Gina Kaye (Host): Welcome to the San Juan Regional Medical Center Podcast, Celebrate Health. I'm Gina Kaye. And joining me today is Amy Link and Bria Rubie, both doctors of physical therapy. For this podcast, we are going to dive into a discussion about pelvic health physical therapy. Thank you both for joining me today.

Bria Rubie: Thank you for having us.

Amy Link: Yeah, thank you for having us.

Host: What is pelvic health physical therapy?

Amy Link: So, pelvic health PT is the evaluation and treatment of pelvic floor conditions. Our pelvic floor muscles are the sling of muscles at the bottom of our pelvis that go from the pubic bone all the way back to the tailbone. These muscles are responsible for giving support to our organs and keeping us continent and working alongside with our core and glute muscles to help support our back and our hips.

 As pelvic floor therapists, our job is to figure out why these muscles aren't working the way they should be. And so once we get an idea of why they aren't working, we'll give specific exercises as well as sometimes we give lifestyle adjustments, those sorts of things for the patient to do at home in order to get things activated and working like they should.

I do like to mention that a lot of times people think that pelvic floor therapy is just doing Kegels, and they think that we're doing a lot of Kegels in our appointments, which Kegels are the tightening and releasing of those muscles. But that is not the case at all. We may give Kegels as a small part of our program, but we're also focusing a ton on breathing, core and hip strength, and getting the core and the hips and the pelvic floor working together. And so, when our pelvic floor muscles are working the way they should, it should be more automatic, Our goal is to try to get to where you're not having to think about it all the time. So, that's our goal when working with our patients.

Host: What are some of the most common pelvic floor conditions that you can manage or treat through this type of therapy?

Bria Rubie: The most common conditions that most people think about for physical therapy with the pelvic floor is leaking, like bladder incontinence. So, that would be like leaking with, like, exertion or urge or like leaking on the way to the toilet. But we also treat bowel incontinence, pelvic organ prolapse, pelvic pain. So, this might be pain related to endometriosis or dysmenorrhea, so excessive pain with your menstrual cycle. If we're focusing on pain, usually that's like pain conditions of the vulva or around the rectum. But we also work with folks with pubic synthesis dysfunction, SI joint dysfunction, so sacroiliac dysfunction.

 And a lot of folks see that in pregnancy. But we also treat folks postpartum, postsurgical, so pelvic reconstruction, hysterectomy after a C-section. We see all those people. And then, urinary frequency urgency, frequent UTIs are very common for us to see as well. So really, what we're looking at is we're assessing and treating the whole person as it relates to the pelvic floor. So, we will look at, back pain, hip pain, ankle dysfunction, knee dysfunction as well.

Host: Wow, this is great information. And it seems as though there are a lot more things that you guys can help with than the typical person may even think about. And you've talked about some of these already, but what are some of the symptoms people should look out for that indicate they could benefit from pelvic floor physical therapy?

Bria Rubie: There is a lot that we look at with pelvic floor. So, sometimes I get referrals from doctors that relate to pain, and both the patient and the doctor are like, "I don't know if this is pelvic floor related," but that's what we can look at. We can see if it could be something we could treat here or if you need another referral.

So, some of the things that would indicate maybe you should ask for a referral, the first thing is if you're six weeks postpartum, come on in. We can help with tissue healing even just exercises to get back into what you would like to do.

Another thing that would indicate you could come in would be if you're leaking urine. So like I mentioned, with anything like urge on the way to the bathroom, coughing, sneezing, laughing, jumping, running, leaking urine is just not normal, okay? But it is common, right? If we've had babies, or we have started some of those menopausal symptoms, post-menopausal symptoms, we can see a change in our ability to maintain continence. So, we're happy to work with folks with that.

Another symptom would be peeing frequently. So, going to the bathroom every two to four hours or more than eight times a day. So basically, we should only be peeing every two to four hours and feeling like we can make it to the bathroom each time. If you're having pain with sexual activity or if you have a menstrual cycle that is affecting your ability to go to work because it's so painful, or you can't go to school because it's so painful, we can help with that.

Basically, no pain is normal. That indicates there's a tissue dysfunction. So, we can help people reduce pain. And then, another common symptom would be constipation. Even if you're having incontinence and you have constipation, that's something we can look at. So, constipation would be if you're pooping less than one time per day.

Ideally, we should be pooping every day or if you're straining for bowel movements, or you have diarrhea or you fluctuate between constipation and diarrhea, that is a common symptom of a pelvic floor dysfunction that we can treat.

Host: Fantastic. I think it's easy to assume that this is a condition that affects only females. But can pelvic health physical therapy help both men and women? And if so, how do the treatment approaches differ?

Amy Link: Everyone has a pelvic floor. And usually, we do think that it's mostly women that deal with pelvic floor dysfunction, and I believe there is a higher amount of women that do deal with pelvic floor dysfunction just because our hormones as well as we're the one giving birth to babies. So, that can cause a lot of disruption in the pelvic floor muscles. But men can also experience pelvic floor dysfunction. You may see in older men with the prostate issues. And so, they might have some urinary incontinence and those sorts of things. But then, even younger men can be experiencing pelvic floor dysfunctions such as leaking, pelvic pain is a big one.

The treatment programs are pretty similar for men and women. A lot of breathing, a lot of core strengthening, and those sorts of things. Right now, we're only treating female patients or the folks with vulvas. But it is something we're considering in the future of potentially adding male pelvic health.

Host: And what about children? Do you guys also treat children for any of these type of symptoms? And if so, what type of issues are you able to help with?

Bria Rubie: At this moment, we're not treating children either. But we're hoping to add this service as well. We're working with some of our teammates on getting them trained to address pediatrics. Because, yes, also children have pelvic floors. So, commonly, they'll experience like bed wetting or urinary incontinence after they've been potty trained.

So, like, maybe a kid has been potty trained and they're doing well, and then suddenly they're starting to wet the bed again, or they're having trouble with urinary incontinence, or they might even have constipation too. So, they might be wetting their underwear or having like abdominal pain. So, that also can be physical therapy treatment as well.

So at this moment, if you know you have anyone or you know a loved one that's dealing with this, they can still go talk to their doctors. Pediatricians are going to have some treatment options for them at this point. Same thing with men as well. Talk to your doctor if you are having difficulty emptying your bladder or leaking, because there are some options for you. And then, we're hoping to add this service for these people in the future.

Host: Great. What role do home exercises and self-management programs play in maintaining pelvic floor once the formal therapy sessions end? I'm assuming this is an ongoing, it's not just one and done at the office.

Amy Link: So, while our patients are working with us, we're giving them a home program that we're very hoping and encouraging them to do while they're working with us. But we do also recommend they continue these exercises to some extent in the future. But I think both Bria and I do this, is we're teaching them how we want them to breathe with certain exercises. So, we encourage our patients to incorporate kind of the overall techniques and breathing techniques into their exercise routine. So, there'll be quite a bit of overlap between what they're doing specifically for their pelvic floor, and also what they're doing for their overall health.

But just like it's important to continue to exercise for your overall health, it's important to consider and work on your pelvic floor health. So, once our patients aren't leaking anymore or they're feeling better, they may back off their exercises and kind of forget that they were doing them. But in the future, they might notice symptoms start returning, especially if they get really sick or stressed, or let's say they get pneumonia and they're coughing a ton, now all of a sudden their leaking is back.

So, we usually try to let our patients know, especially when we're discharging them to be like, "Save these papers somewhere." And if you start having symptoms again, it doesn't mean you're back at square one, but you might need to start revisiting some of these exercises. And of course, if the symptoms aren't getting better, then come back in and see us."

Host: I assume then there are several lifestyle factors that come into play, such as nutrition, hydration, posture, physical activity that significantly influence pelvic floor function.

Bria Rubie: Oh, yes, definitely. We love to talk about two lifestyle pieces I think are really the first thing we like to address in our appointments. I'd say the first is hydration, and then the second is constipation. So, hydration, I would say, often folks are like, "I'm leaking urine. My bladder's full. I can't hold it, so I'll drink less water." But we find this actually increases their urge because then we get bladder irritation from the lack of hydration, so that pee is just much more concentrated. So, we're always like, "Drink more water."

That also plays a role in your constipation. But constipation can really affect the pelvic floor because that stool burden in the pelvis can put pressure on that bladder, make those muscles in the pelvic floor work harder to help control continence. So, we try and get folks if they're having constipation, drink more water, that'll help. We talk about diet. More fiber can help with constipation. Reducing other bladder irritants like caffeine, sodas. Those can also change. I'm not going to tell you to cut everything out, but I'm going to say let's maybe balance it with water.

And then, "Oh yes, physical activity." I mean, we are physical therapists. So, we really do discuss, whether it's urinary incontinence or low back pain, the more movement, the better. That's going to improve your strength, motor control. But I do want to say some people have more symptoms with movement often. You know, you've had a baby. You try and get back into running. You're leaking urine. So, We can help with improving strategies for movement so that you're getting back into it without having those symptoms. So definitely physical activity and, you know, if you haven't been physically active for a long time and you're feeling like you want to get back into physical activity, that's also something that we'd like to help out with, because we know that the more physically active you are, the more muscle mass that you have. And then, that can be more protective against the symptoms of pelvic floor dysfunction.

And I'd like to say we also really think about how everything is connected. So if we're having ankle pain or difficulty running because of a knee pain, and then that is affecting your ability to move, then we also think about how the pelvic floor can be involved with that.

And then, the last piece, so stress can have a huge impact on our whole body. And so the pelvic floor is really sensitive to those increases in stress, whether that's life stress or stress from pain. So, we're really talking to patients on how can we manage that stress with maybe breathwork, meditation, stretching, or just returning to exercise. Sometimes that eases folks' stress. So, we're looking at how the pelvic floor, and some of these things can affect your daily life, because we're thinking about pooping and peeing every day. So, this can really have an effect on your lifestyle. So, we'll definitely be discussing those aspects.

Host: And real quick, how does posture come into play?

Amy Link: So, people can be having different postural issues. So for example, someone who's postpartum, I typically see they're stuck in that kind of pregnancy posture a little bit where, you know, kind of if you can imagine the back is really arched, the pelvis is shoved forward, we have really weak abs, really tight back, and really tight glutes. And so, that imbalance can directly affect the pelvic floor because if the abs are lengthened and really weak, that is going to make it so the pelvic floor is having a hard time working because in order for us to have good continence and good pelvic floor health, we need strong abs, strong glutes that aren't super tight, real tight hips and a back where the back muscles are just kind of nonstop working all day and super tight. So, that's just one example of how posture can affect.

So, that's something, especially with our postpartum moms, we're spending a lot of time working on posture. And I like to think about strengthening the weak and lengthened muscles and stretching and lengthening the muscles that are too tight. And that isn't just for postpartum gals. They're just, I feel like, a good example where it's really obvious to see. But then, of course, we have maybe someone who's a little older who's had a desk job, and they're kind of maybe more kind of that forward posture. It's the same thing, but maybe just a different muscle group. So, we want to think about lengthening tight muscles and strengthening lengthened muscles. And whenever we're more balanced and our shoulders are stacked, our thorax is stacked over our pelvis, and our pelvis is stacked over our feet in the way it should be, our pelvic floor will work better, and our organs will be happier as well.

Host: It's amazing as I'm reading through my notes here that nutrition, hydration, posture, physical activity, those things help everything. And it's just not something people normally think about. All of this is such great information, and it's a great takeaway that if you have any of these issues, you don't need to live with them. There is help available, and I think that's a good message.

Amy Link: A real whole body approach looking at the person as a whole, because it can be kind of easy just to zoom in on the pelvic floor and be like, "Oh, let's just do Kegels all day," but oftentimes that's not the whole story.

Host: None of us want to do Kegels all day, every day.

Amy Link: No.

Host: Maybe when we're at the stoplight. I've always heard that's a thing. If you're sitting at a red light, do your Kegels.

Amy Link: Yeah. One thing me and Bria agree on is instead of doing Kegels, you probably need to do some breathing instead.  

Bria Rubie: Yes, I'm more of a proponent on, yeah, when you're at that stoplight, take a deep breath in because you, you know, you may have just had someone cut you off or something. So, try and relax those muscles. Similarly with your shoulders too, right? Just kind of let those things go. But we also want to focus on strength at the same time. So, if you come see us, we'll let you know how to do that.

Host: To learn more about the topic we discussed today, check out sanjuanregional.com or call the Rehabilitation Outpatient Center at 505-609-6575. Amy and Bria, we very much appreciate your willingness to educate us all about pelvic health physical therapy. Thank you for the information you shared today. It was wonderful.

Amy Link: Thank you.

Bria Rubie: Thank you so much for having us.

Host: If you enjoyed this podcast, please share it on your own social media channels. I'm Gina Kaye. And this has been Celebrate Health, a podcast from San Juan Regional Medical Center. Thanks for listening.

Disclaimer: All content of this podcast is intended for general information purposes only, and is not intended or implied to be a substitute for professional medical advice, diagnosis, or treatment. Please consult a medical professional before adopting any of the suggestions discussed on this podcast episode.