Starting on January 2, 2019, Greater Boston Urology will offer pelvic floor physical therapy for the treatment of pelvic floor disorders (PFD).
What is the pelvic floor? Do both men and women have pelvic floors?DR. JOHNSON: The pelvic floor is a set of muscles that support the pelvic organs. Pelvic floor disorders (PFD) occur when the pelvic muscles are weakened or injured. Both women and men have pelvic floors.
What causes pelvic floor disorders?DR. JOHNSON: A variety of factors can cause pelvic floor disorders. Examples include childbirth, which can cause tears in the vaginal walls and injure or avulse pelvic muscles. Men who undergo radical prostatectomies can experience urinary incontinence due to pelvic floor weakness. Both men and women suffer from pelvic pain that can result for pelvic floor muscle spasms.
What are some common pelvic floor disorders?
DR. JOHNSON: The most common PFDs are urinary incontinence, fecal incontinence, and pelvic organ prolapse. Other conditions include the following:
What is pelvic floor physical therapy (PT)?
DR. JOHNSON: As its name suggests, pelvic floor physical therapy aims to treat pelvic floor disorders. But pelvic floor physical therapy involves much more than the typical physical therapy experienced in a gym. Most people are likely familiar with physical therapy for knee complaints, shoulder pain, back pain, and so forth.
With pelvic floor physical therapy, you work one-on-one with a physical therapist in a private room. The first visit involves a thorough intake and assessment. The physical therapist will evaluate the patient's overall flexibility, including how the patient moves, stands, and walks (while paying close attention to core muscles). They will discuss medical history, lifestyle, and symptoms. From there, they will conduct an internal exam.
For women, this can be a vaginal exam that focuses on muscle strength and muscle tone. For men, it can involve a rectal exam to best evaluate muscle strength and tone. Rock hard muscles can indicate and influence certain conditions, while weaker muscles can indicate and influence others. This knowledge helps to develop the overall treatment plan.
It's important to note that the internal exams aren't painful or prolonged, but because of the sensitive nature of the area, all exams are performed in a private setting one-on-one with the therapist.
Once the physical therapist does this initial intake and evaluation, what happens next?
DR. JOHNSON: From there, the physical therapist puts together a treatment plan for the patient. So, for example, if the pelvic floor muscles are weak, the therapist will guide the patient through muscle strengthening exercises, such as pelvic tilts, Kegels, and other strategies for strengthening the core.
In order to ensure proper technique, the physical therapist might use biofeedback where they put a device in the vagina (or rectum) that actually contracts the muscles, and they can show the patient—on a screen—the effect the exercise is having on the pelvic muscles. So the patient might see a little peak on the graph when the muscle is contracted. Then, they might see a valley when the muscle is relaxed. The biofeedback helps the patient feel and understand what their body is doing. This enables and empowers the patient to properly replicate the exercises at home.
How long do most patients work with a pelvic floor physical therapist, on average?
DR. JOHNSON: A patient typically visits the physical therapist one to two times a week, and a treatment course can range anywhere from six to 12 weeks.
An important caveat: The actual "therapy" isn't what's done during that 45-minute session in the office; it's what the patient does on their own when they're home. The physical therapist gives them tips and techniques on how to strengthen their muscles if they're weak or how to relax their muscles if they're in spasm. But it's up to the patient to commit to the work that happens outside of the physical therapy sessions—that is, if they want to experience the best results.
Does health insurance cover pelvic floor physical therapy?
JOHNSON: Yes, health insurance typically covers pelvic floor physical therapy. Some providers are cash only, but for our services, we'll bill through the patient's insurance.
Let's discuss pelvic floor physical therapy at Greater Boston Urology.
DR. JOHNSON: Our mission at Greater Boston Urology has always been to provide patients with world-class comprehensive care for all of their urologic and urogynecologic needs—in other words, for patients to receive all the care they need within the walls of GBU. So it made sense, especially with the launch of our Women's Health Center, to offer pelvic floor physical therapy in-house to our patients. This service will be available to women and men as of January 2, 2019, in our Dedham Care Center.
Any final points you want to make sure our readers understand?
DR. JOHNSON: Because pelvic floor physical therapy is a specific specialty that requires additional training, it's not as readily available as the PT you receive for your knee, shoulder, etc. So the wait times with other pelvic floor physical therapists in the area can be anywhere from three months to a year for women—and even longer for men.
This is important to mention because patients with pelvic floor disorders often wait on average 6.5 years before seeking treatment. To finally make that call and to learn you have to wait upwards of a year—or longer—for therapy is unfathomable.
We'll be able to serve patients in a timely fashion at our Dedham Care Center.
Another important note: pelvic floor physical therapy is evidence based. According to all of our regulatory societies (such as The American Urogynecologic Society, the American Urologic Association), pelvic floor physical therapy should be the first treatment that we do for any pelvic floor disorder.
Bottom line: it's a minimally invasive, evidence based, effective treatment, and there's a great need for it in our area. So we're thrilled that we can offer pelvic floor physical therapy to our patients.