Category Archives: About Pelvic PT

Introducing Pelvic Floor Physical Therapy for Children!

Pediatric

We are pleased to announce that we will now be offering pelvic floor physical therapy for children in the Upstate area of South Carolina. We are very excited about this new offering and have worked hard over the past few months preparing our clinic space to accommodate children. Our PTs have also attended advanced training through Herman & Wallace Pelvic Rehabilitation Institute to learn about to apply our knowledge of treating adults with PFD to children! Our PTs are trained in working with children experiencing:

  • Urinary incontinence (loss of urine)
  • Enuresis (Night-time incontinence)
  • Urinary urgency and frequency
  • Urinary retention or voiding dysfunction (difficulty emptying)
  • Constipation (including pain with and/or difficulty emptying bowels)
  • Diarrhea (with and without leaking)
  • Constipation with fecal soiling
  • Chronic abdominal pain

We recognize that working with children requires unique considerations, and we strive to provide a comfortable setting where children and their parents can work together with their physical therapist to address their concerns. Our goal is to make Pelvic PT fun and interactive for children, and we use games, books, and prizes to help create the perfect environment for children to reach their goals.

Our physical therapy plans often will include:

  • Thorough evaluation of medical history, diet, sleeping patterns, etc.
  • Assessment of the hip and low back musculoskeletal structures
  • Visual (non-invasive) assessment of the pelvic floor muscles
  • Animated EMG biofeedback training
  • Extensive behavioral and dietary training
  • Appropriate stretching and strengthening as indicated
  • Specific individualized home program

Please feel free to contact our office at (864) 454 – 0952 with any particular concerns or questions. Pelvic Floor PTs treating children are located at our Patewood, Simpsonville, Greer and Spartanburg locations. Referrals can be faxed to (864) 454-0925.

Are you thirsty for more? Check out this post I wrote a year ago on tips for improving bathroom function in children!

Written by: Jessica Powley Reale PT, DPT, WCS

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Why everyone should see a Women’s Health Physical Therapist at least one time after having a baby:

pregnancy

Pregnancy and Childbirth ain’t for sissies! I once had a male colleague liken childbirth to a “motor vehicle accident of your pelvis”! Whether you have had a vaginal delivery or a planned c-section, your body goes through so many changes during pregnancy and the birth of your baby that, if not addressed, can put you at risk for injury in the future. Hormones are secreted that loosen up your joints and make you more prone to injury, your pelvic and abdominal muscles are stretched and weakened, making you more prone to issues such as low back pain, incontinence and prolapse later in life. Sometimes in a vaginal delivery muscles and tissues are torn. During a c-section tissues are stretched and cut to make room for the emerging baby. So, why, with all of this trauma and change do we expect our bodies to return to their “pre-pregnancy state” in a matter of weeks and why don’t we seek help to minimize the effects of this trauma and maximize our body’s healing potential?

I think, in my opinion it’s because

#1 new babies take a lot of time and what new mom has time for weekly visits to a PT?

#2 society considers these changes “normal” and for that reason, they almost becomes a badge that new moms must wear and deal with as just a result of pregnancy and birth

#3 access to physical therapy may be readily available, but unfortunately is not often recommended routinely for new moms by their physicians

In many countries in Europe it is standard for a woman to be referred to and receive several visits with a physical therapist following delivery in order to maximize their body’s recovery. In my opinion, this is one area where we are behind the 8-ball and missing the opportunity to help so many women and prevent dysfunction later in life.

So what can you gain from seeing a physical therapist post-partum?

First of all, a physical therapist can help with pelvic pain that may develop post- partum from muscle spasm. If you did have tearing during delivery (which can result in painful sex) they can teach you ways to minimize scar formation and eliminate the pain associated with it. They can address issues like urinary incontinence, which are common, but definitely NOT normal once you have a baby. The sooner you address these issues, the easier they are to take care of. Urinary incontinence usually suggests a weakening of the support structures to the bladder which can be improved with the correct exercises.

A physical therapist can help address low back pain, hip pain, pubic joint pain and also instruct you in proper body mechanics and breathing to minimize stress to your already loosened joints and optimize healing. They can also check for a diastasis recti ( a separation of the abdominal muscles that is common during pregnancy) or other muscle weaknesses that may exist and help you get back into a safe exercise routine that will help to optimize your core strength and stability.

So…the take home message…if you have had a baby recently, or whether it has been several years, ask your physician to send you to a physical therapist that specializes in the pelvic floor or in working with pregnant women for at least 1 visit to make sure your healing is on the right track! If your only obstacle is finding childcare, don’t worry, most physical therapists will love the opportunity to meet you AND your baby, and don’t mind you bringing them along for your visits! (In fact, it helps us to get our baby fix!) Your body will thank you for it later…especially if you plan on becoming pregnant again in the future!

Written by: Kim Osler PT, DPT, WCS

Ortho therapists… This one’s for you.

Jessica and I recently spoke at the South Carolina APTA’s annual conference and the topic of discussion was Pelvic Floor Dysfunction in the Orthopedic Population.

photo (1)

The information we presented was well received and I thought it may be beneficial to share some tidbits about the role of the pelvic floor in orthopedic diagnoses. So here it goes:

– Don’t assume that because you are treating “orthopedic” patients or athletes that you won’t see pelvic floor involvement.

  • The prevalence of urinary incontinence in women is 25-45% (Eliasson 2008)
  • The prevalence of urinary incontinence in men is about half that of women (12-25%) (Shamliyan 2009)
  • The prevalence of urinary incontinence in female athletes is 30- 41%. Athletes involved in high-impact sports are at a greater risk. (Jacome 2011)
  • What this means is that if you see 10 patients in a day, at least 2 women and 1 man will have some urinary complaints.

– Patients are unlikely to report symptoms of bowel, bladder, or sexual dysfunction UNLESS you ask the tough questions!

  • 90% of women do not report urinary problems to their healthcare providers if they are not directly asked. (Carls 2007)
  • Greater than 50% of community-dwelling, middle-age women experiencing symptoms of UI have NOT discussed it with their physician. (Kinchen 2003)

So how do you do this?

  • Ask direct questions! Say This: Do you ever leak urine when you cough or sneeze? Not That: So umm…… do you….umm…. Ever…well, you know…. have accidents?
  • Use professional wording. Say This: Often times, people experiencing hip pain can have difficulties with sexual activity. Are you having any problems with this? Not That: When you and your husband are, you know, doing it, does it hurt?
  • Be considerate of privacy.
  • Remember: You are a medical professional!

– The pelvic floor muscle group is responsible for WAY more than just “holding back urine, gas, or stool”.

  • The pelvic floor has a significant role in STABILIZATION of the spine and pelvis, support of pelvic organs, sexual function, and of course sphincteric control.
  • Pel & Colleagues examined how pelvic stabilization from the pelvic floor would occur with 3D simulation models in 2008. They found that the pelvic floor activation patterns provided stabilization of the coccyx and together with the transverse abdominus prevented SI shear forces when the pelvis experienced perturbations
  • The point here is that the pelvic floor is crucial to stability and for patients with core instability, incorporation of the pelvic floor into stabilization would be highly effective.

– The pelvic floor can refer pain throughout the lumbopelvic region, hips, and abdomen.

  • If you have found it difficult to accurately reproduce your patients’ symptoms, consider the pelvic floor’s possible involvement.

PF referral

  • Pain can also be reported in the hip, buttocks, lumbar spine, and suprapubic region.

– Kegels are NOT always appropriate

  • Kegels should only be utilized with true pelvic floor muscle weakness and this is unlikely in a patient with pelvic girdle pain. Know that trigger points in the pelvic floor will become aggravated with Kegels

– And lastly, remember:

  • ASK the tough questions, or you will not get the answers.
  • Be aware that patients with postural instability may have weakness and/or trigger points in their pelvic floor muscles.
  • Recognize that the pelvic floor and obturator internus muscle tension/trigger points can present as hip, groin, abdominal, low back or tailbone pain.
  • Don’t ignore the coccyx.
  • Educate your patients and yourself!

 

 

10 Common Misconceptions About Pelvic Physical Therapy

I had never heard of pelvic physical therapy prior to beginning my doctoral program at Duke University. I remember very clearly when I first learned that some physical therapists did “that.” One of my fellow students had completed a small half-day observation at a local clinic, and excitedly told us all about his day watching the “Pelvic PTs.” We were blown away. We had always assumed physical therapists treated back pain, helped patients after surgery, worked with people who had strokes…but pelvic pain? Urinary incontinence? Sexual dysfunction? This was shocking and new.

Not surprisingly, I was not the only person surprised to hear of this *new* specialty. Of the new patients I see, I estimate that 90% of them have never heard of pelvic PT… and in that, there are a TON of misconceptions people have about my profession. I thought it would be helpful to share a few of the top misconceptions with you today.

 

1. The only people needing to see a Pelvic PT are women after childbirth.

 The interesting thing about this one, is that of the patients I treat, only about 5-10% are post-partum women! The other 90% includes young (with our youngest being 8 years old) to old (with our oldest being 95) men and women experiencing a big variety of symptoms: urinary incontinence, difficulties in urination, bowel incontinence, constipation, abdominal pain, low back/SI pain, sexual dysfunction, pelvic pain or coccyx pain, vaginal or rectal pain, penile or testicular pain, as well as men and women prior to or after having pelvic surgery.

 

 2.      Pelvic PTs do not treat men.

 False. We treat many men. Now, I will admit that at our specific clinic, we see more women than men, but this is not true of every pelvic physical therapy clinic. Currently, I would estimate 20-30% of my schedule is men. The most common diagnoses we treat for men are post-prostatectomy related incontinence as well as variations of male pelvic pain—however, we also treat men with bowel dysfunction, sexual related pain, urinary dysfunction and tailbone pain.

 

 3.   If a person is leaking urine, they definitely need kegel exercises (pelvic floor strengthening).

We have discussed this in the past in other blog posts, but this really is a very common misconception I often have to fight with my patients. Urinary incontinence is a failed system, not just a failed muscle. From a musculoskeletal standpoint, a person needs a well-functioning pelvic floor muscle group, abdominal muscles, hip muscles, diaphragm and low back muscles. People need strong, but flexible muscles that tighten when they need to and relax when they need to. If a person has a shortened, irritated pelvic floor, they may have just as much difficulty holding back urine as the person with a weak pelvic floor. It is important to trust your physical therapist to prescribe the specific exercises necessary to help YOU.

 

 4.  If a person has tried “kegel exercises” and they did not work, Pelvic PT won’t be able to help them.

As a Pelvic PT, I take great offense to that… I mean, honestly, do you think I would need a doctoral degree, 100+ hours of additional continuing education, and a board specialization to teach a person Kegel exercises? That all to say, rehabilitation for the pelvis is much more involved than simply strengthening a muscle group. It involves restoring function—improving muscular support around the pelvis, improving behavioral/dietary habits, and re-training body movements to allow for optimal organ and structural function.

 

 5.  If your mother/grandmother/great-grandmother also had constipation/urinary incontinence/diarrhea/etc., then it must be genetic and can’t be helped.

 Also, not true! Now, I won’t say there aren’t genetic components which may cause a person to be more likely to experience certain conditions than others—but that being said, there is always something that can be done to help! It is important to work with a team of healthcare professionals including physicians, nurses, physical therapists, psychologists and nutritionists to ensure a person gets comprehensive and holistic care to achieve optimal health.

 

 6.  People can major in “physical therapy” and become a pelvic PT right after they graduate.

 I wish that were true—it would have saved me several years of work! Actually, the profession of physical therapy has changed significantly in the past 20 years. Currently, most practicing physical therapists have a Masters or Doctoral degree in physical therapy, and the majority of the current educational programs in physical therapy in the United States are doctoral programs. In order to specialize in pelvic PT, a person must have an advanced degree (doctoral/masters) as well as attend continuing education to gain the knowledge and clinical skills necessary to treat this complex population. This equals a total of 7 years of formal education after high school as well as significant amounts of continuing education

 

7.  If a person has already had surgery OR is planning to have surgery, pelvic physical therapy won’t help them.

 The truth is that physical therapists usually work very closely with surgeons to help patients achieve optimal recovery. Surgery will often correct an anatomical problem, but it is important to have improved muscular control and function to help a person attain optimal outcomes after surgery. Research has shown that physical therapy prior to and after surgery improves patient outcomes as well as reduces the need for future surgery.

 

 8.  A physical therapist doing vaginal or rectal exams is weird and NOT conventional.

Physical therapists specialize in working with the musculoskeletal and neuromuscular systems of the body. The pelvic floor muscles run around the opening of the urethra, vagina (in women) and rectum. The only way to truly assess the pelvic floor muscles is via an examination which is performed with one gloved finger inserted into the vaginal or rectal canal. Although this may seem “untraditional” to some, there is a strong anatomical basis for the exam. Pelvic physical therapists are trained in both internal and external evaluation and treatment techniques, and current medical research supports these techniques in the treatment of this patient population.

 

 9.  If a person has a “medical cause” of his/her pain, physical therapy will not help.

 Often times, certain diagnoses can have musculoskeletal involvement. For example, if a woman has endometriosis which has caused significant pelvic pain she will often have severe trigger points, connective tissue restrictions, and muscular restrictions in all of the muscles around the pelvis as a result of that pain. In many cases, if the endometrial tissue is removed via laparoscopy, but the soft tissue restrictions remain, pain will not go away. That to say, a multidisciplinary approach to pain tends to be the best to help people achieve optimal recovery.

 

 10.  A person’s habits (eating, drinking, etc) are not related to pain, urinary or bowel dysfunction.

 This may seem obvious, but this thought is more common than you would think. Many people believe that if they have had certain habits for a long time, it cannot be related to the problems they are experiencing. Unfortunately, that is not the case. Often times, habits such as drinking coffee, eating fried food, exercising too vigorously, or sitting at a computer for long periods of time can strongly influence a person’s symptoms—even if the symptoms are new. It is important for your physical therapist to evaluate all of your habits to help you understand the steps you can take to improve your health.

 

I hope this information was helpful for you today! What were some misconceptions you had about pelvic physical therapy? Let us know in the comments below!

Written by: Jessica Powley, PT, DPT, WCS 

So… What Exactly is The Pelvic Floor?

The pelvis is a complicated and fascinating structure in the body. From a musculoskeletal perspective, it is the central component of your body. A well-functioning pelvis is necessary to walk, bend forward, stand up, and roll over. In addition, the organs of the pelvis work in coordination with the muscles, ligaments, tendons and connective tissues to ensure healthy urinary, bowel, sexual and reproductive functions. Basically, the pelvis rules. It’s crucial. It’s a beautiful part of the body. And, it’s often forgotten, misunderstood, and unappreciated until something goes wrong.

pelvis

Really, think about it. How often have you thought about your pelvis? Men, how many times to do you stand in front of the toilet and feel thankful that your muscles are relaxing right as your bladder contracts to empty? Ladies, how many times do you have sex and thank your muscles for stretching and contracting to help sex feel good for you? How many times do you walk up stairs and recognize that your muscles are perfectly supporting all of your joints around your pelvis to help you take those steps without pain? Unless you have a problem with your pelvis, you probably have answered “never.” Don’t feel bad. You’re not alone. Most people don’t recognize the fascinating complex structures within their pelvis until they have problems with it. And at that point, it can feel like a dark hole—complicated and unknown. That’s where we come in!

First and foremost, you must understand the role of the pelvis and the muscles at the base of our core.

male 1female 1

These beautiful muscles (clearly, a pelvic PT bias 😉 ) serve many roles including sphincteric control, supporting the pelvic organs, stabilizing the pelvis as part of the core, and improving sexual function.

Most of the patients we treat are familiar with the role of the pelvic floor in maintaining continence (not leaking). These muscles wrap around the urethra, rectum, and vagina (in females), and in order to maintain continence of urine and feces, they must contract. Conversely, in order to completely empty our bowels and bladder they MUST fully relax. When the muscles do not function properly–whether they aren’t contracting well or aren’t relaxing well– we see problems in both urinary and/or bowel function. A pelvic floor therapist can help you to coordinate these actions to facilitate complete emptying and achieve continence if necessary.

Secondly, the muscles of the pelvic floor support the bladder, rectum, and in females, the uterus. When these muscles are weak, patients are at increased risk for pelvic organ prolapse (POP). POP occurs when the fascia, ligaments and muscles of the pelvic floor no longer support the pelvic organs resulting in the drop (prolapse) of the pelvic organs from their normal position (FDA). People can develop prolapse of the uterus, bladder, rectum or small intestines. According to Varma et al. “Women aged 50 and older are 6 times as likely as men to present with rectal prolapse. Although it is commonly thought that rectal prolapse is a consequence of multiparity, approximately one-third of female patients with rectal prolapse are nulliparous. The peak age of incidence is the seventh decade in women, whereas the relatively few men who have this problem may develop prolapse at the age of 40 or less”. Some risk factors for POP include childbirth, the aging process, genetic predisposition, connective tissue disorders, obesity and frequent constipation.

In regards to stabilization, the pelvic floor muscles are essential. This muscle group sits at the base of the pelvis and works in harmony with the diaphragm (breathing muscle), transverse abdominus (deep core stabilizer), and multifidus to provide stability prior to and during movement. This combination of muscles work sort of like a soda can to maintain a pressurized pelvis and core to allow for stability of the lumbopelvis. We wrote more about this role of the pelvis in our post, here.

Core

Lastly, the muscles of the pelvic floor play a crucial role in sexual function. We will post more about this at a later time, but for now, know that the pelvic floor is important in women to stretch and allow for penetration and also to contract to provide pleasure and orgasm. In men, the pelvic floor contracts to assist in erection and relaxes to allow for ejaculation.

There you have it! We hope this blog post helps you to better understand how these muscles function.

Written by: Jenna Sires PT, DPT and Jessica Powley PT, DPT, WCS

I Think I Have a Problem… Part 2

Part 2: Be Prepared to Talk to Your Health Care Provider

So, you’ve decided you are finally going to ask for help? Great! It’s very important to try to be prepared before you go to see your provider. Try these steps to get prepared for your appointment.

1) Write down all of the symptoms you are experiencing so you can help them understand your problem.

2) Write down any questions you have for your doctor or physical therapist.

3) Call ahead to get a copy of the paper work to fill out before your first visit. Often times, this paper work is fairly extensive. Filling it out ahead of time will save you time at your appointment and get you in sooner.

4) If you have done any research on your own, feel free to ask your provider about what you found. Most of us are very open to your ideas, and will help you sift through what will be most helpful to you.

5) If you are worried about what to expect at your appointment, feel free to call ahead and ask to speak with someone about what the appointment will entail.

How do you get prepared for your doctor’s visits? Leave your comments and suggestions below!

I Think I Have a Problem, What Do I Do?

Part 1: How do I know when to seek help?  

Every new patient I examine is asked a series of questions. “What brings you in today?”  “How bad is your pain?” and the most interesting question of “How long has this been going on?” This is where it gets really interesting… I hear a spectrum of answers from my patients. 2 weeks. 6 months–  And my favorite answer—15 years.  Can you believe that? 15 years. That’s 180 months. 5475 days. Shocking, really, that a person would deal with having problems with her body for that long. But the problem is, most people have no idea when is the right time to seek help. So, the next few posts will help to answer that.

The basic bottom line is this: It’s always better to seek help sooner rather than later. Now don’t misunderstand me. I’m not saying you should run to your doctor every time you have the tiniest little problem. What I am saying is this: If there is something that doesn’t feel right and it doesn’t seem to be responding normally(i.e. getting better in the right amount of time), then it is in your best interest to get it checked out.  That being said, I have a few myths/fears to dispel about going to see your doctor:

Myth #1: If I tell my doctor, she’s going to want to do surgery. I don’t want to have surgery.

I hear this close to once each week. And I always say the same thing. First, just because you see a surgeon, does not mean he will even recommend surgery. I’m being totally honest.  Most of my referrals come from surgeons—and that means that they are recommending something other than surgery. Remember that there are many options to help with whatever problem you are experiencing. If you are seeing a good physician, he should be able to help you understand all of your options. Second, just because a physician recommends surgery does not mean that you have to have surgery. You can choose not to. You can choose to wait. So, that brings me back to the main point: It’s always better to seek help sooner rather than later.

 

Myth #2: After you have babies, it’s normal to _________________. (Fill in the blank: Have pain, leak when you cough and sneeze, hurt during sex, etc.)

I could go on and on and on about this one. I hate hearing this. It is one of my biggest pet peeves.

Common ≠ Normal

It is common to have all of these problems after you have babies. BUT, that doesn’t mean it’s normal. That doesn’t mean you have to live with it. Many times people can do really well in a short amount of time and really regain their function if they receive the right treatment. (See my future posts of what that treatment will look like).

So, that all being said, go get help if you are having a problem. Working together with a physical therapist or a physician can really help you get the most out of your body. Whether you are 25 or 95, you shouldn’t have to “just deal” with a problem.

Please feel free to leave any questions or concerns!!

Written By: Jessica Powley PT, DPT

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