While I am sure many of you are by now familiar with the cutting edge Pilates based physical therapy that Dr. Amanda Heritage provides our patients at Nelson Chiropractic, something you may not know is that she is also this area's leading specialist in pelvic floor physical therapy!  We caught up with her to explain a little about her specialty.
Q:       Dr. Amanda, how did you become a physical therapist specializing in pelvic floor rehabilitation?
A:       Well, my fascination with the pelvic floor started with my love of the core, how the body functions and my foundation in Pilates. The pelvic floor is an integral part of your core stabilization system, which is always working throughout the day and is overlooked as the cause of many issues.
About 70% of women worry about stress urinary incontinence and 30% modify their activities throughout the day based on their bladder habits. Its takes up to 1 year for a woman to ask her doctors about her concerns and only 25% of women seek help! These numbers are staggering to me. As a woman, I am out to change this perspective! Not only for all the women in my life, but the men as well!
Q:       What is pelvic floor physical therapy?
A:       Pelvic floor physical therapy is specialized physical therapy aimed to treat pelvic dysfunction and promote optimal pelvic health for both women and men. Pelvic floor dysfunction refers to a wide range of diagnoses pertaining to the pelvic muscles and the pelvis, including urinary/bowel incontinence, pelvic pain, pelvic organ prolapse, and postpartum pelvic girdle dysfunction to name a few. At least 1 out of every 5 Americans will suffer from a pelvic floor dysfunction at some time during their life.
Q:        Why would I need pelvic floor physical therapy?
A:       There are a multitude of reasons one may need pelvic floor physical therapy. Pelvic dysfunction occurs when pelvic muscles become weak, tight, or when there is an imbalance within the surrounding joints including, lower back, hips, and coccyx. Specialized pelvic floor physical therapists help men and women across the lifespan continuum, including young athletes, childbearing aged women, peri-menopausal women and men with pelvic health complications.
Q:        What is the pelvic floor?
A:        The pelvic floor is a group of muscles that attach to the pelvis. Their function is to support your organs, allow for elimination, stabilize your pelvis and hips, and promote sexual function. Remember pelvic floor muscles are just like any other muscles in the body. They contract, relax and function like a bicep muscle would. Because our daily functions, including urination, elimination and sexual function are controlled by these muscles, it is important to remember your pelvic floor can be influenced by your organs, abdominal muscles and skeletal system and vice versa. For example, urinary incontinence is not a "weak bladder" it's a weakness and imbalance of pelvic muscles, poor toileting habits and altered fluid intake.
Q:        Do men have pelvic floors too?
A:        Of course! Even though men do not carry children or go through menopause, men have a pelvic floor which functions similarly to a woman's pelvic floor. Men with pelvic floor dysfunctions will report a slower urine stream, difficulty or pain with erection, tailbone/lower back pain, constipation, or bowel or bladder incontinence. It is not uncommon for a man to have an increase in these symptoms after having any kind of prostate surgery or hernia repairs.
Q:        What can I expect during PT treatments?
A:        Your first evaluation includes a lot of talking and discussion of your concerns. You will have the opportunity to share your past medical history, including pregnancies, abdominal or back surgeries, and gynecological/urinary history. Your exam may include general movement like bending forward and backward, observing how you move your body and some other special tests. I will educate you specifically about the pelvic floor musculature, function and normal bladder/bowel habits and how the pelvic floor is truly the floor of the core.
During the follow up visit, an assessment of your pelvic muscles internally may be valuable, however you have the option to choose or refuse any part of the process with which you don't feel comfortable. Remember this is a team effort and active participation is necessary to bring you to your healthiest self.
All evaluations and treatments are private and one-on-one.
Q:       Do I need a prescription?
A:       Yes! Just like traditional physical therapy, you will need a prescription in order for the treatments to be covered under your insurance. However, the prescription must say "Pelvic Floor PT." Your primary care provider, gynecologist or orthopedic doctor may write this type of prescription. Many pelvic conditions have multiple causes and may require a specialist to rule out more serious conditions. Therefore it is necessary to have your medical provider to help coordinate care.
Q:        My gynecologist told me to do "Kegels". I do them every day, but I am not sure if they help to improve my leakage? What is going on?
A:        Kegels, or a pelvic floor contraction, are important to strengthen and maintain good function of the pelvic floor including improving incontinence. However, research shows 40% of women perform Kegels incorrectly and can actually promote more leakage! Many women who have leakage with coughing, laughing, sneezing have an altered pattern of contracting their pelvic floor muscles. Pelvic floor PT can teach you to re-train your pelvic muscles to properly coordinate a contraction to eliminate or minimize most types of urinary incontinence.
If you have any questions, concerns or feel you may need a pelvic floor physical therapy assessment, do not hesitate to call the office. Let's change the perspective of our pelvic floor and truly make it the key to the core!
In Health,
Dr. Amanda Heritage, PT, DPT

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