An interview with a specialist in pelvic floor disorders
Note to readers: this post has been updated with Kim Bryant’s new email and website information.
There was a time when nobody talked about things like bladder leaks, fecal incontinence or weak pelvic floor muscles. We simply accepted that losing the ability to control our bladders was a part of aging or a side effect of childbirth, and we dealt with it very discreetly. Thankfully, the stigma of suffering from incontinence has lessened, but it’s still very embarrassing for many women, so much so that they don’t want to talk about it. (By the way, men can suffer from bladder control issues and fecal incontinence, too.)
As a fitness professional in a senior living community, I have become aware of how common pelvic health issues are. As a runner, I have learned that I need to manage my fluid intake before and during long runs so that I don’t have to stop for bathroom breaks (especially during races—they don’t stop the clock while you pee!). I have to find the right balance between staying hydrated and being able to complete a race with little to no stops. I actually plan my long training runs for locations where restrooms are available. I don’t remember having to scope out restrooms ahead of time when I was younger. So what happens? Is it normal? Is there anything we can do about it?
For my BoomerChiX followers, I sought out a professional in pelvic floor disorders for more information. I interviewed Dr. Kim Bryant, who practices in Phoenix and Tempe, AZ, to learn about her profession and get some advice regarding treatment options.
BOOMERCHIX: Most people probably aren’t aware that there are specialists in pelvic rehabilitation. How would you describe what you do?
KIM BRYANT: I have a doctorate in physical therapy, but I have taken additional course work (over 200 hours) to specialize in pelvic floor therapy. As a pelvic floor physical therapist, I treat so much more than what is in the pelvis. I focus on re-establishing the intricate 4 gears of the core system, which includes the diaphragm, deep abdominals (transverse abdominis), pelvic floor and spinal stabilizers. In addition to treating urinary and fecal incontinence, I also treat pelvic organ prolapse, core weakness, back and hip pain and sexual dysfunctions.
B: What inspired you to specialize in helping women with pelvic floor disorders?
KB: I was working at a rehab facility and independent living community treating patients with hip replacements, strokes, open heart surgeries, falls, pneumonia, and urinary tract infections, to name a few. I started asking the question, “how are you sleeping at night”? I would say 9 out of 10 times my patients would say they get up 2-3 times a night to use the restroom and then have a hard time falling back asleep. I thought, how can I ask these people to go for more walks or do more exercise if they are not getting the adequate rest they need at night to maintain every day activities and recover? I needed to address this piece of the rehab puzzle.
I reached out to a friend of mine who was doing pelvic health at the time. She gave me a few pieces of education and exercises but said if I wanted to know more, I should take the introduction to pelvic floor health course. So of course, I did, and I am so glad that I chose this path. I learned about a huge group of underserved women and men that can be helped. There is no reason women or men should be missing out on travel, lunch with friends or should have to wear black pants all the time due to fear of leaks or an overactive bladder. It is my mission to let people know they do not need to suffer or struggle anymore; there is help out there.
B: How long have you been doing this?
KB: I have been a PT for 10 years, (time flies when you’re having fun) and specializing in pelvic health the last 3.
B: Urinary incontinence is a fairly common problem for women as we age, but it’s also embarrassing to discuss. What would you say to women who think they have a problem, but are afraid to talk about it?
KB: You are NOT alone. One in 4 women has issues with incontinence. We often hear about shoulder problems or back problems, why not start talking about leakage? Urinary incontinence is very common but IS NOT NORMAL, regardless of your age or how many children you have had. The more we can talk about it the more we can help. Bowel and bladder control are normal body functions. Many times incontinence is simply because the muscles of the pelvic floor are weak.
If you have fallen before and have had physical therapy, you know that you work on strengthening the muscles of the hips and knees. Well, when you have issues with leakage you need to strengthen the muscles of the pelvic floor as part of your rehab plan. Often I have people come into my office saying Kegels (pelvic floor contractions) don’t work. Research shows that 75%, and I would say even more than that, do not do the contraction correctly. I ask these patients if their provider showed them how to perform the pelvic floor contraction or if they watched how they performed the contraction, and most often the answer to both of those questions is no.
B: How can you help women with incontinence? What kinds of techniques/treatments do you use?
KB: The first step to gaining control of your bladder is awareness of the pelvic floor. I teach my patients to use their breath to bring awareness to that area of the body. Once that is achieved, we look at posture and ensure that their foundation is solid and stable enough to decrease excess strain on the body.
Once the foundation and awareness is there, then we can work on strengthening the muscles. I use specialized cues and techniques to ensure effective contractions of the pelvic floor. In some cases, I use external biofeedback or a specialized unit to help strengthen the muscles if they are extremely weak. I don’t not use external devices for very long because my philosophy is that I want you and your body to make the neural connection.
After a the muscles have regained strength then we can start to integrate that into every day movements like getting in and out of bed or up and down from a chair so that bladder control and pelvic stability is the new norm regardless of what you are wanting to do.
B: What is the difference, if any, between incontinence and an overactive bladder?
KB: Tricky question, but a good one. Incontinence is anytime you leak that you don’t want to. That can be a couple of drops or needing to change your clothes. An overactive bladder is when the muscle of the bladder, called the detrusor muscle, spasms and sends the signal to go to the bathroom. If the detrusor spasms and you have a weak pelvic floor you may have incontinence.
It is important to note that the bladder should hold about 2 cups of fluid before you truly need to go, however, I often see that when people have issues with incontinence they either do not drink much water or they go to the bathroom any chance they get because of the fear of leaks. The issue with that is if you don’t drink enough water, urine can get very concentrated, which can irritate the bladder lining causing bladder spams. In addition, if we do not let our bladder fill to full capacity most of the time, it can shrink so that we are going more often. The good news is that most of the time we can fix both issues with physical therapy.
B: Female runners, especially those of us who are a little older, have to balance hydration with limiting toilet stops. What advice would you give to runners regarding fluid management?
KB: Make sure you are hydrating properly. By that I mean drinking ½ your body weight in fluid ounces per day. 75% of that needs to be water. You may need to increase that some if you are exercising or if you are in extreme heat like here in AZ.
You also want to sip water through the day. I like to give the example of watering a plant. If you have your hose on full blast, which is like drinking 16 oz all at once, the water will spill over and not much will be absorbed. Our body is the same way, it can only absorb so much at one time.
B: Is there something we can start doing now to prevent incontinence later?
KB: Yes, see a pelvic floor physical therapist and get the right exercise program for you. Everybody is different so there is not a one size fits all fix. They can give you a tailored program that you can use for a lifetime. I typically use the patient’s video on their cell phone to provide them with all the cues and exercises that are specialized for them. That way they always have access to it and can use it for years to come.
B: For those women who have daughters or granddaughters, would you tell us what other issues you treat which may apply to younger women?
KB: I specialize in and enjoy treating fertility issues, pregnancy, and postpartum issues. I have also recently enjoyed learning more about treating perimenopause conditions like incontinence, poor sleep, pain and sexual dysfunction because this is my season of life, too.
B: Is your treatment covered by insurance? Do you require a prescription from a physician?
KB: Yes, pelvic floor therapy is covered by insurance just like typical physical therapy is for a shoulder or knee. As long as the therapy is medically necessary, it should be covered. Arizona is a direct access state, which means you do not need a doctor’s prescription to have an evaluation, however I highly encourage it because most insurances will require one.
B: Is there anything else you would like us to know about you or your practice?
KB: I recently changed my company name from Kim Bryant Physical Therapy to Thrive Pelvic Health and Wellness. You will also see a new logo that I am really excited about. I am in the process of transitioning websites and emails so just be aware there are new things to come in 2020. I have 2 locations, Tempe and Ahwatukee (Phoenix) and I am looking to grow more in the next year.
You can reach me any of the following ways:
Phone: 602-791-9298
Email: kimb@thrivepelvichealth.com
BOOMERCHIX: Thanks to Kim Bryant, DPT, for sharing some valuable information. If you are experiencing urinary or fecal incontinence, or other pelvic-related disorders, it’s good to know that there are specialists who can help you and who understand what you are experiencing. You are NOT alone!