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That’s Not Normal

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LOUISVILLE Given the sheer volume of commercials and advertisements for incontinence products on TV and in the media, it’s easy to assume the problem is widespread. In fact, it is. An estimated 25 percent of women experience urinary leakage. However, take that a step further and it’s easy to assume that, because there are so many leakage pads and products, there must be nothing you can do but live with it. That assumption simply is not true.

Julie Lockwood, PT, women’s health physical therapist with Frazier Rehab Institute, part of KentuckyOne Health, says, “In our society we’ve kind of normalized peeing in your pants.” She says it’s common for women to think that urine leakage is a fact of life after childbirth or with aging. “We need to let people know that’s not normal, and there is help for it. It’s not normal to have pelvic pain or incontinence,” says Lockwood.

Lockwood has a doctorate in physical therapy from the University of Kentucky. Having specialized in outpatient orthopedic therapy for eight years, Lockwood sought out training in women’s health pelvic floor therapy four years ago when the University of Colorado Hospital, where she was working, added woman’s health to the range of therapy it provided. She has been providing women’s health physical therapy in addition to orthopedic therapy for over four years and has been with Frazier Rehab for a year and a half since moving back to Kentucky with her family.

Women’s health physical therapy is not just for urinary incontinence. It is also indicated for pelvic pain, fecal incontinence, interstitial cystitis, organ prolapse, hysterectomy, and women who are pre- or post-partum. “There’s really a lot of things we can treat, and not very many people are familiar with this aspect of physical therapy. I’d say 90 percent of my patients don’t even know that it’s an option. While it’s getting more popular, it’s still kind of a mystery,” says Lockwood. Even though patients in Kentucky can self-refer to physical therapy, the lack of knowledge of the specialty means most of Lockwood’s patients are generated by physician referrals from primary care physicians, OB/GYNs, and urogynecologists.

Evaluation and Treatment

In terms of evaluation and treatment, there are many similarities between a women’s health and orthopedic physical therapy visit. “The exam starts the same as an orthopedic exam. We’re looking at posture and the entire neuromuscular system,” explains Lockwood.

That’s followed by an external and internal exam of the pelvic floor area, which looks for abnormal muscle tone, muscle contraction and coordination, and pain.

Treatment plans are individualized based on the evaluation of the patient’s entire body. For example, pelvic pain treatments may include manual therapy, relaxation techniques, and biofeedback to decrease tone. For a patient with incontinence due to pelvic floor weakness, treatments may include training muscles to contract in a coordinated movement, strength training exercises, changing bowel habits, and addressing posture.

Because of the sensitive nature of the issues, patients are treated in a private room. Sessions usually last one hour, and the typical course of treatment involves an appointment once a week or every other week for eight to 12 weeks.

While these services are gaining in popularity, for Lockwood, the most important thing is to get women talking and raise awareness because living with pelvic pain or incontinence is not normal, and there is help.

That’s the problem with women’s health. They’re estimating that 25 percent of women are having some kind of leakage. I think this is happening to millions of people and nobody is talking about it.– Julie Lockwood, PT

Get Your Patients Talking

Some of the biggest obstacles to treatment of incontinence and pelvic pain are that patients, and providers, do not know these therapies exist and no one discusses them. Julie Lockwood, PT, with Frazier Rehab Institute, suggests asking patients the following questions to get them talking:

Do you have any leakage of urine, gas, or stool?
Do you feel like you have to go to the bathroom more often than normal?
Do you have pain when you go to the bathroom?
Do you have heaviness in your pelvis or pain during intercourse?