Hey Mary Ellen, Why Pelvic Health?
Back when I first started as a physical therapist (PT) it was 1992 and I was working in inpatient rehab. I worked with stroke and trauma patients. At that point in time, any form of pelvic PT was in its infancy, if not fetal stage. Our last segment in PT school covered pelvic issues. There was no discussion about pelvic floor evaluation, but we did discuss kegels.
There was not much for me to do regarding pelvic rehab (or so I thought) while working inpatient rehab. Nursing did bowel and bladder care, and sex was only discussed if the patient brought it up. A part of me wants to go back in time and do things differently to help manage the incontinence and discuss sexual questions that patients and their partners had. I am certain that pain and prolapse issues were also rampant.
If I am to be totally honest, I would not have been comfortable working with pelvic floor issues when I first graduated. I was raised in a very large catholic family and basically taught that I did not exist from my belly button to my knees and that region of the body was to never be discussed. It took me many years to move past the shame that I was brought up with. I needed to feel comfortable with my own pelvis and human sexuality before I could be comfortable working with patients in this area.
A decade later I was working in outpatient clinics and specializing in myofascial release, lymphatic drainage, and visceral manipulation. I was much more comfortable with myself and had moved through a lot of that shame. At one point I had a patient with back pain that was adamant that her issues were due to the pelvic floor and begged me to work on it. I was not aware that any continuing education courses were offered and had no idea where to look, so I hit the books. I self-educated and agreed to treat her. I extrapolated the manual treatments that I already knew and applied them to the pelvic floor and viscera with amazing results.
I quickly came to love working with the pelvis. I found that working with bowel, bladder and sexual dysfunction gave my patients profound improvements in their quality of life. It was an area of their lives that they often did not feel comfortable sharing with friends and family members. Many of them felt isolated and had pulled back socially. Others had relationships that were shaky that blossomed as their bodies and confidence improved. What a privilege it is to be able to work with someone who is sharing their most intimate issues, feeling alone in the world, feeling like they have no control of their bodies, and often in pain-physically and emotionally.
Aside from bladder, bowel and sexual dysfunction, the pelvic floor can have impacts on pain and dysfunction in the body well outside of the pelvis. Many therapists are aware of how the pelvic floor can impact low back pain. Some are aware that it can impact or mimic hip pain. But the pelvic floor can also impact other body parts like the jaw, neck, GI tract, and knees. Being fluent in pelvic floor therapy can help a therapist treat the region of the body that is the primary location of the dysfunction in a more timely manner.
As a therapist, you do not need to have expertise in the pelvic floor, just like you do not need to be a certified hand therapist to work in any setting. However, having a basic understanding of the pelvic floor is important for the overall well-being of our patients. Knowing who the skilled pelvic floor practitioners are in your area is extremely important. If you are not comfortable with directly asking questions relating to the pelvic floor, have it on an intake form as part of a screening tool to know who might need that referral. We all want the best for our patients, which is why knowing about pelvic health is so important.
Written by our pelvic floor specialist:
Mary Ellen Kramp, DPT, CLT-LANA
