Fostering a Better Pelvic Health Community: featuring Dr. Stephanie A. Prendergast MPT

Recently, our founder, Lauren, talked with Dr. Stephanie A. Prendergast MPT, the esteemed co-founder of the Pelvic Health and Rehabilitation Center (PHRC) in San Francisco, CA and author of Pelvic Pain Explained.

In their chat, Dr. Stephanie shared her story of becoming a Pelvic Health PT after discovering the profound impact of these conditions on patients' lives. She also highlights the importance of pelvic health education, the knowledge gap in medical training, and the need for increased awareness and resources for both patients and healthcare providers.

Catch the entire chat on YouTube, or check out 5 of our highlights below!

 

1. Why Pelvic Health Awareness Matters, Even Before Issues Arise

Lauren: 

How would you explain the importance of pelvic health to someone that's never heard about it before?

Dr. Stephanie: 

That's a great question. I think a lot of people don't think about their pelvis until something goes wrong. Most of the time, we don't have to think about our bowel and bladder function. It just works as we need it to. But when things start to change, that's when people realize we also have muscles in the pelvis, just like everywhere else in the body. So I start with the basics by explaining that we do have muscles that control bowel and bladder function, our pelvic comfort, our sexual comfort.

But when those muscles become dysfunctional, a whole host of symptoms can arise, and so for some people it could be a pelvic pain issue, such as pain with intercourse or irritated bladder symptoms for some people after having a baby, they're absolutely shocked that no one informed them. You know, at the 6 weeks “You're fine,” but nobody feels fine. There can be things like pelvic organ prolapse which people really have no idea about, as we were saying, until it starts to happen.

And then there can be other disorders, such as stress incontinence, constipation, and the whole range. And so these muscles actually carry a fair amount of responsibility, and they also happen to be innervated by what's called the pudendal nerve, which is very different from every other peripheral nerve in the body, and the reason is because some of our pelvic functions are autonomic. We don't think about them.

For example, as urine starts to collect in the bladder, our pelvic floor muscles start to reflexively tighten. We don't think about that happening. It just does, and that keeps us from leaking urine. Now, when that mechanism starts to be interrupted via pelvic floor dysfunction or obstetric changes or age-related changes, now symptoms start to arise and people may leak, or they may not be able to empty.

All kinds of things can start to happen that we, as physical therapists, can help the patients identify what their impairments are and then develop a treatment plan that consists of short-term and long-term goals to help them get back to their public health.

Lauren: 

It's great to hear that. And it's something that I experienced myself when I was early postpartum. I thankfully had a package of appointments set up with the pelvic floor physical therapist. So I had resources, but I was surprised when I was diagnosed with prolapse. 

And it was one of those things, too, where it's like, I was feeling things. I was Googling things. It was like, “What is going on with me?” And I felt very educated and empowered and all of those things through pregnancy and postpartum. So I was like, “Golly! If people like myself are blindsided by this, you know there's still so much work to do.” 

Like you said, it's the things that your body just does, and you don't think about it. What I try to explain to people who haven't experienced prolapse before is the mental toll it takes on you. You feel all these things that you never felt before. You never thought about that area of your body before when you're walking, running, doing any of those things. And yeah, it's such a dynamic experience going through that. 

So I think, for people who are new to it, there's a big learning curve on what the pelvic floor is, how all of these things work together, and then what kind of tools and resources do I have if things start to go wrong?

 

2. Addressing the Gaps in Medical Training & Patient Awareness

Lauren: 

What are some of the common misconceptions that you still face or you feel like are still pervasive that we're kind of up against on the education front for public health?

Dr. Stephanie: 

There's a now well-understood and documented research knowledge gap about pelvic floor disorders. There is missing education in medical schools for gynecologists and neurologists about identifying pelvic floor dysfunction, whether it's low-tone or high-tone. And I mean, that is still the case now.

So I teach for a few societies that help train physicians on how to do pelvic floor exams, which has been a really interesting experience because gynecologists are coming to these courses, and they're saying, “I've been practicing for 20 years. No one ever taught me how to do this,” and I can teach them that in under 60 seconds. 

And so it’s important that both a urologist and a gynecologist can do a transanal or transvaginal exam very quickly and palpate the obturator internus, the levator ani. And I see if there's strength or pain in any of these areas; strength, weakness, pain, lack of control. That can help them educate people that they can benefit from physical therapy. 

And I think changing the language. I mean, just helping them learn how to do these exams has been so helpful and really hearing the confessions. It's not their fault they were not taught this. It's not said that this should be the standard of care. 

So I understand how we got there, but it still makes patients who maybe went to 10 to 15 doctors incredibly upset about their process, and a lot of people by the time they arrive here have so much medical trauma from everything that happened along the way that we kind of have to undo it. So I think we're trying to foster a better community instead of “Oh, my gosh! I was misdiagnosed, and they did all these terrible things.”

And then really try to help with social media. If it's not in medical schools yet.

It's been interesting to teach for a medical society, and then a patient advocacy group which is called “Tight lipped” which they are helping to bring people like us into OB GYN Residency programs and teach them on a Saturday or on a Friday afternoon on their own time. We can do this in two hours. So that's also been wonderful. And I think that people want the information. It's just not given to them in standard curricula.

Lauren: 

Yeah, I think it's so cool to hear about those initiatives, because I think that it's exactly right. People want to do better. They want to be able to provide the service, help their people feel better. But if you aren't taught it, and you don't know that you're not taught it, how do you know what you don’t know? It's that whole thing.

So that's really exciting to hear. Because I think it just makes such a ripple effect, too. It's like, once one person knows about it, then they're telling their community, and it just keeps that wave going, which is exciting for everyone involved.

Dr. Stephanie: 

Can I ask you a question? When you had a baby and were going through PT yourself, how many mom friends did you have that you probably shared your experience with that probably didn't know? I mean, that's another way. Word is getting out.

Lauren: 

That's exactly right. I would say, most people in my circle did not know what pelvic organ prolapse was. They didn't really know what my symptoms were, and they had varying levels of what their imagination was of it. And of course it varies, you know, from person to person. 

It was interesting because, as I talked to more people outside my circle–actually, in the garment design process: the pattern makers, different people like that–it was those people who I was talking to that were like, “Oh, my aunt has that,” or “My grandma has that,” or “I think that my mom has that.” Either they were talking about it actively with people, or they were thinking, based on the things I was sharing, “Oh, I think so-and-so had that,” or they wished they had talked with family members before they passed to get a better understanding of whether that was something they were dealing with.

I'm very open to talking about it. I'm always happy to share my story, tell people what the garments are about, that kind of thing. And it has been interesting in doing that, hearing from people, if they've experienced it or not.

It's also interesting, because when I talk to more men about it a lot of times, I feel like they are more like, “Who does this like apply to?” And I'm like, “Well, first of all, everyone has a pelvic floor.” So that's an interesting dynamic as well, because I've come across men a lot more in business competitions or mentors or things like that where I'm explaining the product or pitching it. And there's definitely that education component of, “Yeah, what's the pelvic floor?” Everyone has one. And just kind of how these conditions can impact people over time.

Dr. Stephanie: 

And they have problems, too: post-ejaculatory pain, erectile dysfunction, perineal pain, post-prostatectomy incontinence. I mean, they don't realize either, but they're not escaping this.

Lauren: 

Yeah, they're not immune. 

 

3. Pay Attention to Your Body and Seek Help Early

Lauren: 

What are some tips or habits that you would recommend to folks? Of course, you know, pelvic health varies from person to person. But if you were to leave somebody with one thing for them to consider or incorporate in their day-to-day life, what would that be?

Dr. Stephanie: 

I think, paying attention to the body. The body is important. When symptoms start they may not be severe, and they may be common, but “they're not normal" is a big phrase that I think people use now. So things such as if you notice a change in your bladder abilities, whether it's starting your stream or not being able to control it; if you have a hard time evacuating stool, if sex starts to hurt–all of these things can be symptoms of bigger problems that may be starting to form. 

There's a lot of opportunity for our bodies to start to have altered neuromuscular control between our abdominals, pelvic hip process and the pelvic floor. And so there are studies that also show that with hip pain and back pain, up to 98% of people also had some sort of pelvic floor dysfunction.

Lauren: 

Wow!

Dr. Stephanie: 

But orthopedic and pelvic are very separate. And so, as people are trying to rehab maybe what seems to just be a hip injury, they might have a pelvic floor problem that's preventing them from fully hitting their goals. And so I think it's important for people to pay attention to their bodies, and just keep looking if you're not getting the answers that you need or the help that you need. There may be more going on.

I think just getting people to think about their pelvic floor has been a big change.

Lauren: 

Yeah, which is great. Yeah, because I feel like, for me, I didn't know the words “pelvic organ prolapse”. It's one of the things I'll tell people that as I've gone through this journey, now I have the words to describe the heaviness, the dragging, the bulging. At first, I didn’t. I didn’t know how to describe what's happening to me. So, yeah, just having the vocabulary to do that is helpful.

Dr. Stephanie: 

People having platforms to educate them, as well, like with what you're doing, have really helped. People are looking for answers, and they're finding them in more commercial places. What you're doing is great with that.

Funny note–for everybody listening who didn't know what prolapse was, I have friends who are physicians who recently had babies. I got a panicked call from one of them that went like this: “I was in the shower and I could see my uterus!” Just the horror! And nobody can get their head around the fact that an organ can come out of your vagina, and we can just poke it back up there until we figure things out.

Lauren: 

Right.

Dr. Stephanie: 

Literally, I was like, “Lay down and just poke it back in.” And she was horrified.

So then she said, “I'm gonna stand up. It's gonna come back out.”

And I’m like, “It didn't, did it? No.”

I think we should have better education around prolapse so people could know what they should be looking for after birth. And if it's there, it's going to progressively get worse unless you manage it. And so, between how to manage it, what to do, how to make yourself comfortable with the products in the acute phase, I think is so important.

Lauren: 

I think that's a great point, too. I feel like it's also so challenging and a lot of people don't know where to turn for resources. And so they turn to Google, and they also feel like their options are very limited. I feel like there's a big stigma.

I feel like, if you ask people about surgery, the big idea is that it fails. Or if you ask people about pessaries, it's like, “Oh, I don't want one.” 

I think that's so challenging, because those can be amazing tools. I myself finally got a pessary after numerous tries, but it's been a game changer. And for me, there was never a stigma about it. It was more just about, how can I get one and get a provider that's supportive of that? 

But you do see, on forums and different groups, people talking, or I've had customers who have called in and their first thing is, “I don't want to get a pessary. I need to learn about your garment.” And that's fine, but they're so polarized on it.

And that education on the options is so important, too, for people to have the tools at their disposal, know what's right for them, the pros and cons, and how they could change over time. 

What works for you when you're in your thirties and forties may be different when you're in your fifties, sixties, seventies, and beyond. 

So I think trying to better understand that journey is also helpful, because, like you said, your condition can change over time as your body changes, and that whole thing.

Dr. Stephanie: 

I think people are learning, but we still see that people are more comfortable in certain regions of the country than others talking about these things.

 

 

4. The Benefits of a Pelvic Floor PT Throughout All of Life’s Stages

Lauren: 

So I know the postpartum, perimenopausal, and menopausal stages are times when people can find someone like yourself for help. Can you talk just a little bit about how it can be helpful for women throughout the different phases of their life, and how, even without a problem, it can be helpful to have a relationship with a pelvic floor physical therapist?

Dr. Stephanie: 

Yes, that's one of my favorite lectures, especially with women, because we do have more opportunity for things to go wrong with our anatomy than our male counterparts. And just our life milestones, starting from when we first have menarche and get our first period–there is a disease called endometriosis, which manifests as severe menstrual pain and a number of other symptoms, but the pain is the hallmark. 

And so it's very challenging, because to get a diagnosis for that, it has to be biopsy, proven with a surgery. A lot of teenagers are menstruating earlier and earlier, suffering every month (for sometimes a full week) with dysmenorrhea. And that's leading to pelvic floor dysfunction–in a teenager.

The second caveat with that is, they are also almost always immediately given OCPs (Oral Contraceptive birth control Pills), because that will help reduce dysmenorrhea, but it causes something called vestibulodynia. And so, if somebody does have endometriosis, and you start oral contraceptives under the age of 17, you are eleven times more likely to develop a condition that results in pain at the opening of the vulva and irritated bladder symptoms.

So before these people may even be sexually active, they're going to be in for a surprise when they either try to have a gynecological exam with a speculum, use a tampon, or have a sexual encounter, and that's not being counseled to people. 

And so I really think that that's a problem, as we see the age of menses starting earlier and earlier. I mean, I have some patients who were 10 years old.

So that's a change in the world. So we get through our early periods with or without endometriosis, OCPs, with or without endometriosis are also given to people for everything. They've got acne, they're not getting their period, to “regulate” their period. I mean, to me it's insane because we should not be messing with hormones and teenagers. I'm for birth control, but we need to let people know that this is a risk.

Not everybody is going to have this problem, but for the ones who do, it may go undiagnosed for a long time and then become a bigger chronic pain issue, which I have a problem with.

Then we get into our twenties. Let's say we get past all that. Then comes pregnancy, which is a miracle of anatomy and physiology. Then birth, and then we immediately get thrown into menopause as soon as you give birth in the genitourinary area to produce breast milk, which also causes this vulvar problem and bladder problem, with or without incontinence and prolapse. Doesn’t this all sound awful?

And I really think the phrase that came out last year that is so helpful is, “Postpartum is forever.” So you have a new baby, and maybe another little at home. You can't go to PT right now. But just know it's there when you can, and don't forget about it, because at whatever point you can identify what impairments are in your body, and then have a treatment plan to fix them both in and out of the clinic. So I think that's important.

Because all of the problems that happen from birth on, then get enhanced with age-related changes that really start at the age of 40. So people are now realizing perimenopause is around age 40, and that we can be in it for 10 years before menopause actually happens. And that's an opportunity again to help strengthen muscles that are going to naturally weaken because of the hormone deficiencies. But also, these neuromuscular impairments are almost always there by the time we're in our forties; that's why we all start to hurt. 

And so I really like working with our medical colleagues and that age bracket to optimize both and help prevent discomfort for what's going to be the next third of someone's life. After they went through all that big mess!

5. Why Seeking a Pelvic Floor PT can be a Game-Changer

Lauren: 

If somebody was hesitant to see a pelvic floor physical therapist, what encouraging advice would you give to them?

Dr. Stephanie: 

It does sound scary. And people don't think of us (pelvic floor physical therapists). When these issues start to happen, they think of a gynecologist or a urologist.

I think it shouldn't sound as scary or weird as it may. A lot of everybody who's a physical or occupational therapist in the space has really taken it upon themselves to get advanced education, to be able to work with this patient population, because we also aren't taught this in school.

So if it's reassuring at all to people trying to make a decision, people who are trying to do this work really have spent a lot of their own time and money to be able to help these patients. And a lot of us that are in the private space (like our company), put a lot of information on YouTube, Instagram; patient stories just trying to get a more normal conversation started about it.

But a barrier, I will say, is the uninformed physician saying to somebody, “Oh, that's not going to work.” Or, “You can try physical therapy, but I don’t think it’s gonna work.” And that may discourage somebody for years from going. It’s like, you've got your life to live, and now you have to go somewhere once or twice a week for appointments, for something that might work? The language that we're trying to teach the medical community can also help support patients getting the help they need.

Lauren: 

Yeah, I think that's such an important point. Because I think, too, as a society, we are so trusting of healthcare providers and we think what they say is gold. And we listen to that. So when it is something negative, it is so impactful. And I think teaching people to be stronger advocates for themselves, and if something is discouraging, trying to find another option, if that's possible, can really go a long way. Because to your point, that one negative comment can change someone's trajectory for care. And it's disappointing. 

And hopefully, as people become more educated and have this be destigmatized more, and have resources more readily available, they can have better discussions and conversations. And hopefully, they can get care sooner, and get care with providers that feel like the right fit for them, because even if somebody is a good, passionate provider, they still may not be the right fit for your personality or something. And teaching people that that's okay. And it's okay to switch. And those kinds of things. 

So It's an exciting time to be in this space and see the improvements that can still be made, and hopefully get people pointed in the right direction.

This has been an amazing conversation, Stephanie. Is there anything else that you would like to leave us with before we wrap up?

Dr. Stephanie: 

I think that there are commercially available products, such as yours, coming out that can help people and people can do their research and just find what's going to work for them.

I think a lot of these issues are completely treatable. You just need a strategy and a sequence with the right person, the right things at home, and it can be okay. So try to neutralize some of the fear people feel when they start hitting Dr. Google.

Lauren: 

Yes, right. It could be a scary place.

 

Are you a pelvic floor healthcare professional? We’d love for you to be a part of the Hem Support Wear community! Learn more about our resources, including our clinic sample kits, healthcare-focused monthly newsletter, and more. If you’d like to be featured in our Expert Spotlight series, let us know!

 

 

**Medical Disclaimer: This post is intended to provide information and resources only. This post or any of the information contained within should not be used as a substitute for professional diagnosis, treatment, or advice. Always seek the guidance of your qualified healthcare provider with any questions you may have regarding your healthcare, conditions, and recommended treatment.