WOMEN'S HEALTH AND PELVIC FLOOR PHYSICAL THERAPY
By Elaine Morrison, PT So, this is personal. I started studying and attending continuing education sessions about pelvic floor weakness and pelvic dysfunction when I was a young physical therapist and new mom, because I realized that being pregnant and recovering from delivery was no easy task! In fact, I had tried to get help from the physical therapists I knew at the time but could not find anyone who could ease the pain or help with the instability I was experiencing. I promised myself that I would become that “go-to” person! This was in the early to mid 1990’s, and there were only two or three “women’s health” PT providers and only one pelvic floor specialist in PT in the Indy area. We came together and offered courses on the topics, and I traveled to various states to learn about pregnancy and back pain, stabilization during and after pregnancy, urinary and fecal incontinence and biofeedback/surface electromyography for pelvic floor rehabilitation. While studying about women’s health issues, I learned about osteoporosis and the specific exercises that will help and protect (and which ones will hurt) the spine and other bones. I attended several courses on the topic of lymphedema, and especially treatment after breast cancer treatments. Next came other difficult topics of vulvodynia, interstitial cystitis, dyspareunia - which were addressed in more advanced coursework. I had a mentor who allowed me to partner with her and we started our own division of our PT company, just for women’s health issues. We positioned ourselves next door to the Urogynecologists at Methodist Hospital - where we both participated in patient rounds, discussions, and taught the interns about what physical therapists do to retrain the pelvic floor muscles. Pelvic floor dysfunction can occur in males also, so another course on male pelvic pain helped identify what could be done in PT to help with painful spasms and difficulty with incontinence in the male population. Now, I find myself in the position of seeing several pelvic floor PT’s spring up in the area, and truly - I am glad. Glad that there are professionals in this area who are dedicated to helping folks with these intimate issues - incontinence, inability to completely evacuate, pain with intercourse, frequent urination, spasms in the pelvic floor with sitting or lifting, tailbone pain, difficulty stabilizing the pelvis during pregnancy, and sciatica or back pain during pregnancy. Now it’s your turn! So, how do I get help from a pelvic floor physical therapist and what exactly should I expect? Good questions! :) You can choose to come to physical therapy now without a doctor’s order for PT, for 24 days of treatment before we would need to have a signature on the plan of care. This is a state law. However, for Medicare recipients, your physician should already be aware of the problem for which you are seeking PT help, so that they will send a prescription, or sign the plan of care to enable us to see you for several weeks.
On the first visit at ZPT, as with any skilled PT evaluation, you will fill out medical history information and identify specific areas for which you are seeking help. Then I will evaluate your condition - strength, pain, alignment, motion, and balance in a private treatment room, much like a physician’s exam room. You may have someone present for this and any appointments. There are both internal and external methods of treating the pelvic floor, and you can help determine with which you will be most comfortable. I find that much of my time with each patient involves education regarding the anatomy and physiology of the pelvis, and pinpointing the reason each patient is having pain or dysfunction. We discuss several conservative, behavioral changes that can create a healthier body, better “working parts” and a stronger, more stable pelvis. Each time you come for an appointment, you can expect to learn best exercises, research proven methods to improve your function, have hands- on help with your trigger points, and gain suggestions for you to do on your own or with your partner at home. Healing and strengthening can take several weeks. Typically after about 6 to 8 weeks, my patients indicate that they can do most of the work on their own, and they are feeling much better, much more knowledgeable, and returning to activities they love. For me, the therapist, the satisfaction comes from knowing I have helped someone improve the quality of their life. It’s not very glamorous, but … sometimes the best things in life are the unseen work of people caring for others.
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