie: What can women do also on their own to help maintain their pelvic health? You mentioned those Kegels but if you were to tell somebody, “I’d like you to do this every day a couple times a day”, what are you telling them?
Ms. Meyer: Once we figure out where the pelvic floor is to do a Kegel and that is a huge piece that I see. I see a lot of men and women who come and they have no clue where the pelvic floor is or, even worse, with a Kegel, it is a squeeze and lift up into the body cavity and oftentimes, we’re squeezing and bearing down. So, if you imagine and just pay attention to yourself when you’re bending over to pick up something—anything--it can be the lightest thing. We are oftentimes bearing down with that and we have to do the opposite because if we’re bearing down, what we’re doing then is leading ourselves to have prolapse. Prolapse can be when there’s a sense of heaviness in the pelvis and that may be because the bladder has so-called fallen or the uterus has fallen or even the rectum and it falls into the walls of the vagina. We help that out by bearing down which is not what we want to do because that may require surgery.
Melanie: How often does someone need to see a physical therapist? Is this something that they’ll need to keep doing to maintain that strength or is it something that could be worked with a 6-8 week program?
Ms. Meyer: What usually happens is that the first visit is what we call “biofeedback” and there’s a lot of education that goes on there. I’m talking about the pelvic floor muscles, where that even is, talk about a Kegel and the biofeedback is we actually use a probe, usually a vaginal probe with women and for men, a rectal probe. That’s connected to the biofeedback machine in the computer and we can find out these results. Actually, it’s pretty enlightening because most people leave going, “Oh, my goodness. Thank God I finally found you” because what we talk about and why it’s occurring makes so much sense. The second visit, they come back and it is usually an internal exam. I would do an external exam of the pelvis and the legs. I’m looking for muscle tightness and if the pelvis is rotated because all of those things affect the pelvic floor. Then, we do an internal exam, usually vaginal with women and rectal with men. I’m palpating, specifically, the pelvic floor muscles and, again, I’m checking for muscle tightness, trigger point pain. If the women has episiotomy scars, they can be causing a lot of pain right at the vaginal opening. So, I can teach a woman how to do scar massage. From there, I can create an exercise program for them. Initially, again, it may be first relaxing the muscles and doing hip stretches or leg stretches for that. Then, we work on Kegels but we start lying down and from there we go to standing. Then, we do lunges or we step up and all of this is really about body awareness, figuring out where the pelvic floor is – making the connection between the brain and the pelvic floor. Again, that oftentimes has been lost. It’s been very, very successful.
Melanie: In just the last few minutes, please, Pam give your best advice for women who may be suffering from stress or urgent continence or painful intercourse or any of these pelvic floor disorders and why physical therapy can help them.
Ms. Meyer: When you are looking for a therapist and you have to find a specialized, trained therapist in women’s health or maybe it will be called “pelvic health”. I would prefer pelvic health because we treat men and women. You have to find somebody that is trained in women’s health because it is a specialized training. If you do not, you’re going to find a therapist who’s going to do a lot of strengthening of your abdomen and they may or may not know where the pelvic floor is and that it’s just because they don’t have the specialized training. That is the most important thing. If you are having any urinary issues and you’re given by your doctor or somebody else a sheet and it says go do your Kegels, please go on your own, do your own research. Find a women’s health therapist. It is much more important to know what you’re doing correctly and you usually need the education. Sometimes it’s one visit but sometimes it’s three months of therapy. But, three months may start out as once a week to every two weeks to once a month. It is not something you’re coming to therapy for two and three times a week. It’s not like that at all.
Melanie: Tell us about your team at Aspirus and why women or men should come there for their care.
Ms. Meyer: First of all, I’ve had a lot of experience with women’s and men’s health. That is what I specialize in. That’s what my training has been. I’ve been doing this for almost 15 years and I really enjoy the relationship that I have with multiple physicians in the area who do understand what I do and so you have more of a team approach. If I do an evaluation on somebody, I can call that physician’s office, explain what I see and then they can go forward with some type of treatment or adjust their plan of care and we work very well together.
Melanie: It’s great information. Thank you so much, Pam, for being with us today. You’re listening to the Aspirus Health Talk. For more information you can go to asiprus.org. That’s aspirus.org. This is Melanie Cole. Thanks so much for listening.
Specialized Physical Therapy Helps Women With Pelvic Health Issues
Melanie Cole (Host): When you feel that something’s not right down there and it affects how you feel everywhere else but, fortunately, there’s a growing field of medicine devoted to treating these unique complications. My guest today is Pam Meyer. She’s a physical therapist with Aspirus Health System. Welcome to the show, Pam. Tell us a little bit about women’s health or pelvic health physical therapists. What are you there to do?
Pam Meyer (Guest): Thank you, Melanie. Primarily, the pelvic floor muscles, women would know it as when they are doing a Kegel. An old way of instructing a woman to do a Kegel would have been to, while you’re urinating, stop your urine flow. Those are the group of muscles that we use or we talk about as the pelvic floor muscles. For men, they also have pelvic floor muscles but they don’t understand the Kegel, usually, because they have not been talked to about that until they have prostate issues. For a man, it is usually when they have fully urinated and then they squeeze and they get the last few drops of urine out which is emptying the urethra which is in the penis. That’s when they’re using their pelvic floor muscles.
Melanie: So, you said in the old days they were taught to stop their urine stream. Is it different now?
Ms. Meyer: It’s very different. We do not instruct people to do that whatsoever because what that does is, is it helps then to train the bladder to want to empty or send the message to the patient to empty their bladder sooner than is needed. So, I may use that as an example. If someone is having difficulty understanding where the pelvic floor is, I may say, “Imagine that you’re urinating. Now stop your urine” and that can help but never do we have women do Kegels to stop their urine as part of their exercise program.
Melanie: So, what’s the most common condition women may seek physical therapy for for something with pelvic floor?
Ms. Meyer: Usually, people think about incontinence and that’s the leaking of urine. There’s different kinds of incontinence. There is incontinence called “urge incontinence” which means when you have the urge to urinate and you don’t get to the bathroom in time because you can’t hold it that’s urge incontinence. But there’s also stress incontinence. Stress is common as we age, per se, but it doesn’t have to be related to age nor does it have to be related to having children. Stress incontinence is when you cough, sneeze, laugh, or jump as if you’re working out, and then you leak.
Melanie: So, when somebody has these kinds of complications and for women it can be even difficult to discuss or bring up with their doctor, so then, when does it come to the point where they come to see you, Pam? What would bring them to see a physical therapist and how can you help them?
Ms. Meyer: Well, it’s pretty wonderful here at Aspirus in that I have a very nice relationship with urology associates and they have a very good understanding of what I do. So, oftentimes women are going to a urologist because of incontinence issues; they’re going to have pelvic pain, potentially; sex may be painful; they’re having issues like they’re frequently urinating and frequency is at least one time an hour. Normal is that we urinate anywhere from one time every two hours to five hours. If your water intake is good and high where it’s supposed to be, you may be going a little bit more than that but you should not be urinating two to three times an hour. We often times get referrals from urology and before, a woman, for example, was stress incontinent, they may want to do a sling where you pin up the urethra to help with the incontinence. But, these women are then sent to us. The first step is we do something called “biofeedback”. What that is, is just an assessment of the pelvic floor muscles. What I need to find out is, first of all is their issue even related to the pelvic floor? What I’m looking for is, are those muscles able to relax and when I have the person do a Kegel after instruction, can they do a Kegel, how long can they hold that contraction? After you do a Kegel, do your muscles relax? A lot of times, Kegels fail because the pelvic floor muscles are not relaxed. In other words, that’s what I’m seeing a lot of and it’s called “pelvic floor dysfunction” or myalgia or tension. You can’t strengthen a tight muscle. So, the first step, oftentimes, is to relax the muscle and once that relaxation occurs, then oftentimes the pain is gone with sex or urgency reduces, frequency reduces. Then, we go from there to strengthen. It is, again, much more than just Kegels. Kegels is the first step.
Melanie: What can women do also on their own to help maintain their pelvic health? You mentioned those Kegels but if you were to tell somebody, “I’d like you to do this every day a couple times a day”, what are you telling them?
Ms. Meyer: Once we figure out where the pelvic floor is to do a Kegel and that is a huge piece that I see. I see a lot of men and women who come and they have no clue where the pelvic floor is or, even worse, with a Kegel, it is a squeeze and lift up into the body cavity and oftentimes, we’re squeezing and bearing down. So, if you imagine and just pay attention to yourself when you’re bending over to pick up something—anything--it can be the lightest thing. We are oftentimes bearing down with that and we have to do the opposite because if we’re bearing down, what we’re doing then is leading ourselves to have prolapse. Prolapse can be when there’s a sense of heaviness in the pelvis and that may be because the bladder has so-called fallen or the uterus has fallen or even the rectum and it falls into the walls of the vagina. We help that out by bearing down which is not what we want to do because that may require surgery.
Melanie: How often does someone need to see a physical therapist? Is this something that they’ll need to keep doing to maintain that strength or is it something that could be worked with a 6-8 week program?
Ms. Meyer: What usually happens is that the first visit is what we call “biofeedback” and there’s a lot of education that goes on there. I’m talking about the pelvic floor muscles, where that even is, talk about a Kegel and the biofeedback is we actually use a probe, usually a vaginal probe with women and for men, a rectal probe. That’s connected to the biofeedback machine in the computer and we can find out these results. Actually, it’s pretty enlightening because most people leave going, “Oh, my goodness. Thank God I finally found you” because what we talk about and why it’s occurring makes so much sense. The second visit, they come back and it is usually an internal exam. I would do an external exam of the pelvis and the legs. I’m looking for muscle tightness and if the pelvis is rotated because all of those things affect the pelvic floor. Then, we do an internal exam, usually vaginal with women and rectal with men. I’m palpating, specifically, the pelvic floor muscles and, again, I’m checking for muscle tightness, trigger point pain. If the women has episiotomy scars, they can be causing a lot of pain right at the vaginal opening. So, I can teach a woman how to do scar massage. From there, I can create an exercise program for them. Initially, again, it may be first relaxing the muscles and doing hip stretches or leg stretches for that. Then, we work on Kegels but we start lying down and from there we go to standing. Then, we do lunges or we step up and all of this is really about body awareness, figuring out where the pelvic floor is – making the connection between the brain and the pelvic floor. Again, that oftentimes has been lost. It’s been very, very successful.
Melanie: In just the last few minutes, please, Pam give your best advice for women who may be suffering from stress or urgent continence or painful intercourse or any of these pelvic floor disorders and why physical therapy can help them.
Ms. Meyer: When you are looking for a therapist and you have to find a specialized, trained therapist in women’s health or maybe it will be called “pelvic health”. I would prefer pelvic health because we treat men and women. You have to find somebody that is trained in women’s health because it is a specialized training. If you do not, you’re going to find a therapist who’s going to do a lot of strengthening of your abdomen and they may or may not know where the pelvic floor is and that it’s just because they don’t have the specialized training. That is the most important thing. If you are having any urinary issues and you’re given by your doctor or somebody else a sheet and it says go do your Kegels, please go on your own, do your own research. Find a women’s health therapist. It is much more important to know what you’re doing correctly and you usually need the education. Sometimes it’s one visit but sometimes it’s three months of therapy. But, three months may start out as once a week to every two weeks to once a month. It is not something you’re coming to therapy for two and three times a week. It’s not like that at all.
Melanie: Tell us about your team at Aspirus and why women or men should come there for their care.
Ms. Meyer: First of all, I’ve had a lot of experience with women’s and men’s health. That is what I specialize in. That’s what my training has been. I’ve been doing this for almost 15 years and I really enjoy the relationship that I have with multiple physicians in the area who do understand what I do and so you have more of a team approach. If I do an evaluation on somebody, I can call that physician’s office, explain what I see and then they can go forward with some type of treatment or adjust their plan of care and we work very well together.
Melanie: It’s great information. Thank you so much, Pam, for being with us today. You’re listening to the Aspirus Health Talk. For more information you can go to asiprus.org. That’s aspirus.org. This is Melanie Cole. Thanks so much for listening.