Bill Klaproth (Host): Pelvic floor problems have many causes and can affect many areas of your life. Here to talk with us about pelvic health, is Donna Pagano, a Licensed Physical Therapist with Tidelands Health. Donna, thank you for your time. What are some of the conditions associated with pelvic floor disorders?

Donna Pagano (Guest): Hi. There are so many different ones, and so many times people think pelvic health is all about urinary incontinence, but that’s just part of it. We deal with fecal incontinence and urinary incontinence both. We deal with digestive issues including constipation and diarrhea, IBS, colitis. We deal with pelvic pain. In particular, we deal -- in this community, a lot with postmenopausal ladies. When you go through menopause, the tissue changes and you end up with a little bit more skin tissue and exposed nerves, so you have a lot of pain after menopause.

People who are here as young folks here will also have a lot of pain with post babies and episiotomy scars, which should not be painful to have intercourse and there’s actually help for that. People don’t realize it and they just kind of quietly go along in pain. Pelvic health, it’s grown tremendously. We treat both men and women, and it’s just a great thing to be doing and bring it to the community to know that there is help for these people that suffer so quietly.

Bill: What are the sources of these issues? I know you mentioned menopause and episiotomy, are there other sources for these conditions?

Donna: Yes, most of the time with stress incontinence – and that’s just urinary incontinence – that just usually comes with the weakening of the pelvic floor just with age. It doesn’t have to be, but you also have internal things that can lead to it. Like I mentioned before, constipation often leads to – in children, bedwetting, and you have to treat that cause to get rid of that.

You also have – one thing that’s often missed – and especially in women after menopause – and it doesn’t even have to be – is sleep apnea. You don’t even have to be a snorer to have sleep apnea. You can get that at any point in your life, and if you’re getting up at night to urinate, quite often you actually have a full bladder to go, a lot of times, what the cause is, is undiagnosed sleep apnea because that puts extra stress on your kidneys and your adrenal glands, so they overproduce urine. It’s called polyuria. You can’t get a good night’s rest because you’re up urinating all of the time, so you never reach that point at night in restful sleep that you actually secrete growth hormone to actually repair your body because you never reach that because you’re getting up so often at night to urinate. Those are some of the underlying things that cause problems you wouldn’t even know about.

The other big thing is when people have abdominal surgeries. This is another huge problem that is underlying with so many pelvic floor disorders. Old scars, even from gallbladders, hernia repairs, C-sections, hysterectomies, appendectomies are a big one, and people don’t realize that that scar tissue can wind around forever and ever and attach even twenty years later over the bladder. It pulls your bladder and your urethra in odd positions, and it can lead to pain and incontinence. You can have muscle asymmetries from old sports injuries that in time, start to catch up with you and you have an imbalance of the symmetry of the muscles of the pelvic floor that cause chronic SI joint problems or chronic hip bursitis.

A lot of those things you’ve been seen by orthopedic physicians and they try treatments of injections and things like that, but if you’re one that didn’t find relief with that, a lot of the underlying problem may be the pelvic floor muscles, which are treated very differently internally. You can actually find a cure for something that you feel like you could never find the cure for because we just haven’t reached the right set of muscles.

Bill: How do you diagnose them? How do you wind your way to find the correct diagnosis?

Donna: Well, the diagnosis actually comes from the doctor, but in the treatment process, what we’re treating as physical therapists is the things that lead to it. If you have scar tissue that’s attaching, I’m able to palpate and find that. That also leads to facial restrictions. A lot of people have heard of plantar fasciitis, but we have fascia all over our body. It’s connective tissue. It runs head to toe, and it gives your body shape and form.

Fascia is controlled by the central nervous system – it’s innervated by nerves. When it contracts, it actually can provide up to 2,000 pounds of pressure per square inch. The way you get that to release is a very different kind of treatment than just telling somebody to stretch muscles because your muscles are voluntary control. It’s a whole different control – nervous system over those things. The central nervous system is kind of like if I told you, “Hey, Bill. Go digest that sandwich you just ate.” You don’t have control over that. Fascia will contract that way, and you don’t even realize that’s what’s causing the underlying problem, and it attaches – you can be born with tight fascia for that matter – but it can contract from emotional distress. It can contract from injuries. Those things are gaining a lot more recognition as the source of the problem for pain.

Bill: Interesting. So, Donna, how do you treat this then? What are the treatment options available?

Donna: Well, that’s when you come in to see me for therapy, and we use a lot of manual skills – hands-on skills to do the facial release. That’s something that typically is not learned in general PT school. That’s something that I’ve gone on to learn through taking additional coursework in pelvic health.

There is certainly a muscular component that we use from an orthopedic background also, in that anything that attaches to your pelvic bones is going to affect the lineup of your pelvic floor muscles. You’ve got your lower extremity muscles, your quad muscles, your hamstring muscles coming up from the bottom end; you’ve got the costal angle, which is right there below your sternum, and that tissue runs all the way down to your pubic bone. Who would have ever known that when you had heart surgery, and they did a sternotomy that that asymmetry then caused you to have some urinary leakage five years later? Or, when people have a baby, and your baby has got their feet sticking up in your ribs for nine months, and that costal tissue doesn’t come all the way back down, that is going to change the angle of the pelvic floor via the pubic bone just based on muscle attachment.

We really look at pelvic health very much through an orthopedic standpoint, and most people don’t even realize your core muscles – when we think of core, we think of the sexy, washboard muscles – but your four, deep core muscles, are your diaphragm, your pelvic floor muscles, your transverse abdominus muscle – which is a deep abdominal muscle in the front of the spine – and then some muscles that line from the top of the spine down called the multifidi muscles. Those four core muscles really play a huge role in our basic balance and stability. There are many different ways, as a physical therapist that you’re going to tackle someone with a pelvic floor disorder.

Bill: And what about medication and surgery, are there options there, too?

Donna: Well, the medications, certainly – and surgery – would be up to the doctor, but I will say with therapy, many many times, you can prevent someone from having to take medication to handle the pain and disorder, or you can prevent surgeries. If you’ve got some prolapse, which means that you have something coming down – if a lady has a uterine prolapse that’s a grade one or two or if you have a bladder prolapse or a rectal prolapse, you can actually catch that early and work on that strengthening to help keep that from falling out even further, which would then require a surgical intervention. If you can prevent the problem ahead of time, you can certainly avoid that.

Bill: Now, are there ways – you’re speaking of prevention – are there ways to prevent pelvic floor disorders?

Donna: Well, if you’re aware of the four core muscles and keeping them strengthened, certainly. In other countries – Germany, Canada, Australia, England, we have – pelvic floor has been around much longer. It’s part of the maternity package, in fact, to come to a physical therapist post-baby to learn how to get all of that back in shape and back in proper working order after the trauma of being pregnant. You learn those things, and it then does prevent problems down the road, certainly.

Bill: And Donna, if you could wrap it up for us, why should someone choose Tidelands Health for their pelvic floor needs?

Donna: Hi, well I do really think that Tidelands Health really has a really standup program in town here. We have some therapies under our belt here that are not available anywhere else. I do do internal pelvic health, and that’s one of the – part of the necessary things to properly evaluate somebody that you actually do the physical exam intrarectally, intravaginally, whatever it takes so that you are doing the correct exercises. A lot of people have heard of Kegels, and sometimes, Kegels are not what you need at all. That’s something that somebody may tell you to do. Without the instruction, you may be doing more harm to yourself. I really feel like here; we have a plethora of options as far as the amount of education gone into pelvic health here that would be beneficial to everyone.

Bill: So much information here, Donna. Thank you so much, for being on with us, today. For more information about Tidelands Health physicians, services, and facilities, visit TidelandsHealth.org, that’s TidelandsHealth.org. This is Better Health Radio. I’m Bill Klaproth. Thanks for listening.