Scott Webb (Host): Many of us have heard of Kegel exercises, and though they may be a part of a physical therapy plan for pelvic floor issues, there's much more the PTs can do to help. And joining me today are Physical Therapist Amina Phelps and Senior Physical Therapist Amy Senn, and they're both here today to tell us more about Pelvic Floor PT and how they can help the full gamut of patients at Summa Health.

 This is Healthy Vitals, a podcast from Summa Health. I'm Scott Webb.

It's really nice to have you both here today. We're going to talk about physical therapy, sure, but we're going to talk about specifically pelvic floor physical therapy and what that means. So, Amina, I'm going to start with you. What is pelvic floor physical therapy?

Amina Phelps, PT: Pelvic floor physical therapy is an area within physical therapy that focuses on muscle and tissue function of the pelvic girdle. So specifically the muscles, bones, joints, and tissues that support the pelvic organs, that assist with bowel and bladder control and contribute to sexual function.

So just like someone might be referred to or seek out PT for their back or neck or shoulder pain or dysfunction, pelvic floor PT is still PT. It just happens to be focused on a part of the body that although it may be a little intimidating or embarrassing to talk about for some people, it encompasses important functions of the body.

Host: Yeah, important for sure. And, you know, sort of physical therapy or PT gets thrown around a lot, but it is so specialized, I've learned, both in my needs and needs of my children and so forth. So, this is specific or unique to the pelvic floor and Amy, just wondering, how does someone know if they need pelvic floor PT?

Amy Senn, PT, MSPT, BCB-PMD: That's a great question. I would first and foremost say if they think they need physical therapy, they probably do; because pelvic floor issues are very common. Right now they say about one in three women and about one in five men have some type of pelvic floor issue. Some of the things that you would look for that would maybe lead you to want to seek out a physical therapist is any type of bowel or bladder concerns.

That could be feeling like you need to go to the bathroom all the time. Having trouble going to the bathroom, feeling like you have to strain to be able to empty bowel or bladder. Anytime during pregnancy we can be of assistance, anytime postpartum or after delivery of baby. Additional things, can be any type of pelvic pain, either feelings of pressure, if you're having trouble doing your daily activities, whether it's workout activities, child care activities, within your home, if you're feeling a heaviness or a pressure in your pelvis, a discomfort with a doctor's exam, like the yearly gynecological exams, if those are uncomfortable, that would be another reason to seek out a therapist.

 After any type of pelvic or abdominal surgery is another great time to consider pelvic floor physical therapy.

Host: Yeah. And Amina, I'm just assuming this is a lay person speaking, of course. I'm assuming even though both men and women may benefit from pelvic floor PT, that you see more women than men. And that may not be true again, purely anecdotal. And what do I know? But, uh, generally speaking, who gets pelvic floor PT?

Amina Phelps, PT: Yeah, so I think pelvic floor PT has traditionally been thought of as something to help, particularly like postpartum patients, exclusively. But our scope is so much broader than that population. Pelvic floor PT is a conservative, effective, evidence based therapy for individuals of all age groups, genders, and sexual orientation.

So we really do treat the gamut of people and diagnoses and conditions.

Host: So, Amy, then, are there some myths, if you will, about pelvic floor physical therapy? I feel like there are. Like, maybe I just said one, that really only women get pelvic floor PT, which is clearly not true, as Amina said. It's the full gamut, young, old, etc. What are some of the myths, maybe, that you can dispel?

Amy Senn, PT, MSPT, BCB-PMD: This is actually a favorite question of mine because there are many, many myths out there. And as you said, it's thought of oftentimes as just something for women or something for women in the later stages of life. But I always say everybody has a pelvic floor. If you're a human being, you have a pelvic floor.

So it really is for everybody. But another common myth that we like to dispel is that pelvic floor physical therapy is not something scary. It's not something weird. It's often thought to be this invasive, weird, unheard of type of physical therapy, but it is just still physical therapy.

All physical therapy treatments are done completely within the range of patient comfort level. The patient is completely in control of the session and we only work to their comfort level. There are so many aspects that we look at both internally and externally to the body. And so the treatments are done completely to patient comfort level.

Another big myth is that pelvic floor physical therapy is just being told to do your Kegels. So some patients say, I don't need to go. I've tried my Kegels. They didn't work for me. Well, pelvic floor physical therapy is a lot more than just Kegels. It's a lot of education. It's a lot of bowel and bladder retraining.

We look at soft tissue, we do hands on skills, we do exercises. It really ranges the entire gamut of looking at the entire individual. And a little joke we like to have is that most of us therapists wouldn't spend six or seven years in school just to tell someone to do their Kegels. So, it is definitely much more than just a Kegel.

A couple other myths that we like to talk about and that we like to dispel, is really the phrase that just because something is common doesn't mean that it's normal. There's lots of jokes of like, oh, I know every bathroom from here to the Mississippi and all my friends do too. Well, just because all your friends go to the bathroom constantly doesn't mean that that's normal.

So common does not equal normal. And we like to help people know what normal bladder and bowel and sexual functions should look like. Then another common myth that we like to talk about is that there's aggressive or invasive internal work. While pelvic floor physical therapy may include an assessment of the pelvic floor muscles, there is nothing that is aggressive or invasive.

Again, all treatment being done to patient comfort level. And treatments are traditionally done in a one on one setting, behind a closed door and private setting for patients so they can truly feel comfortable to talk to us about anything that they feel like they need to talk about.

Host: Yeah, I was wondering when Kegels were going to come up, but I love the way you put that. We didn't go to school, you know, six, seven years just to tell people to do Kegels. Yes, that may be a part of it for pelvic floor, but there's so much more. And that leads me, Amina, to wonder then, at the actual sessions, what can folks expect?

Amina Phelps, PT: Sure. So at a patient's first visit, which is often called an initial assessment or an initial evaluation, the PT will ask a lot of questions to get to know you, get to know your symptoms. How long the symptoms have been going on, kind of what functional limitations and challenges you're having in your daily life. We'll do a, a review of your medical and surgical history because sometimes those can play a part in what may be going on.

And also most importantly, talk about your goals for pelvic floor PT. You know, what did, what do you as the patient want to accomplish with this? So there will likely be an external exam. So what I mean by that is the PT will take a look at things such as posture, alignment, movement patterns, strength, breathing, all of which have a direct or indirect relationship with pelvic floor function or dysfunction.

Sometimes not always, again, as Amy emphasized, this is always to the patient's comfort level; we'll complete an internal pelvic floor muscle exam. So for females, that's typically transvaginal and digital. So you are using the finger, not a speculum. And for males, transrectally, if indicated.

We provide lots of education. Usually that first visit is, kind of just really talking about what this is all about, answering any questions, going over like assessment findings with the patient and, then providing kind of tools and resources for the patient to work on at home before they come back for their next session.

 We typically see patients about once a week, and that's at Summa. There are other models of course, but here at Summa, it's typically once a week. And, we work on a lot of different things that could include behavioral strategies and modifications, external manual therapy work. So things like scar mobilization, if a patient has had a surgical intervention, massage, organ mobilization, kind of more of the traditional strengthening exercises, stretching exercises, and we have a broad range of different therapeutic modalities that we can use as well. And we would always discuss those things and explain those to the patient before trying them so the patient is aware and you know consents for it, too.

Host: Amy, is there a certain number of sessions and maybe insurance is a factor here, but generally speaking, when we think about pelvic floor PT, how many therapy sessions are there to get folks where they, you know, need to be or want to be?

Amy Senn, PT, MSPT, BCB-PMD: So this is a variable based on each individual and their needs. As Amina mentioned, often sessions are about once a week, but that can also change person to person. Usually once a week is the most that we would have a patient come in. Some patients only need to come in once every other week, some even less than that.

But as far as how many, oftentimes it will span over the course of two or three months, again, given the severity of symptoms and what the patients are needing from us. Sometimes it can be a little bit shorter, sometimes a little longer. I would say on average, somewhere between about six to 12 sessions.

And really during those sessions, we greatly want to give the patients the tools and the knowledge and the skills that they need to fill their toolboxes to help themselves and empower themselves to take the best care possible of their own bodies and their own pelvis.

Host: Yeah. As you say, the metaphorical toolbox, they take that home with them. And if they're only going in to Summa, let's say once a week, they're certainly probably, there's an expectation that they would be doing some of these things, Kegels or otherwise at home as well, right?

Amy Senn, PT, MSPT, BCB-PMD: That is true. I always say if me just seeing you 45 minutes to an hour once a week, if you're doing nothing outside of that session, probably not going to get you where you need to go, but we can spend some very valuable one on one time for that brief interaction during the week that can be further facilitated by continuation with your home exercise program and practicing the skills and maybe the lifestyle changes that we talk about to really have maximized the benefits.

Host: Yeah, Amina, I mentioned the insurance companies and you can't really talk about medicine without talking about insurance, of course. So do insurance companies generally cover pelvic floor PT?

Amina Phelps, PT: So in general, yes, they do. Of course, it's always best practice to just double check with your insurance provider. But pelvic floor physical therapy is physical therapy. So if the insurance company covers PT visits, physical therapy visits, then it will cover pelvic floor physical therapy. They're not two separate things.

Host: Yeah, that's good to know, right? We're sort of really narrowing the focus here today, but physical therapy is physical therapy. So if your insurance covers it, you're good for pelvic floor and finish up with you here, Amy, today. And we were just talking about the toolbox we take home. So let's talk about that.

Some of the exercises and behaviors that we can do at home, to both sort of complete the treatment, the initial treatment, and then also maintain pelvic floor health.

Amy Senn, PT, MSPT, BCB-PMD: Definitely. So first and foremost, I would just say in general, staying active and staying healthy. That helps overall bowel and bladder function when we're mobile and on the move, whether that's just from walking or swimming or whatever your favorite means of being an active, healthy individual. As part of that, keeping ourselves well hydrated and well hydrated with water.

We can still have some of the fun beverages, but our body really does need water. So those would be my top two. In addition to that, when we're doing activity at home, whether for leisure or for work, we want to watch our postures and watch our breathing pattern. Many of us have bad habits of holding our breath during activities of exertion, and that puts excessive undue pressure down on our pelvic floor.

So we want to make sure we're always breathing through an activity. We mentioned Kegels earlier. And so I always like to say, let's not be doing excessive Kegels, for two reasons. One excessive exercise of any type isn't good, but there's also kind of a, an additional myth that just because somebody is having leakage, they have weakness.

And that is not always the case. So we don't need to be doing excessive Kegels. And lastly, I would just say, as far as behaviors at home, if you have any questions, please don't hesitate to talk to your doctor, consider a referral to physical therapy. Worst case scenario, you come with a therapy referral and maybe you only need to see us a time or two, so we can give you some additional health tips that you can continue to use for your lifespan.

Host: That's perfect. If you could see me right now, Amy, you'd be very disappointed. I'm leaning forward. I'm all scrunched up. I'm drinking coffee, not water. I'm doing everything wrong. My toolbox is empty, apparently.

Amy Senn, PT, MSPT, BCB-PMD: Well, you know where to find us.

Host: Absolutely. Uh, this has been great today. We had some fun along the way, uh, as we're sort of establishing here that pelvic floor physical therapy is just PT, right? It's just unique or it's specialized to the pelvic floor. It's for men, women, young, old, et cetera. So thank you so much.

Amy Senn, PT, MSPT, BCB-PMD: Thank you.

Amina Phelps, PT: Thank you.

Host: And to take our quiz, go to sumahealth. org/pelvicquiz. And if you enjoyed this episode of Healthy Vitals, we'd love it if you'd leave us a review. Your review helps others find our educational content. I'm Scott Webb. Thanks for listening, and we'll talk again next time.