Selected Podcast
Find Healing with Pelvic Floor Therapy- Treatment for Prenatal and Postpartum Patients--and More
Pelvic floor therapy can benefit women before and after pregnancy. Dr. Kelly Cooke, Physical Therapist and Outpatient Clinical Coordinator of Gibson Area Hospital Therapy Services, discusses pelvic therapy.
Featuring:
Kelly Cooke, PT, DPT
Kelly Cooke, PT, DPT has a Bachelors of Science from Olivet Nazarene University in 2012, Doctor of Physical Therapy from Governors State University in 2015. Staff Physical Therapist at Gibson Area Hospital since 2015, specializing in orthopedic and pelvic rehab. Transcription:
Melanie Cole (Host): If you experience urinary leakage, pelvic pain or dysfunction; you are most definitely not alone. Pelvic floor dysfunction is such a common condition experienced by women, myself included. However, physical therapy may help. Joining me today is Kelly Cooke. She’s a Physical Therapist and Outpatient Clinical Coordinator of Gibson Area Hospital Therapy Services. Kelly, I’m so glad to have you join us today. I want to start by asking about incontinence. A lot of women think this is a normal part of aging. Are pelvic floor dysfunction and disorders, are they just a normal part of aging that we just sort of have to deal with?
Kelly Cooke, PT, DPT (Guest): That is a great question to start with. And I love debunking this myth. Because I love to say that pelvic conditions including incontinence, pelvic pain, constipation, anything that really involves the pelvis; those things are very common, but they are not normal. So, you are going to see them a lot, you are going to talk about them with people, you are going to discuss those issues with your doctor frequently, but they are not normal. And they are not normal parts of aging. They are just common.
Host: Well they certainly are, this is kind of something that just happens. When women describe this condition to you, or their primary care providers; are they embarrassed? Do you find that women are embarrassed? I mean I’m not, but do you find that women are embarrassed to discuss this?
Kelly: Yeah. nobody wants to admit that they have incontinence or that they suffer from constipation or that they have pelvic pain and it hurts to sit. I mean those are not comfortable conversations to have. But a lot of us do have them and then by the time they get to a therapist and they are in my office or they are in my treatment room; they are experiencing symptoms that are very, very severe because they didn’t want to have that awkward conversation months or years ago. So, it’s absolutely worth the conversation so that you can get help quickly before anything escalates.
Host: When you say anything escalates, how do we know when it’s time to seek help? I mean you laugh, or you cough and a little leaks or like you say or got forbid fecal incontinence but any of these things or pelvic pain which is really common. But we feel like we just have to live with it. When do we know it’s time to get help?
Kelly: When you feel like it’s not a normal part of your day or that it is a normal part of your day because it’s happening way too often; it’s time to talk to somebody about it.
Host: Okay so pelvic floor physical therapy. Tell us what that is and what special training that you have that can help us with these kinds of disorders which would seem to be antithesis to normal physical therapy.
Kelly: Yeah, so, pelvic physical therapy is fairly new. I mean physical therapy has been around for 60 to 70 years now for knees, shoulders, backs, feet, all those things. and we’ve always studied the pelvis but not to the extent that we are now. In the last several years, it’s actually been termed more women’s health physical therapy and that is changing. That’s changing in the APTA, that’s changing across the board where we are now calling it pelvic rehab so that both men and women with pelvic concerns are feeling included. Which is huge for just our practice alone because I can treat men and it’s not that much different than treating women. And we do have some very similar issues. What makes my training different from a regular physical therapist who sees you for back pain or shoulder pain is that I have gone to some very specific extensive classes that teach me how to do a pelvic exam, that teach me how to check the muscles of your pelvis in a very specific but pain-free way so that I can better help you get through your problems.
A lot of the problems that we talk about are all muscularly related and they can be treated very similarly to back pain or shoulder pain. They are just hard to get to. So, a normal physical therapist who has been through PT school does not have the training that I do. It is extra.
Host: Well thank you for that very comprehensive answer. So, as we talk about that kind of treatment; tell us what it is that you do. I mean we’ve heard about Kegels and women try and do that and men even too and I’m glad that you mentioned that you can work with men because I was going to ask you that. But not everyone really knows how to do them, or they think they are doing them correctly. Tell us what else that you can do for us whether we should be keeping a voiding diary or bladder training. What do you do as a physical therapist to help us with this?
Kelly: So, exactly what you mentioned are some of the things that we start with. So, are Kegels appropriate? And you can say that word anyway you want to, it really doesn’t matter. I’ve heard them a thousand different ways. But essentially, it’s a pelvic floor contraction just like you do a bicep curl. It’s a pelvic floor curl. You are essentially tightening those muscles and then relaxing them. But what most people do wrong is that they tighten too many things. Because it is a very subtle sensation. Most people are doing too much. So, a lot of my education is allowing and teaching patients to dial in to very specific muscle groups to make sure that they are not worsening the problem.
And then it’s just a – it’s very simple. It’s if muscles are tight, we work on stretching and relaxing them. If they are weak, we work on strengthening them. If it’s a reflex problem, in particular I’m thinking urinary urgency where you are going to the bathroom every 20 minutes and you are like I know this isn’t normal. That’s more of a reflex problem than it is a muscular problem, but it can be fixed. So, we work on reflexes. I can use biofeedback which essentially is just like putting little electrodes on your skin to teach you when they are firing and when they are not firing. We can use a lot of manual therapy. So, I use my hands to teach you where things are at, how they feel, what they should feel like, make sure that they are not painful. And making sure that all the other muscles that are connected to your pelvic floor which are many; making sure that they are working appropriately and if they are not, they could be wreaking havoc on your pelvis as well.
Host: Well that really is a comprehensive approach. So, tell us about the comfortable, caring compassionate, private, confidential way that you are working with women and what you can do for them. Give us your best advice and tell us how comfortable women are getting this type of treatment and men for that matter.
Kelly: Yeah, so because these are very uncomfortable topics, I do my absolute best to make sure that when you come in and have a conversation with me, and that’s really what the first appointment is. It’s just to have a conversation. It’s to figure out where you are at, what’s going on, what really is the root of the problem and I ask a very, very detailed pelvic history. I really get into the nitty gritty of how many babies have you had, was labor intense, how long did you have to push, did you have any tearing, have you had any symptoms since then and I don’t care if it was 40 years ago. Like I want to know how specific it was. I want to know how long you’ve had symptoms and are they getting worse. I want to know how long you’ve had pain or how long have you had constipation and we get very, very specific. But I also really, really care. You should be able to have a normal bowel movement. You should be able to go to the bathroom when you want to. You should be able to do all the things without any pain. And it is my absolute honor to be able to teach you and guide you through some of those things with very little treatment which is the best part.
Host: Well it certainly is, and I can hear the passion in your voice Kelly. And I can hear that how much you love your job and how you are really helping women in this private confidential and caring way. Thank you so much for joining us and explaining what pelvic physical therapy, pelvic rehab really is. Thanks again. And that concludes another episode of Getting Healthy With Gibson. Talk to your primary care provider about a referral for pelvic floor therapy or call 217-379-2500 for more information about pelvic floor therapy services available at Gibson Area Hospital Therapy Services in Paxton. Please visit our website at www.gibsonhospital.org for more information and to get connected with on of our providers. Please remember to subscribe, rate and review this podcast and all the other Gibson Hospital podcasts. This is Melanie Cole.
Melanie Cole (Host): If you experience urinary leakage, pelvic pain or dysfunction; you are most definitely not alone. Pelvic floor dysfunction is such a common condition experienced by women, myself included. However, physical therapy may help. Joining me today is Kelly Cooke. She’s a Physical Therapist and Outpatient Clinical Coordinator of Gibson Area Hospital Therapy Services. Kelly, I’m so glad to have you join us today. I want to start by asking about incontinence. A lot of women think this is a normal part of aging. Are pelvic floor dysfunction and disorders, are they just a normal part of aging that we just sort of have to deal with?
Kelly Cooke, PT, DPT (Guest): That is a great question to start with. And I love debunking this myth. Because I love to say that pelvic conditions including incontinence, pelvic pain, constipation, anything that really involves the pelvis; those things are very common, but they are not normal. So, you are going to see them a lot, you are going to talk about them with people, you are going to discuss those issues with your doctor frequently, but they are not normal. And they are not normal parts of aging. They are just common.
Host: Well they certainly are, this is kind of something that just happens. When women describe this condition to you, or their primary care providers; are they embarrassed? Do you find that women are embarrassed? I mean I’m not, but do you find that women are embarrassed to discuss this?
Kelly: Yeah. nobody wants to admit that they have incontinence or that they suffer from constipation or that they have pelvic pain and it hurts to sit. I mean those are not comfortable conversations to have. But a lot of us do have them and then by the time they get to a therapist and they are in my office or they are in my treatment room; they are experiencing symptoms that are very, very severe because they didn’t want to have that awkward conversation months or years ago. So, it’s absolutely worth the conversation so that you can get help quickly before anything escalates.
Host: When you say anything escalates, how do we know when it’s time to seek help? I mean you laugh, or you cough and a little leaks or like you say or got forbid fecal incontinence but any of these things or pelvic pain which is really common. But we feel like we just have to live with it. When do we know it’s time to get help?
Kelly: When you feel like it’s not a normal part of your day or that it is a normal part of your day because it’s happening way too often; it’s time to talk to somebody about it.
Host: Okay so pelvic floor physical therapy. Tell us what that is and what special training that you have that can help us with these kinds of disorders which would seem to be antithesis to normal physical therapy.
Kelly: Yeah, so, pelvic physical therapy is fairly new. I mean physical therapy has been around for 60 to 70 years now for knees, shoulders, backs, feet, all those things. and we’ve always studied the pelvis but not to the extent that we are now. In the last several years, it’s actually been termed more women’s health physical therapy and that is changing. That’s changing in the APTA, that’s changing across the board where we are now calling it pelvic rehab so that both men and women with pelvic concerns are feeling included. Which is huge for just our practice alone because I can treat men and it’s not that much different than treating women. And we do have some very similar issues. What makes my training different from a regular physical therapist who sees you for back pain or shoulder pain is that I have gone to some very specific extensive classes that teach me how to do a pelvic exam, that teach me how to check the muscles of your pelvis in a very specific but pain-free way so that I can better help you get through your problems.
A lot of the problems that we talk about are all muscularly related and they can be treated very similarly to back pain or shoulder pain. They are just hard to get to. So, a normal physical therapist who has been through PT school does not have the training that I do. It is extra.
Host: Well thank you for that very comprehensive answer. So, as we talk about that kind of treatment; tell us what it is that you do. I mean we’ve heard about Kegels and women try and do that and men even too and I’m glad that you mentioned that you can work with men because I was going to ask you that. But not everyone really knows how to do them, or they think they are doing them correctly. Tell us what else that you can do for us whether we should be keeping a voiding diary or bladder training. What do you do as a physical therapist to help us with this?
Kelly: So, exactly what you mentioned are some of the things that we start with. So, are Kegels appropriate? And you can say that word anyway you want to, it really doesn’t matter. I’ve heard them a thousand different ways. But essentially, it’s a pelvic floor contraction just like you do a bicep curl. It’s a pelvic floor curl. You are essentially tightening those muscles and then relaxing them. But what most people do wrong is that they tighten too many things. Because it is a very subtle sensation. Most people are doing too much. So, a lot of my education is allowing and teaching patients to dial in to very specific muscle groups to make sure that they are not worsening the problem.
And then it’s just a – it’s very simple. It’s if muscles are tight, we work on stretching and relaxing them. If they are weak, we work on strengthening them. If it’s a reflex problem, in particular I’m thinking urinary urgency where you are going to the bathroom every 20 minutes and you are like I know this isn’t normal. That’s more of a reflex problem than it is a muscular problem, but it can be fixed. So, we work on reflexes. I can use biofeedback which essentially is just like putting little electrodes on your skin to teach you when they are firing and when they are not firing. We can use a lot of manual therapy. So, I use my hands to teach you where things are at, how they feel, what they should feel like, make sure that they are not painful. And making sure that all the other muscles that are connected to your pelvic floor which are many; making sure that they are working appropriately and if they are not, they could be wreaking havoc on your pelvis as well.
Host: Well that really is a comprehensive approach. So, tell us about the comfortable, caring compassionate, private, confidential way that you are working with women and what you can do for them. Give us your best advice and tell us how comfortable women are getting this type of treatment and men for that matter.
Kelly: Yeah, so because these are very uncomfortable topics, I do my absolute best to make sure that when you come in and have a conversation with me, and that’s really what the first appointment is. It’s just to have a conversation. It’s to figure out where you are at, what’s going on, what really is the root of the problem and I ask a very, very detailed pelvic history. I really get into the nitty gritty of how many babies have you had, was labor intense, how long did you have to push, did you have any tearing, have you had any symptoms since then and I don’t care if it was 40 years ago. Like I want to know how specific it was. I want to know how long you’ve had symptoms and are they getting worse. I want to know how long you’ve had pain or how long have you had constipation and we get very, very specific. But I also really, really care. You should be able to have a normal bowel movement. You should be able to go to the bathroom when you want to. You should be able to do all the things without any pain. And it is my absolute honor to be able to teach you and guide you through some of those things with very little treatment which is the best part.
Host: Well it certainly is, and I can hear the passion in your voice Kelly. And I can hear that how much you love your job and how you are really helping women in this private confidential and caring way. Thank you so much for joining us and explaining what pelvic physical therapy, pelvic rehab really is. Thanks again. And that concludes another episode of Getting Healthy With Gibson. Talk to your primary care provider about a referral for pelvic floor therapy or call 217-379-2500 for more information about pelvic floor therapy services available at Gibson Area Hospital Therapy Services in Paxton. Please visit our website at www.gibsonhospital.org for more information and to get connected with on of our providers. Please remember to subscribe, rate and review this podcast and all the other Gibson Hospital podcasts. This is Melanie Cole.