Dr. Warner Huh (Host): Hello, everyone. It's Dr. Warner Huh, the Chair of Obstetrics and Gynecology at the University of Alabama at Birmingham, and I'd like to welcome to you this to this monthly episode of Women's Health with Dr. Huh. So excited. It's finally the fall and the weather's starting to cool down. So today we got a really cool topic.

We're going to talk about Pelvic Floor Physical Therapy. And some of our listeners may be like, what is this? And why are we talking about it? And with me today is Jennifer Fagen, who is one of our physical therapists at the Spain Rehab Center that's associated with UAB Medicine. And she's actually our only Pelvic Floor Physical Therapist here at UAB and has been plenty busy with her practice. So I'm super excited that she's with us today. And we're going to talk about pelvic floor physical therapy, what it is and why it's important. So welcome, Jennifer.

Jennifer Fagen: Thank you, Dr. Huh. I appreciate it. I've been looking forward to doing this. So, I'm excited to be here.

Host: That's great. I mean, this is your opportunity to pass on the gospel of pelvic floor physical therapy, so to speak. So I think just to kind of jump right into it. I think most of our listeners kind of when they think about physical therapy, they're talk, they think about rehab after let's say a sports related injury or orthopedic procedure or recovery after a stroke.

Most of our listeners are like, what is pelvic floor physical therapy? So I thought maybe you can explain what that is. And in the area of women's health, what kind of disease processes do you normally treat and manage?

Jennifer Fagen: So, just to start off, for those who don't even know that they have a pelvic floor, that's big component of what we teach. It's the anatomy and the physiology of the pelvic floor are, super important to understand before we treat whatever condition the patient has. So, basically it's a group of muscles that are hammock-like in shape and they support our various organs in our pelvis as well as allow for certain body processes to occur.

So, even if someone comes in with a specific pelvic floor problem, we also have to incorporate other orthopedic problems such as hip issues, low back, SI, stuff like that. So this is a specialty that really does include ortho too, it just depends on what condition the patient has.

Host: So what kind of things do you normally treat when you're trying to help the pelvic floor typically?

Jennifer Fagen: I see a lot of actually, it's called dyspareunia. It means painful intercourse because various reasons, but the pelvic floor muscles have either tightened or been traumatized in some way, either through surgery or some other physical injury. So, I see a lot of that and that just is exactly what a physical therapist does. We treat the muscle problem. And when you have any kind of pain from any process occurring, even disease processes like a stroke, you can certainly have patients come in that have had a stroke and their pelvic floor muscles are not working properly. We just tie every diagnosis back to how we treat muscularly.

Host: And if I'm not mistaken, you also play a significant role in, for instance, women that have incontinence or even prolapse. Is that correct?

Jennifer Fagen: Absolutely. Absolutely. A lot of women I do see, not even older women, but a variety of ages come in with incontinence issues and that includes bladder and bowel. So, because we have the pelvic floor that allows for those things to occur, if it's not functioning properly, we have to address it.

Host: Okay, that's great. So I to kind of summarize that again for our listeners, for those that don't know what the pelvic floor is, it's this, and that's the perfect word to describe it, like this muscular hammock-like structure at the base of your pelvis. It's involved with several functions, including bodily functions, but that weakening of the pelvic floor can cause some issues, health related issues, and again, there are a multitude of conditions, and again, not just in women, in men too, that would benefit from pelvic floor rehab. So Jennifer, could you tell me what's involved with pelvic floor therapy and kind of talk about a little bit about what patients, what they would expect if they were to see you and undergo a pelvic floor rehab program?

Jennifer Fagen: Sure. The first thing that I do, it's, it is different. Most of us know when our knee hurts or, when our shoulder is bothering us and we, we know our deficits in that area. But with the pelvic floor, it's really an oddity because we don't understand it until we are educated on it. And that is the first thing I do is educate my patients on just what it is and what it is supposed to do and what it is not supposed to do. So that is a huge component, especially of the first visit is just education. Then I address their specific problem and set them up immediately on some sort of home program, not necessarily exercises right away, but a lot of it, like I said, is them understanding more about their body and what is going on.

So, I would say if you come to see me the first time, you're gonna learn a lot. Whether we get to the actual treatment that day is not necessarily, but, I recommend it for every single female, whether you are having an issue or not, because we can do a lot to prevent issues. So this is one specialty that I consider it prehab.

I hope that they will never have to have rehab, but if they can come see me before problems start, we may be able to prevent them from even happening.

Host: Okay. So there's a, there's a lot to kind of unpack there. So what I'm hearing from you, which is a pleasant surprise for me is that a lot of these exercises are actually done at home. They don't necessarily need to do it with you one on one, although I'm sure there are some of that. But B, that there are sort of preemptive exercises before some of these health conditions really come, become obvious to women that they can prevent a lot of these issues with regular rehab and exercises. Is that what you're saying?

Jennifer Fagen: Yes. Mm hmm.

Host: And so I, it's too bad because you know, this is, it's all recorded on audio. We don't have a video component of this, but like, could you give us a general idea of what those, maybe of what those fundamental exercises look like if you're able to do that in just words or?

Jennifer Fagen: Well if you do have an incontinence issue, be it bowel or bladder; ideally, my first day, I would include an internal exam. That is the only way I can truly tell if the muscles are too tight or weak or both. Then I tailor what exercises I'm going to give for whatever I find on exam. So yes, that is again, first day, a lot of education, but I would rather someone come to me and never come back because I will have given them some food for thought and they can from there on do what they need to do. So one visit is big when it comes to the pelvic floor.

Host: And so again, and when you talk about an internal exam, you're talking about like a vaginal exam is what you're talking about? And you're, and you're, I'm presuming that you're doing that so that you can assess some level of feedback about, A, whether they're doing the exercise right, but B, whether you think it's actually helping them.

Jennifer Fagen: Yes. So let's take Kegels, which is the huge, you know, we have other orthopedic joints, that do a lot of exercises. Well, we're limited with the pelvic floor, so we pretty much have Kegels. But, I do need to decide first day or pretty quickly, what condition the pelvic floor muscles are in, and then I can prescribe either relaxation exercises or Kegels. And so they pretty much have a clear idea of what path we're going down with pelvic floor therapy.

Host: And, you know, from what I know about physical therapy, having not done pelvic floor but other types of physical rehab is jus that and again, I'm going through the specifics just because I think it's important for our listeners to basically visualize the best of their abilities of what exactly is going on with that visit. It's really a kind of a cool thing and I just which kind of leads into my next question, which is, you know, I think we're appreciating that this is a really a key element for many of the health conditions that we manage, particularly in women's health. And we've already talked about two of them, incontinence, prolapse, and, and dyspareunia or difficulty or pain on intercourse. What kind of outcomes should patients expect with this type of physical therapy? And, what I'd like for you to be able to do is your, just your general observation of how patients respond to this type of physical therapy?

Jennifer Fagen: I have to say, it is quite successful. It is quite successful. I have a great group of patients. I have some very smart ladies. They know their bodies. They know something is not right. And they're eager to get it in as best shape as possible. So, have had success with each of those issues. Of course it depends on age. It depends on comorbidities. It depends on diagnosis, but, I treat 18 and up. I think the oldest patient I have right now is 81.

So I see success in all groups and types of women.

Host: That's awesome. This is great. So one of the things that I just would love for you to be able to answer because like just sitting here over the last 10 minutes, it's really kind of inspiring to kind of hear you talk about your profession and the changes that you make, is a little bit about your journey and how you got into pelvic floor physical therapy. Can you share that with me and the listeners?

Jennifer Fagen: Sure. Absolutely. I had a PT friend who was going on maternity leave and she asked me to cover her clinic for three months. And I said, sure, no problem. It's an orthopedic clinic. That's exactly what I used to do. And she said, well, I do some women's health. And I said, okay, that's not a problem. She goes, no, I do pelvic health. And I said, okay, what exactly are you talking about? And so she taught me some things. And at the same time I was entering menopause and I thought, oh my goodness, I need to find out more about this, not only for myself, but this is fascinating. And I was hooked. I went to my first course and I knew I was going to do this.

Host: And again, for our listeners, so it's really too bad that we don't video record these because your, your facial expressions and your investment in this is just priceless to look at. So I, it's like the conviction on your face is amazing. The second part of my question is this, is like, I've known about pelvic floor physical therapy for a long time, but you're the only here at UAB as part of the Spain Rehab. There are not many of you all in the state of Alabama. And so what's the reason for the limited number of pelvic floor physical therapists, maybe not just in Alabama, but the entire U.S.?

Jennifer Fagen: Well, I don't want to blame it on location, but I kind of have to, you know, it's been going on in California and up north forever. And it's finally trickled down to the south. It is, sad that we don't have many of us even around the state. However, that is changing. We are getting the word out and they have now put curriculum into our schools here.

So, that is all positive. It's just taken us a little longer to get this ball rolling. And it's unfortunate, but I'm just thrilled that we at least have it now. And all of us know each other. So, if we cannot see a certain patient, we make sure they go to someone who can. So, we're working, we're trying.

A lot of us are older. And now new grads are coming out with some sort of education on it, but they still have some training to do. So, you know, we're going to be busy for a while teaching the new ones what to do, but it's fun and it really is a pleasure to educate and get more of us going. Because we need it.

Host: That's an understatement. And I know maybe it's not avant garde for the rest of the U.S., like the West Coast and New England, maybe parts of the Midwest, but it is very avant garde for us. And, I'm sure you, you think about this often, but you're very much on the leading edge of something really special for the patients that we serve.

So again, like I'm thrilled that you're, that you work with the department. I'm thrilled that you're here at UAB Medicine. How does one access you? Like, is it normally through a referral through another physician or do they call, you know, 1-800-Jennifer Fagen, they come in and see you? No, no, no. And by the way, that number doesn't exist. I'm just making, just making, making jest. But I just was wondering exactly how they actually access your services.

Jennifer Fagen: And I do see, I don't just see UAB patients, however, you can go online and punch in UAB Women's Health and you will find me and you will find the number to call to get, what you need to get. But most of my doctors are now understanding more and on board and are sending just when they visit, even from primary care. You don't have to go to an OBGYN. You don't have to go to a urogyne. A PCP can send a referral and you can come see me. And that's the case with every pelvic floor therapist.

Host: This is awesome. This is great. Do you have any, any other closing comments you want to make to our listeners about this topic at all?

Jennifer Fagen: I would just say, we ladies tend to ignore our own self care very well. But if you can just take an hour to come see me, I'm able, may be able to help you in that timeframe to do things and learn things, and we're very independent.

So it is a more independent type of physical therapy. You don't have to come see me three times a week. But I can teach you a lot that, again, hopefully prevents you from coming to see me later on.

Host: And that's what I'm learning. I actually didn't know. I mean, you clarify, I thought maybe this is like, you know, come in once a week, but what you're saying is a lot of this is at home by themselves in their own house and teaching them the right exercises, but you know, I want to go back and say that Jennifer, your skills and expertise in this area have been transformative for women's health.

And in fact, when we built this program and we invited you to come, we were really excited about it. But you'd never know how busy or how successful that anyone is going to be. And you really have knocked it out of the park and you hit the nail on the head. We need more of you. We really do. And the outcomes and positive changes related to this type of therapy have been truly transformative.

I'm not, and that's. I, I can't overstate that basically, so, but anyway. Right. So, well, thank you very much. It was great. I, I really appreciate that.

Jennifer Fagen: Thank you.

Host: And, uh, thank you for educating us on the topic of Pelvic Floor Physical Therapy.

Jennifer Fagen: My pleasure. My pleasure.

Host: In closing, I'd like to thank, uh, Ms. Fagen for discussing this topic with us and as always, uh, please rate this podcast and we welcome any comments, particularly on topics that you're interested in and if you're interested in learning more about OBGYN care, including pelvic floor physical therapy, including all aspects of women's health, our sexual health clinic, and other clinical services that UAB provides, please check out uabmedicine.org. And until next time, we'll see you next month, and enjoy the fall, and have a great day. Take care. Peace out.