Healthy YOU Podcast, Episode 27: Strengthening the Foundation: Pelvic Floor Health for Men and Women

Frankye Myers: From Riverside health system. This is the Healthy you podcast, where we talk about a range of health-related topics focused on improving your physical and mental health. We chat with our providers, team members, patients, and caregivers to learn more about how to maintain a healthy lifestyle and improve overall physical and mental health. So let's dive in to learn more about becoming a healthier you.

All right, I am really excited to have in the healthy you studio today with me, Katie Tahamtan, physical therapist with Riverside physical therapy in Williamsburg. This episode, we're going to be talking about strengthening the foundation pelvic floor health for men and women. So welcome, Katie.

 Katie Tahamtan: Thank you.

 Frankye Myers: All right. Often, pelvic floor health is overlooked, yet is a common health issue that affects both men and women. Roughly 40% of women and 16% of men will experience pelvic floor dysfunction in their lifetime. Okay. That's something that I didn't even know as it relates to men. So that was very informative.

Katie Tahamtan: Absolutely.

Frankye Myers: So we're going to dive into it a little bit. So, Katie, first, I'd like to start out by asking what made you pursue a career in medicine and more specifically as a physical therapist?

 Katie Tahamtan: Yeah, that's a good question. I think if you'd asked me when I was a kid or a teenager, I probably would have told you something like a scientist, hawaiian tropic model. Writer, actress. I wanted to do it all, right? And then, of course, you start going through life, and you kind of think that things are going to go how you think they're going to go. You make all your plans, right? And then life happens.

 Frankye Myers: Oh, yeah.

 Katie Tahamtan: And sometimes you find yourself in situations that you didn't necessarily sign up for, and that's usually not always the easiest thing. And so I just happened to be at a season in my life when it was time to make decisions for college and things like that. That one of the main role models in my life was actually my primary care doctor. He caught the fact that I had Hashimoto's thyroiditis when I was eight years old, and that was pretty life changing for me.

 Frankye Myers: Absolutely.

 Katie Tahamtan: And so as I kind of went through to that period and found myself trying to narrow down what I wanted to do, he encouraged me to look at all aspects of medicine so that if I wanted something that allowed more work life balance, I could do that with the way that medicine was changing. And so I found myself in small town Kentucky, and I had just recently heard about physical therapy. I had never needed it myself, and I walked into a clinic in high heels and a dress, and the director laughed at me and very kindly told me to go get changed. And then over the next couple of months, I got to see how in these situations where people hadn't necessarily signed up for it, they weren't feeling great about it, there was basically this option to either try to do what you could do to make things better or give up that people were able to, with the right guidance, actually find ways of help heal themselves.

 Frankye Myers: Right. Get back to normal living. Exactly.

 Katie Tahamtan: That is. And you got to be a part of that empowerment, that hope to be a part of a medical team that was all working for the same goal. And you got to see on a weekly basis how people get there. And to me, that just was like a very powerful and life changing thing. So that's what did it for me.

 Frankye Myers: Absolutely. And we put so much focus on other things, but not as much focus on our body alignment.

 Katie Tahamtan: Yes, right. Exactly.

 Frankye Myers: This is a piece of equipment, and it has to stay in alignment. Exactly. Like you go get your tune up or your line.

 Katie Tahamtan: Exactly.

 Frankye Myers: Great. So,  let's start out at the beginning. So, talk a little bit about what is pelvic floor dysfunction.

 Katie Tahamtan: Yeah. So pelvic floor dysfunction can be a lot of things. I think the easiest way of breaking it down is just talking about what is the pelvic floor? It's a collection of muscles, ligaments, different structures that come together, and there's a few primary functions, bladder function, bowel function, sexual function, but then also a place of force transfer and support for the body. So, just like you said, it's a foundation where everything that we're doing with our environment as we're moving around is kind of moving through that area.

 Frankye Myers: Okay.

 Katie Tahamtan: So dysfunction is just a disruption to that.

Frankye Myers: Okay. And I'm going to back up a little bit. So is there a special niche in physical therapy if you want to be in this particular domain or aspect of physical therapy?

 Katie Tahamtan: As of now, that's mostly how it's treated. I think there's more entry level programs that are at least giving a brief overview of what this looks like. But if you do want to specialize in it, there's certainly coursework that you can go down, and there's a variety of that, which is what all of us on our team have done.

 Frankye Myers: So it's like post training after you finish your initial education as a physical therapist.

 Katie Tahamtan: Exactly.

 Frankye Myers: Become licensed. Okay, very good. Yeah. So you started to address this, and I think we often associate, like, pelvic floor dysfunction as something women struggle with more often than men. I myself, as a healthcare professional really never thought about the contrast to that male part. Can you talk to us a little bit about that myth and the prevalence of pelvic floor dysfunction in both men and women? And what does the male presentation look like compared to the woman? Because absolutely, anatomically, we have different organs. Yes,

 Katie Tahamtan: Right, exactly. So I think going back to what the pelvic floor does and the fact that everyone has a bowel bladder for the most part, and sexual function, and we have a pelvis for the most part, there's a lot that can go. That needs maintenance, I should say. I'm not going to say it goes wrong, but that just needs maintenance every time. And I think traditionally, just different cultural beliefs, different systems, it's hard to talk about that area because there's a lot of shame associated with it. And I think for women generalizing, I think some of us are more comfortable talking about that and that childbirth is a very obvious example of when things can happen there. But I think that people are getting more comfortable advocating for their needs over time. There's more openness to discuss this. And these issues can pop up with men, too. There can be issues with urinary incontinence, fecal incontinence, which is just unintentionally losing urine and feces.

 Frankye Myers: Right.

 Katie Tahamtan: There can be pelvic pain with our cyclists, with different injuries, erectile dysfunction, and different things like that. And so I think as health literacy improves in general and there's just more equity in care, people are aware that it's an option. And with our aging population, one of the great things is that overall, we're living longer. But then that also means that there's more maintenance needed.

 Frankye Myers: Absolutely.

 Katie Tahamtan: And I think for men, it's just good to know that your prostate will get bigger over time. And sometimes there can be issues associated with that. That if that tissue needs to be addressed, there can be anatomical changes, that it's just harder to control your bladder. And then with aging, with muscle mass kind of declining in general, it's just harder in general to maintain our strength. That's where we can come in and help with things, with quality of life.

 Frankye Myers: Okay. Does it often get misdiagnosed in men just because of other things going on with the prostate and age?

 Katie Tahamtan: Yeah, it can. And certainly sometimes I think that one of the things out there that floats around is that it's always like a muscle issue. Sometimes it's not just muscles that we're addressing. When you come into physical therapy, sometimes it's education, with working around structural changes it's kind of taking a step back to look at where we fit in the care team and just making sure we're really going over those basics because we have the time to do it. Of what does diet look like? What do our lifestyle habits look like, what stressors are present in our life? It's just this really good intersection of let's back up and look at the bigger picture.

 Frankye Myers: Okay. In women, is it more common because of childbirth?

 Katie Tahamtan: So childbirth is certainly a risk factor for pelvic floor dysfunction because of all.

 Frankye Myers: Of the things that occur during childbirth.

 Katie Tahamtan: Exactly. Delivery.

 Frankye Myers: Not all women deliver, but exactly. From carrying a child.

 Katie Tahamtan: Absolutely.

 Frankye Myers: Is that one of the reasons? Can you talk a little bit more about that?

 Katie Tahamtan: Absolutely. So I think just understanding everything that goes into how a body accommodates pregnancy, you have a big release of hormones that relax all the ligaments in our body. You're carrying, hopefully for most of us, like, an increased amount of weight throughout that pregnancy. That is a load for those muscles to carry. And then they're actually behaving differently because your ligaments are oriented a little bit differently. And then you get to the actual birth experience, which can be vaginal, caesarean.

 Frankye Myers: Right.

 Katie Tahamtan: And there's things that can happen that, again, will just kind of challenge that tissue in different ways. And so for some people, they walk out of it pretty easily, and there's no dysfunction for other people, pretty immediately, you're starting to see changes in how they're living their life. We're here to help with all parts of it.

 Frankye Myers: And then I know also sometimes you'll see your hips become more broad after childbirth. So that's major shifting in what your bone structure absolutely looks like.

 Katie Tahamtan: That's your feet change. I was saying there's things like this is, like, nerdy, but even how much your ankles bend and all that changes permanently after having kids, there's some really big changes. And so I think it's one of those things that if you had a sports related injury or something else where you knew that there was a big change in how your body was actually put together, you'd probably go get it worked on or at least looked at. And I think it's really the same with these milestones, that if you are delivering or you're pregnant, it's worth getting looked at.

 Frankye Myers: Okay, so how do you confirm diagnosis of pelvic dysfunction? Dysfunction?

 Katie Tahamtan: Yeah. So really we're looking at function because as physical therapists, we can really pick someone apart as far as strength, coordination, all that. We can find an issue if we look hard enough. But it really comes down to, is there an impairment with their quality of life? Is going to the bathroom becoming disruptive to what they need to do for the day? Are they able to have intercourse? Are they able to work the job that they need to work those kind of things?

 Frankye Myers: Okay. I know I had a pelvic tilt issue one time. Yeah. And had to do some physical therapy. What is the difference? Or are they fairly similar?

 Katie Tahamtan: It's similar. And I think this is a good opportunity to bring up that pelvic care is still physical therapy, and the pelvis is just one part of the chain. So when people come in, a lot of times they're surprised that we are looking all the way up and down into what's going on with their feet all the way up. And so it's not just looking at those muscles of the pelvic floor. It's looking at, overall how that force is transferred through the pelvis.

 Frankye Myers: Yes. So I did some exercise and some maintenance, but as I look back, and it was a lot of stress going on in my life at that time, and so my body was presenting with that issue with my pelvis.

 Katie Tahamtan: Yes. And I think it's particularly important that we honor that and try not to pathologize things that are going on.

 Frankye Myers: Okay, so this is where you come in. Right. You've been diagnosed. What does that treatment plan look like for someone who's reaching out or wants to explore and talk to you a little bit more about that?

 Katie Tahamtan: Absolutely. So it really comes down to what the patients want and need. Yeah, it's really like, whatever the patient needs. I'm not here to try to sell someone on something they don't need. If they're not going to do it, there's no sense in taking their time up, trying to go after it. So I think the evaluation always starts with, what do you want out of this? What's important to you? And then from there, I offer tools. I look at everything head to toe and say, okay, these are the things that I'm seeing realistically. How much time do you have? What resources do you have? What other things are you juggling in your life right now? And does it basically add to your quality of life to come in here once a week or however often? And that's how we come up with the plan together. But it's very patient driven.

 Frankye Myers: Yes. And I know there was a lot of exercises that I had to do at home, and I had to be kind of committed to doing not kind of I had to be committed to doing, to doing those things, and then it resolved over time.

 Katie Tahamtan: That's awesome. Yes. So it sounds like you did your exercise.

 Frankye Myers: I did my exercises. I had to make a plan to do my exercises.

Sometimes there's some confusion around chiropractor and physical therapist. Yeah. Can you talk a little bit about the difference in the two? Because I know they deal with some adjusting and some aligning as well.

 Katie Tahamtan: There's definitely a lot of overlap. So we can do joint manipulation as physical therapists. It kind of varies state to state on what's part of our practice act. A lot of the tools are the same, the underlying theory can be different, and the way that it's actually implemented is different. Traditionally, our founding came from the fact that we got our referrals from medical doctors. Okay.

 Frankye Myers: Yeah, very good. One of the things that we continue to want to reiterate on the podcast is the importance of appropriate nutrition and exercise for overall health. In this case, healthy diet and an active lifestyle make a difference in PFD symptoms.

 Katie Tahamtan: Yes, absolutely. And to build on your analogy of kind of like car maintenance or vehicle maintenance, you can't expect to put maple syrup into a car and get something that functions well out of it. You have to have regular movement tune ups, and you have to put in the right type of fuel to make it operate effectively. And I always say it doesn't have to be perfect, but whatever your baseline is, if we can make it just a little bit better, that's going to have huge benefits down the road.

 Frankye Myers: Absolutely. And I know the information you provided today will help, because the key is early identification and ruling out other things as well. So as we wrap up the show, I want to make sure we talk about living with pelvic floor dysfunction and not giving up. And I also think it's important that we encourage and know that there is support for this disorder.

 Katie Tahamtan: Absolutely.

 Frankye Myers: Do you have any recommendations for those living with pelvic floor dysfunction?

 Katie Tahamtan: Yeah, absolutely. I think this is my favorite thing to talk about, is because I think the thing that makes suffering so much harder is that a lot of us do it in isolation or with shame. And this is a safe place to dive into that, where you have people that want to answer those questions and sit with you in whatever's going on and get with you to the other side. So if you're at all curious, this is here for you. It's not a commitment, it's just an option.

 Frankye Myers: And I think this is the purpose of this podcast, and I'm really so appreciative of all of the healthcare professionals, they give up their time to be able to talk and share, and so we can reach and extend that information likewise to the communities that we serve. So, is there anything else you want to share before we wrap up today?

 Katie Tahamtan: Not particularly. Thank you for the opportunity.

 Frankye Myers: Okay. And then, last thing, we didn't talk about med therapy.

 Katie Tahamtan: Yeah.

 Frankye Myers: So I didn't want to end without talking a little bit about that. I know that's probably very individualized, and you can't really get into the detail of what meds would be for one person to the next.

 Katie Tahamtan: Definitely. So I have to be careful with this. I think it's my job as a therapist to have an idea of what certain medications do or what they can react with, so that I have a better idea of why a patient could be presenting the way that they are.

And I think it's really important to stress that we are a part of the care continuum. We're not anti medication, we're not anti surgery or anything like that. We are just a supplement to kind of reiterate, if patients have questions that these are the reasons why your doctor may be prescribing this, or these are questions you might ask.

And so there are some things that we can loosely just say, like anecdotally, I've heard this or whatnot for over the counter things. I do feel like at Riverside, there's a good enough relationship that we can just talk about. Hey, I've noticed that people like this patient do well on this medication, that you can always just ask questions as long as we're doing what's right for the patient, which is making sure the people best equipped to make those decisions are the ones making it.

 Frankye Myers: That's a great point. Great point. So when we talk about things to avoid, and we say avoid certain activities that increase tension or pain, what are some examples of activities that may cause that?

 Katie Tahamtan: So I think the biggest thing is, movement is generally the best thing that you can do for a body to keep things functioning well, to keep things strong. So I never want people to be afraid of movement. That being said, I think that looking at why you're doing things and the how of how you're doing the things makes a big difference. And that's where I think we are a great source for education for people in general. I'd say if you're having more than a little bit of soreness that's lasting more than a day or two after doing an activity and it keeps happening, it's time to kind of re examine that and see, can we make this better?

 Frankye Myers: Right? See someone.

 Katie Tahamtan: Exactly.

 Frankye Myers: Yes, absolutely. And then, of course, always drink plenty of water.

 Katie Tahamtan: Yes.

 Frankye Myers: And I know I have a plan for that every day, and that's a work in progress, but that is so important.

 Katie Tahamtan: You're doing great. You're doing the work. I see it.

 Frankye Myers: And then follow a meal plan that's healthy. So you want to talk just briefly about those things?

 Katie Tahamtan: Yeah, absolutely. So different bodies need different things. I think just loose. Recommendation is if you can find your body weight in kilograms, just convert that to ounces. That's roughly how much fluid you should be consuming daily between food and drink. So if you're not someone who loves water, you don't have to become like a water fanatic. Just add some fruits and vegetables, try to put things in your body that aren't going to irritate your bladder, like alcohol, caffeine, artificial sweeteners, carbonation, things like that.

 Frankye Myers: Really acidic things as well, right?

 Katie Tahamtan: Yeah, absolutely. And that's perfect. And that's with nutrition. I would say when you're in the grocery store, if you could just avoid things that are boxed or bagged, in general, just stick to the fresh stuff as much as possible. There are some pelvic floor diagnoses that there will be a little bit of nuance to that, but that's an exception. So in general, fresh, like whole foods are going to be better. And that will make a huge difference in how your pelvic floor functions.

 Frankye Myers: Good. Very good. So, Katie, if one of our viewers wanted to reach out to you, can you tell them how they can contact you?

 Katie Tahamtan: Absolutely. So my email is [email protected]. And they can always just give our clinics a call and either me or someone on our team can help them out.

 Frankye Myers: All right, Katie, thank you so much for taking time out of your busy schedule to join me today on the podcast and sharing all of that invaluable information. And to all of you listeners, thank you for listening. If there's a health topic you're interested in learning more about, please email us at [email protected].

 Katie Tahamtan: Thank you, Frankye.

 Frankye Myers: Thank you.