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Terry Streetman (Host): Welcome back to Well Within Reach, presented by Riverside Healthcare. I'm Terry Streetman, Marketing Communications representative, and we're joined here today by Noelle Fillmore, Riverside physical therapist, who's going to discuss pelvic health and how Riverside Rehabilitation and Physical Therapy can help. Thanks for joining us, Noelle.

Noelle Fillmore: Yeah, thanks for having me.

Host: Of course. We get to our questions, we're going to take a quick break for a message about myChart.

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Host: All right. So, it's your first time here with us on the podcast, I believe. Can you tell us about your background and your role here at Riverside?

Noelle Fillmore: Yeah. I've been a physical therapist now for 11 years, a little over. I've been with Riverside for most of that. I've worked in variety of settings. So, started off working inpatient, I've done home healthcare and outpatient therapy as well. So currently, with Riverside, I split my time between doing home healthcare and then pelvic floor physical therapy on the outpatient side.

Host: Okay. And I love that because it highlights sort of that full spectrum of physical therapy and care that we can provide here at Riverside.

Noelle Fillmore: Absolutely, absolutely. They're both a lot of fun in different ways.

Host: Awesome. So, you mentioned pelvic health, that's why we're here today. Can you tell us about what do we mean when we say pelvic health and why is it important for more than just women, which people might not know?

Noelle Fillmore: Yeah. And it's kind of a buzzword that not everybody really knows what we're talking about all the time. If I had to kind of drill it down, I would say it's a specialized form of physical therapy that's addressing pelvic floor muscle dysfunction.

Host: Okay.

Noelle Fillmore: And so, that typically involves bowel, bladder, and sexual functioning. It also includes, I mean, a variety of diagnoses in regards to bowel and bladder issues as well. But I would say the reason it's important is everybody has a pelvic floor.

Host: Sure.

Noelle Fillmore: Regardless of gender. I think a lot of people assume that just women have pelvic floor. I have had many people express that to me. I'm like, "No." So, it's important if you're a human because it can absolutely be relevant to you. That's also true of any age as well. I have a lot of people that assume, "Well, I have never had kids. I'm not going to have problems," or "I'm younger, there's no way I'm going to have issues with this." But in reality, issues can affect everybody of all ages and diagnoses.

Host: Okay. Well, we're going to touch on that a little bit in the next question. So, perfect segue.

Noelle Fillmore: Awesome.

Host: What are some of the most common pelvic health issues that you see in the clinics and, as you kind of touched on just now, do they change with different stages of life, like pregnancy, postpartum, aging, that kind of thing?

Noelle Fillmore: Yeah, I would say as far as most common, we see a lot of people that come in with a referral for a urinary incontinence. There's a variety of kinds that, you know, we could always talk about. There's urge incontinence, stress incontinence, things like that. We also see a lot of people that come in with overactive bladder symptoms, pelvic pain issues, even something like low back pain, sciatic issues, bowel issues as well. So, we treat constipation or fecal incontinence too. And then, pelvic pain, pain with intercourse, those are all things kind of within our purview. The other big one I see a lot is pelvic organ prolapse, which a lot of people aren't familiar with.

As far as age range goes, kind of like I mentioned, I would say a lot of these issues can happen to anybody at any age. But specifically, we see common kind of groupings of these things. So, postpartum, we see a lot of people that come in with maybe new onset of incontinence or pain-related issues. Same thing, postmenopausal, just with changes in hormones, we see changes with pelvic organ prolapse, urinary incontinence, things like that can pop up. And then in pregnancy, there's all kinds of fun stuff that are very particular to that population. So, certainly, pain is a big one, incontinence. But we do a lot of other things as well. So postpartum, we see people for strengthening. There can be issues related to diastasis recti, which is separation of the abdominals that can occur during pregnancy and postpartum that we treat.

So really, I would say it's a spectrum of all-encompassing kind of a thing. But one of the cool things about what we do is everything is connected to each other. So whether it's pain or specific bowel, bladder issues, you know, we're really able to kind of comprehensively treat all those things together.

Host: Oh, nice. Okay. Yeah, I'm seeing a theme here with sort of that full spectrum care.

Noelle Fillmore: Absolutely.

Host: so when it comes to these topics, is there a stigma around discussing them? Does it negatively impact people's health and how do you all deal with that over there in the clinics?

Noelle Fillmore: Unfortunately, that's a huge barrier to accessing care and even participating fully, I think, in therapy. One of the things I try to tell my patients all the time when they come in for an eval is I'm not embarrassed by anything that we're talking about, so I don't want you to be either.

And another big thing I hear from people, sort of when we're ending our time together is like, "Wow, I really wish I would've known about this sooner." Like, "I wish I would've talked to my provider about it." So, I also try to tell people, "Please don't hesitate." Even though these things are not easy to talk about, they can be embarrassing. If there's anything that is bothering you, please mention it to your provider because we can help with those things. So, I definitely think that's a huge barrier. We try to do a lot of education to break that down as much as we can, and explain to people what we do and why it's helpful.

Host: Awesome. Yeah, and that's one of the things I love about my job, is my job is to make sure fewer and fewer people have to say, "I wish I'd known about that." That's why we're here today.

Noelle Fillmore: Yes. I love that. Absolutely. Yes.

Host: Awesome. Well, before we get to our next question, we're going to take a moment to talk about the importance of primary care.

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Okay. We're back and we've got a few more questions here for you. So, are there things that people can do, everyday things maybe, that people can do to support and improve their pelvic health?

Noelle Fillmore: Yeah. So, here's where I can get on my soapbox a little bit. No, there's just a couple basic things that I think a lot of people don't know and maybe aren't aware of. So commonly, one, people are probably not drinking enough water. And water is very important for your bladder. I'm always talking about drinking more water, getting close to that 64 ounces if you can. It's also great for your pelvic floor.

And then, kind of within that would be if you're having bladder issues in particular, avoiding things that are bladder irritants. Okay? So there's certain things that you can eat or drink that can kind of irritate the bladder a little bit. So, carbonation, caffeine and coffee, spicy food, alcohol, all those are really common irritants. And you can look up a list at home. But if you're dealing with issues related to your bladder, watch those things that you're consuming.

Also, I like to tell people that normal urinary voiding intervals every two to four hours. So if you're going more frequently than that, then there's probably some issues related to overactive bladder a little bit. Or if you're not going that often, then you're probably a little dehydrated. So, I always like to get that out at the beginning.

The other thing is get a Squatty Potty. If you've never heard of one, It is a little step stool that goes just right under the toilet that you put your feet on when you're going to the bathroom, and it makes a huge difference.

Host: Okay. I've heard of that.

Noelle Fillmore: So, common things I like to bring up just initially.

Host: Yeah, that's great for people to know. So when someone comes into the clinic, say they have identified a problem, they talk to their provider, which is so important, they come to the clinic, what does a pelvic health visit look like? And what kinds of exercises or therapies might they expect to be told to do?

Noelle Fillmore: So, initial visit is going to involve just going through some background information. So, we're going to ask a lot of those more detailed questions about your bowel and bladder, sexual pain, all of that good stuff to see kind of where the problems lie, what's going on.

Additionally, we're going to probably go through just more of a broad orthopedic assessment with our patients. So, looking at their hips and their back and lower extremities, things like that. And then, a lot of education. So, just talking more about what the pelvic floor is, what pelvic floor therapy is, how we can be helpful. And then, we will go into more detail about how we can actually assess those muscles, what that looks like.

As far as exercise and treatment goes, it really is varied. A lot of people have the assumption that we're going to just do Kegels or pelvic floor strengthening exercise. And pelvic floor therapy is way more than that. And so for some people, that's the opposite of what we want to do. So, strengthening is not always the solution to what's happening with the pelvic floor. So, there's manual therapy that we can do for the pelvic floor and just other areas that might be problematic. The core, the back, things like that. And sometimes certainly includes strengthening the core, the pelvic floor, our hip muscles, that kind of a thing. But we also do a lot of behavioral and lifestyle modification education. So, bladder retraining is one of the things we talk through and just different things like some of the examples I mentioned a few minutes ago that we can just do with our body mechanics or lifestyle changes that can really help with some of those symptoms that we're having as well.

So, I would say there's a combination of exercise, of education, manual therapy, it really just kind of depends on what the patient needs.

Host: Okay. Well, it's good to get some of those myths or those misconceptions like about strengthening out of the way, because there's a lot of people, especially with the stigma, haven't talked about this. Don't know about this.

Noelle Fillmore: Yes, exactly. Okay. A hundred percent.

Host: All right. We're getting toward the end here. So, what would you say for our listeners should be their biggest takeaway from this episode?

Noelle Fillmore: One of the things that I like to say is that a lot of the symptoms that people come and talk to me about, they have not sought help for because they've been told, "Oh, it's normal as you age," or "It's normal because you've had a baby." And so, we like to say these things might be common, but they're not normal. So, any Issue related to bowel or bladder dysfunction or pain, please talk to your provider about a referral or just talk to them in general about what's going on, because there's usually a lot more help out there than people realize.

Host: And that makes me think of one other thing. You mentioned the referral from the provider. Is that a requirement? Can people access the pelvic health clinics directly?

Noelle Fillmore: So, we do recommend a referral from a provider. Illinois is a direct access state, which means that you can see a physical therapist for an evaluation without a referral, but we do need a physician order to continue treating a patient. So often, it's easier to see them initially and get that referral just to kind of keep everything running smoothly.

Host: Great. And that's another thing within Riverside and our use of myChart and all of that, all of those records are in one place. Those referrals are easier. I know I've dealt with that before in other systems, and it becomes a real hassle. So, it's nice to have it all connected.

Noelle Fillmore: Yeah. And we receive referrals from all kinds of physicians. So, OB, urology, primary physicians, gastroenterology. So, really any provider that you're seeing for any issue should be able to send a referral to us as well.

Host: Great. Well, we're at the end here. So before we wrap up, anything else that you'd like to add that we haven't covered?

Noelle Fillmore: I would just reiterate, you know, if you're having any concerns, please, please, please talk to somebody and then seek out that referral.

Host: That's great. Yeah. You don't have to live with it.

Noelle Fillmore: Absolutely.

Host: Talk to somebody about it. It can help improve your quality of life.

Noelle Fillmore: Yeah. And these are major quality of life issues for a lot of people. With almost every patient walk through my door, we've either dramatically improved or been able to resolve a lot of those issues.

Host: I'm sure that means a lot to those folks.

Noelle Fillmore: Yeah, absolutely.

Host: Awesome. Well, thanks again for joining us today, Noelle.

Noelle Fillmore: Thanks for having me.

Host: To learn more about Riverside Rehabilitation and Therapy, you can visit my rhc.net/rehabilitation. Thanks for tuning into Well Within Reach, presented by Riverside Healthcare. Please take a moment to rate and leave a review for Well Within Reach on Apple, Spotify, or wherever you get your podcasts. To learn more about Riverside, visit riversidehealthcare.org.