Pelvic Floor Physical Therapy

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00:00

This is the bridging the gap physical therapy podcast, keeping you active and pain free.

Charlie McDermott 00:05

Welcome! This is Charlie McDermott, publisher of the palm Living Magazine and, in this episode, we’re going to discuss pelvic floor physical therapy with top pelvic floor specialist, Dr. Bri Wyatt of bridging the gap physical therapy. Dr. Wyatt, thanks for joining us how you doing?

Dr. Bri Wyatt 00:24

I’m doing great. Thank you for having me. I’m excited.

Charlie McDermott 00:28

Yeah, and me too, this might be a case of be careful what you wish for. But, pelvic cell therapy is probably not a topic most people are talking about in the public and certainly, I know absolutely nothing about it. So, I really am interested in learning more. So, let’s start with that, what exactly is the pelvic floor?

Dr. Bri Wyatt 00:50

So, the pelvic floor is a group of muscles that support bowel, bladder and sexual function. So, it forms almost like a swelling of muscles, and it connects to your sacrum it connects to, you know, the front of the pelvic bones. So, it’s really a very important structure. Because when things go wrong in the pelvic floor, it’s not like your neck where you just get some pain. People who have pelvic floor dysfunction tend to have issues with sexual intercourse, they tend to have issues going to the bathroom, which obviously really affects somebody’s life. So, when we’re thinking about issues in the pelvic floor, it’s typically a lot more disturbing for someone and uncomfortable for someone and what makes them more difficult is very few people talk about it. So, those people who have issues usually don’t get help until much later down the road.

Charlie McDermott 01:41

Wow, yeah, I can see that just kind of keeping it to yourself and suffering the consequences. So, what then, you know, what do you guys do what is pelvic floor physical therapy?

Dr. Bri Wyatt 01:53

So, pelvic floor physical therapy is almost a little subset of physical therapy, I obviously still went to school and got my doctorate in physical therapy. So, I practice orthopedic here in the clinic, but I have an extra specialization in pelvic floor and pelvic health. So, I went to go do additional coursework, where I learned to do both an external examination as well as an internal examination. So, just like I would look at the muscles of your bicep, I would look at the muscles of the pelvic floor. Now you can’t see those, they are all internal. So, I do an internal examination where I will palpate the muscles of the pelvic floor, see if they’re strong, see, if you’re able to hold it, I will have you do a couple of exercises activities and see if the pelvic floor is engaging like it should. So, it’s an extra little additional skill set that I have, in addition to my orthopedic practice, where I really get to work with men and women in fixing an area of their body that they’re not comfortable with sometimes, and that they’re not familiar with, especially when you’re thinking of a female, everything is internal. So, they don’t exactly know what’s going on and sometimes they don’t know that they have a problem until it’s much later in their life.

Charlie McDermott 03:13

Wow and you certainly have a unique skill set that is much needed and again, I’ve been on this earth for almost six decades, and this is brand new to me. So, this is gonna be really helpful, I know for our listeners, but I’m just curious, you know, did you get to grade school and decide man, I really want to be a pelvic floor, physical therapists mean it had all this come to fruition for you.

Dr. Bri Wyatt 03:41

When I was in physical therapy school, I was convinced I was going to work with athletes. I played Division One softball for four years, and I personal trained all through school, and I was convinced I was going to work with athletes. I was going to get them to be extremely competitive and really good at their sport and I graduated physical therapy school, I moved down to Florida, and I started working with our horror population, which is not a lot of athletes. We worked with a lot of golfers, but I didn’t see the softball players I thought I was gonna see or the basketball players and track athletes. And, you know, that was a big change for me and then as I was about four months into practicing and orthopedics, I started to develop my own issues. I had my gallbladder removed and then about six, seven months later, I had my appendix removed and especially after my appendix removal, they inserted a catheter to drain my bladder because it’s located so close to the appendix and I started to develop pelvic floor issues and at first, I was like, okay, it’ll go away.

I’ll just ignore it, it’ll be fine and then it started to just become more and more problematic and when you have pelvic floor dysfunction, it’s hard to understand if you haven’t experienced it but it really almost eats its way into your life where what started as just an uncomfortable pain was starting to interfere with my ability to have a good relationship with my, with my fiancé, I was having leakage issues, and I was like, I’m not even 30 yet and I haven’t had a baby, and I’m leaking urine when I’m doing simple activities and so many women just kind of brushed it off, they’re like, oh, that’s normal, I just have to deal with this, or oh, I had a baby, this is expected. But as a physical therapist, I knew this is not normal, I can fix this. So, luckily, with my physical therapy background, I was able to find a pelvic therapist to help me through my process. But even so with my connections in the physical therapy world, I had a really hard time finding a provider that could help me with this issue, because very few therapists are actually specially trained in pelvic floor. So, I took that as my motivation to go get certified and go take all these extra courses, to help women who went through what I went through. So, I immediately made that change. I said, look, athletes are not what I want to do. I’m super passionate about pelvic floor, I took a ton of courses, I got a couple of certifications, I started writing a book, like I just dove head into pelvic floor, and I really became super passionate about it, and I think it personally experienced pelvic floor dysfunction helped me better communicate and better connect with my patients, because I understand what they’re going through for some of these issues. So, I honestly, if you asked me five years ago, what I would be doing, I would have never said pelvic floor therapy. It was nowhere on my radar. But that’s just where I’m at right now and I love it. So, I’m really glad that all of this happens and I’m where I’m at today.

Charlie McDermott 07:01

Yeah, it’s amazing how life’s hardships can turn into, you know, wonderful opportunities, not only for ourselves, but in your case, mean for the wonderful people in the Naples area and Bonita Springs and Estero and, I’m sure there are listeners, because as you know, this show brings in listeners all over the globe. So, for those outside of the area that can’t just stop by and see you and take advantage of again, that unique skill set, you know, what point should our listeners or should someone consider seeing a pelvic physical therapist?

Dr. Bri Wyatt 07:40

I recommend that anybody who has had a baby goes in for an internal evaluation, because the body and the pelvic floor especially changes so much when you are pregnant and accommodating for a growing baby. But also, once you have delivered that baby, the thing that your pelvic floor has to do to be able to allow that to happen is pretty extreme. So, in countries like France, at that six week point where you’re checking up with your OBGYN, they automatically refer to a pelvic floor therapist for an internal examination. Because a lot of women have things like prolactin, and you know, dysfunctional tissue, they just don’t have any symptoms yet. So, if you can go in for an examination at that six week, eight week, mark, after you’ve been cleared by your OBGYN who returned activities, you’re gonna understand a lot more about what your body’s been through and where you’re at that point in time. Oftentimes, women are going to their OB and their release to go to activities, and they go back to something like running, which is actually really hard on your pelvic floor, and they’re not ready for it, but they don’t know it and then they come back two years down the road, and they have something like a prolapse and they’re coming to me for help and so I’d like to believe that if you had a baby and you’re about to go back for something that you would come in for an appointment just to make sure everything’s heading in the right direction, and that you know, how to strengthen your pelvic floor along with all the other muscles you need to strengthen to return to an activity and then I would also say, anybody who’s having any bowel or bladder issues, any leakage of urine, any pelvic pain, pain penetration, any men who are having difficulties initiating the stream who are having pain with ejaculation or urination. Now, these are all things where sometimes we just ignore it and we hope it gets better. But there are things that can become worse if we leave it untreated and because it can be difficult to talk about a lot of people don’t go see someone immediately. But it is extremely important to treat it right when it happens. Instead of letting it grow and continue to get worse.

Charlie McDermott 09:57

Yeah, be proactive, address it right away versus yeah, putting it off putting it off and again, you know, there, I know, listeners who aren’t in the area here, gone wow, I really need to see a therapist, maybe spend a minute or two explaining, you know, how does a pelvic physical therapy session differ from your typical physical therapy session?

Dr. Bri Wyatt 10:20

So, with pelvic health, number one, it has to happen in a one on one private treatment room, we are not doing anything for pelvic floor out in the open. When people think of physical therapy, they usually imagine this gym like environment where there’s like, four mat that you’re treating patients on, and then you’re getting up and you’re doing exercises. In the world of pelvic health, it’s just myself and my patient, it’s just the two of us and obviously, we still examine the external structures, I’m still going to look at things like the hips, the abdominal muscles, the spine, just like I would, as a regular orthopedic therapist, I just have an extra component to it. So, all of my sessions have to be an hour long, I cannot get through an external examination and an internal examination and less than an hour and be thorough. So, typically, how it works in our clinic is I will have someone come in, we start with just a subjective examination, where I’m really trying to get to know all the different aspects of life that play a role in pelvic floor dysfunction. Things like, you know, childbirth history, bowel and bladder habits, breathing, diet, all of those things play a role.

So, I take a lot of time just to get to know the person in front of me, why exactly they’re here? What are their habits, like? And then after that, once I know everything, then we dive into the typical orthopedic examination that I would do with my non pelvic patients and I’m going in, okay, how are you moving? What does it look like, when you bend? Do you have pain with that, you know, how are your hips moving, how’s your strength, and I look at all of those things and then I just have an additional component and then I have them, you know, undress from the waist down, and they’re completely covered with a with a drape. And, you know, I’m doing that internal examination to see, you know, what are the muscles of the pelvic floor like, and it’s the same things as an orthopedic therapist, I’m looking at strength, I’m looking at endurance, I’m looking at the ability to relax the muscle and then at the end of the session, that’s when we tie it all together and I talked about these are the orthopedic findings, I found, this is how that’s gonna influence the pelvic floor. These are the pelvic floor things that I found and together, this is what we need to do to get you back to what you want to do, or to get rid of whatever problem you came in with.

Charlie McDermott 12:49

That is awesome. So, then, Dr. Wyatt, halons, a pelvic physical therapy exam, different from a gynecological exam, then?

Dr. Bri Wyatt 12:58

The most obvious difference is, sometimes we’re looking for different things. When you go to the gynecologist, they’re usually doing a look at your reproductive organs, you know, they’re looking to see how does the prostate look? How does the, you know, how does the ovaries look? How are the cells internally, so they’re going to use things like stress and a speculum to really get into the body to look at those structures? I do not use stirrups, I don’t use a speculum, I’m really taking the time to assess the muscles and so I’m not exactly looking for the same thing. I’m not doing a pap smear. I’m not trying to look for the presence of cancerous cells, that’s when I would refer to a gynecologist, and I do work very closely with other health care professionals because I do a very thorough exam of just what does it look like? And if I see anything, then I want to be able to refer and a gynecologist is looking for the same thing. They first want to look at what’s in front of them and say, okay, is there anything wrong with that before I even go internally, but I am not assessing, you know, the ovaries. I’m not looking for precancerous cells. I’m just looking at how do the muscles work? Do they work? How do they function, and I will assess for things like prolapse? But I’m going to make it as comfortable as possible. I’m always going to use a glove I’m always going to use a lubricant and I’m not going to put you in an uncomfortable situation like with stirrups or with the use of the speculum and for some of the women that I see who has had traumatic experiences with gynecological exams, I like to make it very clear how we differ and I’m very, very open and very slow as we begin that internal examination process.

Charlie McDermott 14:55

Dr. Wyatt you are an absolute treasure. We’re so blessed. This area has you and I know our listeners, you’ve opened their eyes and probably a relief to many of them knowing that there’s a solution and it’s close by. So, really thank you for sharing this and looking forward to a future interview. I know you’ve got quite a few topics that you want to delve into. So, I appreciate you being on this one and look forward to the next one.

Dr. Bri Wyatt 15:22

Well, thank you very much.