Become a Creator today!Start creating today - Share your story with the world!
Start for free
00:00:00
00:00:01
Pelvic Floor Health & Therapy
138 Plays10 months ago
In this eye-opening podcast, we dive into a crucial yet often overlooked topic: pelvic floor health. Join us as we break down the myths, misunderstandings, and stigmas that have kept this essential conversation in the shadows for far too long. From understanding what the pelvic floor is and why it's so important for both men and women to addressing common issues like incontinence, pain, and prolapse, we aim to shed light on how maintaining pelvic floor health can enhance your overall well-being.
Our expert guest, Miranda Duffany of Fitzgerald Physical Therapy Associates will provide actionable advice and empower you to prioritize your pelvic health. Together, we'll discuss the social stigmas that prevent open conversations, explore how these misconceptions impact daily life, and offer ways to embrace a proactive and informed approach to pelvic care.
It's time to break the silence and start talking about pelvic floor health, removing the shame and misinformation that often surround it. Whether you're experiencing symptoms or simply curious to learn more, this podcast will give you the tools and knowledge to take charge of your health with confidence.
Recommended
Transcript
Introduction to Engaging Aging
00:00:03
Speaker
Welcome to Engaging Aging with Erin and Lauren. Join us as we share laughter, tears, and demystify the realities and silver linings that occur later in life.
00:00:16
Speaker
Welcome back to Engaging
Pelvic Floor Health with Miranda
00:00:18
Speaker
Aging. It's Erin and Lauren, and we are so excited to be sitting in an actual PT room with Miranda to talk about something really special. So, Erin, why don't you give us a little taste of what we're actually gonna be talking about. Okay, before we- It's fascinating. Yeah, before- And we're crazy, so let's dive into it. Okay, so if you know me, you know I have four kids.
00:00:42
Speaker
And what comes with four vaginal births is oftentimes urine incontinence. But guess what also comes with aging? Whether you've had a vaginal birth or not, or whether you're male or female, oftentimes urine incontinence can impact and affect many people of both genders at any given age. And before we introduce Miranda and have her introduce herself, I got really excited when we came in here tonight and I saw this.
Understanding Pelvic Floor Anatomy
00:01:11
Speaker
So this is a male and this is a female rendering of the inside layers and anatomy of your pelvic floor. And I am not a physical therapist, Miranda will explain this further, but there's only one major difference.
00:01:28
Speaker
And that's a second hole. So Miranda will give the scientific terms to these things, but we're just thrilled to dive into this really private conversation that no one really wants to talk about. But there's a lot that we can do to increase
00:01:44
Speaker
our strength and our flexibility and our body's ability to minimize some of the symptoms that come with a weak pelvic floor, one of those things being urine incontinence. So without further ado, Miranda. Miranda, before we get into there, what the heck is a pelvic floor?
00:02:01
Speaker
Great question. So these models are wonderful representations of what a pelvic floor is. The biggest difference we see male to female is the change in two muscles, but the pelvic floor is a hammock of muscles that sit at the bottom of your pelvis. So you have your bony anatomy that we can feel here, our hip bones or our sit bones or butt bones that we feel in a chair.
00:02:20
Speaker
And amongst that, we have a hammock of these muscles sitting at the bottom. The function of these muscles are to maintain bowel, bladder, sexual function, help with maintaining stability of the pelvic anatomy so that our bones aren't rotating too much and keeping us nice and stable. So this is our pelvic floor and kind of what we'll be talking about today.
Miranda’s Journey in Pelvic Health
00:02:41
Speaker
Fantastic. So tell us a little bit about yourself, your name, where you work, and how you chose this very specific field. Sure.
00:02:48
Speaker
So my name is Miranda. I graduated from Northeastern University. I knew early on in my career that I wanted to focus in pelvic health. I had my own struggles with pelvic health. I was a patient of it for two years. My world into battling endometriosis is what kind of provoked this for me and I remember going into my PT's office and she was the first person that kind of looked at me as an individual and I remember all the time I'd have these symptoms that were going on and I had like this laundry list
00:03:16
Speaker
But I remember feeling like I could only pick like my big three. Otherwise people wouldn't take me serious. And she was the first person that really looked at me and I said my big three and she said, okay, and what else? Cause I know that's not it. And I was like, really? You want like the whole, the whole list?
00:03:32
Speaker
And I just, I gave it all to her and she saw the whole package. And I think that's really important and what sparked my interest here is you need to know the whole package. It's not just about three things. People are more than just those big three issues. It's their whole life. It's what affects them day
Breaking Stigmas Around Pelvic Health
00:03:47
Speaker
in and day out. So I went to PT school. I geared my training towards this. So my last rotation, I was very lucky. I did a 14 week rotation.
00:03:55
Speaker
with a woman in Portsmouth, New Hampshire who's been doing this for 20 years. She teaches classes all across the country, so it's very privileged in my learning and experience. Most pelvic clinicians go to a weekend training course and kind of start trial and error, see what works, see what doesn't work. So it's very privileged in my training and it set me off early in my career to be able to specialize. So now I work at Fitzgerald Physical Therapy. I do this 40 hours a week. We have two other pelvic therapists here.
00:04:22
Speaker
Right now I'm the only therapist that treats both male and female genders, but one of my proudest things about working here is that we accept insurance. And that's a huge importance to me because I remember having to pay a good chunk of change, a cash rate to see my public PT, and I'm all about making this more accessible, whether it be just information or being able to access services.
00:04:43
Speaker
So I have a question for you. Oftentimes, whatever the ailment is or the issue is, people don't know that there's a service or a resource out there. Why do you think pelvic floor health in general? It's not discussed. The resources aren't known about. I think that there's a lot of social stigmas that we've layered into our society over the years, whether it be male or female.
00:05:11
Speaker
I think we have seen those barriers be broken down when it comes to females over the past several years, whether it comes to postpartum care or body autonomy and sexual expression and those sorts of conversations have come forward a bit more. I think there's still a lot of work to be done there, but even still I think there's a lot of stigmas around.
00:05:30
Speaker
Oh, well, you've had a baby. Well, of course you pee or of course you get up five times during the night. Of course these things happen to you or that your stomach's a little bit squishier than before. Those are what we call common things, but not normal things, right? We don't just accept those as being what they are.
00:05:46
Speaker
It's so refreshing, sorry, just to chime in here. As a woman that experienced four vaginal deliveries, it was never discussed. The only way I ultimately heard about pelvic floor physical therapy is when I really had to make the case to my OB-GYN that like yearning continents is having an actual impact in my life. What can I do about it? And then I had to ask for the actual referral.
Cultural Differences in Pelvic Care
00:06:10
Speaker
Is it the same way in all countries or is this really unique to the United States?
00:06:15
Speaker
It's hard to speak thoroughly here because I don't have the full gamut perspective here but from what I understand there are some differences in other countries. Some countries when you go and deliver the obstetrician that delivers your baby is yours then from there on out. So in our country when you have an OB that might not be the person that delivers your baby that day.
00:06:37
Speaker
and that person that delivered your baby that day might not be the person that does your follow-up care. So that's some of the differences and then from there you're automatically assigned in some places a pelvic PT postpartum to help with those initial experiences talking about breastfeeding mechanics because
00:06:53
Speaker
If your pelvic floor is intact, that's wonderful, but now we have a change in weight from our belly to our breasts, whether it's breastfeeding or bottle feeding. Same thing there as well as positioning. We are doing more lifting than you've ever done in your whole life once you're postpartum, but no one ever talks about that. But if you are a construction worker who's lifting all the time, given varying weight, but repetitive motions,
00:07:14
Speaker
There are laws and regulations in place to help protect your body and use your mechanics efficiently. Interesting. I never thought about it that way. Very interesting. And touching back to, you know, why socially we also don't have as much of these conversations, we see those stigmas for females. A lot of times when you hear about pelvic floor, it's called women's health. Well, how inclusive is that for a male to walk in here and expose his struggles or his challenges? And we know from research that
00:07:43
Speaker
Women tend to get support in their social peer groups. They're more likely to have these conversations. Men aren't.
00:07:50
Speaker
men are more so likely to sit on their symptoms for a longer period of time, so that when they finally make it in the door, their symptoms have been going on for so much longer.
Recognizing Pelvic Health Issues
00:07:58
Speaker
That makes so much sense. So what are some of those symptoms, I guess, for, there's obvious reasons if you've had a vaginal birth or, you know, whatever, but for those that haven't or for men, like what are things that they could be experiencing to say, oh my gosh. This could help, right? Yeah.
00:08:14
Speaker
So it's very similar male to female. Some differences along the way here, but I am a young woman. I haven't had children, but I've had endometriosis and that's one reason why someone might seek services. Other reasons are kind of going through in an order here, thinking about bladder dysfunction here. So urinary leakage or trouble starting a stream, a slow stream.
00:08:37
Speaker
pain with urination, any surgeries of the pelvic organs, so bladder, bowel, or reproductive organs for surgery there. Also thinking about if you're going to the bathroom too frequently or too urgently, all of a sudden your signals go from, I don't have to go to, oh my gosh, where's the restroom?
Understanding Prolapse and Management
00:08:57
Speaker
If you're that person that you hit every stall, you know where every one of them are, your friends are teasing you.
00:09:02
Speaker
And we see this so often in older adult males, and it's just poo pooed as common aging. But that frequency, the urgency, and to your point, there's such a social stigma against this that many men, and I don't know about geriatricians, but the average primary care physician, do you feel that they're aware that pelvic floor physical therapy can help alleviate these symptoms and give back quality of life to older men and women? That is a really good question.
00:09:31
Speaker
I do, it kind of depends on where you're working. Some clinicians, I get providers referring their patients to me and they're like, you need to go get to see pelvic PT. This is absolutely what's going to make that difference for you. And some providers, you know, when we talk about prolapse and we can get more into this,
00:09:51
Speaker
I've had some patients have a really significant prolapse, and I'm calling their doctor saying, hey, X, Y, and Z, this is what we're working on. And they're like, how does that help? What does that do? So there's still even an education there between providers and clinicians that I think needs to be broken down as well.
00:10:06
Speaker
To that point about prolapse, one thing I was fascinated to learn when I went through my pelvic floor physical therapy journey is the connection between bowel movements, urine incontinence, rectum, colon, and what is the connection between that whole space and how do they impact each other?
00:10:23
Speaker
So if we think about our pelvic dish here again, I'm going to be referencing the female anatomy as we most often see a prolapse occur with females. First of all, what is a prolapse? A prolapse is, it could be one of three things. So you have your rectum kind of resting here, you have your vaginal canal with cervix and uterus above it, and then you have your bladder at the front of that.
00:10:45
Speaker
So as we age tissues, the laxity kind of increases, we don't have this equal balance of hormones which can cause breakdowns or weakness in the walls of the vaginal canal. The walls of the vaginal canal kind of keep bladder over here and rectum over here saying, you stay in your lane, I'll stay in mine. As we age, that kind of breaks down postpartum, that breaks down a little bit.
00:11:06
Speaker
There is risk factors for that as far as other co-diagnoses and whatnot, but essentially it's when either the uterus and cervix can kind of descend down or fall down into the vaginal canal. The bladder could kind of push in or the rectum could come in, so that's some crowding that can happen.
00:11:22
Speaker
And it ends up eventually, if untreated and progressed through poor lifting mechanics and whatnot, can then kind of descend and protrude out the vaginal canal. So some of these symptoms would be pressure, bulging, feeling like you have a tampon in, or something you have to physically push back up and in. But to your question is, how does that then relate to bowel, bladder?
00:11:44
Speaker
And the pressure that you're feeling here is you're fighting for space in your pelvic cavity. You only have so much space, right? So if I have my vaginal canal here with crowding of my bladder coming in and I have a full bladder, but not too much enough so that my sensors are saying, hey, you need to pee yet. But then I also have a full rectum of stool. Now your stool is pushing up against that bladder.
00:12:08
Speaker
sending information to the brain that makes you feel as though your bladder is more full than it truly is, but it's just because it's being compressed. So this is why with prolapse, whether you're presenting with bladder urgency and frequency, we're still talking about your vowels and saying vice versa, right? They play on to each other.
00:12:24
Speaker
I think so often, and Lauren, you can speak to this in our line of work, just talking about bladder and bowel incontinence has so much just shame and fear and that we've really built our approach and our practice on creating a safe environment with deep trust and rapport so that we can have these conversations. That's why we're thrilled to have you on the podcast today, that people can listen to this in the privacy and comfort of their own home without any of that stigma and embarrassment.
00:12:53
Speaker
What do you find is some of, is it like constipation has more of an impact on the prolapse or opposite of that, loose bowel movements or it just depends on the scenario? So I would say even bigger than that, if I have, prolapse is one of my favorite things to treat because I think it's the easiest way to empower someone about their body because most people are like, eh, it happened, you just push it right back up.
00:13:18
Speaker
The biggest takeaway, if you learn nothing else from me about prolapse, it is pressure management. That is your biggest risk factor. Above all outs, above the bowel movements, above sexual function, above bladder function, it's pressure management, right? If we think about our torso, this is my go-to here, if we think about our torso as a can of Coke, right? So closed can of Coke, you squeeze that can, it's pressurized, it's firm, you can feel all the density and the pressure there.
00:13:45
Speaker
crack that lid open, you can squeeze a can and that pressure's gone, right? You have a pathway of least resistance
Practical Tips for Pelvic Pressure Management
00:13:50
Speaker
that that pressure can come out. Close that can of Coke, poke a pen hole in it. Now you have all that pressure coming pouring out, right? But then what if you cracked that lid again?
00:14:02
Speaker
Well, that hole up top is bigger than the one down here, so your pressure comes up and out. Okay, so now take that and apply it to your body. Your pelvic floor is the bottom of your coke can, your core is the front, and your glottis and your throat, where we can close off and go...
00:14:17
Speaker
Right? That is closing your can of Coke. So if I go to lift up the laundry every day or mow the lawn or get out of bed or a chair and I go, every single time, and I have a weak pelvic floor and a prolapse, that's my hen hole, right? I'm putting my pressure down. So, yes. Which is that your natural instinct to close off up here. Exactly. Yes. And so, you know, it's important to talk about the vowels and it's important to talk about the bladder, but it's
00:14:46
Speaker
50, 100 times throughout the day, you're closing off your airway and putting pressure down. That is more detrimental than one bowel movement a day. Potentially, this is a theory here, right? But this is fascinating. And Mom, if you're listening, I'm sure you won't kill me because it's for the greater good of all. My mom's a farmer. She has done her entire life heavy lifting on a farm all day, still does. And she has major pelvic floor issues, including rectum.
00:15:14
Speaker
prolapse and so this makes so much sense to me that when we just like grid and merit or push up I'm wondering if statistically like yeah like weight lifters and other people have more occurrences of this later in life and now I want to ask the question of my clients like what
00:15:30
Speaker
activities did you do throughout your life and you know all of that. But also what do you do now to make a difference? Like if you're going down to reach something and you're naturally doing that is there something else that you can be doing? I'm so happy you asked. I'm gonna get this tattooed on my forehead one day. My patients always laugh. Don't do that because you have a beautiful face. They always tease me because I'm like keep your ease together, keep your ease together. What does that mean if it requires effort you exhale?
00:15:59
Speaker
you get to choose where that pressure goes. So if you're going to go and push something, if we exhale and use our muscles to support that air coming up and out of this bigger hole here, this bigger weak spot, our glottis, our throat,
00:16:14
Speaker
then that pressure isn't going to want to go to find someplace else. We're directing it up and out of our torso. So what I say to people, and I think we understand this with exercise, if you're going to squat, you exhale as you stand and you squat. We understand that with exercise, but then when we get out of bed, we go, we get up. But what if you
00:16:36
Speaker
stand up, keep your ease together. If it requires effort, you exhale. Remember it's such an easy thing.
Are Kegel Exercises Right for You?
00:16:42
Speaker
I literally was with a client yesterday moving in and she sat down to test out her new bed and it was one of those. And now as I'm like doing it, you can feel the pressure going down. So breathe it out.
00:16:57
Speaker
All right, so my next question I am naturally sitting here doing key goals while you are talking like is that something that we should be doing or if you're Like do you need to really know and understand what's going on with your body more so than just doing key goals? Because I think as women we're all saying do your key goals Yeah, but does that really make sense or do you need to understand more about what's happening with your own body?
00:17:24
Speaker
I think this is the biggest misconception about pelvic floor PT is that everyone should be doing kegels, and if you can't go see a pelvic PT, just do some kegels and it'll fix it. I've even had providers say to patients that are coming to me with urinary leakage, whom their presentation does not warrant kegels. It is the, it's like the bane of their existence. They should not be doing kegels. And their provider's like, hey, just, you know, do some kegels, get that, the pelvic floor stronger, you know, right?
00:17:49
Speaker
No, not everyone should be doing kegels. People with pelvic pain should not be doing kegels.
00:17:55
Speaker
at that time. When we think of urinary leakage, I think this is the bigger place that we talk about kegeling. What is kegels? First of all, kegels are all of these muscles contracting and squeezing just as if we contracted our bicep and made a bicep curl. That is that squeezing, lifting, holding back gas or urine. For females, we sometimes cue this as lifting your genitalia or thinking about shrinking and pulling the penis back into the body for those of you that don't know how to contract them.
00:18:23
Speaker
So a key goal, when we think about urinary leakage, most of the time everyone assumes it happens because, well, your pelvic floor muscles must be too weak, it must not be able to kink off the urethra, therefore leakage happens. And that can be one cause.
00:18:37
Speaker
This is just my experience. This isn't saying what it is in life. My experience though has been most of my patients are coming to me with a pelvic floor that is too tight and not knowing how to relax and leaking urine because of that.
Impact of Stress on Pelvic Health
00:18:49
Speaker
So how does that happen? So the way I describe it to my patients is it's almost as though your pelvic floor muscles are so tight. They're so elevated. They sit like this all day long. That would be like my bicep sitting like this all day long in a nice bicep curl.
00:19:03
Speaker
And then I add a five pound weight by the end of the day. Well, if I'm contracting all day long and then you had a five pound weight to this, I'm going to go, I can't do it. I'm going to give out. I'm going to break that damn breaks for a moment to kind of take off some of that load and pressure. That's what we're seeing happen with the pelvic floor. It's elevated. It's squeezed. It's contracting all day long. And then you add more urine.
00:19:25
Speaker
you add a cough, you add a sneeze, you add a push, you add getting out of bed, or something that's physical and stressful, and it's like, I can't do this, and it gives out, and then it catches again. And so that's why you can have leakage with a tight pelvic floor. So for that person, we don't want a kegel. You don't want it stronger and tighter. You need to relax and loosen so it can work when it needs to. Exactly. You often find that it's tight if you're naturally tight, like in the rest of your body, or when would a tightness present with somebody
00:19:54
Speaker
Great question. I feel like you have a good history. I'm just very curious. Like our listeners are like intuition. Yeah, so personality does, I think, in some ways play a role in it. I haven't done much research to see if the data out there supports that.
00:20:11
Speaker
But I think from my personal experience and also clinical experience, what I'm seeing with patients is I think our personalities drive that. We know that there's a connection between the central nervous system and the pelvic floor muscles. So the same way that we clench our jaw and make our body smaller, shoulders high, our butt clench, our toes curl when we're anxious or in a room when we're trying to make ourselves small.
Consultation and Treatment Approach
00:20:31
Speaker
Our pelvic floor does that too. And some people are more prone to that. So people with endometriosis or chronic pain in general. Or trauma, sexual trauma, not feeling safe. 100%.
00:20:41
Speaker
Um, different personality types as well. If you're that high strong type a perfectionist type person that go, go, go tend to suspect maybe more pelvic tension, potentially more pelvic pain. Um, so a lot of the work that we do here to treat because you had alluded to, all right, so that person doesn't want to Kegel. We want to relax, lengthen, retrain.
00:21:00
Speaker
Well, how do we get those muscles to stop doing that? A lot of it is behavioral retraining, trying to tap into that central nervous system, trying to not allow it to rev up all the time, but rather teach it to come down and not hold on to that autonomic fight or flight state throughout the day. And we do some release work, we do some breath work and whatnot.
00:21:19
Speaker
But that's really the driver of it. I usually say to people, you know, anything that we're doing here on the table in this room, this is what, you know, gets you out of PT. I can do all of this and help get you out of here. But what prevents you from coming back is that central nervous system regulation.
00:21:36
Speaker
is the lifestyle modifications, the behavioral strategies that I'm teaching, and I'm a big proponent of education. We'll spend sessions just talking, educating, and want you to know the why so that if something happens down the line, you know exactly what to do to fix it. You don't have to call me right away.
00:21:52
Speaker
So that's a perfect segue into the next question. So there's obviously different ways to approach treatment, different treatment plans, everyone's individual with their needs. I do want to talk about like this is internal work as well. So some of it's conversation and breathing exercises, but some of this is
00:22:10
Speaker
getting inside to our anatomy, assessing and addressing on a tissue cellular level. Can you explain a little bit how that process works from getting to know from a consultation to actually doing the work? So every provider is a little different. Myself and I believe a couple of the other providers here, we believe that it's important for there to be an established relationship and trust and communication between both of us.
00:22:34
Speaker
There are certain cases where, you know, we might not say, you know, this person is appropriate for an internal or they might say, I don't ever want to do an internal and that's okay. We can still treat many of these things without an internal. I would say, again, no specific stats here. My thought is maybe around 95% of people I can help without doing any internal work.
00:22:54
Speaker
And we can have that conversation and say, let's see how far we get just from an external approach. And if we're running into a wall at some point, let's revisit this conversation and see, you know, is there more of a relationship established? Are you more aware of why we might be doing this, more open to this, and then we can venture into it?
00:23:11
Speaker
So for us here, we believe that it's important to just first day, get a big picture. I want to know bowel, bladder, sexual function, your life, your goals, what's going on, how can I support you, what are your needs? So it's just a conversation. Occasionally I have a patient coming in like, I want to know what the heck's going on. That was me. I'm dying in, I've had four kids, I have no. Let's go, do an internal. Show me what's going on, let's address it. If that empowers you, that empowers you. I'm here to make you feel supported. So if you want to jump to that piece,
00:23:39
Speaker
We can totally but it's interesting you say that so the last year or so I've really done a separate deep personal dive with nervous system healing work and energetic birth work and breath work and so when I did the PT pelvic floor physical therapy a few years ago I didn't have wonderful success and I think it's
00:23:57
Speaker
It is because I didn't integrate the holistic approach to all of it. So just sitting here talking today, it's like, that resonates with me. It's all of it. So maybe it is time to dive back in the saddle, so to say. But it's
Choosing the Right Pelvic PT
00:24:11
Speaker
all of it. And I can see why 95% of people can have improvement just through the external piece that makes sense. But so to your point, Erin, Miranda, how does somebody find the right provider for them based on what they need? Because obviously,
00:24:26
Speaker
Aaron, you could have a totally different experience with someone that really understands the holistic approach and what needs to happen. I would definitely say it's a process. It's not necessarily as easy as just saying, oh, I'm going to go to a PT and treat an ankle, right? When we're in school, when you go through PT school, you have to do the whole body.
00:24:46
Speaker
But the pelvic floor tends to be, if at all spoken about, maybe a lecture, maybe a week-long course if you're someplace that's really generous here. But most of the time it's like, well, if you pee to Kegels and if there's pain, relax, stress management. And so it's not as easy to just say, well, I'm going to go to any pelvic PT.
00:25:04
Speaker
And we also want to consider what their practice models are like. How much time are they spending with you? Is it a private treatment room? Here it's a private treatment room. It's one-on-one. You get 45 minutes with your therapist. There's been places that I have heard of where you're going into a
00:25:22
Speaker
big large area and you're discussing these really intimate details of your life in an open setting and that's just not appropriate. Even in this one-on-one setting, kind of closed door, I even find on that first session in those first couple of weeks patients are holding back because they don't know what's okay to share, they don't know what judgment might be cast upon them for sharing things.
00:25:42
Speaker
from my perspective, none, but they don't know that. Now, can you imagine doing that in a room full of people? No. So there's that. Also checking, what is their training? What is their scope of training? Did they just do a weekend course? Have they done continuing education?
00:25:57
Speaker
How often are they practicing this? Are they doing it full-time? And there's no judgment to be cast there, right? You could be doing this 10 hours a week because it's your passion, but something else serves you differently. But just to get a good understanding of how much exposure do they have? What is their training? Getting to see if maybe you can do a phone call with them, right?
00:26:17
Speaker
Not to go into your whole history here, right, that's what your evaluation is for, but to get a sense of the therapist's demeanor, their character, their intentions. I think most providers that truly, truly care about, you know,
Insurance and Healthcare Alignment
00:26:32
Speaker
your best interests would be okay with a five, 10 minute phone call just to say, hey, I'm Miranda, it's nice to meet you. What are some of your initial concerns or hesitancies coming into the room? How can I make you most comfortable walking in? So I'm sure for a lot of our listeners, there's been a lot of aha moments like, okay, maybe this is for me.
00:26:52
Speaker
Can they just come to you and say, here's what's going on, there's a consultation, and then you can bill through their insurance? Or do they have to go to their primary care physician, talk about their potential issues for them to then refer to you? Sure.
00:27:08
Speaker
So insurance is a little nuanced here, so try not to be too generalized. Most insurance companies will cover pelvic floor PT the same. Medicare. Do you know about Medicare specifically? Medicare will cover pelvic floor PT. It's the supplementals that can sometimes be challenging. But for the most part, insurance companies will cover pelvic PT the same way they would if it was your foot or ankle.
00:27:34
Speaker
So you encourage people, anyone listening, call your insurance provider. If you are over 62, open enrollment comes in October. So if pelvic floor issues plague you, you can make changes in October to your plan to make sure your supplemental insurance does cover pelvic floor PT. So for the most part, it depends on what your insurance requirements might be. You might need a prescription, you might need a referral from your doctors in Massachusetts. We're a direct access state. So some insurance companies you can
00:28:03
Speaker
just kind of blow past needing a referral or prescription, you can just come right in. Others, not so much. So definitely call and ask and see what your benefits are. Here, our front admin staff is very nice. They will check that on your behalf as well.
00:28:19
Speaker
and communicate that to you, but to be well informed, I would say to do that yourself. But for the most part, it should be covered very similarly to your typical PT session. So whatever your benefits are, if you get 30 visits per calendar year to use on PT, that's what you get. That means if you need to see me for 10 of those to square away whatever's going on public floor wise,
00:28:40
Speaker
you get 20 left to deal with your foot or ankle if that comes up down the line. This is great. Lauren and I talk often with our clients at different educational events and one-on-one with consultations. It's so important that you feel aligned with the professionals that you choose to work with and I think more than ever if the professional is someone that needs to go on an intimate deep dive with you to address
Encouraging Pelvic Health Awareness
00:29:04
Speaker
the stigmatized issues of pelvic floor health. This is the time more than ever to make sure that you feel in alignment with that professional. So is there any like parting words for anyone out there who may be and maybe has been suffering for a long time with some issues with, whether it's urinary incontinence or prolapse scenarios, like what's your advice? What are your parting words on this topic? I think the biggest thing I would say is, you know,
00:29:35
Speaker
At least have the conversation. At least make the phone call. At least get in the room to have a conversation. There's no requirements that you continue with that therapist. There's no requirements that you continue with that plan. Just take that first step and see what it's about. Ask some questions. Don't be afraid to kind of share what's going on. I can understand both from personal experience the nature of this. It's hard to be vulnerable.
00:30:00
Speaker
This is the person to share those things with. There is no shock and awe. You're not going to surprise us. We've heard it all, but that doesn't make it any less uncomfortable for the people that are coming to see us. It's more than just bladder dysfunction. It's more than just postpartum care, right?
00:30:17
Speaker
We can talk about infertility, we can talk about bowel challenges, we can talk about pain with intercourse. None of those things should just be accepted as your body. Don't let the social stigmas kind of get you down. We're in this new wave of where we're saying common but not normal, right? These are things that happen. We can manage them, we can address them, and we can help you feel better in your life, better in what you're doing, and get back to all the things that you enjoy.
00:30:39
Speaker
So one last question for you. As professionals that really help older adults look at all things aging, right, and come up with a solution and a plan for them, and for a lot of our listeners that are also adult children that have hearts of gold that really want to help their parents or their loved ones, what are some things that we can say or understand in a kind way that would lead us down to the path
Effects of Diuretics on Pelvic Health
00:31:07
Speaker
of maybe pelvic floor PT is a path that you need to go down without making the individual feel as though we're being overly intimate or overly intrusive in sort of their personal life. Yeah. You could start by just kind of asking or kind of just observing their behaviors. If your person that you're working with is always running to the bathroom, you can kind of key into those routines, right?
00:31:36
Speaker
You know, you can ask and say, you know, maybe make it about yourself. Yes, read by example. Sometimes I have to go to the bathroom more often, not, you know, I notice that it's you, too. You know, have you ever thought about, like, Pelly PT? I've heard about this thing and kind of segue it that way. You know, asking the simple question of being a little bit more directive, are you someone that's always looking for the bathroom? Are you planning your day around your bowels or your bladder?
00:32:00
Speaker
which I have to, I have to interject. What about somebody that's taking diuretics that literally I hear all the time from our clients. It's so hard because I have to plan for my day, understanding that that's obviously what the medication is doing for them. But are there things that they could be doing to tighten those muscles or anything else to help them through that process? Or is that more the diuretic?
00:32:25
Speaker
I think it's a little bit more of a loaded question than that. There's so much change that we can create as far as urgency and frequency when it comes to taking a diuretic. But if there's things like leakage that's coming along with that, certainly we can manage that. Where we're addressing that urgency and frequency could be a side effect of the diuretic. So we'd have to do a little bit more teasing out there. But I certainly see people that are coming in, they're not leaking, they're just going to the bathroom too often, too frequently.
00:32:51
Speaker
You know the difference between a good long pee versus a tinkle and you're like, all right, that wasn't worth the noise, right? And teasing out those bladder retraining behavioral strategies, those urge suppression strategies.
Changing Views on Aging
00:33:02
Speaker
I think another great thing you can ask is if there was a solution
00:33:07
Speaker
To your frequency or if there was a solution to your leakage, would you want to explore it? Yeah, would you learn more? That's a great way to phrase it. I love I'm gonna steal that Yeah, like would you want to learn more and if the answer is no, I would say why not? Yeah, if the answer is yes Well, we have some resources for you that just isn't I think when we normalize it and we just say oh
00:33:30
Speaker
feel felt found, right? Many people I work with have experienced the same thing and feel maybe embarrassed or ashamed. But what they have found when they start doing the work and learn more is that they can live, you know, their best lives. And I think the more we come together to have these conversations, we really start to change the way we view and support aging in America and
00:33:52
Speaker
cut down this ageism that we, when you were speaking earlier, it is just accepted that as a body ages, you will become forgetful. That's a lie. That is not normal, healthy aging. You will have frequency, urgency, and pain with intercourse or urination. No, that is not necessarily the truth. So by shedding light on these topics, we're able to say, no, that's just ageism and not true. So let's find resources to
00:34:19
Speaker
to feel and thrive later in life at any point in life. Absolutely.
00:34:24
Speaker
Miranda, we thank you so much. Thank you for having me. This is awesome. I loved getting to geek out about this and answer all the questions and kind of debunk a couple things. So thank you for your opportunity. I'm sure it's not the last time we'll be talking with you. Be sure to like and follow us. We hope to have some upcoming in-person events and online events with Miranda to continue to shed light on this. And happy peeing to all of you. Thank you. Take care. Thank you.
00:34:52
Speaker
Thank you for joining us today. To continue the conversation, follow us on social media at Dovetail Companies or visit us online at dovetailcompanies.com. And remember, change can be difficult. Aging doesn't have to be.