Maggie McKay (Host): When it comes to pelvic floor health and physical therapy, how much do you know? Today we'll find out more with physical therapist, Ashleigh Kreuter. Welcome to Stoughton Health Talk. I'm your host, Maggie McKay.

Thank you so much for joining us, Ashleigh.

Ashleigh Kreuter, PT, DPT: Thanks for having me.

Host: What is pelvic floor physical therapy?

Ashleigh Kreuter, PT, DPT: Pelvic floor physical therapy is therapy focused on treating issues that surround pelvic health. So that can be anything from issues with urinary or bowel incontinence. So issues with peeing or pooping, either control, or frequency or pain. It can be issues with pelvic pain. It can be issues that result from pregnancy.

It can be issues that result from prostate issues. So it's kind of a big umbrella term, but we focus on helping patients achieve better function and improve the quality of life in relation to this part of the body.

Host: So it affects both men and women?

Ashleigh Kreuter, PT, DPT: Absolutely.

Host: When should someone seek help for pelvic floor issues?

Ashleigh Kreuter, PT, DPT: As soon as they notice an issue. It is something that is much easier to treat earlier on. I think you can say that with pretty much any issue related to the body, but oftentimes it is not something that patients are comfortable talking about, even with health care providers. There's a lot we can do to treat issues like this. So as soon as you start to notice something, it's worth calling your doctor and asking for a referral.

Host: What type of conditions are you able to treat with pelvic floor physical therapy?

Ashleigh Kreuter, PT, DPT: We treat issues with incontinence. So leakage of bowel and bladder. We treat issues with something called pelvic prolapse. So that's where your internal organs, if you're a female, such as the uterus, the bladder, may start to drop internally. So you might notice like pressure through your pelvis.

You might have more issues related to urinary or bowel symptoms such as constipation. We treat issues with pelvic pain and that can be due to issues with tension in the muscles. It can be due to scar tissue. We treat issues that have to do with frequency. So if somebody maybe isn't leaking, but they are urinating more often, and that's interfering with their quality of life, or they might have pain with urination, or issues that occur during intercourse. If people are having issues with pain during intercourse or issues orgasming, there's really a lot of different things that can go wrong.

And for most people, you might not know it's an issue until you experience it, or even that it's treatable.

Host: How are issues diagnosed?

Ashleigh Kreuter, PT, DPT: It depends on what the issue is. Oftentimes the issues that patients see me for are more of a functional nature. So if they have incontinence, they might go and bring it up to their doctor. So then their doctor would put a diagnosis of incontinence, or pelvic floor dysfunction is kind of a generic term we use.

And the diagnosis is often not as important when it comes to physical therapy because we're treating the functional issue, but other issues would be pelvic floor tension that can create issues with pain or even incontinence. Prolapse would be a diagnosis. I will see patients that are pregnant.

I will see them for issues like with diastasis recti, which is where they have a little bit of thinning or separation of the abdominal muscles. Often diagnoses can relate to pain. So that can be pelvic pain. It can be tailbone pain. I'll see a lot of patients that have hip pain that is related to their pelvic floor, since there's a lot of interaction there as well. I will see patients post surgery. So when I see males, oftentimes they have a history of some sort of prostate issue, whether it was surgery, or treatment related to prostate cancer or enlarged prostate. Those are oftentimes when I see a male population, but they can also have issues with pelvic pain, constipation, tailbone pain, so.

Host: What do you do for treatment? How do you treat the issues?

Ashleigh Kreuter, PT, DPT: Treatment involves a lot of different options. It really depends on the person, but when it comes to the pelvic floor, there often is a ton of different factors that we want to address because, there's so many things that we do that have an impact on your pelvic health.

 Typical treatment for me, we're definitely going to assess to see if there's flexibility issues within the hips and the pelvis. If we opt to do an internal exam, we're looking for issues with pelvic floor tension, as well as your ability to engage muscles. So we're going to try to train those muscles, either what we call up training, where we're trying to get those muscles to turn on better.

Or we might be doing a treatment called down training, where we're trying to essentially get those muscles to relax better. Sometimes there's hands on manual treatments that can be just externally working on the muscles of the hips or the abdomen. Are the legs, in certain instances, internal treatment is recommended, and that would be trying to get those muscles to either move better, if there's in instances of scar tissue, or those muscles to relax better in instances where there's a lot of tone.

And sometimes we're also just trying to trigger those muscles to turn on better, by kind of using my hands to help cue the right muscles to turn on. Other treatment and things that I look at, I actually look at things like pressure management, because that's a huge one. So how people, bend, lift, squat, those sorts of things, the body mechanics they use is really important to address because the pelvic floor is a huge component of our pressure management system.

 For the same reason, we also look at breathing patterns because we want to make sure that your body and your ribcage and your back and your pelvis is moving in a way that can facilitate really good muscle activation. And if you've got restrictions in one area, another area has to compensate.

 Beyond that, we look at your posture. We look at how you bear weight through your feet because that can affect how your muscles engage in the pelvis. We're going to be doing doing the general stuff like balance and strength. A lot of what I do is education because habits such as, how much liquid you drink or, how you bend over to pick something up or, if you consume a lot of bladder irritants, things that might create more urinary frequency or leakage if it makes the bladder irritable. Those are all educational things that we can go over and touch upon as needed.

Host: I had no idea there were so many moving parts connected to pelvic floor health, how do you ensure patient privacy and comfort?

Ashleigh Kreuter, PT, DPT: For the first visit when I see patients, actually for all the visits, I am typically in a private treatment room. So for the first visit especially just because the first visit we go through a lot of history because there's a lot of different parts of patient history that can impact how I will treat and also impact symptoms and causes and that sort of thing.

 So we have a private treatment room, closed door. If we do an internal assessment, if the patient is okay with that, and again, that is not required; the patient will be covered and draped. We also have a curtain that we pull up, even when we have the door closed, just in case, something happens where the door were to open, that's never happened, but you never know.

 So it's very private.

Host: Do patients need a referral from their physician or how does that work?

Ashleigh Kreuter, PT, DPT: It depends on the insurance. In Wisconsin, we have what's called direct access and pelvic floor physical therapy is billed the same as regular physical therapy for the most part. As long as your insurance covers regular physical therapy, and you are not Medicare or Medicaid, then you can call on your own and set up a pelvic floor evaluation. Most people are more comfortable contacting their doctor and getting an order for that, so that's typically what I recommend just because there's sometimes less hoops for insurance companies to go through.

Some physicians want you to go in for an appointment so that they can assess you or something like that, cover their bases insurance wise. But sometimes I'll have patients just call into their provider and say, Hey, I'm experiencing leakage or pelvic pain.

I was wondering if you would put an order in for pelvic floor physical therapy. And if the provider is comfortable with that, that saves them a visit copay with the provider too.

Host: Ashleigh thank you so much for sharing your expertise. We really appreciate it. This has been, like I said, very educational and helpful.

Ashleigh Kreuter, PT, DPT: Great. Yeah, it was fun.

Host: Again, that's Ashleigh Kreuter. To find out more, please visit stoughtonhealth.com. And if you found this podcast helpful, please share it on your social channels and check out our entire podcast library for topics of interest to you.

I'm Maggie McKay. Thanks for listening to Stoughton Health Talk, a podcast from Stoughton Health.