Your Pelvic Floor, Your Health: What Every Woman Should Know

A few weeks ago we covered pelvic floor dysfunction in men. So for this episode, we’re focusing on pelvic floor dysfunction in women. Our expert is physical therapist Ashlee Crawford, DPT, Texas Tech Physicians Physical Therapy Specialty Clinic in Amarillo. She answers our questions about causes, symptoms —treatments and how to go about seeking treatment — and how we can encourage people to talk about this more. 

Transcript

Melissa Whitfield  00:00
Hello and welcome back to Texas Tech Health Check from Texas Tech University Health Sciences Center. I'm your host, Melissa Whitfield. We want you to get healthy and stay healthy with help from evidence based advice from our physicians, health care providers and researchers. A few weeks ago, we covered pelvic floor dysfunction in men, and as I was preparing for that interview, I was surprised that pelvic floor dysfunction affects men too. So for this episode, we're focusing on pelvic floor dysfunction in women. Our expert is Dr Ashlee Crawford, Texas Tech Physicians physical therapist in the Physical Therapy Specialty Clinic in Amarillo. She answers our questions about causes, symptoms, treatments and how to go about seeking treatment and how we can encourage people to talk about this more.

Melissa Whitfield  01:09
Dr. Crawford, welcome to our podcast.

Ashlee Crawford, DPT  01:11
Hi. Thank you so much for having me.

Melissa Whitfield  01:14
Can you tell us a little bit about yourself, your expertise and what you do at the Health Science Center?

Ashlee Crawford, DPT  01:20
Yes. So I am a physical therapist. I work at the Texas Tech Health Sciences Center in Amarillo, and I'm a clinical instructor. And so basically what that means is I am in the clinic with patients most of my day, but I also get to spend a smaller piece of my day with students, and so I'm usually in the lab with them, working on those hands-on skills that they get to use as they move into the clinic. I am a Texas Tech alum through and through. I went to Texas Tech University in Lubbock for my undergrad, and then I went to Texas Tech Health Sciences Center here in Amarillo for my doctorate in physical therapy. I love Texas Tech, and I'm really excited to be here to talk about pelvic floor, because that's one of the areas that I've been interested in since school, and I've specialized in pelvic floor and orthopedic physical therapy since I graduated.

Melissa Whitfield  02:20
Well, we're very happy to have you on, especially because a few weeks ago we had somebody locally talk to us about pelvic floor dysfunction, but that was in men, because I assumed it was just a problem that women had. So we're happy to have you on to discuss the female side. Can you tell us what is pelvic floor dysfunction, and what are the main functions of the pelvic floor?

Ashlee Crawford, DPT  02:46
Yes, so I actually listened to that podcast. So I was so excited to be able to come and just continue the discussion. There was a lot of good information, and I do, I primarily specialize in women's health, and so I see more on that side of it, but with pelvic floor, I always feel like most people think of it, and they're correct, as a group of muscles, so it's usually when we think about that there's three layers of muscle that's at the bottom of the pelvis. So it's kind of like the bottom of a bowl or a hammock. And with those muscles, there's also ligaments, and there's muscle attachments to joints and bones and nerves, and so there's a lot going on in that area. And so when we think about function of the pelvic floor, we can also think about support, and I think that's the big one that most people think about, is we have all those pelvic organs and those pelvic floor muscles really help us day in day out, with supporting and they help us with stabilizing our pelvis. They also help us with a big thing like continence and so preventing any unwanted leakage, urinary and bowel. It plays a large role in that. It also helps with sexual function, and it helps us throughout pregnancy and childbirth, which most people think about when they think pelvic floor. But it also helps with small things, day in and day out, like our posture, just sitting up how we are now talking, our pelvic floor is working and helping us stay in this upright posture. And it helps with core strength. It helps with pressure management, so when you think about if you have allergies and a cough or sneezing, it helps manage those pressures throughout the day, or if we have jobs where we're lifting things or lifting kiddos up and down, it helps manage that pressure. And so it does a lot for us throughout the day. And so dysfunction comes in, and a lot of those places as well. And so when we think about all the structures that are there, there are unique circumstances in the pelvic floor, but it's very similar to other parts of our body. And so we have difficulty with coordination and the pelvic floor, and I feel like that's a big one for people, because when we think about coordination. It's basically just using our muscles. And so in other areas, we get a visual of that. So when we're moving our bicep or we're doing a bicep curl, you can look down and you can see your bicep activate, and you can watch your elbow bend. And so dysfunction can happen, though, if you're not able to activate that. And with the pelvic floor, we don't get that good visual, and it's hard to pinpoint. What does a pelvic floor contraction look like? What does it mean to rest my pelvic floor when I can't see it? And so that's something that we run into a lot dysfunction wise is just coordinating those muscles and knowing how to use them correctly. And also we see weakness. And so just like anywhere else in the body, we can have weakness of the pelvic floor muscles, and we can also have tension or tightness. So just like our upper traps can get tight, our pelvic floor can too.

Melissa Whitfield  05:50
Whatcauses pelvic floor dysfunction and how common is it? Is it just a certain age range?

Ashlee Crawford, DPT  05:58
No, it can affect kind of how y'all talked about in the last podcast, it can affect men and women. It can affect all ages. And so we can have children with pelvic floor dysfunction. And then we as we age, we can also have pelvic floor dysfunction. There's lots of different numbers out there, but one I consistently see is that one in three women will have a pelvic floor dysfunction at some point in their lifetime. And so that's a lot of people, and it can range from all ages. And so we see that there's lots of different causes because of that. So it's not just aging. Of course, that can play a role in it, and it's not just pregnancy. So a lot of times we think about, you know, pregnancy can be hard or childbirth, and those can definitely lead to it. But we also have other factors, like chronic conditions. If we have chronic constipation or comorbidities like connective tissue disorders, if we have a chronic cough or increase in pressure that can lead to pelvic floor dysfunction. We can also think about surgeries. Any sort of abdominal surgery or pelvic surgery can also attribute to that, and any sort of trauma, increase in stress, I think a lot of us can relate with that one. So like, if we experience a lot of chronic stress, that can contribute as well any major breathing changes. So like, disorders like COPD and things like that, can affect your pelvic floor as well. And so I think one of the other big things I see is a lot of times people think vaginal birth, and that definitely attributes. But C sections as well can have more likelihood of having pelvic floor dysfunction too. So they can both lead to that.

Melissa Whitfield  07:40
Wow, that that was a lot. It is a lot of things that a lot of us go through. So when a patient is ready to see do they need to get a doctor's referral to get treatment, or can they just go see you directly?

Ashlee Crawford, DPT  07:54
In Texas, it can be a little bit of both. So in Texas, we have something called direct access, where patients can go to a physical therapist directly. Right now, that gives you about 10 consecutive business days to be seen. Hopefully in September 1 we're hoping to see that change to about 20 days. But typically in pelvic floor, I see that it's really beneficial to have that referral, because a lot of times when you go to whatever health care professional is appropriate for your symptoms, then they can clear out different medical diagnoses and look at those things. And a lot of time, a team approach is great. So it may not just be pelvic floor dysfunction. There may be something else going on. And so I think having that interprofessional teamwork usually provides the best results, but you can definitely have that initial evaluation if needed without

Melissa Whitfield  08:51
What are some of the most common symptoms, and is it always incontinence? Does it affect sexual health?

Ashlee Crawford, DPT  08:58
Yes. So there are lots of different symptoms when we think about pelvic floor. And so one of the biggest ones is definitely incontinence. And there can be different kinds of incontinence. So you can have urinary incontinence, like stress, and that occurs with activity. So like when you cough or you sneeze, or people think about jumping on a trampoline, that's always the one I hear. And that definitely happens. And then you can also have urge incontinence, so just you have urgency and you can't make it to the bathroom and you have some leakage. You can also have bowel incontinence. And then you can also have difficulty with sexual dysfunction. You can have pain, just pelvic pain in general, that occurs throughout the day with sitting or with certain activities, you can also have straining and so you can have difficulty having a bowel movement. Constipation, you can have straining or difficulty initiating or completely emptying with voiding as well. So it can also have more ortho conditions as well can be affected by the pelvic floor. And so when we think about coccyx pain or hip pain or low back pain, I also see patients with those symptoms that is coming from the pelvic floor as well.

Melissa Whitfield  10:12
So then, how do you treat patients with pelvic floor dysfunction?

Ashlee Crawford, DPT  10:16
It's very patient specific. And what we're seeing: what are their symptoms, what's going on, and what is that dysfunction, kinda we talked about at the beginning. Is it coordination that they're struggling with? Is it strength? Is it muscle tension or tightness? And so I think the biggest thing is, I always start with telling people it looks how you want it to look. It's definitely something that I think is important to normalize, but I also think we can respect it and know that it's sometimes hard to come in. And I want people to feel as comfortable as they can, and I'm gonna recommend things of how I feel is best to approach it, but at the end of the day, I want patients to know that they can say, "Let's what if we do something else?" and that's always okay too. It's whatever the patient feels comfortable with. But doing a thorough exam is important, and so we do a comprehensive history with the patient. We look at doing a pelvic floor muscle assessment, if appropriate. We look at screening their back, their thoracic or their mid back, with their rib cage, and how they're breathing, we look at the hip, and so we look at all of those things, and then we work on whatever deficits that we find. So if that's breathing, then we work on breathing exercises and connecting that with the pelvic floor. And we work on coordination of the pelvic floor. So when to contract, when to rest. What does that feel like? What does that look like for that patient? We work on strengthening. So just like any other physical therapy for any other joint, we would work on strengthening those muscles if needed, and then we can work on decreasing tightness or tension in those muscles too. And I think a lot of it is education. So just educating patients on different lifestyle changes or things that they can put into their daily life to help.

Melissa Whitfield  12:09
So then, since you mentioned education, is there a way to prevent pelvic floor dysfunction and can symptoms come back after treatment?

Ashlee Crawford, DPT  12:18
I definitely think that the biggest way to prevent it's just being aware of symptoms and also living a healthy lifestyle where you're active. I think when we're active and moving, and we do that in the right way, that that helps protect our pelvic floor as well as the rest of our body. I think that knowing to ask questions early. So if there's something going on not to wait, I think that's a big thing. I usually tell patients, is, go ahead and ask your doctor ask those questions, and that way you're addressing things early and not waiting too long.

Melissa Whitfield  12:54
How can we encourage people to talk about this more?

Ashlee Crawford, DPT  12:56
I think we've come a long way. I've been doing this for about 10 years, and when I first started, I just remember people coming in and be like, I don't know why I'm here, which is understandable. And I think now I see it more. I see it in social media. I have my friends or people I know ask me about it, because they know that's what I do, so they bring it up and they asked me. So I think we've done a great job, but I think just continuing to talk about it and giving people the knowledge that it's not just you. Like we talked about earlier, one in three women, that's a big number, and so knowing that it's not just you who's going through that, and it's okay to ask your doctor questions. It's okay to look for that information, and that way you can get the help or the assistance that you may need.

Melissa Whitfield  13:43
Is there anything else that you'd like to add?

Ashlee Crawford, DPT  13:46
I just really enjoy getting the chance to talk about it and increase that awareness. I feel like knowledge is so powerful. And when people know what could happen or those symptoms or what to look out for, then people are able to catch things early. And so the more we know, and the more we talk about it, and the more we normalize it, that it's it happens, and like we talked about earlier, there's so many different symptoms that can occur, and there's definitely ways we can treat it. And so just having that knowledge and information.

Melissa Whitfield  14:19
Well, thank you so much for taking the time to come on our podcast and give us the female or woman's side of pelvic floor dysfunction, which we all think we might know, but we don't. So thank you,

Ashlee Crawford, DPT  14:33
Yeah, of course.

Melissa Whitfield  14:36
Thanks for listening to Texas Tech Health Check. Make sure to subscribe or follow wherever you listen to podcasts. This information is not intended to be a substitute for professional medical advice. Always seek immediate medical advice from your physician or your health care provider for questions regarding your health or medical condition. This is our final episode for this season. We will come back in a few weeks with more episodes and experts on topics to keep you healthy. Texas Tech Health Check is brought to you by Texas Tech University Health Sciences Center and produced by T.R. Castillo, Suzanna Cisneros, Mark Hendricks, Kay Williams, Krystal Meazell and me, Melissa Whitfield.