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Addressing Pelvic Floor Dysfunction

Rachel Kim, PT, DPT, discusses pelvic pain and pelvic floor dysfunction, including how common these conditions are and treatment options.
Addressing Pelvic Floor Dysfunction
Featured Speaker:
Rachel Kim, PT, DPT
Mrs. Rachel Kim graduated from the University of Massachusetts Lowell with a Bachelor of Science in exercise physiology and a doctorate in physical therapy. She has experience in the outpatient setting with special interest in prevention and management of running injuries, concussion management and female pelvic health. Mrs. Kim received her Level I certification through the American Physical Therapy Association’s Women’s Health Section. She is active in Emerson Hospital’s running injury assessment and running conditioning clinic. 

Learn more about Rachel Kim, PT, DPT
Transcription:

Prakash Chandran (Host):  You may have heard of Kegel’s, but pelvic floor therapy can help you get the most out of physical therapy for pelvic pain, and urinary symptoms. Let’s talk about it today with Dr. Rachel Kim, a Senior Physical Therapist at Emerson Hospital.

This is HealthWorks Here, the podcast from Emerson Hospital. I’m Prakash Chandran. So, first of all Dr. Kim, I’d love to learn a little bit more about what the pelvic floor is and where it’s located.

Rachel Kim, PT, DPT (Guest):  Yes, so the pelvic floor is a group of muscles. You have both internal and external muscles as part of your pelvic floor. These muscles attach mainly from your pubic bone which is at the front of your pelvis to your tail bone or coccyx. These muscles are acting as support. So, the main action of these muscles is to support your inner organs, to support your postural stability and maintain continence so that you can walk yourself to the bathroom and go to the bathroom and then that’s not just happening.

Host:  Right. So, one of the things that we’re talking about today is general pelvic health and this is really the first time that I’m learning about the pelvic floor and the pelvis. But I did research something called pelvic floor dysfunction. Maybe you can talk about that a little bit.

Dr. Kim:  Yeah so pelvic floor dysfunction is when something is going on with these muscles and you end up having some symptoms. And pelvic floor dysfunction is a lot more common than many people think. I have some just general statistics to throw out. More than 25 million Americans are suffering from some sort of pelvic floor dysfunction, 80% of that group is women and most commonly it’s urinary incontinence which is the inability to keep your urine in resulting in some sort of leaking. To break it down further, this is happening more so in the pregnant and postpartum population. About half of pregnant women will suffer from some sort of incontinence and then this will continue on after the delivery of their children. But it is something that can happen in kind of any age group of individuals.

There are some different risk factors for that kind of including like I said that pregnant, post-partum group; also the post-menopausal group. As women age and estrogen decreases, that puts you at more risk of dysfunction. Any sort of abdominal surgery, this can happen in really high intensity athletes, individuals that are overweight or obese or anyone having any other kind of neurological disorders. And I know that we kind of talk a lot about this happening in women, but I do want to mention that pelvic floor dysfunction can also happen in the male population. It’s a little bit less common but it does happen and it’s usually in the form of incontinence or pelvic pain.

Host:  Okay. And I do want to get back to how it manifests itself in the male population but one thing that I wanted to note is that we just had a new baby three months ago –

Dr. Kim:  Oh congratulations.

Host:  Thank you very much. But my wife has been surprised because her pelvic floor still seems to be recovering and she has expressed some of the symptoms that you mentioned, the urinary incontinence and also the constipation and it’s just – it’s kind of something that really, she didn’t expect. So, maybe talk a little bit about what kind of symptoms people go through post-partum and what they can expect I terms of a treatment plan and getting themselves better.

Dr. Kim:  Yeah, that’s a great question. What we always say is these symptoms are common as we discussed, but they are not normal. So, anyone that’s dealing with these symptoms, out big message and the reason that we are doing a lot of this education is we want people to know that there is something that they can do about it. It is a treatable condition and we want to kind of reduce the stigma that’s associated with it. So, I’m glad that you brought that up.

Pelvic physical therapy and intervention is really great and in more than 60% of individuals they are getting a resolution of symptoms with it. So, some common symptoms that you are going to see. I usually divide it pelvic healthy dysfunction into the following categories. So, I’m just really going to make this very general but it’s the group of people that can’t keep it in. So, that’s the urinary incontinence, sometimes some bowel incontinence can happen, prolapse where some internal organs are actually descending out. That can happen especially after childbirth. You are going to feel a lot of pressure and things like that.

Then the second category is individuals that can’t get it out or are having pain. So, that’s the constipation, retaining urine, not able to get that urine out, pain with intercourse or internal exams or tampon use or things like that. That’s another category.

And then kind of that third category is that post-partum, prenatal category. So, both people that are just having symptoms while they are pregnant or immediately after; that can be a separation of your abdominal wall which is called a diastasis recti, pubic symphysis separation which can happen while you are pregnant where there’s some pain and separation in the pelvis. You can also get scar restrictions if there’s any trauma during delivery or with cesarean sections or just kind of pelvic pain. A lot of pregnant women are wearing braces and things like that. So, those are all symptoms that are common and things that we can treat in therapy.

Host:  Okay. Let’s talk a little bit about what therapy looks like. Like so let’s say my wife, she is expressing some of the symptoms that you mentioned, she goes for I guess pelvic therapy with someone like you. Talk to us what a normal appointment looks like.

Dr. Kim:  Yeah, so what we do is we have the patient come in. Usually they are referred from their physician. And we are really just going to start with a comprehensive history, so we want to know everything that’s going on, is there any medical history, how many children do you have, kind of take us through those births. We are getting really detailed in everything that’s going on. Any other lifestyle factors or history that we need to know about. That’s kind of the first line.

The second most important thing is that we are usually performing an internal examination. So, we really need to look at those pelvic floor muscles and that’s the best way to do it. With that being said, we understand not everyone is comfortable with that so we can always make adjustments to our evaluation and do more external examination as needed. But we are going to look really closely at what those muscles look like. Just like we would on any other part of the body. Is there any scar tissue? Are there any muscle knots, muscle spasms going on? What is the strength of those muscles? What is the endurance of those muscles? We are looking at the alignment of the pelvis. Are all those bones aligned the way that they should? Flexibility, hip strength, core strength. Really comprehensive detailed evaluation. We might not get to everything on day one, but we are going to look at that through the course of the treatment and really individualizing our evaluation based on the symptoms.

And then our big thing in the beginning is education. Again, this is a foreign subject to a lot of people. They’ve never even thought about their pelvic floor. So, we are just really trying to educate people what can be done, what can we do and then we move forward from there. And common treatments if you want me to get into that –

Host:  Yeah, my wife, she’s been going to therapy and there’s a series of exercises that she’s doing. After an examination, putting together a schedule of exercises that she should be doing to strengthen her pelvic floor. So, maybe talk a little bit about those exercises and any other treatment plans that you might offer.

Dr. Kim:  Yeah definitely. So, just like we talked about, there’s many different categories of pelvic floor dysfunction; there’s not going to be a one size fits all treatment approach. But there are many options available and like I said, we are going to individualize that to each patient. The big things that are commonly done for treatment are pelvic floor muscle strengthening. We can use biofeedback which is using electrodes set up to the pelvic floor muscles that are going to show up on the computer and then give that patient feedback on what they are doing if they really can’t get that muscle control down. Sometimes, we need to do some soft tissue mobilization, some scar mobilization both internally and externally to help align those muscles better.

We might do some strengthening, overall postural and core strengthening, certain behavior modification strategies, things like that. I know you brought up Kegel’s in the beginning and I think everyone has heard of Kegel’s. I think that’s just kind of a thing that you’ve heard of. Most people have tried them at some point in their life. They’ve maybe read a magazine article that says do your Kegel’s every day. That is great. We’re glad that that message is getting out. I just want to say that sometimes, especially those who can’t keep it in pain diagnoses that I touched upon briefly; sometimes those individuals should not be doing Kegel’s. And they should actually be avoiding that exercise.

So, I just want to caution if someone starts to do Kegel’s and they really feel like their symptoms are getting worse or they are not getting better; then that would be kind of an indication to seek out some professional help. Another interesting thing about Kegel’s is through research and things like that, we found that 50% of individuals do Kegel’s wrong just with verbal instruction or written instruction alone. So, really just seeing a pelvic therapist and fine tuning how you are doing that exercise to really get those deep muscles and do them correctly is worthwhile.

Host:  Yeah, it really, I mean the message that I’m taking away from you here is that when you’re experiencing some of these symptoms, it’s really important to go seek professional help sooner because it’s not a one size fits all solution. You really need to get diagnosed to see where you are in your pelvic floor health journey and then get the right treatment or exercise plan according to you. Wouldn’t you say that’s correct?

Dr. Kim:  Exactly, yes.

Host:  So, one of the things that I wanted to talk about is let’s say someone listening to this man or woman, isn’t experiencing any problems right now but they want to be proactive about keeping their pelvic floor healthy and strong so in the future they don’t run into any of these problems that we are talking about here. Do you have any advice for them?

Dr. Kim:  Yes. So, I think that in those cases where you might be asymptomatic, Kegel’s are a great preventative exercise to do. So, working on trying to strengthen that muscle preventatively is great. It especially helps in the prenatal population. We found that pregnant women that do Kegel’s are really reducing the chance of having some dysfunction into that post-partum period so that could go for anyone. Just making sure that they are staying strong. Core strengthening is really great. Our abdominal muscles work very closely with our pelvic floor muscles so if your abdominals are weak, then your pelvic floor muscles are going to have to work harder.

So, if you are maintaining just a nice exercise program incorporating some core strengthening into it; that’s great. And then just awareness, I think. In some countries pelvic physical therapy is part of the treatment plan as soon as someone has a baby, or they have a certain treatment or surgery; they are automatically kind of funneling into that treatment. That unfortunately is not the case here. we are hoping to kind of raise more awareness and get that to be the common practice. But kind of being proactive and maybe asking your doctor should I seek out these therapies when I’m pregnant or have a baby or when I’m going through this abdominal surgery or treatment, should I do this and kind of asking for that referral or questioning things. I think that’s a great message.

Host:  And I’m curious as to how effective some of these treatment plans are. You talk about once you make the assessment and you put them on a plan whether it be exercise or beyond; I’m curious as to if it actually works or if sometimes maybe something more serious like an interventional surgery might be needed. Maybe talk a little bit about that.

Dr. Kim:  Generally speaking, we have great results. Physical therapy is really the first line of defense for especially like urinary incontinence and diagnoses like that. We are seeing a huge reduction in symptoms, more than 60% find a huge reduction or even a cure with physical therapy alone. But at the same time, we are not always fixing everything. There could be something a little bit more serious going on or that pain is just not going away. So, we work really closely with the referring doctors. we are constantly reassessing, reevaluating, sending that information over to the doctor and really communicating and then figuring out what the next best plan is. So, just kind of that close relationship and constantly reassessing is helpful.

Host:  Got it. And just to wrap up here, I know you’ve probably seen so many people regarding their pelvic health. I’m curious as to what advice you might have or something that you wish that people knew before they came to see you.

Dr. Kim:  I think the big message is kind of what I already said is that these symptoms are common, not normal. We want people to know that they can have a better quality of life. I think you hear it all the time where women are oh, I can’t jump around with my kids or when I cough, I have to – I might leak some urine and this just how – this is as good as it gets. I had kids. We don’t want people to have that attitude. We want them to know that they can be functioning better and that it’s not scary. Come on in and see us. It’s a basic internal exam. We are not using any tools, any speculums, anything like that. And we are really tailoring it to each individual. So, we are going to make you feel comfortable. We are going to tailor that exercise program to you and it’s definitely worth a try.

Host:  Yeah, that’s 100% true and I think one of the things that I’ve learned especially going through this post-partum experience with my wife is there really isn’t a lot of information. So, just talking to you today and understanding that there is a path to normalcy and to strengthening your pelvic floor and eliminating some of these symptoms is just really good to hear. So, I really appreciate your time today. that’s Dr. Rachel Kim, a Senior Physical Therapist at Emerson Hospital. Thanks for checking out this episode of HealthWorks Here. Call to schedule a pelvic floor physical therapy consultation or visit www.emersonhospital.org to learn more. If you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you. Thanks and we’ll talk next time.