Monday, October 28, 2013

"So I read in Cosmo"….Questions that I get Asked as a Pelvic Floor Physical Therapist

A guest blog by Christina Bobco, PT, DPT, ATC, LAT.

When someone asks what I do, I tell them that I'm a physical therapist. But as the conversation progresses and I tell them that I deal almost exclusively with bladder, bowel and sexual health, eyes widen and a few moments of silence usually ensue. But after that, the questions start pouring in. For this post, I've compiled the questions that I get most often about my job.

What on earth made you want to do this?

I get this from almost every patient at some point in their course of therapy. Typically, after we’ve already spent  time looking over the Bristol stool chart.  I did not always know that I would end up here.  I actually planned on going into pediatric physical therapy.  However, when we had lectures in school about women’s health, instead of hiding my face behind a binder and whispering a mantra of, “I’m never ever having a baby” like many of my classmates, I was fascinated by the complexity of the pelvic floor and disorders. What I love more than any other part of being a physical therapist is providing my patients with education and helping them understand a practical approach to what seems like an solution-less problem. I feel that the area of men’s and women’s health demands a focus on education more than almost any other setting, and because of that, I feel I’ve found my niche. 

So what can you actually do about any of these problems? Aren’t those organ problems?

While problems may start out at the organ level (think urinary tract infection or endometriosis), any irritation to the organs can affect the surrounding tissues, often causing long-term pain  and dysfunction.  In another scenario, the pelvic floor itself may have endured insult by trauma or surgical intervention and is now unable to properly support organs that may have some dysfunction themselves (think urinary incontinence after childbirth or fecal incontinence with Irritable Bowel Syndrome).  By impacting the muscles and tissues of the pelvic girdle, we’re able to reestablish a healthier and happier support system for those organs, resulting in better function. 

Do Kegels really work? 

Probably the second most frequent question I get, from patients and acquaintances alike. If performed correctly, yes! Pelvic floor contractions are the basis for strengthening programs for patients with incontinence or with pelvic organ prolapse. Unfortunately, there’s some bad information out there about how to actually perform a Kegel, so consult a pelvic floor physical therapist to make sure you’re doing what you think you’re doing.  One or two squeezes a week also won’t make a big impact. Research ranges in reports, but some studies say up to 80 contractions per day is necessary to see a functional change in continence.

Do you teach people how to urinate or have a bowel movement differently while they’re rehabbing? 

Depending on the issue, we can certainly provide recommendations for positioning  or tricks that may make urination or defecation easier, less painful, or more complete. Manual therapy can also assist some patients in eliminating more easily as well. 

Penetration is painful for me, no matter how much lubricant I use or what tricks I try.  Am I broken?

You are not broken. Painful intercourse is a very common complaint that I see and something that often goes unacknowledged for years, even if you mark it on an intake form at the doctor’s office.  And while repeated frustrating unsuccessful trials can certain have psychological repercussions, this problem is not all in your head.  There is something actually happening in your body, usually involuntary muscle spasm or nerve irritation, that gives physiological rise to the issue. Speak up about this issue at your next gynecological appointment and state that it’s something you want to resolve. Pelvic floor physical therapists are specialists in finding the source of your pain and working you toward pain-free intercourse or participation in intercourse at all if you have never been able to achieve penetration due to pain. 

This is incredible. Why did it take me so long to find pelvic floor physical therapy?
Pelvic floor, or women’s health physical therapy, as it is often termed (although we see many male as well as female patients) is a relatively new field. Plenty of doctors don’t even know we exist.  Patients often receive multiple rounds of various medications before coming to our office with a problem that we can address directly with stretching, strengthening, or manual therapy. While we try to spread the word as much as we can, we haven’t reached everyone. Ask your doctor if they have any knowledge of pelvic floor physical therapy and bring them information you’ve collected to see if they think you’d be a good candidate.

Christina Bobco is a physical therapist practicing at Sullivan Physical Therapy, a men’s and women’s health specialty clinic in Austin, Texas.

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