This is a continuation of our education series on pelvic floor therapy. We’re interviewing Dr. Karla Wente, PT, DPT, WCS, CLT about how pelvic health therapy interacts with disabilities.
To learn about what is pelvic floor therapy, the benefits, who it’s for, and common conditions, read Part 1: What is Pelvic Floor Therapy?
To learn about how to find the right therapist, red flags to watch out for, what to expect in a session, and how long you’ll need to stay in therapy read Part 2: Finding the Right Pelvic Health Therapist For and Near You.
Nicole: You mention in Part 2 that progress and outcomes in pelvic floor therapy are variable and often interact with disabilities. Could you please talk more about that?
Dr. Wente: I have patients who are relatively healthy, meaning they have absolutely no medical conditions and they take no medication. Maybe they had a baby, and they have some pain during penetration because of a scar. This patient is probably going to be different from a patient with pelvic pain who is 75 years old and has had Multiple Sclerosis (MS) for 30 years.
If you have a disability or chronic condition that affects your muscle function and nerve function, I would generally add some time to your expectations of how quickly you will progress. Then again, people surprise me all the time.
Women will come back and say they are doing so much better, and that is great!
If you’re having pain, your therapist should be able to identify or reproduce your pain. Within a few sessions, they should have some ways to reduce or eliminate that pain. Even if it’s just temporarily.
Oftentimes, we do what is called pre and post testing. For example, I will have somebody standing and I'll have them bend forward, bend backwards, bend to the sides, rotate, move their legs in certain ways. We'll find a motion that increases their symptoms, then we'll do a treatment. After the treatment, we'll go back to the movement that increased their symptoms. If it's better, that's a good sign.
Is it fixing the problem indefinitely?
Not usually, but there should be some effort from the therapist to show you in real time that your symptoms are changing or improved. I harp on this with every other physical therapist I know. We should be showing people progress in session and identifying what we can change immediately.
Nicole: What are some common disabilities or conditions for which people seek out pelvic health PT?
Dr. Wente: Anybody that has a neurological condition conceivably could have pelvic floor symptoms.
These are people who have a progressive neurologic condition, such as Multiple Sclerosis (MS), Parkinson's Disease, or peripheral neuropathy. They could also have non-progressive neurological conditions. For example, a spinal cord injury, spina bifida, or somebody who's had a stroke.
I have seen patients with all of those conditions because they are more likely to have issues with their pelvic floor, urinary, bowel, and sexual function.
When you have a neurological condition sometimes the expectations are a little different.
Maybe we don't expect you to get to full strength in your pelvic floor. But I want to emphasize that when I see a patient who has these chronic conditions or disabilities, I'm still seeing Betty, I'm still seeing Bob. I'm seeing the person, not solely their disability or condition.
I'm not dismissing the disability, but I am saying it is just another facet of the person and you can really make improvements despite the fact that you have this other condition.
I think, oftentimes, patients with chronic conditions or disabilities, especially neurological diagnoses, do not get referred to PT for pelvic floor therapy because there is an assumption that their symptoms can’t improve or that this treatment is not going to help. I don't believe that at all.
Will it help maybe as much as somebody who has no neurological condition? Maybe, maybe not.
We don't have a ton of studies on these conditions either. There are not a lot of studies looking at pelvic floor therapy in patients with neurological conditions.
Now again, when we look at disability from a broad standpoint, chronic pain is a disability, having back pain is a disability, having depression is a disability. All these can affect your sexual function. Having had cancer is a chronic condition and affect your sexual function, urinary, and bowel function.
As a woman who is disabled, you may have to advocate for yourself more.
This is the unfortunate reality of disability in our culture. Our environment is not adaptive enough for all the different types of people, functions, and abilities.
As a society we have constructed this concept that people have a disability that is impairing them, but it is actually that we do not have an adaptive, flexible, and versatile environment. Which gets to Springrose’s adaptive bra. Who made traditional bras? They were designed in a way that works for most people, so we just went with that?
There are a lot of reasons why we practice this in our business, culture, and nation. But, if we make everything more flexible and versatile, then we can meet the needs of all people.
In therapy, whether it is physical therapy, occupational therapy, or speech therapy, we are professionals trained in working with and adapting to people across abilities.
Nicole: Ultimately, from your perspective, what’s the biggest difference between a physical therapist and other healthcare professions?
Dr. Wente: I think the biggest difference between my profession and some other medical professions, is that we really focus on people's function. Getting them from what they can do to what they want to be able to do. And again, this can look different for each patient.
I care that my patients are happy with their ability to do what they want to do and am less concerned with them returning to “normal” function. For example, I may teach a patient how to have sex adaptively, toilet adaptively, etc. It matters less about how it looks, or how it differs from the typical, and matters more how you are able engage in society, participate in you life, and feel at home in your own body.