Amanda Wilde (Host): We don't talk about it much, but pelvic floor issues affect a great many women. So, we are talking about women's health and pelvic floor therapy with physical therapist, Katherine Middleton.

This is Woodlawn Health Doc talk, and I'm your host, Amanda Wilde. Katherine, thank you so much for being here to get in depth on something that we can all benefit from learning about.

Katherine Middleton, PT, DPT: Yeah, no problem.

Host: Well, pelvic floor issues, as I mentioned, are not uncommon, but what is pelvic floor therapy, which is what you do?

Katherine Middleton, PT, DPT: So, pelvic floor therapy, we treat anywhere from anything that goes on with the pelvis, so bowel issues, bladder issues, pain with sex, any of that kind of stuff. Pain, just generalized pain. We do that through hands-on therapy. We may bring in some different tools. We do strengthening. We work a lot on breathing and just body mechanics and posture. And there's a lot that goes into it.

Host: So, having these issues can be normal, but treating them is not something people generally do. They are treatable.

Katherine Middleton, PT, DPT: Yeah. Most of them are. And we may not be able to completely get rid of it like a prolapse. Especially a prolapse that is like a grade 4, which is a pretty bad prolapse, we may not be able to get rid of that. But there's things that we can do to help lessen the symptoms and maybe make it a little better. And same with pain and incontinence. And if you have like diverticulitis or things like that, like after surgeries-- you know, I'm not doing the surgery part-- but we can do a little bit of rehab to help prevent this from getting worse.

Host: I was going to ask who would benefit from this service? It sounds like anyone who has any of the issues you just mentioned. Who do you normally see?

Katherine Middleton, PT, DPT: I primarily only see women right now who are referring men to different places. I am willing to see some children if they're old enough to follow directions and things like that. But primarily women, most of mine have been menopausal age. Some of them have been younger where they're pregnant. Some have been post-pregnancy, so between that like menopause and pregnancy ages. So, there's a whole wide range of ages that I treat.

Host: That's interesting, because I think a lot of us tend to associate pelvic floor issues with having given birth.

Katherine Middleton, PT, DPT: Yes.

Host: So, what causes pelvic floor issues generally?

Katherine Middleton, PT, DPT: That's a tricky question, because there's so many things that can cause it. Part of it could be our diet, part of it could be just different diseases that we might have. Birth can cause it, being pregnant because that puts a lot of pressure on those tissues. Just being human, unfortunately.

Host: So, you see all kinds.

Katherine Middleton, PT, DPT: Yes.

Host: What are some of the signs of pelvic floor issues?

Katherine Middleton, PT, DPT: Some of them would be like pain. It is not normal to have pain in your pelvic region, especially if you're having constant pain, where it's not necessarily normal to need pain relievers for your period and things like that. You might have noticed some leaking, especially with like coughing or sneezing or having trouble getting to the bathroom on time, peeing more than once or twice a night, or going more than like eight times a day is really not normal. Having stools that are being constipated or having diarrhea, so stools that are super loose or stools that are really, really hard. Another one is just having to strain and push and having difficulty with pooping.

Host: No wonder we don't talk about these things, but I am so glad we're having the conversation. As women age, it does become increasingly common to have some form of incontinence. Is this something pelvic floor therapy could help with?

Katherine Middleton, PT, DPT: Absolutely. So as we age, especially women that once we hit menopause, our estrogen decreases. So, our muscles, you kind of lose muscle mass. The tissues also kind of shrink, the pelvic tissues shrink when we lose estrogen. And that could cause some dryness, some irritation, and also result in that incontinence. And especially as we've developed habits throughout our lives, some of those habits may not be very good habits, and that could be contributing to it too. So, we can absolutely treat that. We might work a lot on diet and changing habits and things like that.

Host: Can you talk a little bit more about the part nutrition plays in keeping a healthy pelvic floor?

Katherine Middleton, PT, DPT: Yes. So when we're dehydrated, especially for the bladder when we're dehydrated or we're eating a lot of acidic foods or drinking a lot of caffeine, whether that's coffee or pop or tea, any of those, they are really, really irritating to the bladder. So when we're eating those foods and we're not drinking enough water with it, then it will really make us go pee more often and almost make our bodies more sensitive to having to go pee. And then, that causes more issues. So, having enough water is so important. So, we often say half of your body weight in ounces. So if you weigh like 200 pounds, you should be drinking at least a hundred ounces of water.

Now, if for some reason you're on a fluid restriction, you know, obviously, we need to adhere to that. But if you're not on a fluid restriction, we really want to aim for lots of water. For the bowels, we want lots of fiber. So, getting that 20 to 35 milligrams depending on if you're male or female. Fiber is super important. It helps move our stool through the system, helps make our stool either solid or a little looser, whichever way we want it to go, it helps both of those. Nutrition is a huge part in it.

Host: For those who are having the revelation right now, that there is help for some of these things that we often come to expect. What can one expect from our first pelvic floor therapy session?

Katherine Middleton, PT, DPT: So usually, for your first physical therapy session, I have patients fill out just a little form. It is just kind of like an intake form, and then a questionnaire before I bring them back just makes things a little bit smoother. We just talk about a lot about what's going on. Tell me your symptoms, things that kind of cause your symptoms, all that type of stuff. We talk about if you've had births, how many births you've had, what type, any complications, anything, like all of that stuff, because all of that also plays a part into it.

If you're still having menstruation, if you're postmenopausal, if you're menopausal, we talk about all of that. We also talk a little bit about your diet, more about your fluid intake. We talk about how often you're going poop and pee, maybe what type of stools you're having, and all of that. And then, I'll test your muscles, make sure we'll do some different tests. So, we'll do muscle strength. We'll make sure that you're able to stand on one leg normally. We'll check your breathing. We'll make sure that you don't have any splitting of the abdomen, which is very common after birth. We check to make sure the core is strong and the back muscles are strong. So, we kind of look at everything on the first visit, externally anyway.

And then, usually, for the second visit, as long as my patients comfortable with it and they feel ready and okay with it, we do an internal assessment. So, depending kind of what the issue is, we'll either go vaginally or rectally and kind of palpate the muscles, make sure the muscles are nice and strong, or they're tender, or any of those things, kind of figure out internally what's going on. I can get a pretty good picture from the outside, but sometimes you miss things if you don't go internally.

Host: It's so reassuring to know that help is available. How does someone go about setting up an appointment? Do they need a referral?

Katherine Middleton, PT, DPT: So unless you're Medicaid, you do not need a referral. But it is usually easiest to just get a referral from your physician. They can just send it over like they normally do for any other physical therapy. And, yeah, then we'll call and set up an appointment.

Host: I love how sensitive you are to the needs of each and every client that you have, and I think a big takeaway from this conversation for me is, because we don't talk about it a lot doesn't mean you have to accept this as part of life. You can see someone like Kat Middleton and she will assess you in a very thorough way and be sensitive to your needs.

So Katherine, thank you so much for sharing your insights and expertise and education on pelvic floor therapy.

Katherine Middleton, PT, DPT: You're welcome.

Host: That was physical therapist, Katherine Middleton. For more information on pelvic floor or physical therapy, go to woodlawnhealth.org. 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. This is Woodlawn Health Doc Talk. Thanks for listening.