Melanie Cole, MS (Host): ​ Welcome to Bryan Health Podcast. I'm Melanie Cole. And today, we're learning about pelvic floor therapy. Joining us is Laura Anderson. She's an occupational therapist at Crete Area Medical Center. Laura, thank you so much for joining us today. What is the pelvic floor? People don't always even know what that entails, what that means.

Laura Goracke Anderson: Hi. Thank you for having me today. The pelvic floor is actually a group of muscles and tissue that spans the bottom of the pelvis, and it functions like a hammock. These muscles play a crucial role in supporting the pelvic organs, including the bladder, the bowels, and the uterus in women. The pelvic floor is essential for maintaining control over urination, bowel movements, gas, and it contributes to sexual function and core stability. And when it's functioning well, it helps you delay urinating until it's convenient and supports overall pelvic health.

Melanie Cole, MS: Well, thank you for such a great explanation. So, we've heard about pelvic floor issues, disorders. Are they pretty common? Do we know what some of the causes are? And do you think, Laura, that they're underreported because many people, women specifically, are hesitant to discuss them? Are they a normal part of aging? Should we be embarrassed?

Laura Goracke Anderson: So, pelvic floor dysfunction can be caused by a variety of life events and conditions. One of the largest ones that I see is childbirth and menopause. But I also work with patients in the oncology population. Bowel habits can contribute to pelvic floor dysfunction. And then, even sexual dysfunction, whether due to pain, trauma, or muscular imbalance. One of the things that I'd love for women to realize is that they do not have to be embarrassed by these issues, that there is treatment available, and we are happy to help them.

Melanie Cole, MS: Well then, tell us about some of the signs and symptoms that would indicate that someone has a pelvic floor disorder.

Laura Goracke Anderson: Common symptoms can include pain, leaks and pressure. So, pain can be in the pelvis, the low back, the hips or even during intercourse. Leaks can be urinary or bowel incontinence, like with the typical coughing, sneezing, laughing, pressure or heaviness is a sensation of something falling out or bulging in the vaginal or rectal canals, often related to a condition called prolapse. Other signs can be urgency, frequency of urination, feeling like you just can't empty your bladder fully, constipation, pain with putting in a tampon and even recurrent UTIs.

Melanie Cole, MS: What conditions do you treat, Laura?

Laura Goracke Anderson: Some of the most common ones are stress or urge urinary incontinence, constipation, pelvic organ prolapse; high tone conditions like vaginismus or pelvic pain, painful intercourse and scar pain, which can be from birth, surgery, or injury; difficulty emptying bladder or bowels and bowel incontinence.

Melanie Cole, MS: Laura, you just mentioned a word high tone. Can you tell the listeners what a high tone or a low tone pelvic floor dysfunction is?

Laura Goracke Anderson: Yes. I love this question actually, because it helps bust myths and highlights why customized care is really important. So, low tone means weakness or underactivity. And we often see that with urine leaking, prolapse or difficulty activating your pelvic floor muscles. Conversely, high tone means overactivity or tightness, which is often seen with pain, incomplete emptying, or urgency. And the most important part here is that Kegels can actually make high tone issues worse, which is why a professional evaluation is so important.

Melanie Cole, MS: And what are the benefits of these types of therapies that you offer?

Laura Goracke Anderson: Pelvic floor therapy can improve bladder and bowel control. It can reduce or eliminate any pain you may be experiencing. It can enhance sexual health and comfort. It can improve your core stability and overall function. I've noticed so much that it helps restore confidence and quality of life for the patients that I see. And another big one is it just helps you feel more connected to your body and empowered in your health journey.

Melanie Cole, MS: Well then, tell us what the evaluation is like. What is that first appointment with you like? What do you evaluate? How do you work with these patients?

Laura Goracke Anderson: The pelvic floor evaluation typically begins with a detailed conversation. So, we talk about your symptoms, your history, your bladder, bowel and sexual function, and your overall lifestyle. Then, with your consent, we may perform either an external or an internal exam to assess your muscular tone, coordination, strength, endurance and any areas of tenderness or dysfunction. But one thing is that the evaluation is always tailored to your comfort level and your goals, and education is a key component.

Melanie Cole, MS: So then, what about treatment? How comfortable are women getting these types of treatments, caring, compassionate, private, confidential? Speak about what the treatment is actually like.

Laura Goracke Anderson: So, the treatment is highly individualized. And I really root all my treatments in function-specific goals. So, there's never a one-size-fits-all approach. So, a lot of times women will come in and say, "Well, my friend recommended this" or "I read online, you know, I should do these type of exercises." But there's really not a one-size-fits-all approach. Treatment is going to vary depending on the person. The timeline just depends on the condition and goals. It could be several weeks, it could be a few months. We'll always do an assessment first. We always begin with a thorough assessment. But contrary to proper belief, kegels are not for everyone. For example, leaking can be either a sign of low tone, which is weak muscles or high tone, which can be tight, overactive muscles. But the treatment for each is very different. We always involve education, lifestyle strategies, potentially manual therapy, guided exercises, breath work and biofeedback, depending on what your goals are.

Melanie Cole, MS: Well then, how does somebody begin this type of therapy? To whom do they reach out? What do they do first?

Laura Goracke Anderson: I am personally located in Crete, and I'm able to provide pelvic floor therapy services. But if you are not in the Crete community, I recommend asking your primary care provider or your OB-GYN for a referral to pelvic floor therapy. Or in some areas, you can self-refer. I would look for a licensed occupational or physical therapist who specializes in pelvic health. And the first step is often an initial consultation where we get to know your history and goals and map out a plan.

Melanie Cole, MS: Do you recommend things that patients can do at home and on their own to maintain good pelvic health?

Laura Goracke Anderson: Yes, I do. Practicing diaphragmatic breathing is a great way to coordinate the core and the pelvic floor together. Another big tip is to avoid chronic straining with bowel movements, and you can do that by staying hydrated and maintaining activity levels. And another one is learning to relax and engage the pelvic floor with intention. And most importantly, don't self-diagnose. See a specialist for individualized guidance.

Melanie Cole, MS: Do you have any final thoughts, Laura, that you'd like to leave patients with about pelvic floor disorders and dysfunction, and why you feel it's so important that they reach out to you and to the experts? Because as you said, this doesn't have to be a normal part of aging, and there are so many things out there. You have a lot of tools in your toolbox to help them.

Laura Goracke Anderson: That's correct, Melanie. Pelvic floor dysfunction is a common part of life, but it's not normal. Pain, leaking and pressure doesn't have to be your norm. We can work together with your goals and get you to the lifestyle that you want to achieve. And I have done that with several people and it's been a very rewarding process. I actually started rehabbing myself after the birth of my first child. It's kind of how I got into this. And I have to say, just being pain-free, being able to adequately control bladder and bowels really helps a woman maintain her quality of life.

Melanie Cole, MS: And that's really what it's about, is quality of life. And congratulations on the birth of your first child. Such an exciting time. Thank you so much, Laura, for joining us and really sharing your experience as an occupational therapist and why we women shouldn't be embarrassed to seek help for these types of dysfunctions. So, thank you so much. And I'd like to thank our Bryan Foundation partner, Inpatient Physician Associates.

To listen to more podcasts from our experts, visit bryanhealth.org/podcasts. And that wraps up this episode of Bryan Health Podcast. Please remember to subscribe, rate and review Bryan Health podcast on Apple Podcast, Spotify, iHeart and Pandora. Until next time, I'm Melanie Cole.