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Talking about Incontinence and Pelvic Health
Incontinence and pelvic pain may seem embarrassing to bring up to your doctor, but help is available to address these conditions. Dr. Kimberly Burton, physical therapist, discusses how these issues are not a normal part of aging and how the Pelvic Health Program can improve these conditions.
Featuring:
Kimberly Burton, DPT, CSCS
Kimberly Burton, DPT, CSCS, has worked in the Rehabilitation Services Department at Eisenhower Health for nearly 40 years. Kim is a member of the American Physical Therapy Association. Besides having her Doctorate in Physical Therapy, additional certifications include Certified Strength and Conditioning Specialist, and Certified Ergonomic Assessment Specialist. Kim has been involved in the Pelvic Health program at Eisenhower Health since 2008. She treats women and men with pelvic and fecal incontinence, constipation and pelvic pain syndromes. Transcription:
Bill Klaproth (Host): Incontinence and pelvic pain are not topics people like to discuss as you can imagine. But many people are affected by these issues but don’t realize their symptoms may be treatable. So, there is good news. So, let’s get you some help as we talk about incontinence and pelvic health with Kim Burton, a Physical Therapist at Eisenhower Health. Kim, thank you so much for your time. First off, Eisenhower’s Pelvic Health Program is part of its larger rehabilitation services department. So, what types of conditions are treated in the Pelvic Health Program?
Kimberly Burton DPT, CSCS (Guest): Oh thank you so much for asking me to come here. I really appreciate this. The conditions we treat are urinary and fecal incontinence. We treat constipation, pelvic organ prolapse, and we also treat pelvic pain syndromes.
Host: So, those are the main conditions when it comes to incontinence and pelvic health.
Kim: Those are our main conditions, correct.
Host: So, Kim we see a lot of advertising for products related to urinary incontinence. It seems like you can’t watch TV without seeing these ads. How many people does this affect in the US and is it mostly older people?
Kim: So, the prevalence, it’s hard to really be accurate with the percentages because people don’t report this to their caregivers or to their medical professionals. They are very embarrassed by this a lot of times or they think that it’s a normal part of aging which it is not a normal part of aging. So, but of those who do report, 40% suffer from incontinence of some sort.
Host: Wow, that’s a figure higher than I expected.
Kim: Yes.
Host: Well it’s good that you hit the embarrassment factor of this and the fact that most people think this is a part of normal aging, when in fact, as we get older, this is not a part of normal aging, right?
Kim: Exactly. Like I said, most people think that it’s part of aging because they do see these commercials on TV for pads. But this condition can be prevented, and it actually can be treated very successfully through physical therapy and other means.
Host: Yeah, so let’s keep talking about treatment. Your program can help improve bladder and bowel incontinence. How do you work with patients to make their quality of life better when they have one of these conditions?
Kim: So, we actually use biofeedback as an adjunct to our physical therapy program here. we go through the anatomy and the function of the pelvic floor with the patient. We have a model that we use. And we also give them exercises to start on. So, if they are weak with their pelvic floor muscles; these are muscles like any other muscle in their body; so, if they are weak, we can help them localize and strengthen the muscles of the pelvic floor. It’s a little different in constipation because we want to focus on the more relaxation part with the constipation. But we can strengthen. We can teach them how to relax. They can visualize their muscles working in the clinic here. and then we give them exercises to do at home, usually on the very first visit.
Host: And these exercises generally do the trick, is that right?
Kim: Yes, they do actually. The cure rate for stress incontinence which is part of one of the urinary incontinence is up to 70%. So, that’s what we’re seeing in the clinic or more.
Host: Wow, those are really good numbers. So, I’m just trying to understand this better. With incontinence, sometimes also comes pain. Is that right?
Kim: Yes. So, normally what we see is the pain involves muscle tightness more than anything. There are muscles and ligaments and nerves that surround the pelvic floor itself. And because they are muscles like any other muscle group in your body, they can become tight and they can actually develop trigger points both internally and externally. And those can be quite painful. The nerves also that enervate the pelvic floor can become irritated.
The hip and the low back also can refer pain to the pelvic floor as well. So, if you have pain in your hip or pain in your low back; it can also affect what’s going on down below or vice versa. So, the pelvic floor muscles or nerves can actually affect the hip and the low back. So, everything is connected in your body and so, that’s why we do a very thorough history. We want to make sure that the patient is breathing correctly, that they don’t have any issues with their low back and their hips, and we can do tests to kind of rule out those things. And then we can focus on just the relaxation part if that is what is needed.
Sometimes you can have tightness as well as incontinence with that in the pelvic floor muscles. So, we can actually go internally, and we can actually release those muscles.
Host: So, you can have incontinence and then you can have incontinence with pain as well. So, muscular weakness as you were talking about and pain can be confused with other things. How do you identify the cause of pelvic pain then?
Kim: So, we want to make sure, because again those nerves that enervate the pelvic floor can come from the low back. So, there are tests that we can do to rule out that it’s actually coming from the back or that it’s coming from the hip. And then we can really focus more on the pelvic floor itself.
Host: Right. So, then once you do identify that, what are some of the ways to improve that pain?
Kim: So, if it’s tightness; like I said, for females especially; we can go internally which means that we can actually affect those muscles by relaxing them internally or we can actually go externally too to relax the muscles. So, we have the benefit of doing both. We don’t have to just stay outside the body. We can actually go inside the body as well and release those muscles that way.
Host: So, I take it these treatments are under your guidance and are there any technologies that you use?
Kim: Yes. Okay so we use the biofeedback which is awesome. We are able to have the patient actually visualize their contractions on screen. They don’t feel anything with this. We use surface electrodes that are placed outside either the vaginal area or the rectal area because we do treat men as well. And then they can actually see when they are contracting their muscles and they can see when their muscles are relaxing. And then we are there to coach them to make sure that they are using the right groups of muscles and they are not getting all the compensation from other muscles around the area.
Host: Right, I think this is good news for a lot of people. So, the treatment programs are obviously personalized to the patient of course, but how long does a treatment program tend to last? Is there an average number of sessions for most patients?
Kim: Yes. So, we schedule normally for incontinence, we schedule one time a week for five weeks or five visits depending on their schedules and the treatments are actually anywhere from 45 minutes to an hour. And it just depends on what the patient individually needs.
Host: This have been really informative Kim. So, if you could wrap it up for us. What would you say to someone right now that’s suffering from incontinence and pelvic pain?
Kim: I would say that incontinence is definitely not a disease. It is false that it is a normal part of aging. And it can be treated, and it can be prevented.
Host: Well Kim, we’re going to put all of those in the good news column and thank you so much for your time. To learn more about Eisenhower Health’s Pelvic Health Program call 760-773-2033 or visit www.eishnhowerhealth.org/pelvic. And if you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you. This is Living Well with Eisenhower Health. I’m Bill Klaproth. Thanks for listening.
Bill Klaproth (Host): Incontinence and pelvic pain are not topics people like to discuss as you can imagine. But many people are affected by these issues but don’t realize their symptoms may be treatable. So, there is good news. So, let’s get you some help as we talk about incontinence and pelvic health with Kim Burton, a Physical Therapist at Eisenhower Health. Kim, thank you so much for your time. First off, Eisenhower’s Pelvic Health Program is part of its larger rehabilitation services department. So, what types of conditions are treated in the Pelvic Health Program?
Kimberly Burton DPT, CSCS (Guest): Oh thank you so much for asking me to come here. I really appreciate this. The conditions we treat are urinary and fecal incontinence. We treat constipation, pelvic organ prolapse, and we also treat pelvic pain syndromes.
Host: So, those are the main conditions when it comes to incontinence and pelvic health.
Kim: Those are our main conditions, correct.
Host: So, Kim we see a lot of advertising for products related to urinary incontinence. It seems like you can’t watch TV without seeing these ads. How many people does this affect in the US and is it mostly older people?
Kim: So, the prevalence, it’s hard to really be accurate with the percentages because people don’t report this to their caregivers or to their medical professionals. They are very embarrassed by this a lot of times or they think that it’s a normal part of aging which it is not a normal part of aging. So, but of those who do report, 40% suffer from incontinence of some sort.
Host: Wow, that’s a figure higher than I expected.
Kim: Yes.
Host: Well it’s good that you hit the embarrassment factor of this and the fact that most people think this is a part of normal aging, when in fact, as we get older, this is not a part of normal aging, right?
Kim: Exactly. Like I said, most people think that it’s part of aging because they do see these commercials on TV for pads. But this condition can be prevented, and it actually can be treated very successfully through physical therapy and other means.
Host: Yeah, so let’s keep talking about treatment. Your program can help improve bladder and bowel incontinence. How do you work with patients to make their quality of life better when they have one of these conditions?
Kim: So, we actually use biofeedback as an adjunct to our physical therapy program here. we go through the anatomy and the function of the pelvic floor with the patient. We have a model that we use. And we also give them exercises to start on. So, if they are weak with their pelvic floor muscles; these are muscles like any other muscle in their body; so, if they are weak, we can help them localize and strengthen the muscles of the pelvic floor. It’s a little different in constipation because we want to focus on the more relaxation part with the constipation. But we can strengthen. We can teach them how to relax. They can visualize their muscles working in the clinic here. and then we give them exercises to do at home, usually on the very first visit.
Host: And these exercises generally do the trick, is that right?
Kim: Yes, they do actually. The cure rate for stress incontinence which is part of one of the urinary incontinence is up to 70%. So, that’s what we’re seeing in the clinic or more.
Host: Wow, those are really good numbers. So, I’m just trying to understand this better. With incontinence, sometimes also comes pain. Is that right?
Kim: Yes. So, normally what we see is the pain involves muscle tightness more than anything. There are muscles and ligaments and nerves that surround the pelvic floor itself. And because they are muscles like any other muscle group in your body, they can become tight and they can actually develop trigger points both internally and externally. And those can be quite painful. The nerves also that enervate the pelvic floor can become irritated.
The hip and the low back also can refer pain to the pelvic floor as well. So, if you have pain in your hip or pain in your low back; it can also affect what’s going on down below or vice versa. So, the pelvic floor muscles or nerves can actually affect the hip and the low back. So, everything is connected in your body and so, that’s why we do a very thorough history. We want to make sure that the patient is breathing correctly, that they don’t have any issues with their low back and their hips, and we can do tests to kind of rule out those things. And then we can focus on just the relaxation part if that is what is needed.
Sometimes you can have tightness as well as incontinence with that in the pelvic floor muscles. So, we can actually go internally, and we can actually release those muscles.
Host: So, you can have incontinence and then you can have incontinence with pain as well. So, muscular weakness as you were talking about and pain can be confused with other things. How do you identify the cause of pelvic pain then?
Kim: So, we want to make sure, because again those nerves that enervate the pelvic floor can come from the low back. So, there are tests that we can do to rule out that it’s actually coming from the back or that it’s coming from the hip. And then we can really focus more on the pelvic floor itself.
Host: Right. So, then once you do identify that, what are some of the ways to improve that pain?
Kim: So, if it’s tightness; like I said, for females especially; we can go internally which means that we can actually affect those muscles by relaxing them internally or we can actually go externally too to relax the muscles. So, we have the benefit of doing both. We don’t have to just stay outside the body. We can actually go inside the body as well and release those muscles that way.
Host: So, I take it these treatments are under your guidance and are there any technologies that you use?
Kim: Yes. Okay so we use the biofeedback which is awesome. We are able to have the patient actually visualize their contractions on screen. They don’t feel anything with this. We use surface electrodes that are placed outside either the vaginal area or the rectal area because we do treat men as well. And then they can actually see when they are contracting their muscles and they can see when their muscles are relaxing. And then we are there to coach them to make sure that they are using the right groups of muscles and they are not getting all the compensation from other muscles around the area.
Host: Right, I think this is good news for a lot of people. So, the treatment programs are obviously personalized to the patient of course, but how long does a treatment program tend to last? Is there an average number of sessions for most patients?
Kim: Yes. So, we schedule normally for incontinence, we schedule one time a week for five weeks or five visits depending on their schedules and the treatments are actually anywhere from 45 minutes to an hour. And it just depends on what the patient individually needs.
Host: This have been really informative Kim. So, if you could wrap it up for us. What would you say to someone right now that’s suffering from incontinence and pelvic pain?
Kim: I would say that incontinence is definitely not a disease. It is false that it is a normal part of aging. And it can be treated, and it can be prevented.
Host: Well Kim, we’re going to put all of those in the good news column and thank you so much for your time. To learn more about Eisenhower Health’s Pelvic Health Program call 760-773-2033 or visit www.eishnhowerhealth.org/pelvic. And if you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you. This is Living Well with Eisenhower Health. I’m Bill Klaproth. Thanks for listening.