Transcription:
Women's Health Physical Therapy

Caitlin Whyte: Welcome to Aspirus Health Talk, I'm Caitlin Whyte. And today, we're talking all things women's health when it comes to physical therapy and the pelvis. Joining us is Erin McIntyre, a physical therapist with Aspirus. Now, Erin, tell us a bit about yourself to start off. How did you get into this field?

Erin McIntyre: Well, I actually have been a physical therapist for a while. I graduated in 2012 and I didn't really get interested in women's health until probably about five years ago after I had my first child. It was something that I was interested in. And I kind of wanted to explore it because I loved pregnancy and just wanted to really be able to treat pregnant mamas.

At that time, I didn't really delve into it, but after I had my second son, I actually had a very bad cough after giving birth to him. I had a natural childbirth with him, a really great birthing experience. And because I had this terrible cough and got sick, after giving birth to him, I actually ended up having a pelvic floor prolapse myself or pelvic organ prolapse, I should say.

So I went through this myself. I actually had my uterus prolapse and it was something I noticed maybe about four weeks after giving birth to him. And, you know, I called the healthcare system and spoke to the doctors about it and a nurse kind of jokingly said, "Well, honey, you just had a baby. You're fine." And I'm like, "No, I'm a physical therapist. I know human anatomy. I'm not fine."

I had gone in and we realized that I had had a prolapse because having a cough where that intraabdominal pressure after giving birth when everything's so sensitive isn't good. And so I experienced prolapse myself. I had a friend at the time who was a pelvic floor physical therapist, and she examined me and she got me doing the right strengthening exercises and that sort of thing. And within anywhere between three and six weeks, my prolapse improved tremendously.

So I became a believer in it and just really wanted to help women like I'd been helped because I felt like there was a lot of missing education pieces that maybe could have prevented it if I had known things in advance and just got really passionate about helping people that had the same issues that I had.

Caitlin Whyte: So when we talk about women's health physical therapist, what does that focus on?

Erin McIntyre: So basically a women's health physical therapist will treat a variety of conditions that involve the pelvic floor, which I'll talk more about that and I'll expand a little bit more on prolapse as well. But we also treat things like low back pain during pregnancy or some people, you know, can have sciatica pain that sort of thing during pregnancy, or just a very weak core or discomfort after a delivery, after a surgery, even when pregnant women can realize that they have something called the diastasis recti, which is a separation of the abdominal muscles. And so I can treat that even in pregnancy and even better so postpartum. So yeah, we treat a variety of conditions involving the pelvic floor.

Caitlin Whyte: Well, let's jump into some of those conditions. You mentioned that you've dealt with prolapse yourself. Tell us more about prolapses.

Erin McIntyre: Yeah, absolutely. I'd be happy to do that. So prolapse essentially will happen when-- you have three different pelvic organs in your body. They actually fit above those pelvic floor muscles. And what can happen is an organ, either your bladder, your uterus, or the rectal region can prolapse. A prolapse is essentially the bulging or kind of a herniation of one or more of these pelvic organs into or out of the vaginal canal.

So if you have a prolapse, you can normally feel it. There's some people that have it and they don't maybe realize they have it. They just might not have that much of a keen body awareness to realize it. But typically, if it gets bad enough, you're going to have symptoms like a heaviness or a dragging feeling in the vagina, or even into the low back. You might feel even like a lump or something in the vagina or sometimes even outside the vagina if the prolapse is bad enough.

Symptoms of a bladder prolapse, for instance, would be things like a slow urine stream, incomplete bladder emptying, difficulty moving the bowel, or even needing to press in the vaginal wall to empty the bowel because your organs have kind of gotten in the way of things. And it can also cause a little bit of discomfort during sexual intercourse because your organs are kind of in the way of things as well. So it can lead to a number of issues.

Caitlin Whyte: How about urinary incontinence? I feel like that's another big one. Is that something only women who have had kids have to deal with?

Erin McIntyre: Oh, definitely not. So many people deal with this. I've seen even, you know, men in their nineties that come to me with these issues as well as, you know, I've seen women who are teenagers that have these issues because of things like a chronic cough and asthma, where it puts a lot of pressure on your pelvic floor muscles.

So basically the pelvic floor, it's a thin sheet of muscle fibers and connective tissue. And it's underneath the pelvis between the pubic bone at the front and the tailbone at the bottom. So there are muscles that you can't really see on the outside, but they really help with many things like preventing the leakage of urine with a cough or sneeze. They support your organs in your abdomen. They protect those pelvic organs. They hold the pelvic organs in the correct position. And then they can also help with just controlling or passing urine, gas or bowel motions, and play a role in sexual function as well during the intercourse.

So what can happen is people who are young and people who are old, basically people who are of all ages could deal with incontinence and it could be through many different things. It could be from pregnancy. It could be from just a traumatic childbirth. Somebody who's chronically constipated, they're going to put a lot of pressure in their pelvic floor region and in those pelvic floor muscles and so those muscles can get weak over time and they could be dealing with some incontinence issues as well.

A chronic cough, somebody that has asthma, I've seen teenagers who were, you know, coughing at work or have coughed all their lives, they have asthma. And, you know, they go to work, they go into their twenties and they're wearing, you know, really heavy pads at work to prevent themselves from peeing their pants at work. So I see people of all ages. Sometimes people might have a surgery down there or a trauma or just over time with aging, they can get some pelvic floor muscle tension or incoordination or weakness, and all of this could lead to incontinence.

And there's basically two different types of incontinence. There's stress incontinence, which is the involuntary leakage of urine when you cough or when you sneeze, or maybe you're doing something physical like lifting a heavy item or exercising or walking, that sort of thing, or jumping or hopping. I know a lot of mamas after having babies will try to jump on the trampoline with their kids, and they're like, "Oops. You know, I can't do this." And so that's stress incontinence. That's kind of a sign that your pelvic floor muscles are really, really weak.

And then there's also incontinence, which is called urge incontinence. And that's sort of the thing where maybe you might go shopping or you'd be at church or you'd be doing really great, not even thinking about peeing your pants, but for whatever reason, as soon as you get home, you put your key into the lock and you just suddenly have this strong urge to pee. And there's really kind of a dysfunction between the brain and the bladder when you have urge incontinence. And so that can plague people as well, especially some of the older people I find we'll get that more frequently.

Caitlin Whyte: What are some of the other conditions that you see as a physical therapist?

Erin McIntyre: So I'll see people for a low back pain; sacroiliac pain, which is kind of the bony structure underneath your lumbar spine; also sciatica pain, pelvic pain during pregnancy, or just in general in the population, I'll see that too. And then I'll see people a lot of times that have just really weak core strength, discomfort following or even during pregnancy or after a delivery.

We talked a little bit about the diastasis recti or the separation of the abdominal muscles. I'll see that a lot in women who are pregnant or people who are postpartum. It's a pretty common condition in pregnancy. I've even seen some males that have that issue as well. Sometimes people will be focused on more of like their big rectus abdominal muscles, the muscles in front, but they don't focus on strengthening their deep core muscles and so they can have a separation too.

And it's pretty uncomfortable and it's pretty obvious when you have it. You can kind of tell if you're laying on your back and you kind of lift your head or your neck up, if you see like a big bulging in the middle of your abdomen, if it's more than two fingers with that's called the diastasis recti. And it can lead to a lot of discomfort and some back pain too, when you have that weakening in your core muscles.

So I'll also see people for discomfort during or even following sexual intimacy for those types of people. They probably oftentimes will have a tight pelvic floor. So not everybody has a weak pelvic floor. Some people have a lot of spasms and hold a lot of tension in their pelvic floor. People that are chronically constipated typically will have a weak pelvic floor in general. So I'll see people sometimes for that and then frequent urination and inability to empty the bladder completely.

I do see a lot of people that have pelvic organ prolapse. It can be pretty common. Sometimes it's not very extreme. People don't always realize they have it. It'll start manifesting kind of slowly over time. So it's nice to catch that early, especially, you know, maybe after childbirth, that sort of thing, where there's been kind of a trauma to the pelvic floor and it can just, you know, make you more likely to have a prolapse.

And then just pre and post surgery, so after somebody has something like a C-section. There's a lot of sensory issues that go on with that. People need help with scar tissue mobilization. A lot of times the sensation there is just going to be really different because you've had some nerve endings cut into and there's even, you know, some spasms and stuff from getting the abdominal muscles sort of spread apart to get that baby out. And so I'll see people after a C-section, I'll see people after surgery like hysterectomy.

You know, some women will have a episiotomies where they kind of have to make a cut in order to get the baby out, like maybe the baby's just not coming out. And so they have to kind of cut into that vaginal tissue and into the pelvic floor a little bit to get the baby out. So there's sometimes some scar tissue that needs to be worked on in there.

Some people will get a bladder sling procedure if their prolapse is bad enough. Hopefully, those people have gone through physical therapy before they decide to, you know, go get a surgery or something. But I'll see those people for pelvic floor strengthening because oftentimes what I've found in my clinical practice is people will go and they'll get, you know, a bladder sling because they have a prolapse, but they never actually realized why they prolapsed in the first place.

So these people will go get a surgery to fix this prolapse, but they're still not breathing correctly. They're still, you know, not lifting correctly or they're coughing like crazy. And they're doing a lot of the wrong things that cause the organs to prolapse in the first place. So the surgery might, you know, temporarily fix things, but if they don't really know how to breathe correctly and know a little bit about the pelvic floor, then they're likely to prolapse again.

And so a lot of those surgeries will have like a 60% fail rate whereas physical therapy can really make such an impact because, if we can get to the bottom of why you prolapsed in the first place, you might not need something like a surgery.

And then people too that have had radiation, that sort of thing, oftentimes they can have, you know, tissue spasms down there and just some issues where we can help with reducing muscle spasms and making things more comfortable. Those are kind of the main conditions that I'll see. And I've even seen some men after having, you know, prostate surgery or prostate cancer who have urinary incontinence.

I don't see as much men at my practice here at Aspirus, but where I was before, I saw probably like three or four men, just, you know, whether they had urgency incontinence or they just had a true pelvic floor weakness, and you can work on that in a male as well. I typically see more females, but it's not uncommon for males to also have incontinence or have some of these issues as well.

Caitlin Whyte: Now I feel, you know, just with all the things I have to keep in check, keep healthy, workout on my body, I don't really think about my pelvis. How can we be more aware just of our pelvic health in general?

Erin McIntyre: I think being really cognizant of how you're breathing is one of the best things to be aware of. I just recently listened to a good podcast on this too. I think the guy's name is James Nestor and he came out with this book called Breathing. He just came out with it this year.

But a lot of people, if you kind of think of our society and just how stressed we are in general and how maybe fearful people are right now, we tend to kind of live in this constant state of fight or flight where we're running from one thing to the next. I don't think we're really taking time to be still and to really focus in on our body and pay attention to our breathing. And so a lot of us are just kind of in general, doing a lot of mouth breathing. We're not doing more of like those Yogi breaths, where you breathe in through your nose and out through your nose actually, not out through your mouth. And having, you know, a good breathing pattern will just put a lot less stress on the pelvic floor in general. I would say that's the number one thing that you could pay attention to.

There's a lot of good, you know, information out there on breathing. I think for people they oftentimes think of breathing as boring, like, "Okay, I'm alive. I'm breathing. I'm fine." But actually being really honed in on that and trying to take some slow, deep breaths, you know, like a four-second hold in through your nose and a four to six-second hold out through your nose, not through your mouth, is actually very calming to the body and it's more calming to the pelvic floor.

You know, somebody who's doing a lot of yelling or screaming or has a lot of tension in general and is just kind of an angry person, they're actually going to be putting a lot of strain on their pelvic floor. So I think the first thing you can be aware of is your stress levels and your breathing. Honestly, I think that's the best thing.

The other thing is a lot of people will go to their doctor. And, you know, your typical pelvic floor strengthening exercises, they're called Kegels. But a lot of people, sometimes they really need that hands-on to make sure they're doing them correctly. A lot of people think, "Oh, well, I'm doing this correctly. I'm just kind of needing to squeeze or hold in my pelvic floor," but you really need to make sure you're breathing correctly when you're doing Kegels too. And if you're not doing the correct breathing mechanics with it, then you might not really be doing proper strengthening.

And oftentimes people will tell people what a Kegel is, but they're not really checking to see that people are doing them correctly. So just that hands-on, even if it's just one or two physical therapy sessions to make sure you're actually doing things correctly and breathing correctly can be, I would say, the best thing that you can do.

And you know, if you're not going to go in to see a physical therapist, I would recommend some diaphragmatic breathing, looking up like a good YouTube on that or considering that breathing book by James Nestor that he just put out in May. But really in general, just like I said, those slow, deep breath, in through your nose and out through your nose, just help in general with a more calm pelvic floor region as well. And it's good for your whole body.

Caitlin Whyte: Great. Well, Erin, some wonderful tips here. Is there anything else you'd like to add?

Erin McIntyre: So I would just say, I think that there's a lot of women in the population and men too, certainly, but oftentimes it tends to be more women that have this issue. You know, they're wearing pads or they're wearing diapers and they just consider that to be a normal part of life or a normal part of aging.

And peeing your pants is actually never normal. Not at all. It's an inconvenience to have to wear a pad. And, you know, it definitely makes sense to get a prescription for physical therapy for pelvic floor dysfunction and to get that looked at, because oftentimes there is, you know, a cognitive component or there is just a pelvic floor weakness component and we can make that condition so much better.

We can't always make it go away completely, necessarily, but oftentimes we can make people's lives just so much better. You don't have to, you know, go and be wearing a diaper every day or be wearing a pad every day and having to change that or worry about a urine smell. I get women that are like, "Oh gosh, I'm just worried because I think I stink," because they kind of know that they're going to pee their pants when they go to get up or that sort of thing. And it's not normal. It's nothing to be embarrassed about.

I have been through this issue as well. I've had prolapse issues. I've had natural childbirth. My last childbirth was a C-section because my baby was breach. And so sometimes I wonder if like I was put through these situations so I could be a better physical therapist, but I'm just really caring, compassionate about people. I can really empathize with what people are going through from a personal standpoint too. And I think that really helps rather than just coming at it from a scientific standpoint. I've kind of been where people have been. I've coughed and I peed my pants. You know, like I've felt what a prolapse feels like. I unfortunately had to go through a C-section with my third child. And so I know about just like the mental trauma of experiencing that sort of thing, how that can be too.

And so, yeah, I would just say if you're having any issues at all, just feel free to reach out because I really care about people and just want people to be functioning better. And this is just such an area that's not talked about, like it's taboo to talk about it and it shouldn't be, like we can just make these issues so much better. So that's my final thoughts.

Caitlin Whyte: Well, thank you for joining us today, Erin, and for opening up this conversation. And thank you so much for listening to this episode of Aspirus Health Talk. Head on over to our website Aspirus.org for more information and to get connected with one of our providers like Erin. Please remember to subscribe, rate, and review this podcast and all of the other Aspirus shows. For more health tips and updates, follow us on your social channels. I'm Caitlin Whyte. Stay well.