Scott Webb (Host): Pelvic health physical therapy can help patients at all stages of life from pediatrics to geriatrics and from our ribs to our knees. Joining me today to tell us more about how she helps patients is Dr. Mackenzie Rush. She's a Doctor of Physical Therapy and a Physical Therapist with Franciscan Health.

 This is the Franciscan Health Doc Pod. I'm Scott Webb. Mackenzie, thanks so much for your time today. We're going to talk about pelvic health, and physical therapy as it relates to pelvic health for every stage of life.

We're going to kind of go through all the stages, but before we get there, let's just start here. What is pelvic health physical therapy? What does that mean?

Mackenzie Rush, DPT, PT: Pelvic Health Physical Therapy is a specialty of physical therapy that can help you address issues that can occur from your ribs to your knees and everything in between. So just like other parts of our body, we can have pain and difficulty with movement. But when something is awry in this area, our body also has some special functions like bowel, bladder, and sexual function, that can, you know, just mishaps can happen and some issues can occur and so that is what Pelvic Health PT addresses.

Host: Love that, ribs to the knees, right? And, uh, yeah, those of us of a certain age where you really understand what you're saying there, but there's just certain things that hurt and there's help available. And we're going to go through all of that today. Let's just, you know, sort of as an overview, let's talk about who can really benefit from Pelvic Health Physical Therapy.

Mackenzie Rush, DPT, PT: Really anyone with a pelvis, to be super broad.

Host: So, so really all of then, right?

Mackenzie Rush, DPT, PT: Yes, yeah. So, male and female, like, we all have pelvic floors, and they do different things in our body, but a lot of the times, we see both male and females for both bowel, bladder, sexual function, and pelvic pain. We see pretty much everyone, and we also see kids, and so a lot of times people don't know that, so kiddos with bowel or bladder dysfunction, they can really benefit from Pelvic Health PT too.

So, it's not just older people or pregnant people, it is really anyone with a pelvic issue. So yeah, it's very much a everyone thing. And I think really anyone can benefit who has an issue that pertains to their pelvis.

Host: Yeah, I'm sure, and let's just do that. Let's stay with kids, and we'll work our way from kids all the way up, if will. Yeah, so what are the typical concerns of a pediatric patient?

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Mackenzie Rush, DPT, PT: So for kiddos, a lot of times, they will notice symptoms like nighttime bedwetting or not going to the bathroom often enough to where they might have smears in their underwear of stool. And that can be really concerning for patients. And so we'll see those kiddos and oftentimes those issues are happening because they're really constipated.

And so what our job as Pelvic Health Physical Therapists are is we get those kids moving, we get their core really strong. We teach them how to breathe effectively, so that their toileting is effective, so that they're able to have a bowel movement. We teach parents things like abdominal wall massage, so that they can help the bowel move through, or the stool move through the bowel.

 And so we just are there to help facilitate movement and good dietary education so that these kids can get back to having a regular bowel routine so that their leakage is decreased. And oftentimes we see things nighttime bedwetting disappear when we treat constipation. And then with nighttime bedwetting, if that continues to persist after we treat the constipation, we can go through kind of a protocol, if you will, of waking up at night, using the restroom, and then pushing that in the direction of either waking hours or before going to bed hours to make sure that we're dry through the night. So that's really what we treat in kids. And then for pain, this is the age where kiddos are learning how to ride bikes and are active, and so sometimes we can have tailbone or bike injuries that can cause pelvic pain in kids.

Host: Good to know that pediatric patients can benefit. So let's talk about the teens and the tweens.

Mackenzie Rush, DPT, PT: Yes. So with our teenagers, a lot of times our teenage girls, they can come in with urinary leakage, like especially when they're doing any sort of athletics, like dance, or gymnastics, or running, or pole vaulting, any type of athletic event that causes a lot of changes in our intra abdominal pressure, which is good and healthy, but they can demonstrate or show our weakness in our pelvic floor.

And so sometimes, teenagers can have urinary leakage. And so we see that, and we also see pelvic pain. So this is you know surrounding the age of menarche, and girls and teens are starting to use tampons. And so those can often cause pain if there is pelvic floor dysfunction. And so, a physical therapist, our responsibility is to make sure that these muscles are working correctly, that they're relaxed, and that the patient has control over their muscles. Because a lot of times, we just don't even know that we can control these muscles, or that we have any, you know, volition over them. And so, it's really helpful to educate them, so that they know that they can control and relax their muscles, so that there's no pain.

Because pain is not normal in this area. And so, that's really helpful, and can give a lot of freedom to teenagers so that they can participate in whatever they want to participate in, whether they're on their period or not.

Host: Yeah, and whether that's sports or spending dad's money at Starbucks, but I digress, maybe that's just me. All right, so, we're going through here, you know, I really I wasn't aware that pediatric patients and teens and tweens, you know, go for PT for Pelvic Health, but I definitely am familiar, with how pregnant patients can benefit. So let's have you go through that as well.

Mackenzie Rush, DPT, PT: Yes, so pregnancy, you know, can demonstrate a lot of different dysfunctions and problems within our body that we didn't know were there, and then we increase load through the pelvis, and we also make the pelvis really flexible during pregnancy to get ready for delivery, and then we have some pain. So, low back pain is really common, SI joint pain, which is like low back pain, it's just a little bit lower, and then pubic symphysis pain, which is in the front. and then they'll also have, you know, some urinary issues. So urinary leakage or going too frequently those are both very common problems and I would just really encourage anyone who is dealing with those, or living with those, that these are not normal. These are common, like your girlfriends will probably have them.

 But these are things that can be fixed and helped with Pelvic Health PT, and so you by no means have to grin and bear it throughout your whole pregnancy, like you can, get help and these things can be made better. So even though they're really common, they're not normal and we, we don't want you to have to live with them, so.

Host: Right. And as we're going through the ages here, we started with pediatric patients, we're up through pregnancy now. Now let's talk about perimenopause and menopause patients.

Mackenzie Rush, DPT, PT: Yes. So this can really be the whole gamut of issues. A lot of times women especially, have done their best to cope with issues for a long, long time, and then they just continue to worsen, and that's when we see them, is when they're really bad and they've got a lot going on. So, a lot of times we'll see things like prolapse, which basically means that your pelvic organs are dropping or lowering or causing pressure in the lower pelvic area, because the pelvic floor isn't supporting the pelvic organs adequately.

That can be an issue. Urinary and fecal leakage can be an issue or feeling like you have to run to the bathroom, that you're not going to make it in time. And things like constipation, not being able to go at least three times a week is what we classify constipation as. So all of those things can occur.

And also pain with sex, like there are some hormonal changes that occur. And also something called vaginal stenosis or vaginal atrophy that can cause some pain with sex. And Pelvic Health PT can really help with all of those things, because our pelvic floor surrounds all of those very important organs, and so our pelvic floor has a lot to do with the dysfunction that we're dealing with.

And so anything that we can do to conservatively manage and help these issues, I think is a great opportunity to improve the health outcomes and the quality of life you have.

Host: Yeah, it's what it always comes down to. I think so many of the topics that I do is people suffering, whether they're suffering in silence or not is a matter of debate sometimes, but, they're suffering and they either don't know, or they're afraid to reach out because they're just, there's a lot of uncertainty and we can help dispel some of that for them here when it comes to Pelvic Health PT. Tell us what typical course of PT evaluation includes, treatment, and just what can folks expect?

Mackenzie Rush, DPT, PT: Yes. So your initial visit when you show up to our office, you'll be in a private room. It'll just be, you know, me and you or whoever your Pelvic Health PT is. And first we'll talk a lot about what you're feeling. Just different things that you're experiencing that pertain to bowel, bladder, and sexual function.

 Any pain that you've had, any different procedures that you've had, or the babies you've had. We'll get a real thorough history of what's going on. And then we'll do a functional movement exam. So if you've ever had PT in the past, it is super similar to that. So thinking, think like bending down and touching your toes, and doing a squat, and standing on one leg.

Because we want to see how you move. Your pelvis is pretty much the anchor of your body. And so your pelvis does a lot of things and the way that you move can really show us, you know what maybe is causing your pelvic dysfunction. And then we'll also do a pelvic floor exam if it's warranted. And what that includes, so there's no mystery about it, is typically an intravaginal, which is an inside the vagina or an intra rectal, which is inside the rectum exam.

And with that, we are able to feel the pelvic floor muscles and we'll ask the patient to squeeze and relax or cough, so that we can make sure that these muscles are doing what they're supposed to be doing. And oftentimes they're not, and we, you know, communicate that with you in real time, and we make it real quick and really private and pretty seamless.

And I typically don't even have to ask a patient to cough because at some point we're giggling together and that tells me what I need to know. So I think we just do our very best to make it as easy and as, you know, painless and as, you know, least embarrassing as possible. Because we're so used to this, and we know it's a hard thing to talk about, so we make it as easy on our patients as possible.

So, after we do all of that and collect all of that information, we talk about it and we make a plan. And typically, we do follow up sessions, and those are usually once a week for about 6 to 12 weeks, depending on what all you've got going on. And you'll typically meet with your same physical therapist every single time. We definitely make that a priority at Franciscan. So, we think that patient relationship is really important, especially with an issue regarding this. So yeah.

Host: It sounds pretty, as you say, painless, seamless, some laughs along the way. I think maybe the last thing, just to make it a little bit easier on prospective patients, how can they access the PT services at Franciscan Health or just in general?

Mackenzie Rush, DPT, PT: Yeah, so you can access physical therapy with a referral from your doctor, so your family health doctor, your OBGYN, your urogynecologist, anybody that you're gonna be talking to about any of these issues can write you a referral for Pelvic Health Physical Therapy. And then also in Indiana, Pelvic Health PT, and really any kind of PT, is direct access.

So that means if you do not have government insurance, you can come to a physical therapist whenever you want to, and you can get evaluated and treated within 42 days. Now what I typically do, and what a lot of physical therapists do, is we love to communicate with physicians. And so when we evaluate you, we'll ask you know, what doctor you're with, so that we can send your note to that doctor so we can all kind of be on the same team and the same page.

And then we don't necessarily have to have a time frame where we have to complete it. That, 42 days goes away. And so that is typically what happens.

Host: Awesome. Really appreciate your time today. A lot of good takeaways today. I'm sure listeners do as well. So thanks so much and you stay well.

Mackenzie Rush, DPT, PT: All good, thanks so much.

Host: And for more information regarding Pelvic Health PT services at Franciscan Health, go to franciscanhealth.org and search Pelvic Rehabilitation. And if you found this podcast helpful, please share it on your social channels and be sure to check out the full podcast library for additional topics of interest. This is the Franciscan Health Doc Pod. I'm Scott Webb. Stay well, and we'll talk again next time.