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Melanie Cole, MS (Host):   You may have heard of physical therapy for various injuries that you’ve had, but you might not know that physical therapy for women’s health is really a burgeoning field and can be so important for the quality of a woman’s life. My guest today is Emily Grosse, she’s a physical therapist with Stoughton Hospital. Emily, when I say women’s health in the intro, what am I really talking about? Tell the listener what we’re talking about today.

Emily Grosse PT, DPT (Guest):   So when we’re talking about women’s health and in the context of physical therapy, we’re thinking about the ability to not leak urine, not leak stool, and we’re thinking about good sexual health and good mobility of scars if there have been surgeries. Those are the kinds of things that we think about and work to treat in physical therapy.

Host:  Well, it’s such a growing field, as I said. So as we’re leaking when we laugh or cough—and I've had babies, so I know—is incontinence or pelvic pain, pelvic floor issues that we’re discussing today. Are these a normal part of aging or not necessarily?

Emily:  So that an excellent question, and I hear time and time again women say, “Well, I leak a little bit. Isn’t that normal? It’s part of aging.” I think that is just one of the biggest misconceptions about aging. Women suffer unnecessarily all the time with that cough and sneeze and leak. Or turn the key in the door and oh my goodness, I leaked a little bit. This is though a very common condition, it is not normal. I think that’s the really fine distinction that needs to be made that this is not a normal condition. In many, many cases it’s so treatable.

Host:  Well, then that’s a great point that you made that women asked you about this and say, “Well, I just assumed it’s fine.” When do we seek help?

Emily:  As soon as someone is leaking then you should be seeking help. The younger the better. So moms that have just had kids and they’re finding that they have pain in their pelvic floor, pain with intercourse after having kids. They're leaking a little bit, they try to get back to their exercise routine and they're leaking, come to physical therapy. Get treatment before it becomes a much more chronic condition. But even if it is chronic, even if it’s been 30/40/50 years of this intermittent leaking or even consistent leaking, now is the time to come to physical therapy. There's no need to wait. As soon as you have any kind of symptoms, contact your physician. Ask for a referral for physical therapy.

Host:  Well, I'm so glad that you said that and that women of any age can really do this. So how is it treated by a physical therapist? Women might think well this is something I only would discuss with my gynecologist. So what is it that you can do for us? How does physical therapy help with these pelvic floor issues?

Emily:  A basic pelvic floor physical therapy evaluation is going to include a detailed discussion or symptoms and a look into the health history. It will include a musculoskeletal assessment of the low back, the hip, pelvic alignment. So kind of externally looking at how your body moves and where there might be joint restrictions, muscle restrictions. Then as a trained physical therapist, to treat the pelvic floor we do an external assessment of the perineum—or the tissue between your legs and your genital region—and then we do an internal pelvic floor muscle assessment. This is the clear distinction here is this is not a gynecological or a speculum exam that you would see with your gynecologist. This is a pelvic floor muscle assessment. So it is looking at how well the muscles of the pelvic floor or the muscles that surround the vagina, how well do they contract? How well do they function? It’s done by inserting a single finger into the vagina and asking for muscle contractions. It’s a fairly quick exam, but it can be very, very helpful in guiding what kind of exercises I’ll prescribe in a treatment session.

So everyone has heard of Kegels. Kegels are an essential part of physical therapy, but I would say by in large most women that I meet who have been “doing Kegels for 30 years” are probably doing them someone incorrectly. There may be some very significant muscle imbalances that are resulting in their urinary or bowel symptoms or their pain. So training someone to properly use these muscles and also relax these muscles is really important. We may do some stretching. We may do other manual therapies. There’s a lot of behavioral strategies that we can employ when we think about the bladder. The bladder’s like a mini-brain. It likes to control things. So we have to teach people how to regain control of their bladder. So that’s kind of the direction of physical therapy treatment.

Host:  Well, thank you for that description and you're right. Many women haven’t been doing Kegels correctly. It’s not really that easy. That mind muscle, the proprioceptive connection. We can do it with our bicep, but it’s a little more difficult when this is an internal musculoskeletal system that you're trying to attach to, you know? That you're trying to make move or work or feel it. What about some other techniques that you try? Maybe biofeedback. What else might you try besides Kegels and some exercises?

Emily:  That’s exactly right. So for many women, and especially if it’s been many years that they’ve had problems, they can't locate their pelvic floor. You can cognitively say, “Well I know it’s between my legs and I know it surrounds my vagina, but I don’t know where it is. I don’t know how to turn those muscles on.” So for my patients that really struggle with finding their pelvic floor, knowing how to contract and relax those muscles we can use biofeedback. So biofeedback is it’s using an electronic device. It’s not an electrical stimulation or anything like that. It’s just using little electrodes or a vaginal or rectal sensor to assess muscle activity. Then give patients a screen where they can look and see, “Ah. I'm relaxing my muscles right now. I'm contracting my muscles right now.” They can start to connect what they're feeling in their body as they're relaxing or contracting with how well they're doing visually on the screen. That can really make that mind-body connection so much stronger and so much more effective in their treatment and in their recovery from these symptoms.

Host:  Well, Emily, as we’re giving all this great advice about the types of exercises and therapy available for women that have these issues. In your experience, how comfortable are women getting this type of treatment? Tell us about your team, about the caring and compassionate, private, confidential. All of these things that women might feel when they're embarking on physical therapy of this nature.

Emily:  When I see someone in the clinic, it’s always in a private space, a private room. We have many layers of protection so that people don’t accidently walk in the room. I always offer my patients to have a second person in the room when we’re doing an internal exam. I realize that can be an intimate kind of exam, but some people would be more comfortable just having a second person there to feel like everything is out in the open and proper. So we can provide a fully private experience, or we can provide that chaperone or that second person just to increase the comfort level of the patient. We certainly are very sensitive to any difficult histories that a patient may have with either sexual or birth trauma. We’re very respectful of that. For some of my patients, that internal exam is just not appropriate for many different reasons. So that internal exam, even if there’s a person who is not comfortable with that piece of the physical therapy experience, that does not mean that they are not a good candidate for pelvic floor therapy. So we’re very flexible in how we treat each patient and every person as an individual. We seek to make the experience as comfortable and accommodating as we can.

Host:  Well, that’s really comforting to hear. So as we wrap up, what would you like women to know? If they cough, they laugh, they sneeze, they leak and it’s something that’s so common, what would you like them to know? Give them your best advice about what you can do for them?

Emily:  Yeah. So if you're struggling with that leaking when you cough, when you pick up your grandkids, when you pick up that laundry basket. You're afraid to go out to have coffee with friends because you don’t know where the bathroom is going to be. Those are all not normal experiences. There's so much help, there's so much treatment. I would really encourage you to reach out to your physician, ask for a referral for pelvic floor physical therapy. It really can make a profound impact. That’s why I do my job is because I care about people participating in life and doing the things that are meaningful to them. I would say almost every pelvic floor physical therapy is after that same thing. So reach out and ask for the help. don’t just think that it’s normal and live with it.

Host:  Wow, what a great segment. Such great advice about what you can do for women because we do typically think that this is a normal part of aging. But as Emily said, it is not. So contact your doctor. You can get a referral for physical therapy and find out what physical therapy can do for your health and women’s issues. That concludes this episode of Stoughton Hospital health talk. Please visit our website at stoughtonhospital.com for more information and to get connected with one of our providers. Please remember to subscribe, rate, and review this podcast and all the other Stoughton Hospital podcasts. For more health tips and updates, please follow us on your social channels. Until next time, I'm Melanie Cole.