LOUISVILLE You probably won’t overhear women in a coffee shop talking about painful penetration, and you won’t see women posting comments on Facebook or Twitter about urinary incontinence or pelvic pain. These issues are often too hush-hush, too intimate, and too uncomfortable for women to discuss with even their closest friends, let alone their doctor.
But Susan Dunn, PT, of Dunn Physical Therapy, is on a mission – a mission not only to help women, and children, with pelvic floor issues but also to educate the public and health care providers that evidence-based treatments exist and can provide relief from sometimes embarrassing and emotionally charged pelvic problems.
Dunn established Dunn Physical Therapy 14 years ago. The practice now has two Louisville locations, employing six therapists, and seeing an average of 200 patients a week. Because pelvic floor therapy is outside what is taught in physical therapy school, the specialty is somewhat unique. Says Dunn, “We could easily have multiple locations, but you don’t want watered-down physical therapy. And it takes a while to get the training for this.”
An Organic Path to Pelvic Patients
Dunn’s path to specializing in the pelvic floor was more organic than deliberate. “I did not choose this, it chose me,” says Dunn. Her interest in PT school was in sports medicine for the female athlete, but the complexity of the female body necessitates services beyond traditional physical therapy for issues such as pregnancy, post-partum care, and the inability to use tampons. “Athletes were having to go to Indianapolis to see a physical therapist because I did not have training in this area,” she says.
Dunn subsequently did a fellowship program in pelvic dysfunction (now called a residency). “I did not think it would take over my career. I thought it would just be an adjunct specialty I had in treating athletes. When I finished my training, within one year my entire schedule was full once word got out,” she says. As her awareness grew, so did her passion.
Dunn estimates her patient population is 70 to 75 percent female pelvic floor patients, although they do treat general orthopedic physical therapy needs. Each of her therapists that treat the pelvis also specialize in another area of the body, such as pelvis and spine.
In addition to adult female patients, the practice also treats male pelvic problems and pediatric bowel and bladder dysfunction and pelvic pain. Dunn employs a pediatric specialist for these issues in children ages five to 18.
“There’s Therapy for That?”
“The most common complaint I get is patients will come in and say, ‘I had no idea there is physical therapy for the pelvic region,’” says Dunn.
Pelvic floor therapy is applicable for urinary and fecal incontinence, trauma from vaginal delivery, pelvic pain, dyspareunia or painful penetration (whether with intercourse or the use of tampons), and complications from oncology treatments.
While aging, giving birth, and menopause can cause pelvic dysfunction, Dunn insists none of these problems is a “normal” part of life that women just have to deal with. “Women don’t have to live with incontinence. It’s not a normal part of aging. That’s like saying getting obese is a normal part of aging,” she says.
Dyspareunia is a condition Dunn sees in young women. The first sign is often young girls who cannot insert tampons. Dunn educates patients that the problem is a tight muscle and not that something is wrong with them. “With pelvic floor, not everybody is born with the flexibility for tampons and intercourse,” she says. “The more we can make this a public conversation, the more women will know that the treatment is out there,” says Dunn.
Women who survive uterine or cervical cancer often suffer complications from chemotherapy and radiation. “The aftermath is they can’t have intercourse because the vaginal tissue is practically scarred closed. There’s physical therapy for that,” says Dunn.
Therapeutic treatments for pelvic floor issues are akin to any type of physical therapy. “Any research and data we have to treat skeletal muscles applies to the pelvic floor,” says Dunn.
The practice’s treatment approach involves looking at the body holistically, including the pelvic floor, bowel, and bladder. Therapists commonly recommend behavioral modifications and dietary changes. Other treatment strategies include identifying irritants to the bladder, looking at the patient osteopathically for joint alignment, and of course, examining the soft tissue and rehabbing the muscle for strength, flexibility, and endurance.
Independently Owned, Insanely Life-Changing
The practice is owned solely by Dunn and is independent of the local health systems. “Everything is one-on-one with patients,” Dunn stresses. “The reason I stay independent is I don’t want to lose that.”
However the nature of Dunn’s services does require a team approach between physical therapist, referring physician, and consulting specialists. “I always say that treating the pelvic area is like a three-legged stool, and you take one leg away and stool is going to fall over. The three legs of that stool are the MD, the PT, and the third leg can either be a nutritionist or a psychologist, normally a psychologist,” says Dunn. The psychologist is critical to coping with the emotion tied to this area of the body.
With an already full schedule, Dunn’s future wish list includes Southern Indiana and Louisville South End locations. However, the challenge is finding qualified clinicians. To that end, the practice is a teaching facility, and Dunn guest lectures at the PT program at Bellarmine University in the hopes of inspiring PT students to pursue the specialty.
Dunn’s path to pelvic floor dysfunction has not only changed her life but is reaping positive results among her patients. This therapy can be “insanely life-changing,” she says, allowing patients to participate fully in life.