Selected Podcast
Pelvic Health Therapy
Valley Health Specialty Hospital Therapists will be talking about pelvic health and the importance of Pelvic Floor Therapy for both females and males.
Featured Speakers:
Xela Oyer grew up in Albuquerque, NM and graduated from Physical Therapy school in San Antonio, TX from the University of the Incarnate Word. Xela is currently a physical therapist at the Valley Health Specialty Hospital specializing in pelvic health physical therapy for both females and males. Xela has been practicing for 3 years, bringing a high level of passion and personality to the patients she treats. What Xela enjoys most about her job is empowering her patients through knowledge sharing and active treatments to help them get back to the things that make life worth living. When Xela is not treating her patients, she is spending time with her fiancé and her two beagle dogs. She also enjoys hiking, dancing, watching movies and sports, and traveling.
Guang Orestes, DPT | Xela Oyer, DPT
Guang earned her Doctor of Physical Therapy degree from Boston University in Boston, Massachusetts. Guang has completed extensive post-doctoral training in pelvic floor and abdominal health physical therapy, pregnancy, and postpartum care, through the Academy of Pelvic health Physical Therapy of the American Physical Therapy Association and the Herman and Wallace Pelvic Rehabilitation Institute. Before joining Spring Valley Hospital, Guang worked in the outpatient sector and developed and ran a successful pelvic floor physical therapy program across multiple clinics here in Las Vegas.Xela Oyer grew up in Albuquerque, NM and graduated from Physical Therapy school in San Antonio, TX from the University of the Incarnate Word. Xela is currently a physical therapist at the Valley Health Specialty Hospital specializing in pelvic health physical therapy for both females and males. Xela has been practicing for 3 years, bringing a high level of passion and personality to the patients she treats. What Xela enjoys most about her job is empowering her patients through knowledge sharing and active treatments to help them get back to the things that make life worth living. When Xela is not treating her patients, she is spending time with her fiancé and her two beagle dogs. She also enjoys hiking, dancing, watching movies and sports, and traveling.
Transcription:
Pelvic Health Therapy
Amanda Wilde (Host): When you think healthy body, do you ever think pelvic floor? Regardless of gender, pelvic floor health is crucial. We'll talk about that in detail with physical therapists, Dr. Xela Oyer and Dr. Guang Orestes.
This is Health Talk with the Valley Health System presented by The Valley. I'm Amanda Wilde. Xela and Guang, thank you so much for being here today and sharing your expertise.
Dr Xela Oyer: Thank you. We're happy to be here.
Amanda Wilde (Host): Xela, you both specialize in pelvic health therapy. What is the function of the pelvic floor? Describe what that is anatomically.
Guest 1: So, the pelvic floor is made up primarily of two main muscle groups, so the levator ani and the coccygeus muscles. The levator ani is actually kind of three different muscles all in one, but they essentially make up almost like a hammock within your pelvis. And so, it attaches at your pubic bone on the front side and then wraps all the way back around to your coccyx or your tailbone and so, essentially helps to support your pelvic organs. So for females, that's going to be your bladder, your rectum and your uterus. And then, for males, it's going to be your rectum, your bladder and your prostate gland. And so essentially, they are kind of the end-all, be-all to help support and lift up all of those organ. They're a huge part of the core muscle groups. And so, every time we think of core, we think of the abdominal muscles. And yes, that's a big part of it, but there's also the pelvic floor that helps stabilize from below. And so, it's a big, big, big stability muscle.
The other thing that it helps with is the enteric function. And so, we have the anal sphincter, which we know helps with bowel function. It has to be able to relax in order to release bowels. But sometimes when we have hemorrhoids or anal fissures, things like that, it can cause dysfunction. Along the urinary side of things, we have the external urethral sphincter. And so, that again has to be able to relax in order to release urine. If there's maybe been someone who has catheter use, there can be scar tissue buildup that can create irritation or not able to relax that muscle as well.
The other part is sexual function. And so, the pelvic floor muscles during an orgasm have to bring blood flow to that area and this huge contraction of these muscles bringing blood flow there. And that's kind of what helps create this orgasm. But what can happen is, if they're too tense, sometimes that can even lead to pain dysfunction with sex as well. And then just overall circulation, so it's basically like a sump pump. So, the pelvis muscles will help kind of pump blood flow and fluids back up to the heart as well. So, it's a huge muscle group in order for us to stay healthy.
Host: So, I was saying, Guang, you know, that you're both specialists in pelvic health therapy. What kind of dysfunctions do you see? I think Xela kind of touched on some things that can happen when the pelvic floor isn't healthy.
Dr Guang Orestes: Xela already touched on a lot of the things that can happen when the pelvic floor isn't functioning. I just want to summarize and add a little bit more to pelvic floor conditions. And these include urinary incontinence, which means leaking urine accidentally or unexpectedly; pain in the pelvis, in the abdomen, in the low back, in the testicles and in the penis; bowel dysfunctions such as constipation, fecal incontinence, which means leaking fecal matter accidentally or unexpectedly; pelvic organ prolapse, which means descending of the pelvic organs such as the uterus, the bladder, the rectum beyond their original positions in the pelvis; pain during intercourse or other sexual dysfunctions and sexual activities; pain with routine gynecological examination using a speculum or pain during routine rectal examination for prostate examination
Host: And Guang, what can we do to keep our pelvic floor healthy so we don't experience these dysfunctions? Although sometimes that's just circumstance, right?
Guest 2: If you have a healthy pelvic floor and do not have any of the conditions that I mentioned, the things that I really want to look out for is to avoid any Valsalva maneuver, and that just means that you are avoiding creating an unnecessarily large amount of pressure into the pelvis. Imagining you're lifting something really heavy from the ground, I would avoid holding your breath, blow up your tummy to stabilize your trunk to lift. But instead, breathe out and contract your pelvic floor a little bit, so you're not creating so much pressure to the pelvic floor.
Another thing I want to look out for is to avoid constipation as much as possible. And that means you're hydrating while eating good healthy fiber, and to have a good defecation posture when you're on the toilet. What I mean by that is that you should think about elevating your knees above your hips. So when you're on the toilet, you can create a relaxation of the puborectalis muscles that can aid passing stool more smoothly.
Host: Xela, Guang just touched on what the symptoms are if something isn't working properly with the pelvic floor. Can you talk about what treatments are available?
Guest 1: So when someone comes into us, we're doing a thorough assessment, not only orthopedically, you know, what does their posture look like, because we know the pelvis is a huge connection between the entire upper and lower body. And so, oftentimes where the pelvis sits can affect a lot of these different functions within our body. And so, we're doing, you know, what's our back mobility like, what's our hip mobility like, what's our core strength, what's our hip strength like? We're assessing all these things before we even get internal to the pelvic floor muscle group.
We're asking a lot of questions like kind of Guang was saying too, maybe bowel and bladder habits that need to be sort of retrained. Especially women postpartum, oftentimes we do the, "Oh, well I need to pee just because." So oftentimes, those patterns can actually, you know, create bad habits that we start to kind of get into. And so, a lot of times, we're modifying maybe some habits that they've gotten into, and that's, a big, big factor.
And then just overall, then we're doing an internal assessment. And so, we just go in with one digit and we want to feel what those muscles are like. Are they really, really tense and tight? You know, people that do have higher anxiety or stress levels, things like that, the pelvic floor is such a unique muscle group because it not only has parasympathetic but also sympathetic factors. And so, what I mean by that is the pelvic floor has to be able to fully relax in order to have a full bowel movement, in order to urinate properly, in order to have sex, it has to be able to relax. And so, if someone has had trauma or abuse or just those people that are almost like type A and just really have a lot of anxiety stored, oftentimes I describe it as like, you know how your upper traps, everyone gets neck pain and tension, right?
The pelvic floor is the same way. And so, we hold a lot of tension within those pelvic floor muscles as well. And so, we have to be able to kind of fully relax those muscle in order for everything to function properly. And so, we get in there and if we notice, "Man, someone is just not able to relax these muscles. They are so tight," we have to start getting in there and start doing some what we call trigger point releasing or just addressing this tension before we can maybe start to strengthen and see maybe how is there full motion. I always describe it, you know, like think of your bicep. If it's stuck in a shortened state, you see guys walking around with these big old Popeye's biceps, but they're not able to fully extend their arm out. It's almost like the pelvic floor gets stuck in that shortened state, and that can actually lead to chronic pelvic pain conditions. And so, we have to address and be able to fully lengthen those muscles to start getting them to function properly.
And so, that's part of it. We're seeing, "Okay, what's the tone like?" We're seeing, "Okay, what's your strength like of this muscle? Is it really weak?" And like Guang was saying, that could potentially lead to some maybe pelvic organ prolapse because we know it's a huge supportive muscle of these organs. And so, if it's weak or not able to hold for an extended period of time, then when we're upright in these positions all day and women complain, "Well, now after a few hours of standing, I start getting a lot of heaviness or pressure down there." Well, we have to start to build the strength and endurance of those muscles back up.
So, we're really just doing a full assessment on these women and men and just seeing truly what we need to start addressing. And not only manually addressing it, whereas we do a lot of myofascial release if we find scar tissue or tension in certain areas. There's a lot of really great techniques that we know to kind of release that tension, and start getting the muscle functioning appropriately. C-section scars is a big one. A lot of women will come in 20 years after a C-section and they're like, "Oh, well, I just thought I was either never supposed to have sensation there again," or "Oh my gosh, I've had a burning sensation there for the last 20 years." And so, even a few sessions of some working on that scar tissue, people notice, "Oh my gosh, I actually have like normal sensation there now." And then now, we can actually start to build their core strength back up because the muscles are able to function appropriately.
So, there's a lot of different multifactors that we look at within the pelvis. And it's not just the pelvis. We are looking at overall posture. There's a huge correlation between pelvic dysfunction and TMJ issues, temporal mandibular dysfunction, right? And so, oftentimes when people are clenching their jaw, they're clenching their pelvic floor too. Or there could be a lot of tension built up within the backside of their body that needs to be addressed or posturally. Especially as we get older, we start to kind of be in that more forward posture, things like that. And so, there's really a holistic approach that we have to do as far as a pelvis goes, like I said, just within that whole connection of the entire body.
Host: Guang, Xela's describing a lot of hands-on physical therapy and also becoming aware with the patient about posture and the way you're holding yourself. Are there any other therapies or treatments you use in your practice?
Guest 2: Think about the pelvic floor as a muscle that's is just like the muscles in the rest of your body. People go to the gym to exercise other body parts, and why not incorporating the pelvic floor muscles as well? Think about pelvic health, a part of regular health and regular fitness. You are strengthening the muscles, like you're strengthening your biceps. You're stretching the muscles like you are stretching your hamstrings or your calves. Think about when your pelvic floor isn't working. What are some strategies that then you can utilize to be able to aid the process of healing?
Host: Well, Guang and Shayla, thank you for this primer on the pelvic floor. It's your sort of command center of mobility and stability in connecting your upper body and lower body. That's what I've learned today.
Guest 1: Thank you. We appreciate this and we're always happy to spread the word on pelvic floor. So, it's really a topic that not a lot of people bring up. But like we said, nine times out of 10, if someone has chronic back pain and their pelvic floor has maybe never been addressed, that's a big area that you maybe need to look at. Because like we said, it's a huge part of the core and so it's often overlooked and can get a huge impact on these people. And like Guang was saying too, oftentimes with chronic pelvic pain conditions, it's like you can't see it, right? So, these people are written off for years and years and years. And then, they finally get to us and they get some sort of validation of, "Hey, there actually is something going on that's causing this. It's not all in your head," right? And so, I would encourage those people, if you're feeling at all like, "Oh my gosh, I've gone to all these people and no one's giving me any answers," it never hurts just to get an evaluation and just see, you know, this could be contributing to your issues.
Host: That's great advice. And thank you for raising awareness about the function of the pelvic floor.
Guest 1: Absolutely. And the other thing that our big push is, so we recently started a program in the hospital, getting women right away after they have kiddos. We're giving them education on pelvic floor and so many women have been like, "Oh my gosh, I wish I had this with my first kid," or "Oh my gosh, this is such good information," because it is. If we can address these muscles right away after you've had a kiddo, because that's a big trauma to the pelvis. We're finding that we can hopefully get these women back to functioning and hopefully avoid issues that don't present themselves until maybe 20 years down the line. And so, that's a big push of ours right now, is just to try to create awareness in those acute stages, not just later on.
Host: So, get to it before it even starts.
Guest 1: Absolutely.
Host: You just heard from doctors of physical therapy, Xela Oyer and Guang Orestes. For more information, visit valleyhealthsystemlv.com. 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. Thanks for listening to this episode of Health Talk with the Valley Health System presented by The Valley. I'm Amanda Wilde.
Physicians are independent practitioners who are non-employees or agents of the Valley Health System. The system shall not be liable for actions or treatments provided by physicians.
Pelvic Health Therapy
Amanda Wilde (Host): When you think healthy body, do you ever think pelvic floor? Regardless of gender, pelvic floor health is crucial. We'll talk about that in detail with physical therapists, Dr. Xela Oyer and Dr. Guang Orestes.
This is Health Talk with the Valley Health System presented by The Valley. I'm Amanda Wilde. Xela and Guang, thank you so much for being here today and sharing your expertise.
Dr Xela Oyer: Thank you. We're happy to be here.
Amanda Wilde (Host): Xela, you both specialize in pelvic health therapy. What is the function of the pelvic floor? Describe what that is anatomically.
Guest 1: So, the pelvic floor is made up primarily of two main muscle groups, so the levator ani and the coccygeus muscles. The levator ani is actually kind of three different muscles all in one, but they essentially make up almost like a hammock within your pelvis. And so, it attaches at your pubic bone on the front side and then wraps all the way back around to your coccyx or your tailbone and so, essentially helps to support your pelvic organs. So for females, that's going to be your bladder, your rectum and your uterus. And then, for males, it's going to be your rectum, your bladder and your prostate gland. And so essentially, they are kind of the end-all, be-all to help support and lift up all of those organ. They're a huge part of the core muscle groups. And so, every time we think of core, we think of the abdominal muscles. And yes, that's a big part of it, but there's also the pelvic floor that helps stabilize from below. And so, it's a big, big, big stability muscle.
The other thing that it helps with is the enteric function. And so, we have the anal sphincter, which we know helps with bowel function. It has to be able to relax in order to release bowels. But sometimes when we have hemorrhoids or anal fissures, things like that, it can cause dysfunction. Along the urinary side of things, we have the external urethral sphincter. And so, that again has to be able to relax in order to release urine. If there's maybe been someone who has catheter use, there can be scar tissue buildup that can create irritation or not able to relax that muscle as well.
The other part is sexual function. And so, the pelvic floor muscles during an orgasm have to bring blood flow to that area and this huge contraction of these muscles bringing blood flow there. And that's kind of what helps create this orgasm. But what can happen is, if they're too tense, sometimes that can even lead to pain dysfunction with sex as well. And then just overall circulation, so it's basically like a sump pump. So, the pelvis muscles will help kind of pump blood flow and fluids back up to the heart as well. So, it's a huge muscle group in order for us to stay healthy.
Host: So, I was saying, Guang, you know, that you're both specialists in pelvic health therapy. What kind of dysfunctions do you see? I think Xela kind of touched on some things that can happen when the pelvic floor isn't healthy.
Dr Guang Orestes: Xela already touched on a lot of the things that can happen when the pelvic floor isn't functioning. I just want to summarize and add a little bit more to pelvic floor conditions. And these include urinary incontinence, which means leaking urine accidentally or unexpectedly; pain in the pelvis, in the abdomen, in the low back, in the testicles and in the penis; bowel dysfunctions such as constipation, fecal incontinence, which means leaking fecal matter accidentally or unexpectedly; pelvic organ prolapse, which means descending of the pelvic organs such as the uterus, the bladder, the rectum beyond their original positions in the pelvis; pain during intercourse or other sexual dysfunctions and sexual activities; pain with routine gynecological examination using a speculum or pain during routine rectal examination for prostate examination
Host: And Guang, what can we do to keep our pelvic floor healthy so we don't experience these dysfunctions? Although sometimes that's just circumstance, right?
Guest 2: If you have a healthy pelvic floor and do not have any of the conditions that I mentioned, the things that I really want to look out for is to avoid any Valsalva maneuver, and that just means that you are avoiding creating an unnecessarily large amount of pressure into the pelvis. Imagining you're lifting something really heavy from the ground, I would avoid holding your breath, blow up your tummy to stabilize your trunk to lift. But instead, breathe out and contract your pelvic floor a little bit, so you're not creating so much pressure to the pelvic floor.
Another thing I want to look out for is to avoid constipation as much as possible. And that means you're hydrating while eating good healthy fiber, and to have a good defecation posture when you're on the toilet. What I mean by that is that you should think about elevating your knees above your hips. So when you're on the toilet, you can create a relaxation of the puborectalis muscles that can aid passing stool more smoothly.
Host: Xela, Guang just touched on what the symptoms are if something isn't working properly with the pelvic floor. Can you talk about what treatments are available?
Guest 1: So when someone comes into us, we're doing a thorough assessment, not only orthopedically, you know, what does their posture look like, because we know the pelvis is a huge connection between the entire upper and lower body. And so, oftentimes where the pelvis sits can affect a lot of these different functions within our body. And so, we're doing, you know, what's our back mobility like, what's our hip mobility like, what's our core strength, what's our hip strength like? We're assessing all these things before we even get internal to the pelvic floor muscle group.
We're asking a lot of questions like kind of Guang was saying too, maybe bowel and bladder habits that need to be sort of retrained. Especially women postpartum, oftentimes we do the, "Oh, well I need to pee just because." So oftentimes, those patterns can actually, you know, create bad habits that we start to kind of get into. And so, a lot of times, we're modifying maybe some habits that they've gotten into, and that's, a big, big factor.
And then just overall, then we're doing an internal assessment. And so, we just go in with one digit and we want to feel what those muscles are like. Are they really, really tense and tight? You know, people that do have higher anxiety or stress levels, things like that, the pelvic floor is such a unique muscle group because it not only has parasympathetic but also sympathetic factors. And so, what I mean by that is the pelvic floor has to be able to fully relax in order to have a full bowel movement, in order to urinate properly, in order to have sex, it has to be able to relax. And so, if someone has had trauma or abuse or just those people that are almost like type A and just really have a lot of anxiety stored, oftentimes I describe it as like, you know how your upper traps, everyone gets neck pain and tension, right?
The pelvic floor is the same way. And so, we hold a lot of tension within those pelvic floor muscles as well. And so, we have to be able to kind of fully relax those muscle in order for everything to function properly. And so, we get in there and if we notice, "Man, someone is just not able to relax these muscles. They are so tight," we have to start getting in there and start doing some what we call trigger point releasing or just addressing this tension before we can maybe start to strengthen and see maybe how is there full motion. I always describe it, you know, like think of your bicep. If it's stuck in a shortened state, you see guys walking around with these big old Popeye's biceps, but they're not able to fully extend their arm out. It's almost like the pelvic floor gets stuck in that shortened state, and that can actually lead to chronic pelvic pain conditions. And so, we have to address and be able to fully lengthen those muscles to start getting them to function properly.
And so, that's part of it. We're seeing, "Okay, what's the tone like?" We're seeing, "Okay, what's your strength like of this muscle? Is it really weak?" And like Guang was saying, that could potentially lead to some maybe pelvic organ prolapse because we know it's a huge supportive muscle of these organs. And so, if it's weak or not able to hold for an extended period of time, then when we're upright in these positions all day and women complain, "Well, now after a few hours of standing, I start getting a lot of heaviness or pressure down there." Well, we have to start to build the strength and endurance of those muscles back up.
So, we're really just doing a full assessment on these women and men and just seeing truly what we need to start addressing. And not only manually addressing it, whereas we do a lot of myofascial release if we find scar tissue or tension in certain areas. There's a lot of really great techniques that we know to kind of release that tension, and start getting the muscle functioning appropriately. C-section scars is a big one. A lot of women will come in 20 years after a C-section and they're like, "Oh, well, I just thought I was either never supposed to have sensation there again," or "Oh my gosh, I've had a burning sensation there for the last 20 years." And so, even a few sessions of some working on that scar tissue, people notice, "Oh my gosh, I actually have like normal sensation there now." And then now, we can actually start to build their core strength back up because the muscles are able to function appropriately.
So, there's a lot of different multifactors that we look at within the pelvis. And it's not just the pelvis. We are looking at overall posture. There's a huge correlation between pelvic dysfunction and TMJ issues, temporal mandibular dysfunction, right? And so, oftentimes when people are clenching their jaw, they're clenching their pelvic floor too. Or there could be a lot of tension built up within the backside of their body that needs to be addressed or posturally. Especially as we get older, we start to kind of be in that more forward posture, things like that. And so, there's really a holistic approach that we have to do as far as a pelvis goes, like I said, just within that whole connection of the entire body.
Host: Guang, Xela's describing a lot of hands-on physical therapy and also becoming aware with the patient about posture and the way you're holding yourself. Are there any other therapies or treatments you use in your practice?
Guest 2: Think about the pelvic floor as a muscle that's is just like the muscles in the rest of your body. People go to the gym to exercise other body parts, and why not incorporating the pelvic floor muscles as well? Think about pelvic health, a part of regular health and regular fitness. You are strengthening the muscles, like you're strengthening your biceps. You're stretching the muscles like you are stretching your hamstrings or your calves. Think about when your pelvic floor isn't working. What are some strategies that then you can utilize to be able to aid the process of healing?
Host: Well, Guang and Shayla, thank you for this primer on the pelvic floor. It's your sort of command center of mobility and stability in connecting your upper body and lower body. That's what I've learned today.
Guest 1: Thank you. We appreciate this and we're always happy to spread the word on pelvic floor. So, it's really a topic that not a lot of people bring up. But like we said, nine times out of 10, if someone has chronic back pain and their pelvic floor has maybe never been addressed, that's a big area that you maybe need to look at. Because like we said, it's a huge part of the core and so it's often overlooked and can get a huge impact on these people. And like Guang was saying too, oftentimes with chronic pelvic pain conditions, it's like you can't see it, right? So, these people are written off for years and years and years. And then, they finally get to us and they get some sort of validation of, "Hey, there actually is something going on that's causing this. It's not all in your head," right? And so, I would encourage those people, if you're feeling at all like, "Oh my gosh, I've gone to all these people and no one's giving me any answers," it never hurts just to get an evaluation and just see, you know, this could be contributing to your issues.
Host: That's great advice. And thank you for raising awareness about the function of the pelvic floor.
Guest 1: Absolutely. And the other thing that our big push is, so we recently started a program in the hospital, getting women right away after they have kiddos. We're giving them education on pelvic floor and so many women have been like, "Oh my gosh, I wish I had this with my first kid," or "Oh my gosh, this is such good information," because it is. If we can address these muscles right away after you've had a kiddo, because that's a big trauma to the pelvis. We're finding that we can hopefully get these women back to functioning and hopefully avoid issues that don't present themselves until maybe 20 years down the line. And so, that's a big push of ours right now, is just to try to create awareness in those acute stages, not just later on.
Host: So, get to it before it even starts.
Guest 1: Absolutely.
Host: You just heard from doctors of physical therapy, Xela Oyer and Guang Orestes. For more information, visit valleyhealthsystemlv.com. 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. Thanks for listening to this episode of Health Talk with the Valley Health System presented by The Valley. I'm Amanda Wilde.
Physicians are independent practitioners who are non-employees or agents of the Valley Health System. The system shall not be liable for actions or treatments provided by physicians.