Navigating Pelvic Pain & Endometriosis: Dr. Jill Ingenito's Expert Guidance
As part of our Expert Spotlight series, our founder Lauren chatted with Dr. Jill Ingenito DO, a dedicated pelvic pain specialist who provides full-scope OBGYN care. Dr. Jill has over a decade of experience in both private and group practice and focuses on endometriosis and pelvic floor dysfunction, addressing a critical need in her field.
In our conversation, Dr. Jill explains why it's important to understand pelvic pain and related problems, pointing out that catching these issues early can prevent serious problems. She clears up common myths, such as the belief that pelvic floor issues are only about prolapse or that doing more Kegels will solve everything. She encourages better education on pelvic floor anatomy and suggests practical solutions like physical therapy and support wear to help people feel better.
Catch the entire chat on YouTube, or check out 5 of our highlights below!
1. The Hidden Impact of Endometriosis and Pelvic Floor Disorders
Lauren:
If you're talking to somebody that's not familiar with pelvic pain and related disorders, who maybe hasn't experienced anything or doesn't know that they are, what would you say to them about the importance of learning about these conditions and then what that can kind of mean just for their knowledge base?
Dr. Jill:
The majority of what I do is endometriosis care and then pelvic floor disorders. So endometriosis is really common and I think that it's gaining more notoriety, but really it's 1 in 10 women, so it affects everyone. And sometimes I feel like people just walking around don't even know it, which can happen.
The importance of it is that the earlier we catch it, the earlier we get ahead of it, the less likely it is to destroy your internal organs so you don't have to struggle with infertility and suffer and miss out on fun things in life.
So I'm trying to raise awareness in that space just because I find myself saying the same thing every time and I hear the patient say the same thing too: "I wish I would've found you sooner. I wish I would've known about this."
Probably one of the most shocking things with going into the endometriosis space was how much of women's pain was actually coming from their pelvic floor. So I kind of always looked at it before that, oh, it's the endometriosis. But lo and behold, as people start to work through PT, they're like, "No, no, no--that's my pelvic floor pain and this is my endo pain." And the pelvic floor itself, you have to have it. It's essential for overall wellbeing and daily functioning, and some people just don't even know what it is.
And that's probably one of the most shocking things to me is that people have no idea what their pelvic floor is. They have no idea what's going on when they're coming in with prolapse. So it's just a very interesting thing. We all have one and it's so integral for our bowel function, our bladder function, our sexuality, our core stability, our posture, and people are like, "What's the pelvic floor?" "I didn't know it could go wrong!" and it can go wrong in so many ways. The more popular thing that people know about is the prolapse situation, and I personally struggle with that, I've seen patients for years who struggle with that, and for some it gets so severe that it does cause pain.
And then there's the other side of it where the pelvic floor can be just so tight and tense and tender that it's living in a constant gripping muscle spasm. I'm trying to raise awareness about endometriosis. And then as the work has progressed, it's kind of transformed into this more of a pelvic floor thing. And that really came from, to be honest, learning from my patients. They would be like, "I went to the PT and either all my pain is gone or 90% of it is gone. I still had this 10%."
2. “You’re Living in a Kegel”: Why More Kegels Isn’t Always the Answer
Lauren:
Thinking about pelvic floor health and the lack of awareness and knowledge, what do you feel like are some of the top misconceptions that you frequently come across regarding pelvic floor health?
Dr. Jill:
It's getting better. I will see a lot of women now who've just had their baby and say, "I need to see a pelvic floor PT". I'm like, "Okay, great, we can do that. No worries." But I think it's kind of interesting. You were pregnant and then things are just falling out. And so the problem is a lot of these people are just coming off of a major life change. They just had kids or they're pregnant and breastfeeding. You don't really have time to take care of yourself.
And then you're in the stage of raising little kids and then you're in this stage of raising teenagers and you're like, "I don't know what's going on there." And you just kind of deal with it. You're like, "Oh, I can go jump on the trampoline, but I have to change my pants" or all that kind of stuff. I think people are just really busy after they have all this pelvic floor trauma and they just don't have time to take care of it.
So I think probably one of the biggest misconceptions that I see is that the pelvic floor doesn't cause pain, and really the only issue that you can have is that your vagina's falling out or your bladder. So I feel like I see a lot of people who don't know that this could be a problem. They'll ask, "Do I just need to do more Kegels?" And I'm like, "No, you do not need to do more Kegels. Please stop doing Kegels because you're living in a Kegel." So I think that's one of the biggest things is people think it's all the prolapse, but the pelvic floor can be really tight and tender and they're just living in a Kegel.
3. Understanding Pelvic Floor Anatomy is Key
I think one of the other biggest misconceptions I hear is people come to see me for pelvic pain and they'll be in the space of, again, not knowing what pelvic floor is. They'd never heard of it. They've been to the ER 3 million times and they've told them that, "Oh, your pain's coming from an ovarian cyst. Oh, you might have endometriosis, etc."
The ovaries lay on top of the pelvic floor. So you have the "bowl", which is the pelvic floor, and then it's two little peaches in the bowl and they're laying on it. And so a lot of times people will say, "This ovary pain, I have this." I'm like, “It could definitely be your ovaries. And we can definitely check that out with imaging. At the same time, just be aware that your ovaries lay on top of your pelvic floor and sometimes discriminating between what's muscular and what's ovarian is very challenging." And I found the biggest thing to be helpful for people is as they work through PT they're like, "Oh, right. That's my pelvic floor."
If your pelvic floor isn't working, you're going to be constipated, and you can't poop. Maybe peeing is an issue. You can't urinate. Sometimes you can't empty your bladder. Sometimes the urine won't flow. And a lot of times people will say, "I have a UTI, I have interstitial cystitis." Maybe it's just like your pelvic floor doesn't work.
Lauren:
Yeah, it could be the root cause that's causing these other symptoms.
Dr. Jill:
And I feel like especially in medicine and with stuff "down there", we're so quick to go to an organ, like "Oh, it's got to be my colon!", but no one goes, "Gosh, what else?" And so many times I'm like, "It's your pelvic floor. You don't have IBS. You have this issue with constipation because your pelvic floor can't relax."
Lauren:
Those are three really big ones. And I think to me what I'm hearing is a lot of it stems back to just that foundational knowledge of what the pelvic floor is, how it works. And then as you're trying to sift through these things, understanding how your pelvic floor can contribute to so many things, and then what resources you have to help mitigate the symptoms that's being caused by the root cause of issues with your pelvic floor, whether it's laxity, tension, all those kinds of things.
And I do think we are seeing that the general population's knowledge is increasing, but at the same time, there still is a big hill to climb, I feel like, as far as people knowing what kind of help to ask for and then having providers like yourself who are really supportive of that.
I know I've also heard stories where people will ask for a referral to pelvic floor PT and they get varying reasons as to why that may not be a good fit for them. And so it's great when there's folks like you who are knowledgeable and can get you connected and see what it can do for you, and then that can help rule something out or potentially help solve it or be a good contributor.
Dr. Jill:
I wish they would teach about pelvic floor and sex ed, but at that time in your life, you're like, "What is happening?" And then there's not another great opportunity. I feel like that's where it happens and people aren't talking about their pelvic floor at the dinner table (unless they live at my house).
I think there's a great opportunity during pregnancy to introduce what it is, and if we had everybody do third trimester pelvic floor PT, even just a one or two touches with the PT, that would be so helpful. And then just raising awareness. Things like, "This is what can happen after your delivery. If this is you, here's what you got. Just know that there's options out there and you don't have to just deal with us for 10 years."
4. “One of the Best Things You Can Do During Your Pregnancy”
Lauren:
That really leads me to my next question too, which is thinking about, okay, pelvic work, physical therapy, and how it can help someone like a teenager. I know a lot of people think of it for pregnancy and postpartum. Can you touch a little bit about over the course of a woman's life, how PT can play a role over the whole lifespan?
Dr. Jill:
With teenagers, unless they're really struggling, they're not going to PT. You have other things going on. And even some college-age kids. But I think as you move out of that educational space and move into the real world, whatever that is, and you're more established in relationships and that kind of thing, I think that's really where it can play a role.
I do think probably the most obvious intro though is the pregnancy time, and I wish there was also a way to reach women who've had sexual or physical trauma at a young age. But starting PT in pregnancy--I would say we should move to a standard of care for that. That's one of the best things you can do during your pregnancy.
And then from there, it should be that rehabilitation starts right after pregnancy and then going forward, if you have any issues with urinary incontinence or pelvic pain, you should really continue to do PT.
So yeah, I think the teen, they just have other things going on. But if they're coming to see me and they're missing school and work and they can't have sex or they can't do whatever they want and they can't do gymnastics or ballet, they can't do the fun thing that they want to do because they're always in pain, then that's a place to introduce it there. But again, I wish we could teach about it in sex ed.
Lauren:
Yeah, and just start that foundational knowledge early on. Can you share with us some of the most rewarding aspects of your work?
Dr. Jill:
Sure. I definitely think I've shared a couple of those already. Those patients who have been struggling for years and 25 years. Obviously the pregnancy and the delivery, that's such a special time for people. I think every time I'm involved with a delivery or a C-section, I just feel like that's such a remarkable moment for these people, and it's special. I get to be a part of it, but I also try to be in the background because isn't about me. It's about you, your family. So I kind of try to be just a little person in the corner letting them have their moment, but it's just cool to see people go through that. There's so many emotions, and I just learned a lot about the human experience through that and how different people and different families, how that happens for them.
But I think on a day-to-day basis, I'll have people who come back after their endometriosis surgery and after starting pelvic floor PT and they're like, "I'm better. I wish I would've found you sooner." So that's really, really rewarding. They come in, they're crying, they've seen a million doctors. It took them forever to get here.
So those are the good moments. And that's one of the reasons I went into it is I had somebody who came back to me and was like this, and I thought, "Wow, this is as life-changing for this woman as when somebody has a baby." I just felt that same emotional sense, like, "Wow. I just literally changed a person's life."
Lauren:
It feels like a huge transformation.
Dr. Jill:
Yes, they can live their life. They don't have to miss school and work and activities. They can have relationships, they can have sex, things that they just want to do.
5. The Power of “Fact-Finding Missions” in Your Pelvic Health Journey
Lauren:
I have one more question for you, which is, if someone was hesitant to seek help, maybe they're suffering or for various reasons, what is some advice that you would share if you were talking to that person?
Dr. Jill:
So I do see that a lot with prolapse, in the people who are struggling with incontinence. That's a really common thing. And so it's just interesting. I had prolapse and urinary incontinence and I've had two vaginal deliveries, and if I don't wear my pessary to yoga, my yoga pants are going to look like I pee my pants, which to be honest, I don't really care. But I'm also comfortable with all bodily fluids.
So it's always interesting. I'm just like, "Everybody pees their pants. I don't know why." So I try not to take that stance, to be honest. I try to be more empathetic and encouraging. I really try to break it down with those diagrams and anatomy. I'm like, "Hey, listen, your bladder's right here. It shares an apartment wall with your vagina" and just educating that these guys are neighbors, and when your bladder gets full and the weakest point in your body is your vagina, it's just all going to cave in.
I try to normalize it, try to break it down, and then a lot of times when you deliver the information to people, they're just not in a space where they want to hear it. That's actually one of the biggest things I've learned from the incontinence work and the prolapse work is like, okay, hey, this is what's going on. Your whole inside isn't falling out. And yes, you're leaking urine, but is it bothering you? Is it disrupting your life? And that's a personal decision. They have to decide what level of what they're willing to deal with. I can't answer this question for them.
Lauren:
And that's going to vary from person to person.
Dr. Jill:
And it's different every time. For people that have severe prolapse, and I'll say, "You need to do something about this." And they'll be like, "No, I'm good." And then other people have very minor prolapse and they're like, "This is so disruptive." People who haven't had kids and they're leaking in yoga or something like that. And you're like, yes, let's get you in for some pt. Consider a pessary, and all of this. So I just always tell people to schedule one appointment, find out what your options are, and then go home and either do nothing about it, or do something about it. Then you can always come back.
And I would say more than 50% of people eventually come back a year or two and they're like, "Okay, I'm going to need some help, because now it's really bothering me. Now I've had my second kid and I can't jump on the trampoline at all," or "I can't go running," or "I always have to wear a pad because I'm leaking and it's irritating my vulva and my skin is so irritated. Look at this."
Lauren:
And I think that advice of having the one visit to understand your options and taking the pressure off of having to make a decision can be helpful. I feel like some people might feel like if they go in and their doctor tells them to do something, they have to do one of those choices. And actually, you can go on fact-finding missions and make no decisions.
Like you said, take your time and at least you know what the options are. And then as things change or as it bothers you more, at least you know what those different paths can be and you can try the different ones too.
Because I know for some people, when you start off on your journey, you may feel like, "I'll never do that!" And later on, you're like, "Well, I'll consider that," because you learn more or you hear different experiences or your symptoms change and you're looking for different solutions. So I think the fact finding is super helpful.
Dr. Jill:
Yes. And I actually have your Hem posters up in the exam room, and so it's actually a conversation starter. People are like, "Hey, what's that?" And then, "Oh, I think I might need that."
Or they're there for some other reason. They're just coming to get their Pap, they're coming to get a breast exam, whatever it is, and they say, "What's that?"
I'll say, "That's for this."
And then they'll be like, "Oh yeah, I have that. Do you think I should try that?"
"Yeah, give it a try. If it doesn't work, come back and see me. We can talk about what are some other things you can do besides support wear? Do you want to try a pessary? A pelvic floor pt? Are you considering surgery?"
Lauren:
Yeah. And I like having all of them because personally, it's like I have the garment, I use a pessary, and I still do pelvic floor PT. It's like having multiple options is so nice because as things change, you can rely on them for different reasons at different times.
Dr. Jill:
Yeah. I actually thought about it at one point because every time I bring a pessary to somebody, they're like, "What?" I'm like, "These are so common." So many people have them, and so many people have no clue and they've never heard about it. It's actually remarkable. But I thought at one point of taking the sample pessaries and stringing them together in bunting banners and putting them in the exam rooms. But not everybody would agree with that.
Lauren:
Think it'd be great. I know there is a stigma even for people who know about them and you're like, "Guys, this can be a game changer!"
Dr. Jill:
And a lot of people are like, "Oh my God, I'm going to need surgery."
I'm like, "No, you could just try one of these that's hanging on the wall."
Lauren:
Exactly. Yeah. "Which one would you like?"
Well, thanks so much. Are there any other parting thoughts you'd like to leave us with before we wrap up?
Dr. Jill:
I really love the awareness that you are bringing to this space and just giving people options. And actually, I think that this is a great starting point for people because they can go home and they can buy the underwear and they can try it, and they can see what the support garment is and how it helps, and then they can maybe take the next steps if they need to. So I think this is a nice baby step when they're like, "I don't have time to do PT. You're not putting anything inside me, and I'm definitely not having surgery."
Lauren:
Right. Start here!
Dr. Jill:
Yeah. I mean, everyone has to wear underwear, so maybe just give this one support garment a try and see. And then if you want to talk about it more, come back and see me.
Lauren:
Great. Well, thank you so much, Jill. We really appreciate your time. And you, you're welcome. Thank you so much for talking with us!
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**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.