A pelvic floor physical therapist shares her story

To give you a brief introduction to what pelvic floor physical therapy entails, we interviewed Amy Friedman, PT, an experienced pelvic floor specialist and passionate women’s health advocate, about her experience, approach and advice. We asked her to provide a basic and broad overview of pelvic floor physical therapy in the hope it will encourage you to explore this option further.

Amy, can you share your story? Why did you decide to specialize in pelvic floor physical therapy?

I graduated from the University of Illinois–Chicago with a bachelor’s degree in physical therapy in 1996. At the time there were a handful of pelvic floor PTs working to let people know there were resources to go to for pelvic floor dysfunction. From the start, I knew I was going to go in that direction. After gaining some experience in orthopedics, exploring the biomechanics of the body, I began specializing in pelvic floor dysfunction in 2006. For this interview, I’ll focus primarily on women, but I also treat men and children dealing with pelvic floor dysfunction.

When I opened up the first pelvic floor program in my office, I was the only pelvic floor PT there. And though things were changing, a lot of women still didn’t want to talk about it. It’s very embarrassing, and people believe the myth that it’s just old women who leak. As women age, they think they’re just supposed to have this, right? But actually, it crosses all ages. So, I started calling gynecologists and ob‑gyns to remind their patients that pelvic floor dysfunction may be common among women, but it’s really not normal, and they shouldn’t have to live with it.

In my practice now with Bannockburn Chiropractic & Sports Injury Center near Chicago, I see everything from pregnancy and postpartum incontinence to prolapses and beyond. My hope is that pelvic floor physical therapy can help my urinary incontinence patients not only deal with and eliminate a lot of the reasons they need incontinence products, but also help them use protection in a way that’s healthy for their pelvic floor.

What is the basis of your approach to pelvic floor health?

One of the things I emphasize for my patients is that your pelvis is in the middle of your body. And every avenue, every road is going to go there—from your feet up to your head. Every time you take a step, you’re bearing weight, and there’s a lot of shock absorption in your pelvis.

Anytime you exercise or go for a walk, the position of your body can influence what’s happening in your pelvis. Your pelvic bones are attached to your spine. So anything that happens in your spine is going to influence all the nerves and all the muscles that come from your spine into your pelvis. And what about hormones? What about all the organs that are in there? My point is that, because it holds so much and it’s in the middle of the body, it can be impacted by everything you do. It’s profound and complex.

But probably the most important thing I tell my patients from the start is it’s also a very private place, and I’m honored that they are willing to talk about pelvic floor dysfunction with me, even if they’re scared or embarrassed.

Is there more awareness and more willingness to talk about incontinence now than when you started?

Thankfully, yes. With social media, it’s all out there. When you Google incontinence, the recommendation to see a pelvic floor PT is now front and center. That is huge.

So at some level, people are less embarrassed to talk about incontinence. Especially women. We’re all feeling more empowered to focus on self-care. Even the way we talk about menopause is changing. And the really good news is there is available treatment.

Do you need a prescription to start pelvic floor physical therapy?

Typically, you do not need a prescription for any kind of physical therapy, so you can pursue pelvic floor physical therapy on your own. With that said, if you came in and hadn’t seen your doctor in over a year, I would suggest you go see your ob-gyn, urogynecologist or urologist. Get a thorough exam and checkup. That’s pelvic health, too—making sure everything is medically okay.

How do you help your patients prepare emotionally and psychologically for pelvic floor physical therapy?

One of the things that helps me do that with my patients is I always talk to them ahead of time. I think it’s so comforting for a patient to hear directly from the therapist about what you can expect. I let them know there’s no need to be nervous. The first appointment is going to tell you everything. It’s going to educate you. And that usually calms people down a little bit.

What usually happens during a first appointment?

Your first appointment is the most important appointment. It’s not only going to help establish what we’re going to do; it’s going to establish rapport and trust. We talk almost the entire time. It’s about me learning your history. It’s about you understanding some basic anatomy and how the function of the pelvic floor ties in with your body. It’s a lot of education. You’re not just coming in here and immediately lying on the table undergoing an internal exam.

What happens during the assessment and internal exam?

The second visit includes a through and detailed pelvic floor assessment. Broadly speaking, I usually start with an external visual of the perineum. I look at the tissues. I look to see if there is any prolapse. Are there scars and what is their condition? I observe how you lift and relax your pelvic floor muscles. Do you have to use your body or other muscles to do it?

Then I do a comprehensive internal assessment of the three layers of the pelvic floor muscles by inserting a gloved finger in the vagina and rectum. In brief, I look to see if there are trigger points. Is there tenderness? Is there weakness or tightness? I do a couple of tests for prolapse and many other issues. Depending on what I find, we determine a treatment plan consisting of manual work, neuromuscular reeducation and therapeutic exercise aimed at helping you tone your pelvic floor muscles and coordinate pelvic floor contraction/relaxation with your breathing, with your abdominal muscles and with functional activities in your life. Sometimes treatment also includes coordination with other disciplines and healthcare providers.

Any final thoughts?

Pelvic floor physical therapy is not one size fits all. It must be personalized for every patient—whether man, woman or child. It’s important that you get evaluated to make sure you’re doing what’s best for you and your unique bladder issues.

I’m only making recommendations. It’s still your body. You don’t have to do everything that I suggest, but they’re all recommendations that are going to make your life better.