Helen Dandurand: Welcome back to the Well Within Reach podcast. I'm your host, Helen Dandurand, and today I'm going to be joined by Meghan Hannig, Physical Therapist at Riverside, to talk about Pelvic Floor Health for Women, right after this ad from Riverside.

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Helen Dandurand: And we're back with Meghan. Thanks for joining me today. We're glad to have you. Could you start by just maybe telling us a little bit about yourself?

Meghan Hannig, PT, DPT, ATC: I've been a Physical Therapist for five and a half years now, working for Riverside for just over five of them. I have been working with pelvic health since I was still in PT school. I knew I wanted to get into that field, actually working with one of the therapists here as my clinical instructor.  I have an undergraduate in athletic training, which has a big emphasis on prevention, so I use that a lot in my personal practice, trying to help people figure out how to prevent problems before they become an issue.

Host: So let's get into the topic then. What is the pelvic floor and why is it important for women's health overall?

Meghan Hannig, PT, DPT, ATC: So the pelvic floor is a group of skeletal muscle, meaning it can contract and relax on command. It should be just like the muscles in your legs or in your arms, soft and squishy when you're not using them, not painful to touch. And if they are having trouble functioning properly, just like the muscles in your shoulder or your hip, they can cause pain or dysfunction such as pain with intercourse, pelvic pain, difficulty controlling the bowel and bladder.

And it's important for women in particular, because unfortunately it is an area that is still often overlooked, where women are being told that some of these symptoms are just normal, what to expect after childbirth or with time. And unfortunately, a lot of people aren't aware that it's very treatable and you don't have to live with those conditions. So that's where we come in.

Host: Yeah. That's awesome. I think that is like a really common thing that people don't understand. What would you say are some common signs or symptoms that would indicate a woman might need pelvic floor therapy?

Meghan Hannig, PT, DPT, ATC: One of the most notable that I think is considered the most common, but that doesn't mean that it's normal necessarily, is called stress incontinence, which means coughing, sneezing, laughing that can cause some leaking to happen. Also leaking with urgency. So that kind of like, I got to go to the bathroom, can't get there fast enough. Many women will say, you know, I'm pulling my pants down, I just started coming out before I was ready. On the other side, we've got constipation, sometimes some issues with diarrhea can also be treated with pelvic floor therapy, although I'm starting to find that's more of dietary and medication issues.

Again, they can have pain, pelvic pain, pain with intercourse, complications from endometriosis, that's very treatable with pelvic rehab. And then some other ones that I'm finding people don't know are very treatable with pelvic PT is if they're waking too frequently at night to use the bathroom. So over the age of, I think, 55, waking once per night is totally normal, but it really shouldn't be anything more than that unless they're taking specific medications that make them very thirsty at night and they're drinking a lot or if they're taking a diuretic or something like that. And then of course waking or getting up too frequently during the day to go to the bathroom as well. Frequency during the day can also be something that's treated with pelvic PT.

Host: Got it, got it. So what would you say are some factors that can like weaken or affect the pelvic floor area?

Meghan Hannig, PT, DPT, ATC: So this is tricky because this is where need to take a look at the whole person when we're treating pelvic patients. Your posture can affect your pelvic floor. If you have a history of constipation from pain medicine or just general diet or that's just what your kind of used to and straining too much, that can cause a lot of damage to the pelvic floor. Of course, having children does all kinds of fun stuff to a woman's body, especially the pelvic floor, since that's generally, where the baby is sitting as it grows and where the baby is passing through unless they have a cesarean. If they have a cesarean, that opens up a whole new host of issues where they're cutting through the tissues that connect to the pelvic floor via fascial connection and that impacts how you're able to use those pelvic floor muscles as well.

And then something that I think is really important is that it doesn't matter how old you are. If you have the ability to engage the muscles, meaning you don't have a neurological condition, or significant damage from say radiation or an accident; you are able to engage the pelvic floor and you can treat the pelvic floor symptoms. You can strengthen them. You can relax them. Whatever the issue is, you are never ever too old to treat these issues.

Host: That's awesome. I feel like that's something that I've heard just being a woman of people saying, yeah, that's just kind of how it is when you're older. This is what happens when you have kids. And so knowing that there's something that can be done, is really great. So when someone does make an appointment for a PT session, for a pelvic floor therapy session, what can they expect? What happens?

Meghan Hannig, PT, DPT, ATC: It's going to depend on the clinician what happens during that first appointment. If you're coming to see me, I'm spending the bulk of that session talking to you because there are so many different considerations to take in.

So I'm talking to you about your diet, your obstetric history, your sexual history, talking about medications, other medical conditions. Some people, it's a very quick, straightforward evaluation. They don't have a lot going on. They just have a weak pelvic floor or they need to relearn how to use other muscles so that the pelvic floor is not being overworked by compensating.

Very rarely I'm finding am I doing an actual assessment of the pelvic floor on the first session, just because there's not enough time. There's a lot of other things externally that we can work on before jumping in for lack of a better word. So I will usually save that for the second session. And in the second session, we are generally evaluating the pelvic floor function via a vaginal exam.

Very important to know that these patients always have the right to decline that. They always have the right to have somebody with them in the room if they would prefer. And their consent is ongoing. So, even if they tell me it's okay one time, I will always ask and make sure that they're okay with it every subsequent session.

Even if we're in the middle of a session and I've been treating them for a little while and they decide, oh, I'm not comfortable with this anymore, then they can always decline the treatment. I think that's really important for them to know that they're in charge.

This is a sensitive area that we're treating, but just like the shoulder, it's really hard to appropriately address a shoulder issue if I can't see your shoulder, if I can't feel what your shoulder is doing. I can't see what's happening in your pelvic floor, so I have to exclusively feel for it.

Is it possible to treat the pelvic floor without doing a vaginal assessment? Yes. Is it much more challenging and sometimes much less effective? Yes. It can take much longer, take many more visits, eat up a lot more of your insurance money and I like to be as efficient with your money as possible.

So usually I'm recommending it unless there's specific instances that somebody's really not appropriate for it. This is true for all age groups except for children. We will not generally do an internal with anybody who is a minor unless there's, specific circumstances that make it necessary.

Host: Got it. Yeah, that's good to know. I feel like I didn't even know necessarily what goes into the session at all. So I think it's good to know that that is a factor, but also good to know, I think, just thinking without knowing that, like, what exactly happens? What would you even do to help me? Like, what could you possibly do?

I think when you hear that part of it, it's like, okay, so there is a lot going on here to make it all work and to know that you value patient's time and want to make it work is really great.

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And we are back. So how would you say that pelvic floor therapy differs from other forms of physical therapy?

Meghan Hannig, PT, DPT, ATC: Pretty much just the internal component is the biggest factor. There are some more sensitive questions that we're going to focus on more in depth with pelvic floor therapy, especially if their symptoms are having to do with intercourse or pelvic pain in general. We can, of course, start to get into a little bit of trauma discussions as well. In those situations, I am almost always making sure that the patient is receiving talk therapy counseling because they end up usually accidentally using us as that, and we're not trained necessarily as talk therapists. I'm sure there are some out there who are, which is wonderful. That is definitely not somewhere that's my expertise and I always want to make sure that those patients are addressing that trauma appropriately.

And there's a lot of physical ramifications over time from not addressing that kind of trauma. So that's certainly one aspect that you're not going to get if you're coming in to have your knee treated. And then of course, we're addressing things a little bit more sensitively in the sense that it is more nuanced or more focused on can they feel what they're doing on a day to day basis.

It's littler movements because it's not a very big visible muscle group. We're focusing on their neuromuscular control of the area. Can they engage those muscles without engaging other muscles versus how much are they able to lift in a typical physical therapy session? Can they reach certain strength goals to be able to lift heavy things? They don't need to do that with the pelvic floor. It's just the functional aspects that we're more so focusing on.

Host: Cool. Could you be able to tell us a little bit about the misconceptions that you encounter about pelvic floor health and how you address them?

Meghan Hannig, PT, DPT, ATC: I think that people don't realize how many other parts of the body that we are treating when we're looking at the pelvic floor. It's not just us doing the vaginal assessment for the whole session. It's certainly not just Kegels, ever.

There's always more to think about. Other muscles play a role, in the hips, in the abdominals, the back muscles, your inner thigh muscles, all of those are important. They're attaching either to or around the pelvic floor.

And if those aren't doing their job properly, the pelvic floor might be compensating. So, people don't realize how much breathing is a component and posture is a component of pelvic floor rehab and how much of a difference that they can make by addressing those before we even have to palpate the pelvic floor.

Host: That's great. Would you say that there are some exercises or habits that women can adopt, maybe before they even have an issue to help them to have a strong and healthy pelvic floor?

Meghan Hannig, PT, DPT, ATC: Absolutely. And before I jump into that, I'll recommend what you shouldn't do. And that is every time you go to pee, don't try to stop yourself from peeing midstream because that is a reflex that is happening in your body to allow you to urinate.

And you're actually kind of messing with that natural reflex that's occurring, and it can really confuse the brain, spinal cord, pelvic floor communication that's happening. If you really want to know if you can do it, I believe the recommendation is no more than once a week, if you really want to be able to know.

But, what's more important is if you're having other symptoms. That will tell you if your pelvic floor is doing its job properly. As far as things that you should do, always sitting up nice and tall, avoiding that crouched over posture, as I see you sit holding up a little bit.

Helping yourself by not holding your breath when you move. So if you hear yourself making that noise as you bend to pick something up or pick up your child or lift something, you need to try to get out of that habit if you can and allow yourself to just exhale. So, one of the therapists that I've worked with would always say blow as you go.

So, exhale slowly as you're moving, as you're doing something, to prevent yourself from holding your breath. When you hold your breath like that, it does something called the Valsalva Maneuver. And it's a ton of abdominal pressure that's created. And gravity is usually going to win in the human body, so that means all that pressure is usually going to go down and it can cause

 pelvic floor issues. Then the other thing is just exercise such as walking, general hip exercises, nothing crazy, just making sure that you are moving your body so that you don't have the opportunity to find out the hard way that you lost the ability to move a certain way.

Host: Yeah, that's great. Those are all great pieces of advice. And how would you say that women can advocate for themselves if they feel that their pelvic floor concerns are maybe being overlooked?

Meghan Hannig, PT, DPT, ATC: Having had this happen myself, having been told, unfortunately, while I was pregnant and then after having a baby, that I didn't need to go to a pelvic PT, that these problems were normal and just kind of deal with it; if you are seeing a physician, PA, NP, whatever the case may be, who does not feel that it's something that's appropriate for you, but you kind of feel like maybe it's something you should explore; you can always ask your general practitioner, primary care provider. They will almost always be more than happy to give you that referral for physical therapy. Also we do have in Illinois, direct access. I personally always prefer my patients have a referral from a physician because that means other major concerns have already been ruled out like a UTI or other issues.

But if you do feel that you really need this and you just can't for some reason get one of your doctors to give you this referral, you are able to come for physical therapy without a referral.

Host: That's good. Good to know. Where, so here within Riverside, where is pelvic floor therapy offered?

Meghan Hannig, PT, DPT, ATC: Right now, we offer services here in the Frankfurt Clinic in Manteno in the new facility that they have downtown and at the Kankakee Clinic, which is the pelvic floor clinic. They treat pelvic floor exclusively there. That is in the pavilion of the hospital.

Host: Great. All good to know. And if there's a woman who might feel embarrassed or hesitant to seek pelvic floor therapy, what kind of advice would you give them?

Meghan Hannig, PT, DPT, ATC: If you feel like you're alone in it, you're not. There are so many of us who have experienced these issues. Even if we haven't had a baby, even if we haven't had anything that we know of that should be causing this problem, you deserve to have this addressed in a way that doesn't necessarily require medication or other kinds of treatments. It's very conservative treatment in the sense that you're able to manage it yourself forever, as long as you know what to do. There's no medications that we necessarily have to have you taking forever. If it's just a musculoskeletal issue, just consider it the same as if your shoulder hurt. You have muscles there. They have a job to do and they're not doing their job properly right now. We can help you to make them do their job properly.

Host: That's great. I think that's really helpful. And I think that's all we really had for today. Is there anything else you wanted to add here?

Meghan Hannig, PT, DPT, ATC: If you haven't already been talking to your girlfriends about this, I would invite you to have a conversation with them and see who's having these issues. More often than not, I'm having patients come in and say I didn't even know this was something that could be treated. I didn't know all my friends had this until I started getting it treated and I talked to them about it. And now they all want to have it treated. And then also you can always just Google a provider in your area. A lot of people don't know that we're here and we are more than happy to help you with these issues.

Host: That's great. I think it's great to encourage women to just be talking to each other about what's going on, and in order to be able to have a healthier and happier life. So thank you for being here today, Meghan.

Meghan Hannig, PT, DPT, ATC: Thank you so much.

Host: Yeah, and listeners for tuning in to the Well Within Reach podcast brought to you by Riverside HealthCare. For more information, visit riversidehealthcare.org.