Windows into Health Care - Women's Health, Physical Therapy and Kegels

Jan 16, 2018

Kristin Phillips is one of two physical therapists in West Virginia specializing in women’s health. In this episode of our occasional series, Windows into Health Care, health reporter Kara Lofton talks with Phillips about the main issues she sees in her practice. A warning to listeners, this episode includes detailed descriptions of women’s health issues and may not be appropriate for all listeners. The interview runs about eight minutes.

Phillips: So the majority of cases that I see deal with women who are struggling with urinary incontinence. So leaking urine when they don't want to. It's seen as something normal and expected related to pregnancy and bearing children. But it is a common misconception that totally doesn't have to be normal or something that you live with just because you decided to have kids. And then the other cases that I see are women who are currently pregnant and dealing with issues or pain related to their pregnancy usually pelvic pain, hip pain and low back pain. And again, unfortunately, a lot of us think that pain related to pregnancy is normal and expected which certainly, when you're creating a human life and carrying extra weight and things are shifting and moving there are certainly some aches and pains associated with that. But it doesn't have to be debilitating and limiting function.

Lofton: OK, so let's back up. As a woman of childbearing age who does not have kids the idea of leaking is totally new and it probably is for a lot of our male listeners and, you know, non-mother female listeners. How common is this that people experience this and have to deal with it?

Phillips: So the prevalence in young women and this is all kinds of urinary incontinence not necessarily related to childbirth is about 20 to 30 percent. In middle-aged women the numbers are 30 to 40 percent and then in elderly women it’s, the numbers are thought to be about 30 to 50 percent. So that particular study did not necessarily take into account women who have delivered babies or not, but it is significantly more common to experience leakage if you have delivered.

Lofton: And by incontinence we mean basically keeping the urine in the body when you want it to be in the body?

Phillips: Exactly.

Lofton: How do you do physical therapy for that?

Phillips: It depends. So the pelvic floor that I talked about those muscles reside inside the pelvis. So they live inside the vagina and the rectum. So generally, a pelvic floor assessment for someone who's dealing with these issues will involve a pelvic exam where I'm looking at these muscles. However, it's not exactly like a gynecological pelvic exam. My interest, because I'm a physical therapist, I'm still interested in the muscles and their function, so I may do an internal exam with a gloved finger to assess the strength of these muscles, the coordination of these muscles and the general tone of them. Now it's important to remember that the pelvic floor isn't the only muscle that contributes to continence. So our abdominals are super important in supporting all of those organs as well as muscles of our hips and our and our low back. Many studies demonstrate that when someone's given verbal cues alone, so I tell you to activate or engage or squeeze your pelvic floor, the majority of women are actually performing them incorrectly. So 51 percent of women do not do a pelvic floor activation correctly. I'm sure you've heard the word Kegel, so generally people have an idea of what they think a Kegel is, but the majority of the time they are not in fact doing it appropriately.

Lofton: You mentioned that one of the other things that you work on is women who are pregnant who are experiencing pelvic, low back, hip pain. What types of exercises or what type of therapy do you do with those women. Because they are they do have a bowling ball with them. It makes things challenging.

Phillips: So generally exercises are. Have you seen those big yoga balls the big stability balls? So I love those for pregnant women to strengthen their core and their hips. They can do exercises lying on their side. There are many exercises that are totally safe in standing and, fairly recently, the guidelines regarding pregnancy and exercise have changed. And for a while we were recommending that if a woman was sedentary prior to pregnancy that she shouldn't start a new exercise. But we're reframing our thoughts because if a woman is pregnant and exercising her outcomes post-partum are far superior. So, the better physically fit and active and the more active you are during pregnancy, the better outcomes you have postpartum. So we are starting to encourage even sedentary women to find a safe exercise that they can do while they're pregnant. And generally, people who haven't exercised before need a little bit of help knowing what's safe so that something might help them find.

Lofton: So there's one other thing that you said that I thought super interesting  that you can do physical therapy for sexual dysfunction. Talk to me a little bit about that.

Phillips: When it comes to sexual dysfunction. There are a handful of issues that may contribute to the dysfunction and the dysfunction itself can vary. So some women have issues if they're engaging in penetrative intercourse, they have pain with penetration. These women usually also have issues with inserting tampons and with pelvic exams at their yearly gynecology visits, however, not always. Then there are some women who can't tolerate anything on the outside of the vagina or they might have that urinary incontinence during intercourse or with orgasm and then some women have difficulty achieving orgasm. Those again are not all of the things that might happen or someone might be dealing with when it comes to sexual dysfunction.

But let's say someone is having pain with penetration which is common. We work a lot on what's called down training or teaching those muscles how to relax and allow for something to be inserted. Someone who has difficulty achieving orgasm, they might be someone who has what's called a low tone or a weak pelvic floor. Or even a weak abdominal core if you don't have those muscles, if they're not strong enough, they won't be able to have that strong powerful contract relax which is part of a sexual orgasm or climax.

It is a very personal physical therapy but it's really empowering because a lot of these women suffer in silence and they think that they just have to kind of suck it up and deal with it or they're not living their fullest life and they're avoiding intimacy altogether, which is an integral part of any long term relationship or marriage. So they don't have to suffer. There is help.

Lofton: And this is — I mean when we think of sexual dysfunction we think of like the need for Viagra or something. I mean this is actual pain versus sexual drive so to speak.

Phillips: Yes. However, once you have pain associated with this experience it's not uncommon then to experience a decreased drive or desire arousal, understandably. If something doesn't feel good you wouldn't want to participate in it. That's a normal response to pain. But then that can contribute to further dysfunction because now you don't even have the desire to do it because it once hurt.

Appalachia Health News is a project of West Virginia Public Broadcasting, with support from the Marshall Health, Charleston Area Medical Center and WVU Medicine.