Caitlin Whyte (Host): This is UAMS Health Talk. Welcome back. I'm your host, Caitlin Whyte. And with me today are Marlee Anderson and Destinee Caldwell, both pelvic floor physical therapists from the University of Arkansas for Medical Sciences. Today, we're talking all about healthy pelvic floor habits. Destinee, I'll have you start us off today. What is the pelvic floor?

Destinee Caldwell: So, your pelvic floor is just a group of muscles that are located at the base of your pelvis. They're heavily involved in bladder, bowel, reproductive, and sexual health. And they're just like any other muscles in the body, they're just located in a slightly more intimate and personal area.

Host: And Marlee, what kinds of things do you treat as pelvic floor physical therapists?

Marlee Anderson: We treat a lot of different diagnoses. Some of the more common ones that we treat and that we see is urinary and fecal incontinence, as well as urgency and increased frequency. We also treat things like pelvic pain, pain with sexual intercourse, pelvic organ prolapse, pain during pregnancy as well as we work with some of our pregnant patients on labor and delivery prep. And we also work on postpartum recovery and a lot more. That just kind of covers the general basics of what we see.

Host: Of course. Well, Destinee, what are some tips that people can do to promote a healthy pelvic floor?

Destinee Caldwell: So, there's a lot of things that people can do to promote a healthy pelvic floor. So many to list. We'll just start with some things that you can do daily that can help promote that pelvic floor health and bladder health specifically.

So, one thing is if you find yourself hovering over public restrooms, I know it's something that we all just dread using, but if there's a way for us to be able to sit down and allow the pelvic floor to fully relax, that's very, very helpful. Whether that's bringing disposable toilet covers or any sort of like sanitation wipe that can put your mind at peace. Hovering over the toilets will lead to incomplete emptying just because you're not allowing your bladder and your pelvic floor muscles to do their job fully.

Another thing that people do very often is trying to stop the flow of urine. Usually, this is like a check of their pelvic floor strength. Like, "Oh, am I strong enough to stop the urine flow?" And I think that this is something if done often and repetitively, it will lead to incomplete emptying as well. And it will also lead to some tension, which can increase your risk for UTIs. So if you can just when you're on the toilet, sit all the way down and let the urine flow, that will allow your pelvic floor muscles to work as they are designed to.

 I also tell my patients that Kegels aren't always the answer. Some people will start doing Kegels just to strengthen their pelvic floor, like if they're having leakage or something like that. And a Kegel is just pelvic floor contraction. That's what we're talking about when we say a Kegel. But if you have an overactive pelvic floor, this can be something that might potentially worsen your symptoms, or if you're doing a Kegel incorrectly, this could be something that worsens your symptoms.

I just tell people if they're going to look into strengthening, or if you need any guidance on creating a healthy pelvic floor specifically, seek a pelvic floor therapist to give them an individualized care plan. And I think I'll let Marlee talk about a couple of other things.

Marlee Anderson: Just kind of piggybacking off of that, another thing that we will tell almost all of our patients, which is a habit I think absolutely everybody can implement in their day-to-day lives is we tell people to discontinue what we call just-in-case peeing. And it's exactly what it sounds like. So, it's just going and emptying your bladder more out of habit and just in case we have to go later. So, it's more out of fear for needing to go later on. So, you're not going because you have the urge to go, but because you're worried that you may have to go later. So, people will do this, like, you know, they'll go to the bathroom real quick just in case, before they get into a car to go somewhere or before they watch a movie. I find a lot of my patients who are in the healthcare field as well as in education or just work very busy jobs are really guilty of this because you only get short amounts of free time and it's like, "Oh, I better take advantage of it and go to the bathroom," but we may not necessarily have the urge to go.

And so, why this can potentially not be good for your bladder and pelvic floor is because if we continuously empty our bladder before it's full, you're training your bladder to hold less. And so then, we end up going more, which can lead to urgency, frequency, and things like incontinence. It's just an easy habit that we can try to implement and that can make a world of difference if we do implement that. And that kind of goes into like ignoring the urge for too long. Like the other side of that, if we let our bladder fill up too much, sometimes that can also increase our risk for leakage and urgency, things like that. We wanna make sure we're not holding the urge too long. Rushing to the bathroom is also something that a lot of people are guilty of, but we get that really strong urge to go. Rushing to the bathroom can actually increase our risk of urinary incontinence and leakage. So, it's kind of a mental thing, but like forcing yourself to take your time going to the bathroom is super, super important.

And then, the last one that I can really think of is like something we also tell patients not to do is something that we call power peeing. And it's essentially pushing or straining on the toilet to empty your bladder. So, kind of like Destinee said earlier, those pelvic floor muscles need to relax whenever we empty our bladder and go to the restroom. So if we're pushing and straining, we're kind of interfering with that natural mechanism. And it can actually increase your risk for things like pelvic organ prolapse. So, we just need to let the body do its thing, sit down and relax, and just discontinue the straining and the pushing.

Host: Oh my gosh, I do so many of the things that you all listed. And I guess it's the more you know, it's good to know the things I need to change, right? But Marlee, I'd love to stick with you for a second. Is urinary leakage ever normal or to be expected?

Marlee Anderson: I'm so glad you asked that. One thing that we say a lot in our clinic is just because something is common does not make it normal. And so, urinary leakage is never normal, but I feel like as a society, we do tend to normalize a lot of pelvic floor conditions, especially leakage. I can't tell you how many times I've heard patients say, "Well, it's just a part of getting older" or, "Well, like it's normal I just had children." We have normalized leakage so much when it is something that can be addressed and needs to be addressed. So things like childbirth and aging, going through menopause, like yes, those things can increase your risk of urinary incontinence and leakage, but there are absolutely things that we can do to prevent that from getting worse, to go ahead and address it before it does get worse. And so, that is definitely something we tell patients. We need to stop normalizing having leakage as a society. And so, I do think that that is something that we strongly emphasize in our clinic, Destinee and I do.

Host: Beautiful. And Destinee, who should come see a pelvic floor physical therapist?

Destinee Caldwell: Well, I will say Marlee and I are very, very biased, but we personally think everyone benefits pelvic floor PT, as everyone has a pelvic floor. But like Marlee just said, especially after giving birth or going through menopause, those are big changes for women specifically, that they might need some assistance on as it's a big change in their body, hormonally and physically.

But even if you're not in that stage of life, if you're having symptoms of urinary leakage, pain with intercourse, pelvic pain, things like bowel leakage or constipation, you could benefit from seeing a pelvic floor physical therapist and getting an individualized plan of care for you.

Host: I love that we're doing this episode today because recently my chiropractor recommended that I go see a pelvic floor specialist and I never have. So Marlee, I would love to know what should someone expect from their first pelvic floor physical therapy appointment?

Marlee Anderson: Yes. So, we get a lot of patients who come in for their first appointment and they're very nervous because they don't know what to expect. We can kind of Google things that may seem a little scary about pelvic floor physical therapy. So, we tell people the first appointment is an evaluation. So, that's where we're going to discuss your symptoms and your medical history, and just get a lot of information. Now, one thing that Destinee and I are both trained in doing are internal and external vaginal and rectal assessments. Now, we do not do these assessments on the first visit. So, we always tell our patients, "Take a deep breath. Today's going to be a relatively easy day." We're not going to be doing anything like that on the first visit. If we decide that we think that an assessment like that would be beneficial, we have that conversation on the first visit, but we don't do it until the second visit at the earliest.

And then two, we tell patients those assessments are completely optional. They are not required. But we typically have that conversation on the first visit. And, Destinee, I'll let you kind of jump in on the rest of what we do with the first visit.

Destinee Caldwell: Yeah, absolutely. So, if we're not doing internal exams, what are we doing? Well, we're doing a lot of external examinations. So, we look at your posture, we look at your strength, whether that's your hips or your legs, we look at your breathing assessment, or we can look at like your abdominals, right? If we're thinking someone who's after a C-section or even some laparoscopic surgeries through the abdomen, there's a lot of things that we can look at on the first visit depending on what your symptoms are that can be very, very beneficial. From there, we'll work on creating goals, figuring out a course of action that works for you specifically. And then, we provide a lot of education and we like to get people started on exercises.

I will say Marlee and I, this is what we do. This is our training. Now, if you go to a pelvic floor physical therapist in a different location, or even if you're in a different state, you expect some of this to be different. They may be open to doing an internal assessment on the first time, but that's something that you can communicate with them, especially if you're a little apprehensive or kind of worried about that, you may be able to ask them like, "Hey, can we delay this until after a few visits or until the second visit?" That's always an option.

Host: Then Destinee, wrap it up for us today. Where are you currently located and how can we schedule an appointment with you all?

Destinee Caldwell: Yes. So, we are located at the UAMS Women's Center on the ground floor. To get started to come see us, all we need is a referral from your primary care physician or a specialist if you're seeing one of those. And then, to make an appointment, you can Google UAMS Women's Health Physical Therapy. That will take you to our website with a link to scheduling, or you can call 501-296-1500.

Host: That was Marlee Anderson, and Destinee Caldwell. Thank you both so much for joining us. For more information or to make an appointment, call 501-296-1500. If you enjoyed this podcast, please share it on your social channels and check out the entire podcast library. for topics of interest to you. I'm Caitlin Whyte, and this is UAMS Health Talk. Thanks for listening.