By Karah Charette, PT, DPT, RYT
When I first met Sara* (name changed for the story), I knew she was going to do well with pelvic floor physical therapy. She was motivated, curious, and engaged in her healing process. She came in with questions and reflections each session, and was open to learning something new every time we met. So when I was thinking of success stories to share, she was the first to come to mind.
Sara had been dealing with the symptoms of heaviness and pain in her pelvis that all too often happen with pelvic organ prolapse. Not only that, but she had been overlooked by her medical team for education on hormones in menopause and the important role they can play in keeping pelvic tissue healthy to prevent or decrease prolapse.
Working with Sara, we were able find a holistic approach that embodied the healing tools of exercise, education, hormone therapy, and the mind-body connection in order to empower her and help her regain control over her symptoms and her body. This is her story:
- What were your symptoms and experiences before coming in?
I had an unfamiliar feeling in my vagina, which felt like a descending tampon. I am 64 years old and am well past menopause. I think I felt something was wrong before my symptoms became ‘clear’ to me. Additionally, I experienced fatigue, and some abdominal pain, like light but annoying menstrual cramps, fatigue and increasingly, some slight fear. I knew I had to do something, but dreaded going to my GP because of COVID. Not so much because of fearing infection, but because of my increasing dissatisfaction with customer service at my GP practice in San Francisco.
- How did you find us?
I consulted with my colleague and friend in Berkeley, who is well versed in (female) medical issues, and had recently experienced pelvic pain. She recommended PHRC and I did not hesitate for a moment to follow through. Fortunately, we had just sold our house in the city and I had financial resources to use for my healing, regardless of my insurance and my doctor’s recommendations.
- What were the key parts of the treatment that worked for you?
The first key part of the treatment was the professional and encouraging attitude of my physical therapist, Karah Charette. She gave me confidence in the viability of the treatment and mapped out the next steps with clarity and conviction. Right away, closely-held fear of what was happening to me dissipated and I began to understand the cause of my ailment and the way to health. I began to understand my body better and developed trust in Karah’s approach and confidence that I could do this myself.
- How did you experience success? What goals were achieved for you?
For me, success was first of all the fact that I did not have to worry about paying for treatment. I was lucky to have plenty of resources for it. I know this may seem out of the scope of this questionnaire, but the larger picture is that women, often the ones that forgo helping themselves, need universal access to pelvic health clinics, without the worry to pay and/or see a generally dismissive physician first.
Success was also to find Karah, who ‘spoke my language’, meaning that our personalities seemed to be nicely compatible, ranging from being very open and trusting physically, to mental and intellectual ideas about the treatment and the larger socio-economic context of women’s health issues in general. These did come up because of my dissatisfaction with my current GP, and the seemingly persistent neglect of women’s issues in internal medicine. My confusion about which issues are OBGYN and which are ‘internal’ contributed to this as well, a fact I attribute to the way my GP office is managed.
Success now is the awareness that the healing path is clear and success is now mostly up to me. Exercise in general and targeted physical therapy exercises will heal me, and bring me insights and support for years to come. I can share my experience with friends – and I hope that the conversation about pelvic health becomes a mainstream topic in 2021.
Success for me has also been my raised awareness of the importance of pelvic health, especially during COVID, which was part of the triggering mechanism of my pelvic prolapse. My sequence was: my dog died (I stopped walking 3 times a day), I moved out of my vertical house of 20 years (walking 37 steps of stairs each day, moving and carrying boxes up and down), and not being able to go to my group dance classes anymore.
- What do you wish people would know from this experience?
Aging women, especially those who have gone through menopause and are in transition from leading active sexual and professional lives, should be as aware of pelvic health risks as they are of breast cancer. I had yearly mammograms for decades, but there seems to be a lag in care for post-menopausal reproductive organ care and awareness. My regular OBGYN retired, and it felt like I became a medical orphan. No one seemed to know me or care for my reproductive health as much as the person who delivered my two babies. I remember that she asked me if I wanted HRT (hormone replacement therapy) years ago, which I refused because I did not see the need. Now, I would like to investigate the need for HRT and cannot get to the right physician to get started.
With the advice of Karah, I purchased Julva Cream and will use it until my insurance situation is settled. I’m in full transition now, due to moving from SF to Mendocino, joining my recently retired husband in Medicare in eight months, and COVID.
I have names of young, female physicians in Santa Rosa who practice Integrative Medicine, with whom I will connect in 2021. I really look forward to meeting and working with the next generation of female physicians. In the meantime, my excellent experience with Karah and the philosophy of PHRC will carry me through the first part of this year in health and wellbeing.
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Are you unable to come see us in person? We offer virtual physical therapy appointments too!
Due to COVID-19, we understand people may prefer to utilize our services from their homes. We also understand that many people do not have access to pelvic floor physical therapy and we are here to help! The Pelvic Health and Rehabilitation Center is a multi-city company of highly trained and specialized pelvic floor physical therapists committed to helping people optimize their pelvic health and eliminate pelvic pain and dysfunction. We are here for you and ready to help, whether it is in-person or online.
Virtual sessions are available with PHRC pelvic floor physical therapists via our video platform, Zoom, or via phone. For more information and to schedule, please visit our digital healthcare page.
In addition to virtual consultation with our physical therapists, we also offer integrative health services with Jandra Mueller, DPT, MS. Jandra is a pelvic floor physical therapist who also has her Master’s degree in Integrative Health and Nutrition. She offers services such as hormone testing via the DUTCH test, comprehensive stool testing for gastrointestinal health concerns, and integrative health coaching and meal planning. For more information about her services and to schedule, please visit our Integrative Health website page.
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FAQ
What are pelvic floor muscles?
The pelvic floor muscles are a group of muscles that run from the coccyx to the pubic bone. They are part of the core, helping to support our entire body as well as providing support for the bowel, bladder and uterus. These muscles help us maintain bowel and bladder control and are involved in sexual pleasure and orgasm. The technical name of the pelvic floor muscles is the Levator Ani muscle group. The pudendal nerve, the levator ani nerve, and branches from the S2 – S4 nerve roots innervate the pelvic floor muscles. They are under voluntary and autonomic control, which is a unique feature only they possess compared to other muscle groups.
What is pelvic floor physical therapy?
Pelvic floor physical therapy is a specialized area of physical therapy. Currently, physical therapists need advanced post-graduate education to be able to help people with pelvic floor dysfunction because pelvic floor disorders are not yet being taught in standard physical therapy curricula. The Pelvic Health and Rehabilitation Center provides extensive training for our staff because we recognize the limitations of physical therapy education in this unique area.
What happens at pelvic floor therapy?
During an evaluation for pelvic floor dysfunction the physical therapist will take a detailed history. Following the history the physical therapist will leave the room to allow the patient to change and drape themselves. The physical therapist will return to the room and using gloved hands will perform an external and internal manual assessment of the pelvic floor and girdle muscles. The physical therapist will once again leave the room and allow the patient to dress. Following the manual examination there may also be an examination of strength, motor control, and overall biomechanics and neuromuscular control. The physical therapist will then communicate the findings to the patient and together with their patient they establish an assessment, short term and long term goals and a treatment plan. Typically people with pelvic floor dysfunction are seen one time per week for one hour for varying amounts of time based on the severity and chronicity of the disease. A home exercise program will be established and the physical therapist will help coordinate other providers on the treatment team. Typically patients are seen for 3 months to a year.
What is pudendal neuralgia and how is it treated?
Pudendal Neuralgia is a clinical diagnosis that means pain in the sensory distribution of the pudendal nerve. The pudendal nerve is a mixed nerve that exits the S2 – S4 sacral nerve roots, we have a right and left pudendal nerve and each side has three main trunks: the dorsal branch, the perineal branch, and the inferior rectal branch. The branches supply sensation to the clitoris/penis, labia/scrotum, perineum, anus, the distal ⅓ of the urethra and rectum, and the vulva and vestibule. The nerve branches also control the pelvic floor muscles. The pudendal nerve follows a tortuous path through the pelvic floor and girdle, leaving it vulnerable to compression and tension injuries at various points along its path.
Pudendal Neuralgia occurs when the nerve is unable to slide, glide and move normally and as a result, people experience pain in some or all of the above-mentioned areas. Pelvic floor physical therapy plays a crucial role in identifying the mechanical impairments that are affecting the nerve. The physical therapy treatment plan is designed to restore normal neural function. Patients with pudendal neuralgia require pelvic floor physical therapy and may also benefit from medical management that includes pharmaceuticals and procedures such as pudendal nerve blocks or botox injections.
What is interstitial cystitis and how is it treated?
Interstitial Cystitis is a clinical diagnosis characterized by irritative bladder symptoms such as urinary urgency, frequency, and hesitancy in the absence of infection. Research has shown the majority of patients who meet the clinical definition have pelvic floor dysfunction and myalgia. Therefore, the American Urologic Association recommends pelvic floor physical therapy as first-line treatment for Interstitial Cystitis. Patients will benefit from pelvic floor physical therapy and may also benefit from pharmacologic management or medical procedures such as bladder instillations.
Who is the Pelvic Health and Rehabilitation Team?
The Pelvic Health and Rehabilitation Center was founded by Elizabeth Akincilar and Stephanie Prendergast in 2006, they have been treating people with pelvic floor disorders since 2001. They were trained and mentored by a medical doctor and quickly became experts in treating pelvic floor disorders. They began creating courses and sharing their knowledge around the world. They expanded to 11 locations in the United States and developed a residency style training program for their employees with ongoing weekly mentoring. The physical therapists who work at PHRC have undergone more training than the majority of pelvic floor physical therapists and as a result offer efficient and high quality care.
How many years of experience do we have?
Stephanie and Liz have 24 years of experience and help each and every team member become an expert in the field through their training and mentoring program.
Why PHRC versus anyone else?
PHRC is unique because of the specific focus on pelvic floor disorders and the leadership at our company. We are constantly lecturing, teaching, and staying ahead of the curve with our connections to medical experts and emerging experts. As a result, we are able to efficiently and effectively help our patients restore their pelvic health.
Do we treat men for pelvic floor therapy?
The Pelvic Health and Rehabilitation Center is unique in that the Cofounders have always treated people of all genders and therefore have trained the team members and staff the same way. Many pelvic floor physical therapists focus solely on people with vulvas, this is not the case here.
Do I need pelvic floor therapy forever?
The majority of people with pelvic floor dysfunction will undergo pelvic floor physical therapy for a set amount of time based on their goals. Every 6 -8 weeks goals will be re-established based on the physical improvements and remaining physical impairments. Most patients will achieve their goals in 3 – 6 months. If there are complicating medical or untreated comorbidities some patients will be in therapy longer.