Jaime Lewis (Host): Think about the center of your body, your core. That center is carried by the pelvic floor. It's fundamental to our internal organs and systems, not to mention our quality of life. But we often ignore it when something isn't right. Here to discuss the benefits of pelvic floor therapy is Kristen Toussaint, an occupational therapist at the University of Maryland, St. Joseph Outpatient Rehab Institute.

Welcome to the Live Greater podcast series, information for a healthier you from the University of Maryland Medical System. I'm your host, Jamie Lewis. Hello, Kristen. Welcome to the podcast.

Kristen Toussaint, OT: Hi, Jamie. Thank you for having me.

Host: I suspect many people don't actually know what or where their pelvic floor is. Can you provide a basic overview?

Kristen Toussaint, OT: Absolutely. So, the pelvic floor is a hammock-like group of muscles and connective tissue at the base of the pelvis. They provide support and stability for pelvic organs, your pelvis, and all the surrounding structures. They play an important role in elimination and urinary and fecal continence. They also play a role in your sexual function.

Host: All right. Now, you work in pelvic floor therapy. What is that and how does it work?

Kristen Toussaint, OT: Yes. So, pelvic floor therapy is a conservative treatment option for pelvic floor dysfunctions. So, it is provided by physical or occupational therapists with advanced training in pelvic health. It can include exercise, manual therapy, behavioral modifications that are prescribed by your therapist and they address the causes of the dysfunction with hopefully improvement.

Host: How does pelvic floor therapy differ from, say, another form of occupational or physical therapy and when is that recommended?

Kristen Toussaint, OT: Pelvic floor therapy is different from other forms of therapy, because it focuses specifically on dysfunctions related to the pelvic organs and supporting structures. So, it's recommended to treat incontinence, constipation, prolapse, sexual pain or dysfunction, as well as pelvic pains.

Host: Okay. So specific to the pelvic floor and its functions, can you share some common issues or conditions that pelvic floor therapy can address and how prevalent are those concerns?

Kristen Toussaint, OT: Absolutely. The primary one, I think, that most people will be aware of is urinary incontinence, which is leakage of urine. And that can be a full loss of bladder control, inability to make it to the bathroom on time, or even just a couple of leaks if you're sneezing or jumping. So, even just a couple of drops can be considered incontinence. And for women, the rates, depending on the population, can range anywhere from 36-83%. And for men, it's up to 39%. And it does increase over time, so older populations are more susceptible. Constipation or bowel incontinence can be a common symptom. And constipation can be anywhere from 2-28% and bowel incontinence up to 8% of the population.

We also address pelvic pain. So if you are somebody who has pain in your pelvic region, general pain, sitting pain, pain related to movement or exercise, this can affect up to 6 6-25% of the population and specifically chronic pelvic pain. So, pain that's non-cyclical and lasting more than six months. Therapy can address pelvic organ prolapse, which is a sag or bulging of any of the pelvic organs. It is most common among women or individuals assigned female at birth, so anywhere from like 3-11%. And then, we also can address dyspareunia, which is pain during sex or impaired sexual function. And that can impact anywhere from 10-28% of the population at some point during their lifetime.

Host: Well, given its position in the body, you touched on this a little bit, but I can imagine there are some folks who would especially benefit from pelvic floor therapy. Are there specific populations like pregnant, postpartum, perimenopause, postmenopause, people who may particularly benefit from it?

Kristen Toussaint, OT: Yes. So, you said pregnant and postpartum individuals, absolutely. They may need help strengthening and retraining their muscle coordination during their pregnancy and even after delivery. People in peri and postmenopausal stages, they may notice changes to bowel, bladder, and sexual dysfunction, so therapy could help to address that. Older adults, especially individuals experiencing weakness or chronic health conditions, they may notice incontinence or constipation.

Another population that is often benefited from pelvic floor athletes or individuals engaged in high-impact sports or exercises. They may have imbalances impacting pain, continence, and sexual function. So, an example of that are cyclists, runners, heavyweight trainers, or gymnasts.

Host: Right. What role does pelvic floor therapy play in addressing chronic pain or discomfort? And what are the long-term benefits of it?

Kristen Toussaint, OT: Pelvic floor therapists can help to address some of the causes of pelvic pain. They can prescribe exercises to strengthen muscles. They can release muscle or fascial tension that may be causing the pain or discomfort. And then, for long-term relief, your therapist can also prescribe a maintenance program for you to continue at home, as well as modifications to some of your daily activities that may have contributed to the dysfunction in the first place.

Host: Let's just say I'm considering pelvic floor therapy. What does a typical session entail and what can I expect during the treatment process?

Kristen Toussaint, OT: First things first, pelvic floor therapy will always start with an initial evaluation. Your therapist will ask questions. They want to better understand your symptoms and how they're impacting your daily life. Based on that interview, your therapist will assess your physical and psychosocial factors that may be causing your symptoms. This can include an assessment of your posture, your pelvic and spinal alignment, muscle strength, your bathroom routines, and even your current diet. And then, once they've done their assessment, they might also assess strength, coordination of your pelvic floor muscles. So, those are specifically the muscles of the pelvic floor. And that can be done by manual assessment, ultrasound or other biofeedback devices. After your assessment, your therapist will then develop an individual treatment plan to address your unique needs.

Host: What are the potential benefits and how soon could I expect to see results after therapy?

Kristen Toussaint, OT: Benefits off therapy could include improved control of your bowel and bladder function. It can include a reduction in pain, it can include a healthy and sustainable bladder and bowel habits, as well as improved strength and general confidence.

Host: Those are all good things. is, pelvic floor therapy something that only happens in a rehab center? Can I do exercises at home? What guidance do you provide for effective home treatment?

Kristen Toussaint, OT: So, if you have any concerns, I do recommend being assessed by a pelvic floor therapist. But there are ways to start at home. Many of your listeners may have heard of Kegels or Kegel exercises, which is just a contraction of your pelvic floor muscles. So, these exercises can be a great place to start for many people, especially those experiencing incontinence. To do these, you want to keep your abdominal muscles and your gluteal muscles, the muscles of your bottom relaxed. And then, you want to gently contract the muscles of your pelvic floor, like you're trying to stop the flow of urine or hold back gas. You want to make sure that between contractions that you are fully relaxing and releasing your muscles. One way to help encourage relaxation is through a big 360 breath. So to do this, you fully inhale, fill your belly, your side ribs, and feel your pelvic floor expand and release as you lengthen and expand your lungs full of air. So if you feel a worsening of your symptoms, pain or pelvic pressure, or a lack of improvement in your symptoms with these gentle Kegel exercises, please communicate this to your medical team as you really may benefit from a more individualized assessment and treatment. But it's a great place to start.

Host: Right. for anyone who is hesitant about trying pelvic floor therapy, how would you reassure them, or what advice would you give them?

Kristen Toussaint, OT: I say take the first step, give it a try. Because no matter what your age, the severity of your symptoms, or the level of your comfort, your therapist is going to meet you where you are. They're going to modify their approach, change the interventions, to really make sure that no matter what stage you are, you feel confident in your care, and you can get the results that you need. So, take that first step and just go and see what it's like.

Host: Well, you obviously have so much to teach us. Thank you for your time. Is there anything else you'd like to add?

Kristen Toussaint, OT: I want to share please, please, please do not let embarrassment of your symptoms prevent you from seeking help. If you are having any symptoms or concerns, please speak up. Don't be embarrassed and you are not alone. So, talk to your healthcare providers so that you can get the help and the improvement that you deserve.

Host: Thanks again, Kristen, for being on the podcast.

Kristen Toussaint, OT: Thank you for having me.

Host: That was Kristen Toussaint, an occupational therapist at the University of Maryland, St. Joseph Outpatient Rehab Institute. Find more shows just like this one at umms.org/podcast and on YouTube. I'm Jamie Lewis. Thank you for listening to Live Greater, a health and wellness podcast brought to you by the University of Maryland Medical System. We look forward to you joining us again, and please share this on your social media channels.