Physical therapy, Love it
I love what I do! If anyone had said to me when I graduated from physical therapy school in 2000 that I would be specializing in the pelvis, I would have called them crazy! I happened to stumble upon pelvic physical therapy in 2013 when I was having pelvic issues of my own. My urologist, knowing what I did for a living, asked me if I worked on the pelvis. I replied, “I didn’t know you could!”
I knew physical therapists (PT) could re-align the bones and work on the hip muscles as well as the back muscles that attached to the pelvis and maybe the abdominals. PT’s would never put our hands on an area covered by a bathing suit let along go inside….that is just crazy talk! Leave that “area” to women therapists to treat “women’s pelvic health” of incontinence. That is how it was taught back in school, and sadly, while having made progress, it is still mostly taught that way.
Changes over the years
Even my professional association, the APTA (American Physical Therapists Association), just this year, 2020, changed the name of the section for “Women’s Health” to be more inclusive and is now “Pelvic Health” so men can start to catch up. Wait, what? Men are behind in pelvic health? Absolutely! I offer this example: the industry is not going to make a product for a problem not being socially talked about. Depends first hit the market in 1984 with June Allyson as the spokesperson because it was older women who were talking about incontinence. Kimberly-Clark Corporation listened and brought their product to market and has been in the front of the marketing curve, making Depends one of the most known and trusted brands out there.
Depends for Men did not come to market until 2012. Think about it, 28 years later there was finally enough social conversation among men regarding incontinence that Kimberly-Clark said, “We hear you; we have a solution for you!” The right question, wrong answer. It is too easy to cover up a problem like incontinence but the risk we take by doing so is we never get to the root cause of the problem and are often ignoring other issues building in the background such as sexual dysfunction (yes, in men and women), pelvic pain, constipation, vulvodynia, coccydynia, testicular or scrotal numbness/pain.
My thoughts on Pelvic Therapy
I often describe pelvic physical therapy as “orthopedics in a cave.” I wish I could claim that line as my own, but I am borrowing it from one of my teachers. What we mean is the tools we use for the shoulder are the same tools we use for the pelvis; except we do our work internally as well as externally. This requires special training to have the knowledge of anatomy and the sensitivity of one finger (more than one finger and it is no longer therapy) inserted rectally or vaginally if the person has one.
PT’s literally letting their fingers do the walking, or in this case, seeing for us. Most physical therapists prefer not to go there because of various reasons, but fundamentally we are taught anywhere a bathing suit would be worn is off-limits.
Similarities Male and Female
Needing pelvic therapy is a result of having pelvic floor dysfunction. This means according to the Cleveland Clinic website you are unable to correctly relax your muscles in the pelvic floor to urinate and have a bowel movement. In women, this could mean you could have pain during sex and in men, it could mean erectile dysfunction.
The reality is men and women are pretty much the same! Both genders have the same bone structure, same nerves operating the same muscles. Now, I will give you that the anatomy looks a bit different based on the gender being expressed but nature is very efficient at being lazy! Why create a whole new template for one part of the body for just 50% of people? It doesn’t.
Ischiocavernosus is a pair of muscles starting at the sits bones then meet at the base of the penis to become the tissue that engorges with blood for an erection. Same thing for the clitoris. The bulbocavernosi form the root of the penis in men and the labia in women, however, sends fibers up around the top of the penis and the clitoris in order to help maintain that appendages erect state.
The bottom line is we as people get in our own way without even realizing it sometimes. My mission as a physical therapist is to not only bridge the pelvic gap with my colleagues but also for men, women, and trans. Guys, it is time to come out of the pelvic closet and get your needs met!