“I’m peeing all the time… How could a PT possibly help me?”

With tomorrow being the last day of my last clinical rotation, I thought I would educate people a little on what I do. I am receiving my doctorate of physical therapy degree in 9 days (yes, I have a bachelors degree and then completed 3 years of graduate school and no it was not a “weekend course” like some patients have asked me). The last 9 months of my school career have been clinical rotations, aka I’ve been paying tuition to work 40 hours a week, but is very similar to a medical doctor’s intern year in which I am learning  from mentors and clinical instructors but still managing my own case load of patients.

My last rotation has been 12 weeks of women’s health, specifically pelvic floor disorders. This is what I wish to specialize in.

  1. Much like a cardiologist is an expert in the heart and cardiac disorders, a physical therapist is an expert on the musculoskeletal system and functional movement disorders
  2. Your PELVIC FLOOR is a group of muscles located at the bottom of your pelvis and is female_pelvic_floor_diagram_copyrightpresent in women and men (although for now I am focusing my education on women-based disorders.. one thing at a time). These connect at your pubic bone in the front and your coccyx (or tailbone) in the back. The function of these muscles is to support your pelvic organs, assist in urination and defecation, and sexual function. 3 openings exit through these muscles in the female: urethra from your bladder, vagina from your uterus, and anus from your rectum. These muscles work involuntarily AND voluntarily. Yes, you can control these muscles. The coordination, strength, and endurance of these muscles in a female is best evaluated vaginally, using one finger to palpate (or touch) these muscles. This is done much like if you were coming to me for your knee, I would look at your knee and touch your knee and test the strength of it … same for your pelvic floor, except that you may need to take your bottoms off if you’re comfortable doing so. No, it’s not an OB/GYN exam and I don’t use a speculum and I TRY to make it as comfortable for you as possible.
  3. bfffe5cff6bd8f333e9c6e60ae7ca1ae.jpgAt rest, the pelvic floor sits in the shape of a hammock with a little bit of tension to keep you continent (not leaking urine or feces). When it contracts (when you tighten it much like you would your biceps when flexing your arm), it should tighten and lift. It should also be able to relax and bulge out further, such as during urination and defecation, to allow the passage of waste (or during intercourse to allow penetration).
  4. If your pelvic floor is too tight, it can not contract or function properly, may contribute to urinary or bowel urgency, and may cause pain. If you are leaking (such as with urinary incontinence) but you “do kegels all the time”, chances are that you are not performing the kegels correctly (you should not be squeezing your legs, butt, or tummy to do so) or that your pelvic floor tone is elevated. By seeing a pelvic floor trained physical therapist, you can be reassured that you are performing pelvic floor exercise (or “kegels”) correctly or be taught how to use them properly. Most often, I need to down train a patient (relax their pelvic floor) before beginning kegels for strengthening
  5. Disorders and dysfunctions I treat in this area include
    • Stress urinary incontinence (leakage associated with exercise, movement, coughing, sneezing, or laughing)
    • Urge urinary incontinence (leakage associated with urgency to use the bathroom)labled_pelvic_floor_and_trunk2a
    • Mixed incontinence (stress and urge)
    • Urinary frequency or urgency
    • Pelvic organ prolapse
    • Bowel urgency
    • Constipation
    • Fecal incontinence (or gas incontinence)
    • Dyspareunia (pain with sex)
    • Vaginismus (pain and muscle spasm/tightening with penetration – intercourse, tampon, etc.)
    • Vulvodynia (unprovoked pain in vulva/genital area with or without penetration)
    • Generalized chronic pelvic pain (pain in the pelvis not associated with disease or pathology)
    • Painful bladder syndrome (considered a type of chronic pelvic pain)
    • Obstetrics – both antepartum and postpartum
    • And many other conditions as well … etc. etc.
  6. My therapy interventions may include manual therapy (internal and/or external), biofeedback (a machine that measures the activity of your muscles much like an EKG measures the activity of your heart), therapeutic exercise including stretching and strengthening and coordination, behavioral modifications (bladder retraining, posture/positioning, diet, going “just in case”, etc.), dilators, and much more.

So in summation I do poop, pee, pain, sex, and pregnancy… and I love it. I get to help people who were told “you had a baby, you’re going to leak”, “it’s all in your head”, “it’s normal”, “don’t worry about it”, or “you’re just going to have to deal with it”… These are conditions that severely affect a person’s quality of life and psychosocial well-being and many are either dismissed or too embarrassed to discuss them. So, to prevent me from digressing and going off on a tangent, I will end with saying… you don’t need to live with any of these conditions (even urinary leakage, ladies) and if you are, talk to your primary physician or OB/GYN about Pelvic Floor Physical Therapy and GET A REFERRAL. Many outpatient physical therapy practices allow direct access (no MD referral needed, however it may be required for your insurance). If they dismiss your initial request, and you need a referral for your insurance, advocate for yourself and demand it.

I have completed my Pelvic Floor I course with Herman & Wallace and therefore are proficient in bladder/urinary symptoms, some pelvic organ prolapse, and obstetrics. In October, I will take Pelvic Floor 2a where I will further my skills and knowledge on bowel symptoms, pain conditions (though I have started training and treating some simple patients in this area), and begin the topic of male pelvic conditions.

Hope this wasn’t too strange of a read for some of you and has given you insight and knowledge into what I do, how I do it, and why and hopefully encourage you to find your own PFPT if need be.

Thank you, sweet friends and you enjoyed!

Resources:

Finding a pelvic floor physical therapist (PFPT):

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