Today, I’m sharing another digestive chat with you. This interesting and informative interview is with one of my favorite, pelvic floor physical therapists, Dr. Caryn Phillips.
In my clinical practice, I have often referred my patients with GI disorders such as IBS or chronic constipation to pelvic physical therapists or alternatively, began the discussions with the patient and the gastroenterologist that a referral might be a good next step in care. Honestly, the majority of my referred patients found some level of benefit from pelvic floor physical therapy–for many, the pelvic floor physical therapy helped significantly with their elimination patterns.
Here is my brief interview w/ Dr. Phillips.
Kate: What is the role of a pelvic floor physical therapist, particularly as it relates to IBS care?
Dr. Phillips: A pelvic floor physical therapist is essentially an expert of the musculoskeletal and neuromuscular systems, specifically in and around the pelvis. This means that if there are any muscle or nerve-related dysfunctions contributing to IBS (tight muscles, irritated nerves, etc), a pelvic floor physical therapists (PFPTs) can treat them to create a more balanced [and more efficiently working] system.
Kate: Beyond IBS, what other conditions do you treat in your practice?
Dr. Phillips: PFPTs can help with any condition related to bowel, bladder or sexual function. Common conditions we treat include urinary or fecal incontinence, constipation, pelvic pain, painful intercourse, urinary urgency or frequency, painful periods, unresolved back or hip pain.
Below is Dr. Phillips working in her practice
Kate: Can you provide a few myths about pelvic floor health?
Dr. Phillips: 1. “Drinking less water will help me pee less.”
The truth is, when you don’t drink enough water, your urine becomes more concentrated and creates and more acidic environment in your bladder. This acidity irritates the bladder and gives a false sense of urgency, leading to frequent voiding and/or possibly leaking. The best thing you can do is drink small amounts of water consistently throughout the day, keeping your bladder happy and calm!
2. “All women should do their kegels”
Sometimes (actually more often than not) kegels can make leaking or pelvic discomfort WORSE. Education is so important to ensure women are doing kegels correctly and whether they should be doing them at all. Having a consult with a PFPT is the best way to find out whether kegels are what you should or should not be doing [for your symptom management].
3. “Only women that have had children can have pelvic floor issues”
Childbirth is only ONE possible contributing factor of pelvic floor dysfunction. There are so many other reasons one may experience issues with the pelvic floor. Posture, breathing patterns, stress, past surgeries, past injuries, muscle weakness, are some other factors associated with pelvic floor dysfunction.
Kate: Can you describe how someone may have weak pelvic floor muscles but the muscles are tight at the same time? I think there is some confusion about this. Is this a common scenario in constipation?
Dr. Phillips: This is a possible scenario. When a muscle is unable to relax all the way, it can lose its range of motion. Since the muscle cannot move through its full range of motion, it will become weaker over time. So the tightness, which is restricting its motion, actually causes the muscle to become weak.
In terms of constipation, this is usually more a scenario where the muscles are too tense and unable to relax all the way. To have a complete bowel movement, the pelvic floor has to lengthen so the anal sphincter can open. When this movement is restricted, one might feel difficulty emptying their bowels without straining.
Kate: I think some people may be a bit fearful of having a practitioner work on their pelvic floor area. How do you work with patients that may be uncomfortable?
Dr. Phillips: Depending on what you’re coming in for, it may be recommended to have an internal exam, since this is the most accurate way to assess the pelvic floor muscles (since they are in fact, internal). This exam is vaginal or rectal, depending on the condition the patient is coming in for. The PFPT will use one gloved finger being used to palpate the muscles to assess the strength, tissue integrity, flexibility and range of motion. There is no speculum or other instruments used. That being said, if the patient is uncomfortable, there are definitely ways to work around it and limit the exam to external palpation only. Any patient has the right to refuse the internal exam if they feel uncomfortable and their PFPT should work with them to try to reach their goals in alternative ways.
Thanks again, Caryn, for sharing your amazing knowledge with my followers.
Dr. Caryn Phillips has a busy practice in Medfield, Massachusetts, her website is here.
Follow her fun and informative Instagram feed, @momlifehealth here.
For more on pelvic floor physical therapy, check out my previous posts:
Do you need pelvic floor physical therapy? found here and Pelvic Floor Dysfunction, found here.