BackTable / OBGYN / Podcast / Episode #28
Pelvic Floor Physical Therapy
with Ingrid Harm-Ernandes, PT
In this episode, Dr. Amy Park invites Ingrid Harm-Ernandes, a pelvic floor physical therapist and co-director and mentor for Duke University's Women's Health Physical Therapy residency program, to shed light on the advantages of pelvic floor physical therapy for various types of conditions and patients.
BackTable, LLC (Producer). (2023, July 20). Ep. 28 – Pelvic Floor Physical Therapy [Audio podcast]. Retrieved from https://www.backtable.com
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Ingrid Harm-Ernandes, PT
Ingrid Harm-Ernandes was a physical therapist specializing in women's health with Duke University Medical Center for nearly two decades.
Dr. Amy Park
Dr. Amy Park is the Section Head of Female Pelvic Medicine & Reconstructive Surgery at the Cleveland Clinic, and a co-host of the BackTable OBGYN Podcast.
Dr. Park and Harm-Ernandes dive deep into the definition of pelvic floor therapy. They emphasize the significance of a comprehensive initial exam to determine the specific assessments that a patient may require. For instance, internal assessments may include evaluating muscle strength, endurance, trigger points, and fascial restrictions. Another key component to pelvic floor therapy is the importance of behavioral therapy integration with physical therapy. For example, it is important to provide patient education over bladder relaxation to reduce urinary urgency and pelvic floor relaxation to prevent constipation. Assessing all body systems, particularly other areas of musculature, can help providers understand how the pelvic floor interacts with other symptoms. Overall, the key feature of pelvic floor therapy is individualized treatment. Pelvic floor physical therapists form the treatment plan around each patient’s goals.
During the discussion, Harm-Ernandes places a significant emphasis on the numerous indications for pelvic floor therapy, as well as common misconceptions surrounding it. For instance, she highlights that many women are often taught to believe that occasional urinary incontinence, particularly with age or after childbirth, is entirely normal. However, she stresses the importance of dispelling these myths and encourages women to seek professional help rather than accepting incontinence, pain during sexual intercourse, or chronic constipation as inevitable experiences. By dispelling these misconceptions and seeking appropriate treatment, individuals can significantly improve their quality of life and overall well-being.
Collaboration among health professionals is pivotal in treating patients holistically and addressing the complexities of pelvic floor disorders. Harm-Ernandes’ extensive knowledge and commitment to educating both patients and providers has been instrumental in highlighting the essential role of pelvic floor therapists.
Book: “The Musculoskeletal Mystery: How to Solve Your Pelvic Floor Symptoms”
[Dr. Amy Park]
Yes, but anyway, I also wanted to just ask about what other indications can you think of to go to a pelvic floor PT.
Yes, there are many, many different reasons to go. I would say one of the unfortunate things, once again, is that people, especially women here are taught it's okay to leak. It's normal to leak. It's normal and okay to have pain with sex. Just live with it. Put a pad on, and one of the reasons men get better quickly is pads are for women. They don't want to have pads. They want to get better yesterday, so it has a little to do with that.
It's this issue of, well, yes, you know, we giggle about it. We laugh about it. If I'm with my friends, I laugh and I pee on myself and we just kind of just say, well, no worries, but we have to dispel those myths that it's normal. I want the conversation to be normal about it, but not that the conditions are normal. Some of the most common things are any kind of leakage with coughing, sneezing, laughing, urgency where you can't make it to the bathroom on time, or even if you now make it to the bathroom, in a year or two years or five years, you might not make it to the bathroom. Solve that problem now before it becomes a leakage issue.
Fecal incontinence, my, that is a big one that people don't want to talk about. That is something that is kind of off-limits for people, but I want people to realize out there, if you've got patients coming in and they're hemming and hawing about things, go ahead and ask. Outright ask because these patients actually want you to ask so that they feel comfortable to say, yes, you know, by the way, every time I pull my underwear down, I have a stain on it. What's going on kind of thing?
Or constipation. No, it's not okay to live with constipation. The more you strain, the worse the problem gets, and sometimes it's such an easy fix working on the pelvic floor and proper toileting position can make a night and day difference with them, so constipation is another thing. Don't wait on that. Prolapse for women right after pregnancy and then later in life. It's been shown that operative deliveries are at a high risk for forming prolapse either immediately afterwards or years down the road when menopause shows up and the pelvic floor starts to change because of that. Any kind of bulging, any pressure that you commonly see in your practices can absolutely be treated by pelvic PT.
Pain with sex. That's another big one that people do not want to talk about, but that should be such a big checkoff right there that if they're having pain with sex, whether it's post, and I'll say fourth trimester, not postpartum because we have to stop thinking that the woman is better after six weeks. We may check off that they're okay, their bleeding has reduced or stopped, and now we say they're ready to go. A lot of times they're not. They're not ready to. They have back pain. They have incontinence. They have prolapse. They have fecal incontinence. These are the patients that absolutely need to go to PT. During menopause, pain with sex, again, increases. That's another time.
You mentioned before back pain and hip pain. This is a big one. If they have incontinence and they have back pain as well or hip pain, wow, that's a telltale sign to get them to pelvic PT. I can't tell you how many patients I've treated that come in and they say, well, I have incontinence and this is going on. I go through their history and they say, you know what, I've had a hip bursitis and I've been treated for it. Injections, whatever it may be. It doesn't get better. I treat their pelvic floor and their "hip bursitis" goes away because it was never hip bursitis, it was the obturator internus, a hip rotational muscle, so we need to look at that broad spectrum of multiple symptoms.
You mentioned before vulvodynia, IBS, interstitial cystitis. If they have this suite of problems, they have more than just a simple fix, I'll call it. They have an upregulated system. They have these comorbidities that are very, very typical. I'd say look for these comorbidities, migraines, asthma, all of that fits into this group of upregulated individuals that absolutely can benefit from pelvic PT.
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