Maggie McKay (Host): Pelvic floor health is not usually something we give much thought to until there's a problem. Our guest today is Sarah Yunghans, a pelvic floor physical therapist with ProMedica to tell us what we need to know when we do have a problem. Welcome to Happily Ever After 40, a podcast brought to you by ProMedica, where we discuss midlife health and wellbeing. In this episode, we'll talk about treating pelvic pain and dysfunction with pelvic floor physical therapy. Thank you so much for joining us, Sarah. It's great to have you here.

Sara Yunghans: Thank you, Maggie. It's great to be here.

Host: First of all, what is pelvic floor physical therapy.

Sara Yunghans: This is the number one question I get. Most people haven't heard of pelvic floor physical therapy. Basically, it's a non-surgical, conservative approach to rehabilitation of pelvic floor dysfunctions, dysfunctions that pertain to pain, bowel, bladder and sexual health.

Host: What does pelvic floor physical therapy involve?

Sara Yunghans: So typically with the first appointment, that's our big appointment, we do a really thorough examination, and really kind of get down into what is really the root of the problem. So, we're assessing different components of your pelvic health. And then, we get into different strategies for how we can help patients achieve their goals, so different behavioral strategies, we have manual therapies, different modalities like biofeedback, exercise, education and then functional retraining of these muscles.

Host: And what conditions can be addressed?

Sara Yunghans: Lots of different conditions. The main ones that we see are urinary incontinence, even fecal incontinence, sexual dysfunctions. We see pelvic organ prolapse. Pelvic pain is also a big one. And then, we see constipation and then lumbar, hip, SI joint dysfunctions that may not have responded to traditional physical therapy.

Host: How does somebody start pelvic floor physical therapy?

Sara Yunghans: So, talking to your primary care provider or an OB-GYN or really any of your providers about your concerns is the first thing that you'll need to do. And then, they will send in a referral so that we can get you scheduled to come in and have that initial examination and be seen for follow-up.

Host: And you mentioned some of the conditions, but let's say you don't even know you need this. What are some of the signs that should get you to go to the doctor and then they can tell you you need it?

Sara Yunghans: So, a lot of women have this unfortunate misconception that pelvic floor dysfunctions are normal. Pelvic floor dysfunctions are very, very common, but they're never normal. So, things like urinary incontinence, 41% of women over the age of 40 have some form of urinary incontinence. And we're unfortunately under the impression that this can be expected as we age, as we have children, but this really isn't the case. And there's a lot that can be done to treat urinary incontinence. So, anytime urine leaks, anytime urine leaves the body when it's not time, is a good time to talk to your doctor about it.

Host: Any other conditions?

Sara Yunghans: So, pelvic organ prolapse is another really common condition that we see. And it is a real top reason for women to seek out care from their primary care provider or their OB-GYN. Pelvic organ prolapse, it occurs when there's weakening of the structures that give us stability in our pelvic floor. So, it can present as sensations like a bulge in your pelvic floor, and sometimes it's present and sometimes it's not. So, people can be kind of confused about when they're supposed to say something about it. But it is a very common condition, and we see about 200,000 inpatient surgeries are done each year in the US to address pelvic organ prolapse, and there's quite a bit that can be done with physical therapy to improve this condition and strengthening the muscles, not just in the pelvic floor, but in the hips, in the core to help stabilize things so that this is not such a heavy impact on quality of life.

Host: And how long does it last? I mean, do you do the therapy and then maybe you have to do maintenance along the way or you never have to do it again?

Sara Yunghans: Well, as much as I would like to say you wouldn't have to do it again, maintenance is required. So, initially, you'll come in for that first appointment. We really get into a lot of detail about what's going on. And then, we can develop a very individualized plan to help you reach your goals. That always involves a home program. So, things that you can be doing, not just exercise-wise, but behavioral-wise to help with your symptoms. Now, after you're discharged from therapy, it'll still be important to keep up with those behavioral changes and keep up with the modifications that we recommend to keep those symptoms manageable long-term.

Host: Is that like eating well and exercise and drinking lots of water, things like that?

Sara Yunghans: A lot of the things that we think about when we think about aging, like decreased activity, say. Decreased activity with the weakening of the muscles that can occur with that can increase your likelihood of developing a pelvic floor dysfunction. It also increases your risk, of course, of weight gain. So, maintaining a healthy weight is very important for a healthy pelvic floor. They actually did a study in 2009 that showed that women who have something we call stress urinary incontinence, so that's that ever popular leakage with coughing, sneezing, laughing. Women who had that condition, if they lost 10% of their body weight alone, their symptoms decreased by 50%. So, that's a fairly impressive statistic, and that was without any exercise or any physical therapy intervention. So, you can imagine if we can couple that with very specified pelvic floor exercises, we can anticipate that women would have an even greater improvement.

Host: That's amazing. Just that alone. Sarah, is there anything else in closing that you'd like to add?

Sara Yunghans: I think most women could really benefit from at least a consultation. Anytime we've had a surgery, before and after pregnancy, and then just with hormonal changes that occur as we age, pelvic floor physical therapy really has a place in the healthcare system. So, get in, talk to your provider, and come on in.

Host: Thank you so much for your time. This has been so informative and helpful. Thank you.

Sara Yunghans: Thank you.

Host: That's Sarah Yunghans. And if you would like to find out more, please go to promedica.org. And if you found this podcast helpful, please share it on your social channels and check out our full library for topics of interest to you. Thanks for listening. I'm Maggie McKay. This is Happily Ever After 40, a podcast brought to you by ProMedica. Until next time, stay happily ever after 40.