Transcription:
Pelvic Floor Physical Therapy Basics

Disclaimer: The medical The medical health information provided during this program is for general information and educational purposes only and is not a substitute for professional advice. None of the given information is for the purpose of diagnosis or treatment. Neither does this program serve as approval for any health product or brand. This program aims to enhance your personal health and wellness through the adoption of healthy lifestyles and your prompt presentation to the health professional whenever you suspect that you are ill. For treatment and professional advice, ensure you consult your physician.

Melanie Cole (Host): If you experience urinary leakage, pelvic pain or dysfunction, you're not alone. Pelvic floor dysfunction is a common condition experienced by so many people. It can result from pregnancy or childbirth, and many women don't want to discuss it with their doctors because they may be too embarrassed or they think it's a normal part of aging.

Welcome to Say Yes to Good Health with Memorial Hospital. I'm Melanie Cole, and I invite you to join us as we give an overview of pelvic floor physical therapy. Joining me is Katie Ruebush. She's a Physical Therapist with a specialty in women's health and pelvic floor at Memorial Hospital. Katie, I'm so glad to have you join us today because this is a topic that not everybody's familiar with and you and I, both being health professionals know about this, and it's been around, not that long.

Give us a little bit of an overview of pelvic floor physical therapy, of women's health, physical therapy in general. Tell us about your background and the clinic at Memorial Hospital.

Katie Ruebush, PT, DPT (Guest): Sure. Well, thanks for having me. I'm so excited to discuss this area of physical therapy that I love and I am so passionate about. And when I was told I had the opportunity to do this podcast, I started thinking about, well, when did I really start getting interested in women's health. And honestly, I think it started from the fact that I have always been a feminist, even from a very young age.

I grew up on a family farm and my parents always instilled that I was going to be doing some of the same jobs and tasks that my older brother was doing. And it didn't matter that I was a girl and through high school and college, and I'm still, you know, a female athlete. That really pushed me to want to help other women live healthy, active lifestyles.

And so I think the idea of empowering women has always been at the forefront of my brain and throughout grad school, when I was in physical therapy school at Wash U in St. Louis, I was then surrounded by practitioners who were pioneers in women's health physical therapy and pelvic floor physical therapy.

And I was able to mentor under them. And that just sparked an interest that has continued. I've done clinicals at Rush Hospital where I was able to work under pelvic floor PTs. I've done lots of continuing education and since graduating from physical therapy school, eight years ago, I've seen all kinds of men and women with lots of different kinds of complaints and conditions.

And it's just been a really neat population to work with. A big reason why I love it is I love connecting with women throughout their lifespan and being a part of different events and milestones that are big life events and transformative moments that I can then be a part of and help women through.

Host: That's really an interesting story and so much experience Katie. So, tell us about the importance, as you're telling us about what women's health PT really is. Tell us about the importance of this multidisciplinary approach. And you can tell us about the clinic at Memorial Hospital as well because people don't understand that there are many providers and you all work together.

Katie: Correct. To start, I think it's important to acknowledge that women's health tends to be lacking. We need to do better as healthcare providers to care for women. So, postpartum care I feel is lacking and I think help for an aging female is lacking also, and we need to change that. And the way we're changing it here at Memorial Medical Clinic is that we are addressing women with a holistic approach and a team approach because the issues we're talking about are really complex. These are complex systems and they require a team approach, full of experts that can help patients with these issues.

Host: So what an important point that you just made because it really is all about a team approach. So, why don't you tell us about some of the conditions that you treat as a women's health physical therapist. Tell us about pelvic floor disorders. What even are they? And do you find that some women are hesitant to discuss them, because sometimes it could be a little bit embarrasing?

Katie: I think there's several reasons that we don't talk about some of these issues. So, some different conditions that physical therapist who's specializing in pelvic floor can treat are urinary incontinence or leakage, fecal incontinence, urinary frequency and urgency, difficulty emptying bladder, constipation.

I see patients with lots of pelvic pain or rectal pain, tailbone, coccyx pain. Lots of different things, but I think people don't love talking about that sort of thing because it is embarrassing, but also I think women tend to not take the time for themselves. You know, women wear lots of different hats and we take care of lots of different people.

And when you start talking to some of these women, it's like, they go to work and they do their job during the day. And then they come home to another job and we need to learn that we need to take care of ourselves because you can't take care of everyone else until you start with taking care of you.

Host: Well, isn't that appropriate right now because we've always used the term, put your own mask on before you put the masks of your loved ones on, like they say on the airplanes. Now that has a different sort of intonation, but it's true, Katie. We are the caregivers of the world. And unless we take care of ourselves, whether it is our pelvic floor and physical therapy or heart disease, whatever it is, we have to know what's going on in our own bodies before we can help those we love. So, why don't you tell us a little bit about whether this is a normal part of aging? Because I think one of the things that women tend to think is, okay, so I leaked a little, when I laugh, I've had three babies it's, you know, and as someone who's had two babies and gone through menopause, I know. I've had to cross my legs sometimes. Tell us a little bit about why these things happen and if it's normal.

Katie: Common symptoms that we're talking about, the urinary leakage, frequency, urgency, pelvic pain; these are very common symptoms, but they are not optimal. And people need to know that there are lots of ways that you can address those issues. We don't need to accept them as a normal part of aging. There are lots of things that we can do to change those symptoms and help you lead a higher quality of life.

The main jobs of the pelvic floor are to provide support for your internal organs. They provide control of continence and they prevent the leakage of urine and stool when they're contracting. If they're relaxed, that allows us to eliminate. The pelvic floor also provides a sexual function, but in general, the pelvic floor is such a complex system and it works in coordination with the abdominals and the diaphragm to create better outcomes when all three are working together in this kind of symphony of coordinating muscles.

Part that makes it so complex is that we need to treat the pelvic floor not only in a top down, but a bottom up approach because not only do we need to work on the strength and coordination and endurance of these muscles, we also need to make sure that they are working at the optimal length intention.

And this is where it gets really fascinating for me because the pelvic floor is a group of muscles that sits in your pelvis, like a hammock. And it attaches from your tailbone to the pubic bone and when the alignment and movement patterns of a person are not optimal, those muscles do not work in the right length intention.

And it's similar to any other muscle group in the body where that if they aren't at the right length intention, they are not generating force optimally and they don't function properly. And this is what leads us to these symptoms that we're talking about, the pelvic pain, the frequency, the urgency and the leakage.

And so even though, again, these symptoms are common, they aren't optimal and there's lots of things we can do to fix those things. And you don't have to live with those symptoms.

Host: So Katie, I'm so glad that we're talking about this. And I think the biggest question that women want to know as you're telling us about the clinic is when, when should they seek help? When should they talk to their physician or their primary care provider or their gynecologist or whoever, when is it that it's time to say enough is enough?

Katie: Well, I think it's really important for every woman to have a regular Gyny exam. We have a wonderful OB GYN here, Dr. Bell. We also have a great OB GYN, Dr. Jones, who are available to see patients. But every woman really needs to have a yearly exam. And do some preventative measures, meaning maintaining a general health and wellness, and your doctor can help you figure out where you need to be and who you need to see to accomplish that.

And besides the preventative side of things, if you have any symptoms, like low back pain, pressure or heaviness in the pelvis or rectum, leakage, pain with intercourse; these are all things that you need to tell your doctor about and encourage them to get you in to see a physical therapist and not only a physical therapist, but a therapist that specializes in seeing patients with these disorders.

It's important just to know that we are here at Memorial Medical Clinic to help you address these concerns. And we will treat you head to toe, mind and body. Know that we have not only a medical staff with an OB GYN, we have physical therapists, we have mental health counseling. We have a dietician. We have all of these people who are here to help you.

Host: Well, thank you for telling us that, because I think that's so important, but how do women or men in this case get to see you? What's involved in making an appointment. If they do talk to their referring physician or do they call you guys directly? Tell us how they get an appointment.

Katie: If a patient would like to be seen for physical therapy, have your doctor write an order for physical therapy and we will be in touch with you. And get you on my schedule. It's as easy as that. If you're having trouble finding that physician, we can help you with that also. The first step is just giving us a call and we can help you work through how to get in to see us.

Host: Okay. So I've mentioned men a few times. Do you work with men too? Like if they have prostate issues or prehab before they maybe have to have surgery, is that also something that you do or is this mostly women's health?

Katie: I see several men every year. I think men are less likely to talk about these issues. However, I see men for the same symptoms. I see men for pelvic pain. I see them for urinary issues. I see men after having prostate surgery and I think men or women that are going into any surgery, or if you're planning on becoming pregnant, or if you are pregnant, strengthening your core, strengthening the pelvic floor, it leads to better outcomes afterwards. So, if you're a patient who is planning to have a procedure, seeing me prior is very beneficial.

Host: I'm so glad that we discussed that portion, because I think that as we concentrate on women, men don't realize, as you say pre-procedure can really help to strengthen up those muscles. Now tell us a little bit about what it's like, what's an appointment like? Is it caring and compassionate? How private is it?

What kinds of things can you even do for the pelvic floor? It would seem that it's so hidden in the body. I mean, as an exercise physiologist, Katie, I can teach someone how to strengthen their core or how to, you know, tone their arms. But that's not as hard to make that connection as it is to reach inside and feel what that pelvic floor feels like with your mind to try and know what those muscles are and how to make them work.

Katie: Right. So, when a patient comes to see me, I get a very extensive subjective history. It takes a lot of time to go through all of the questions I need to figure out what's going on. Within the history, I'm also getting an understanding of what are the patient goals. This is the patient's experience.

And so whatever your goals are, that's what we're going to address. And that's what we're going to work towards. With that initial session, we're also doing an external exam. It's really interesting that a lot of urinary symptoms are reproduced by different movements. And this is where I really nerd out is that movement dictates what's happening with the pelvic floor.

So, certain movements are going to reproduce your symptoms, whatever those symptoms may be. Besides the external piece of the exam, we also do an internal exam. We are of course, in a environment where it's just myself and the patient. And if the patient would like to bring someone with, to be in the room, that's perfectly fine.

It's whatever's making the patient most comfortable. But yes, it's a private environment. It's a comfortable environment and it's always within the patient's comfort level. After doing the exam, we can develop a treatment plan that includes lots of different things. And it depends on the patient.

Everyone that walks in the door is going to leave with a different treatment plan. It's a very individualized treatment principle. And so some people leave with exercises to strengthen the pelvic floor. Some people need to relax the pelvic floor and some people need to manage the load on the pelvic floor through optimal movement pattern strategies and biomechanics. And so it's so multifaceted that it's very specific to the patient. It's very individualized. And like I said before, different professionals may also be included depending on what's going on with the patient.

Host: So, it's not all just like crossing our legs when we laugh or cough. Right. I mean, because when you say the physical movements that can affect it, I just right away pictured in my mind. Or laughing and crossing my legs. I mean, we, women have done that, whether we're taking a walk or wherever it is. So, that's something that we deal with.

Now tell us about what's exciting in your field. What kinds of things can you try? We, you know, we hear about this something called a Kegel. Tell us what that is and when you might even use it or biofeedback, and you mentioned relaxation, tell us about some of the exciting things in your field you might try with a patient.

Katie: Sure. So, with these urinary symptoms or pelvic pain, the issue can sometimes be the fact that you might have one or two drivers of your symptoms and you might think of it like a pie. And maybe 80% of that pie is one or two drivers of your symptoms, but to completely resolve your symptoms, there might be five things we are addressing. And with that said, a Kegel is the contraction the pelvic floor. And some people have urine leakage because those muscles are weak and they need more endurance. They need more strength. They need the power to lift and contract when you cough or sneeze. Some people have pelvic floor muscles that are contracting too often. And when those muscles need to work, they A, don't have the excursion to lift any higher and prevent leakage or B they're contracting too much of the time so that when they need to contract, they're fatigued. They can't do the job that they need to. And so we have to learn to down train or relax those muscles so that when we need them, they're ready and they're ready to contract to that full degree that we need them to.

Host: Isn't that interesting. And so now tell us a little bit about anything that you like women to try at home. I mean, we've heard, okay, so don't drink a lot or, you know, don't drink too much water because you know, then you won't be able to control it. Do you have some good advice that we can use for, I mean, should we be keeping a diary of when these things happen, when we leak or when pain, whether it's during sexual intercourse or during a bowel movement. Can you give us some advice about what you like us to do when we're not in a session with you?

Katie: The bladder, bowel and diet diary is really beneficial to bring in. But I think in general, as simple as it sounds, it goes back to the basics of everything in moderation, diet and exercise. And these are all things that we can get more specific with when you're here. But maintaining a healthy weight, maintaining a healthy diet and in a regular exercise or activity program are huge pieces of advice I can give you.

Host: What important information we're giving here today, Katie. So, why don't you wrap it up for us? Tell women listening what you want us to know about taking care of ourselves, about women's health, physical therapy and symptoms and things that we need to know so that we can take care of our loved ones.

So many of us, have so many jobs, as you say, and we take care of so many and it's time we took care of ourselves. So, tell us what you want us to know about women's health and the specialty of women's health physical therapy.

Katie: I want women to know that the symptoms we've talked about today, urinary leakage, fecal incontinence, pelvic pain during intercourse; all of these things are very common symptoms, but that does not mean that they are optimal. And there are lots of things that we can do to address those symptoms. And I want women to realize that we need to take care of ourselves and know that when you come here to Memorial, that our team of professionals are going to help you, and we're going to take care of you. And we would love to help you.

Host: Isn't it such an interesting profession you're in and pretty exciting time to be in it I would think because it's a burgeoning field. It's something we hadn't really seen physical therapy had been looked at really differently as just rehab right from injury, but that's not necessarily the case anymore, Katie.

And thank you so much for joining us and telling us about women's health and women's health physical therapy and the pelvic floor. You've taught us a lot today. To make an appointment with Katie, you can call 217-357- 6560, or for more health tips, you can always visit our website at mhtlc.org to get connected to one of our providers. That concludes this episode of Say Yes to Good Health with Memorial Hospital.

We'd like to thank our audience for listening and invite you to download, subscribe and rate and review these on Apple podcasts and Spotify and Google podcast. You can see them all over the place and share them specifically with your friends and family. If you know women going through the same thing, tell them about the clinic at Memorial Hospital and about Katie in particular, they can listen to this podcast and learn a lot.

I'm Melanie Cole for Say Yes to Good Health with Memorial Hospital. Thanks for listening.