Are you at the end of your rope and one of many coping with urinary incontinence? Have you accepted that wearing pads or (eek!) adult diapers is your destined path? Or maybe you’re unsure of where your pelvic floor muscles are? Introducing: the pelvic floor physical therapist.
We are blessed to have the amazing, pro-active pelvic floor physical therapist, Dr. Robyn Wilhelm to answer some of our questions. Even if you never knew this type of therapy existed, let’s dive in and discover how this type of treatment can help urinary incontinence in women, post-pregnancy issues and much more.
To start off, let’s deal with the basics: What is a Pelvic Floor Physical Therapist and what do they do?
Pelvic floor physical therapists (PTs) are PTs that specialize in musculoskeletal function of the pelvic floor, as well as all the areas that make up the pelvis. This includes both the vaginal and vulvar area for women, the scrotum and penile area for men and the tailbone, symphysis pubis joint, sacrum and colorectal area for both women and men. A pelvic floor physical therapist often is also very specialized in our core’s musculoskeletal function. We are orthopedic PTs (physical therapists) with specialized training to assess and treat conditions related to the core and pelvic floor.
How can a woman determine if she might need the help of a pelvic floor physical therapist?
A woman could first ask their doctor if they are having problems specific to their core and pelvic floor. One can go to a pelvic PT directly without referral for an examination. I have many patients see me after having their complaint was not addressed by their primary care provider.
What is something a woman could be doing before or after having a baby that could help with her pelvic floor strength?
Pelvic floor strengthening is always a good thing in terms of helping the pelvic floor deal with the added pressure of containing and growing baby. The important thing to do is to not overdue strengthening, often referred to as “kegels.” When I am seeing a woman who is pregnant, we are working on strengthening, conscious ability to relax the pelvic floor, breathing techniques and reducing pregnancy related pain.
What is one of the most common concerns that women come to see you with? How manageable/preventable is it?
The most common is urinary leakage (urinary incontinence in women). Urinary incontinence in women is definitely preventable. That is one reason I always advocate for women to get an examination to find out the current state of the core and pelvic floor, especially after pregnancy or if they are getting even the slightest bit of leakage. If a woman is experiencing leakage, a thorough exam followed by appropriate treatment can be a game changer! The general guidelines of “do some kegels” can help, but will not help everyone. It turns out, kegels are not a cure-all, especially if the pelvic floor muscles are already tight.
It’s great that you offer in-home treatment for women close to your clinic. Is that something a Pelvic Physical Therapist will typically do and if not, what inspired you to do this?
There are some pelvic PTs that do that. I was inspired to help women sooner than the 6 week mark after childbirth. There are some things that are not done until after 6 weeks, but I begin to help new moms out right away with many things, such as care instruction for cesarean incisions or perineal tears, breathing exercises and beginning movement for core and pelvic floor, stretches to help reduce pain associated with breastfeeding and a healing body, and tips and suggestions on how to manage their day that allows for mom and baby bonding as well as adequate healing for mom.
We are in desperate need of a culture shift in the US when it comes to encouraging, educating and supporting postnatal healing and health of the mother.
What is your opinion of kegel products and exercisers?
There are some great kegel products on the market. Many products can be more cost effective for individuals and help to decrease or eliminate symptoms. I do encourage women to seek a consult with a pelvic floor physical therapist before using one if they can.
My concern comes in with women who may be using a kegel device and not seeing improvements. They might begin to feel they are “broken” or just have to “live with it.” In those cases, those women absolutely need to get in to see a pelvic floor physical therapist for a thorough assessment for a good plan.
We love one of your recent Instagram posts: “Telling women sh*t they have never been told, but should have.” Could you talk a little bit more about this statement and what made you post it?
Yes! Someone told me I need to put that on a business card! On a weekly, if not daily basis, I hear at least a few women say to me “why didn’t anyone tell me that?” As a pelvic PT, I provide so much education about the anatomy and function of the female body to my patients, especially in regards to pregnancy and postnatal changes. Many of my patients are left wondering why they are hearing some of it for the first time from me.
I myself do not expect one single healthcare provider to have the in-office time to cover everything. There seems to also be a fear of telling women things that may or may not come up as a problem. I don’t address it as fear-mongering. I talk very openly about things and tell my patients directly “I want you to know this so you understand your body and feel empowered about what is going on or what could go on.”
This might be a dangerous question to ask but I’m sure lots of women may be wondering this. Does insurance every cover pelvic floor physical therapy? If not, what are payment options for women? If it is, what can women do to discuss with their doctor about a referral?
Yes! Pelvic Physical Therapy falls under a person’s physical therapy benefits for their insurance if they have that. Some clinics process insurance for their patients. Many of us run cash-based practices meaning patients pay at the time of service. The patient then submits their receipt to their insurance company for reimbursement. I chose this model for a few reasons:
I work for my patients, not insurance companies, who often short change the provider. In turn, this results in having to see more patients per day to be able to stay in business.
I provide one-on-one treatments with my patients with the initial examination appointments lasting 75-90 min and treatment sessions lasting 55-60 minutes.
They receive direct care from me the entire time. My patients typically see me one time per week because we are able to cover much more and get them set up with a home program.
What is something a woman could begin doing, right after reading this article, that could help them improve their pelvic floor health?
That can be a tough one because in my eyes there is so much! If there was one thing I would say do right now, it would be this. Identify your connection with your pelvic floor. Can you lift (contract) it? Take a deep inhale. Allow the chest and tummy to fill with air and the pelvic floor to just relax. Now, exhale and gently contract the pelvic floor. Are you connected? Can you contract? Practicing something that simple often brings more awareness to women about whether or not their pelvic floor is strong or needs some extra attention.
Find Out More About Dr. Robyn and Her Treatment
For some amazing, eye-opening information, make sure you follow Dr. Robyn or Bloom on Instagram! If you are local to the Phoenix or Mesa area, you could also sign up for her new Bloom program. These classes assist women after pregnancy to recover and strengthen.