By Gwen Dawkins
Previously, in Part 1, I shared with you that after my hysterectomy, I needed help with pelvic rehabilitation and was referred to Pelvic Physical Therapist Denise Alberto. What I didn’t mention, is that my hysterectomy was actually my third major pelvic surgery and depending on how you calculate, I had had a total of four to six surgeries to deal with the effects of endometriosis, fibroids, excessive bleeding and more. The first time I met Denise Alberto was years before becoming her patient. We were both at a Christmas party not long after one of my previous surgeries. She took my hand, looked me in the eye and said, “You need to come see me. I can help you feel better.” I was having a good time at the party despite my underlying condition and I was shocked that she could tell that I didn’t feel quite right. Also, I had never heard of pelvic physical therapy –– and when she began telling me about finding trigger points, encouraging tissue release, and breaking up scar tissue, I got anxious. Trying to be funny, I said, “You’re going to put your hand where now?” But I was actually nervous at the thought. Fast-forward to my post-hysterectomy issues, three different health care professionals referred me to Denise in a matter of a week. My shyness evaporated and true to her word, Denise made me feel better.
Here, we continue the conversation:
You’re literally in people’s business, how do you make them feel comfortable?
I take my time getting to know my patients with their clothes on first, (always a good idea). I have them sit and we discuss their problem, going over all of the details. I spend a lot of time on education and training, showing anatomical pictures and 3-D structures to help describe the things I might be doing. I massage and manipulate organs and tissues both from inside and outside the body, but I don’t do anything without first getting the patient’s permission. Setting expectations up-front helps put people at ease.
What surprises your patients most about their condition or treatment?
They are usually surprised by how comfortable they feel once they get there and find out that their problem isn’t uncommon. My goal is to simplify the problem and create goals so that they can achieve rehabilitative health. For example, I educate people about how the pelvis is shaped and the three layers of the pelvic floor muscle, tissue and fascia that work together to form a hammock to lift and hold up pelvic organs. I also talk about how different body parts, such as hip rotators, are intimately involved with the pelvic area and function. Most people are not very aware of the intricacies of the pelvis.
What’s the typical timeframe for treatment?
Usually about six, one-hour weekly visits. This includes manual therapy and a home exercise program specific to the patient’s problem. It’s not a cookie-cutter treatment. In addition to relief, I’m also providing a good anatomical education and specificity to their problem.
How does lifestyle affect pelvic health?
Some people overtrain their bodies while others are more sedentary. Both scenarios can adversely affect pelvic floor health. One of the most common problems is weight gain, which increases downward pressure on the abdominal wall and pelvic floor –– which can cause both prolapse symptoms and incontinence. How you physically train also matters. Are you doing proper breathing to support the pelvic floor? Are you sexually active or not? The more babies you have had, the more potential there is for ligament laxity, which causes internal organs to start to drop. Some people improperly strain and bear down during exertion on the toilet. All of these things affect pelvic health.
Do you suggest any over-the-counter products?
There are a plethora of products on the market, but are you really going to use them? I do straight-up functional exercises. However, I do suggest specific electrical stimulators, vibrators and dilators for the patients who need them. I always suggest seeing a doctor or physical therapist for proper evaluation and muscle training. However, several over-the-counter products are safe, widely respected and don’t require a referral. A few include:
- Elvie Trainer is a very popular Kegel trainer, offering biofeedback and a phone app to teach you how to contract and relax muscles properly and track progress.
- The Vfit uses biofeedback, LED light therapy for muscle stimulation, blood flow and vaginal toning. It is larger in diameter so has to be the right fit if you will. It comes with a lot of bells and whistles, and because of that it’s pricey.
- Julva products are made with all-natural ingredients, including DHEA, Emu oil, shea butter and coconut oil, which is considered the gold standard for renewing and improving vulva skin elasticity and reducing thinning.
Are Kegel exercises worth it?
Kegel exercises are necessary for all! Here’s a firsthand article by a woman who personally tried and reviewed three well-known Kegel trainers.
Anything else you’d like to add?
It’s my hope and belief that pelvic checkups will become mainstream, like getting a massage. Everyone can benefit from getting checked for weaknesses and tightness. Pelvic physical therapy can help improve function in the area through stretching, exercise, improving mobility and much more.
What’s the best part of your job?
Recently, I had a 15-year-old boy in treatment. One day, he got off the table he said with genuine sincerity, “Denise, thank you for doing this for me.” Knowing that I can help people in such an important and personal way is extremely gratifying.
Where can people find qualified pelvic physical therapists?
The American Physical Therapy Association, allows people to search for certified pelvic health professionals by zip code.
Contact Denise Alberto Physical Therapy, Inc. for more information about her services, areas of expertise and helpful resources.