Julie Johnson, DPT, BCB-PMD
Pelvic Floor Health Specialist
Hertel & Brown Physical Therapy’s Pelvic Floor Health program offers women, men and children unique treatment options for urinary and bowel incontinence, pelvic pain, and/or pelvic floor dysfunction. Julie Johnson, DPT, BCB-PMD, is board certified in pelvic muscle dysfunction biofeedback by the Biofeedback Certification International Alliance (BCIA). She uses high-tech, state-of-the-art equipment to provide women with a safe, nonsurgical option to treat pelvic floor disorders. Call us at 814.456.6000 today to schedule an appointment.
What is pelvic floor dysfunction?
Millions of Americans suffer from pelvic floor dysfunction, yet for most, it is an embarrassing, underreported, and untreated issue. Pelvic floor dysfunction refers to a wide range of problems that occur when the muscles in the pelvis do not work properly in coordination with one another. The pelvic floor is a group of muscles that attach to the front, back, and sides of the pelvic bone and sacrum (the large bone just above the tailbone). Similar to a sling or hammock, these muscles support the organs in the pelvis, including the bladder, uterus, and rectum. Problems with the pelvic floor muscles can lead to many problems including urinary incontinence, overactive bladder, bowel dysfunction, and chronic pelvic pain, just to name a few. This is a difficult and complex area to treat because we cannot see these muscles contract or relax like we can with a bicep muscle. Physical therapy can help resolve these problems using various treatments including biofeedback.
What is biofeedback?
Biofeedback involves the use of sensors that are attached to a patient allowing them to see their pelvic floor muscle activity on a computer screen. The focus of treatment is to retrain pelvic muscles which in turn improves or even corrects pelvic floor dysfunction in more than 75% of patients. Biofeedback has no side effects and is a safe and effective alternative to surgery and medication. In coordination with your physician, we use a multidisciplinary approach to treat many different types of pelvic floor dysfunction. Physical therapy typically consists of biofeedback, pelvic floor re-education, dietary and behavioral modification, and bladder retraining.
Who may benefit from pelvic floor dysfunction treatment?
Women may benefit from physical therapy if they are suffering from pelvic floor dysfunction related to bladder or bowel incontinence, overactive bladder, constipation, irritable bowel syndrome, chronic pelvic pain, pain associated with intercourse, radiation, postpartum or postmenopausal symptoms, pelvic organ prolapse, urogynecological or colorectal surgery, or various other symptoms related to the pelvic floor. Incontinence can be a problem at any age, but is especially prevalent in older individuals, with at least 1 in 10 people age 65 or older complaining of this problem. Although associated with age, age itself does not cause incontinence. Treating pelvic floor dysfunction may be very helpful in reducing and/or eliminating symptoms and pain for many women. Most women show improvement in a short period of time after starting physical therapy.
Men can also benefit from this type of treatment. Men and women possess similar anatomy in terms of their pelvic floor muscles and the way they function. There are a variety of reasons why men may experience symptoms related to pelvic floor dysfunction, including falls, surgeries, prostate conditions and many others.
Although millions of children suffer from pelvic floor dysfunction, most don’t get the help they need. Typically, children are toilet trained by age 4 with only very occasional accidents. After age 4 childhood bowel and bladder dysfunction is considered a major medical problem and greatly affects the quality of life for the whole family.
What are the different types and symptoms of incontinence?
There are several different types of incontinence, the most common being stress incontinence and urge incontinence (overactive bladder). Stress incontinence is an accidental leakage of urine brought on by physical activities such as sneezing, laughing, coughing, or exercise. Urge incontinence is a frequent and sudden uncontrollable urgency to urinate often associated with frequent nighttime voiding. Bladder incontinence can be caused by certain foods, drinks, and medications. Often times incontinence is also associated with childbirth, pregnancy, and aging. Approximately 1 out of 10 individuals with urinary incontinence have bowel incontinence. Bowel incontinence is the loss of normal control of the bowels causing leakage of stool unexpectedly. Causes for bowel incontinence include diarrhea, constipation, muscle or nerve damage, and pelvic support problems.
What is chronic pelvic pain?
Chronic pelvic pain is pain located below the bellybutton and between the hip area that lasts more than six months. The cause of chronic pelvic pain is often hard to find. Many women may never receive a specific diagnosis that explains their pain, but that doesn’t mean their pain isn’t real and treatable. If no cause can be found, treatment for chronic pelvic pain focuses on managing the pain. Some symptoms that may be experienced with pelvic pain are constant, severe and steady pain, pain that comes and goes, dull aching, pressure or heaviness within the pelvis, cramping or sharp pains, pain during intercourse, pain during a bowel movement, pain with sitting, and pain that intensifies while standing and relieves with sitting. Other related causes of chronic pelvic pain are falls on the tailbone, surgical-related trauma, surgical scars, vaginal deliveries/episiotomy scars or perineal tears, chronic constipation and straining to have a bowel movement, and/or physical/sexual/emotional abuse. In general, women experiencing pelvic pain that disrupts their daily life or if symptoms appear to be getting worse should see their physician. Women who experience pelvic pain often have dysfunctional pelvic floor muscles. Typically these muscles are tight and can cause pain and dysfunction of the bladder, bowel, and genitals (sexual organs). We utilize biofeedback and other techniques to help increase mobility/facilitate movement, reduce or eliminate soft tissue inflammation, induce relaxation, improve tissue repair, and improve overall function.
Can physical therapy help?
Yes, pelvic floor dysfunction is a very treatable condition. Women should see their physician if they have any symptoms of pelvic floor dysfunction because treatment of this debilitating condition can provide improved quality of life. Proper treatment can help women return to a more natural lifestyle. Many women believe they have to live with their dysfunction. This is not true. There are many treatment options that physical therapy provides. It is our goal to help women overcome their pelvic floor problem and give them a greater feeling of complete well-being that will last a lifetime.
What is diastasis recti?
Diastasis recti is a gap between your abdominal muscles. It is caused by a separation of the muscles on the right and left sides of your abdomen that run from your rib cage to your pelvis. Diastasis recti can be a result of pregnancy, obesity or abdominal surgery. A study from the University of Oslo in 2016 found that 32.6% of women have diastasis recti 12 months postpartum.
- Physical therapy is a very effective way to manage symptoms and improve functional capacity when diastasis rectus abdominis (DRA) is diagnosed. Treatment includes:Postural training – Improving postural control is one of the most important components of treatment for women who are dealing with DRA. We will help you learn how to stabilize your core, without overuse of the rectus abdominus muscle. This will involve training your other core muscles, such as your transverse abdominus (a deep abdominal muscle), and your pelvic floor muscles. We will show you how to perform daily activities, such as lifting and carrying your baby, while using proper posture.
- Stretching – When certain muscles become weak and overstretched, other muscles may become overactive and tight. We will help you learn which of your muscles needs to be gently stretched to improve your strength and posture.
- Bracing – Sometimes bracing of the low back and abdominal region can provide external support for women with DRA in the early phases of rehabilitation. It can also help teach you the proper position for your midsection, as it provides support and decreases any pain you may be feeling.
- Education – There are factors that you may not even know about relating to your pain or movement challenges that we can help resolve. We can help you understand the movements or activities that are best to avoid, as you recover from DRA. (For example, women suffering from DRA should not perform traditional sit-ups or crunches.) We will be able to teach you safe and effective ways to regain your full function.