Caitlin Whyte (Host): Welcome to This is Life Cast. I'm your host, Caitlin Whyte. And today I have the pleasure of welcoming Laurie Repoll from Infirmary Health. Laurie, a manager and pelvic rehab practitioner at Infirmary Therapy Services will join us for an insightful conversation about women's therapy services focusing on pelvic floor therapy and its benefits.

Well, let's dig into it, Laurie. To start us off, can you tell us what is pelvic floor therapy?

Laurie Repoll, PT, MSHSA, PRPC: So pelvic floor therapy is a specialized type of physical therapy, also can be seen by occupational therapy. We focus on the pelvic floor muscles. Specifically the ligaments, the connective tissue, and their support of the pelvic organs, the stability that they provide to your core. This can include your bladder, your uterus, prostate and rectum, and any symptoms that may be going on with those structures or your pelvis.

This therapy is designed to treat dysfunctions of the pelvic floor. Pelvic floor dysfunction can affect men, it can affect women, it can affect children, and we address all of those issues.

Host: And what are some symptoms and diagnoses that you treat with pelvic floor therapy?

Laurie Repoll, PT, MSHSA, PRPC: Really it's a variety of conditions. We frequently see patients that have urinary incontinence. Urinary incontinence can be stress incontinence, which is probably the more common urinary incontinence, which is often due to pelvic floor weakness. And so stress incontinence occurs when you have leaking with coughing, sneezing, jumping, running.Those are all stress incontinence symptoms. And so we can help with strengthening of the pelvic floor muscles to relieve those symptoms.

You can also have urge urinary incontinence, which is what you see, like when you get home from a long day at work and you put the key in the front door and you have to pee immediately, but you can't quite make it to the toilet in time and you leak before you get there, or you see the toilet and you start leaking before you're prepared to go to the bathroom.

That's urge incontinence.So we can help resolve those issues as well. We also have people that just have overactive bladders, so they find themselves going to the bathroom a lot. So they might go to the bathroom every hour during the day, or maybe they're good during the day, but when they go to bed at night, they're up 3, 4, 5, 6 times a night going to the bathroom and so we can help calm the bladder, help improve the muscle function of the pelvic floor to resolve those symptoms of an overactive bladder.

We also see people who have bowel symptoms. So that can be constipation. We see quite a few patients who are constipated. This is a huge issue in the United States and that constipation may not be caused by pelvic floor dysfunction, but it often results in pelvic floor dysfunction, which can then make the symptoms of constipation worse. So we can help improve, again, that function in your pelvic floor muscles to make bowel movements easier.

We then, on the flip side, have people who have incontinence of their stool. So they have urgency with bowel movements. They don't always make it to the bathroom in time, or they have fecal leakage, some stool that leaks into their underwear. Sometimes that can be a side effect of constipation, but sometimes it is not, and it can be a pelvic floor weakness issue, and so we can help with that as well.

Pelvic organ prolapse is something that many women experience, both after having babies and then just with age. Your pelvic floor muscles do function to support your pelvic organs. So we can be very vital in improving pelvic organ prolapse symptoms. And that kind of leads to pelvic pain. There's a lot of pelvic pain diagnoses. These can include interstitial cystitis, vulvodynia, vaginismus. All of those are kind of pelvic pain issues. And we are very critical in helping to resolve those pelvic pain issues. A lot of the pelvic pain diagnoses, people have been suffering with them for a long time.

They're chronic pain issues. Chronic pain brings about a lot of dysfunction, within the nervous system and the muscles, and so we try to address those to help people manage their pain, to help manage any flare ups in pain. And to help improve the bowel and bladder dysfunction that may come with those.

We see people who have, women who have pain during intercourse, and work with them to resolve those pain issues so that they can find pleasure in intercourse. We, of course, see prenatal and postpartum women, to help manage any issues they may have, may have during pregnancy. Most of those women, it is a pelvic girdle dysfunction, meaning pain.

Sometimes it's in the front of the pelvis, sometimes it's more in the back. So we'll help to manage their pain so that that doesn't limit them during pregnancy. Sometimes they have bowel and bladder dysfunction as well. And then postpartum, it is generally weakness or pain that we're helping to resolve. And then we do see men for pre and post prostatectomy surgeries. So the prostatectomy can result in some pelvic floor dysfunction, some urinary incontinence, some erectile dysfunction, and we can help with all of those.

Host: Is there any special training to become a pelvic floor therapist?

Laurie Repoll, PT, MSHSA, PRPC: So in addition to just your degree in physical therapy, you have to complete some specialized pelvic health training, which may include like postgraduate continuing education courses. A lot of those are hands-on courses that you attend. You do not have to be a certified pelvic floor practitioner.

I am a certified pelvic rehab practitioner through Herman and Wallace, which is one of the big companies that does certified pelvic rehab practitioners. The American Physical Therapy Association also has their own certification program as well.

Host: And what techniques or exercises can be used then by therapists to help women suffering with pelvic floor issues?

Laurie Repoll, PT, MSHSA, PRPC: So due to the variety of conditions that we see people for, our treatments are very much specific to what's going on with that patient. So when you come to see me or a pelvic rehab practitioner, they're going to first start by doing an extensive history with you to find out what's going on, how long has it been going on, how is it affecting your quality of life, to determine which course of treatment they think is going to best be suited for you.

Generally, we're going to do an internal assessment of your pelvic floor muscles, if the patient agrees to that assessment.Pelvic floor muscles, due to their location within the pelvis, the only way you can truly assess what they're doing, is an internal assessment and we'll also do an external assessment.

 And then we determine is there a weakness? Is it tight? You know, is there pain? And that information will help guide our treatment and we will use things such as biofeedback, which is essentially using sensors or trainers to help a patient engage their pelvic floor muscles by having a visual feedback.

So the biofeedback, you can see something on a screen working and it helps you to see that your pelvic floor muscles, whether they are contracting or whether they're relaxing. We also utilize electrical stimulation, which can again be used both for tight, painful muscles or weak muscles. So we can use the electrical stimulation either to activate the muscles or to relax the muscles.

And of course, we do use exercise. So a lot of people are familiar with Kegels. We take Kegels further than that though, to combine with more advanced core exercises. So we're going to use those pelvic floor muscle contractions, and combine them with more advanced exercises that are tailored to wherever that patient is based on how weak their pelvic floor is or how weak they are generally, or any pain that they may have. So those exercises will be very specific to the patient. Breathing and relaxation is also very important to pelvic floor function. Breathing can be very critical in both connecting with the pelvic floor muscles and improving overall function. So we do spend a good amount of time working on breathing, using your diaphragm, which is that largest of all of your breathing muscles. Postural training is often a part of what we do. Postural imbalances can result in pain, can result in some weakness and some decreased muscle coordination. We'll look at your posture and work on improving that posture to allow better motor control of your muscles. And then of course, again, education is just huge. We do a tremendous amount of education about the body, about the function of the pelvic floor, about your bladder and your bowel habits and the health of both of those organs and improving their function.

So it's a lot that goes into deciding how the treatments are going to progress and what we will be doing. And we may start with one thing and slowly evolve into another.

Host: Of course. And what do you want women to know about pelvic floor disorders?

Laurie Repoll, PT, MSHSA, PRPC: So many people don't realize how important the pelvic floor muscles are until they experience issues with their pelvic floor, which can again be the pain or the bowel and bladder dysfunction. Pelvic floor issues are an incredibly personal, they're very private. there's a lot of embarrassment around them.

Some people struggle to even admit their dysfunction to their own physicians. This dysfunction can really impact continence, both bowel and bladder, sexual function, your core stability, your pain. So it is important that they talk to their physicians, that they ask for referrals to physical therapy.

There is so much that we can do to help these people. And there's a lot of research that supports the involvement of a pelvic rehab practitioner, that shows our involvement greatly impacts the success and the quality of life for people dealing with pelvic floor dysfunction. It is surprisingly common in women, children, men after surgery, after trauma, as we age, and it's very often treatable. You just have to ask for help.

Host: And wrap it all up for us today. Where can people find you and what number can people call to make an appointment?

Laurie Repoll, PT, MSHSA, PRPC: I am an Infirmary Health therapist. I go to multiple locations to try to better serve the community. So I am in several locations in Baldwin County and then I also go to Mobile. My phone number is two five one. 251- 279-1640. If they want to have their physician fax in a order because we do only see patients with a physician referral.

Our fax number is 251-435-4876. I can also be reached on my email if they have questions, and my email is laurie. Repoll@infirmaryhealth.org.

Host: Thank you so much for joining us, Laurie. To schedule an appointment, you must have a physician referral. Infirmary Therapy Services are available at multiple locations in Mobile and Baldwin counties. If you have any questions about our services, please contact us in Mobile County at 251-435-4876, or Baldwin County at 251-279-4872.

You can also visit us online@infirmaryhealth.org. I'm your host, Catlin Whyte, and thank you for listening to This Is Life Cast.