Physical therapists branch out on their own for pelvic health

TO PEE OR NOT TO PEE: Pelvic physical therapist Amanda Fugate uses anatomical models to teach her patients about their bodies. Photo courtesy of Fugate

Most people take their nether regions for granted as long as everything is working OK. But when there is pain or leakage or (shudder) painful leakage, it’s time to find help. Enter: physical therapists who specialize in pelvic health.

Pelvic health is not as common a topic as other areas of the body. It may be most associated with Kegel exercises, which are done to strengthen the pelvic floor muscles. “Sometimes I get jokes in phone calls, like, ‘What am I going to do, come and do Kegels with you for an hour?” says Amanda Fugate, who started her company Pelvic Forward three years ago. However, she tells patients she works with them “pretty much from your shoulders to your knees.”

The pelvis extends from the top of the pelvic bones, which is attached to the base of the spine, down to the genitals. It includes the reproductive organs, bladder, intestines, uterus, rectum and prostate, and a group of muscles called the pelvic floor. Therefore, pelvic health includes anything in that location: pregnancy, urinary and bowel issues.

Fugate and other physical therapists in Asheville are making it their life’s work to destigmatize this important part of the body — and they’re doing it by opening their own physical therapy practices to provide more specialized treatment for patients.

Go your own way

The decision to go into private practice was “intimidating,” says Fugate. But the transition was eased by Asheville’s resources for local entrepreneurs. Before branching out on her own, she took a Foundations Business Planning course at Mountain BizWorks to learn about marketing and the financial essentials of starting her own business.

Several physical therapists describe feeling less burned out working for themselves. Kerry Tobin of Kerry Tobin Physical Therapy recalls when she saw as many as 15-20 patients a day under the health insurance model.

And Fugate says she sometimes felt as though she was wasting time — her own and patients’ because health insurance plans would only cover a service that she considered best after a patient paid for four sessions with a different service.

The physical therapists Xpress spoke with also point to the positive difference they’re making in patients’ lives. In private practice, Fugate is able to schedule a two-hour initial evaluation with new patients, compared with a much briefer intake under the health care model. This allows her to get a more comprehensive view of someone’s health issues. And Tobin now sees four or five clients a day for 60-90 minutes each.

Physical therapist Tanya Tracy also finds her life’s passion outside a traditional physical therapy model. She trained as a Pilates instructor and worked at a combination Pilates and physical therapy studio. She integrated Pilates into her physical therapy practice and has found it to be helpful to clients for incorporating posture and core strengthening. “It allows me to [address] more than just one spot, so it works pretty well for more complex patients,” she says.

After taking time off to have children, Tracy opened Flow Physical Therapy and Pilates in Asheville in August. She treats women experiencing postpartum issues, like abdominal muscle weakness; she also realized that some mothers would want to do Pilates classes after birth and bring their children. “I realized I could put the babies in positions that would also be developmentally appropriate for them, like getting in tummy time,” she says. Having taught test-run postpartum Mommy & Me Pilates classes to her friends, she has now started the class at her studio. She also hopes to start a class for perinatal Pilates.

Holding it

Fugate sees many clients experiencing urinary incontinence, or loss of bladder control, and finds urination to be a topic people generally know little about. A 2011 study in the Journal of Urology, which examined combined data from the National Health and Nutrition Examination Surveys in 2001 and 2008, found that the prevalence of urinary incontinence was 51.1% in women and 13.9% in men.

A 2021 study in the American Journal of Obstetrics and Gynecology, which examined data from 2005 and 2017 in the National Health and Nutrition Examination Survey, looked more closely at how urinary incontinence affects women. It found that stress urinary incontinence (coughing, sneezing, etc.) and urgency urinary incontinence (not being able to “hold it”) are most common, and all subtypes of urinary incontinence were higher among women who smoke, experience obesity or other comorbidities or use postmenopausal hormone therapy.

Fugate believes commercials for urinary incontinence protection products, like pads and panty lines, make leakage seem normal at all ages. But she’s adamant that it isn’t. The only time that urinary leakage is normal is in the immediate postpartum period, she says.

Loss of bladder control is a top reason why older people move into eldercare facilities, Fugate continues. It’s problematic that society treats the issue as a foregone conclusion, because urinary leakage leads people to withdraw and restrict their activities.

“If you have something wrong with this part of the body, people stop doing things,” Fugate says. “They feel very alone.”

‘Never be suffering’

Tobin was drawn to working in pelvic health after experiencing painful sex during her 20s. Doctors advised her to drink a glass of wine or use more lubrication — neither of which addressed her issue. She was studying physical therapy at the time and learned that she could help heal her own pain with its techniques. She also appreciated how physical therapy focuses on movement and activity rather than prescribing medications.

Many of Tobin’s clients see her for pregnancy and postpartum issues, and worryingly, she sees a lot of pain. “You should never be suffering,” she says. “There might be some uncomfortable things in pregnancy, but pain is not normal.” Referencing back pain, hip pain, pubic bone pain, vaginal pain, she says, “there’s a lot that we can do to help.”

Tobin hopes to help pregnant people identify pain early on that may cause difficulties in later trimesters or during labor.

In the bigger picture, Tobin wants to help patients live fuller lives by addressing issues that “are at the core of who we are as human beings. If you can’t pee or poop or have sex, it effects everything.”

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