Join The Conversation With Lee McCauley In Our Most Recent Video Series On Pelvic Health
Hello, I’m Dr. Kait Chang, Naturopathic doctor, and I am the founder of Calgary Menopausal Wellness. Today we have Lee McCauley with us from Momentum Health with us. Lee, I know that you are a pelvic physiotherapist.
Tell us what you do and what is pelvic physio?
So, basically, in order to describe what a pelvic physio is, I have to describe what the pelvis is and what area that I treat.
[00:00:30] So the pelvic floor is, basically a group of muscles that’s like a hammock that’s attached to different parts of your pelvis. So, it’s attached to your tailbone, your sit bones and your pubic bone at the front. And there’s a lot of conditions that can arise from dysfunction in these muscles. So, the typical things that you’re going to see are the muscles getting a little bit too tight or those muscles getting a little bit weak.
[00:00:55] So some of the symptoms of those effect the bowel and bladder and they’ll affect our other pelvic organs like our uterus. And so those muscles generally help to lift and support those organs. They’re also helpful in, regulating our bowel and bladder, and they help with appreciation of sexual intercourse.
[00:01:17] So, If there’s any issues with those the typical things that can arise is pelvic organ prolapse or bladder issues such as incontinence or inability to fully empty your bladder, or increased urgency or frequency of going to the bathroom and pain with intercourse. To name a few other things like pelvic pain, anything to do around the back of the abdomen and things like that. So pelvic floor physio is specifically trained to deal with those conditions.
How do you know it is the pelvic pain versus the back pain?
So that is something that you need to be doing, a history and an assessment since you almost have to rule out some of those things. And sometimes people have a little bit of both going on.
[00:02:04] Usually people would see me, the most common place is leaking urine. So usually they’re going to have some issues with that, or they’ll have pain with intercourse, or I’ll see people that are pregnant or postpartum and they’re having some issues related to that. But leaking urine is the most common symptom that people usually seek treatment for.
[00:02:24] Right. So if somebody who goes, who would think that they would have to go to a physio, they wouldn’t, you know, if they didn’t know that there is pelvic physiotherapist, how would they know that? They had to go to a private physio. Would a physio refer them to you? Does that help? Is that how it works?
[00:02:41] Here at West Springs, we have a pretty good, interdisciplinary team. So, the physiotherapists, if they’re seeing someone that they suspect might have some pelvic floors, passion, they’ll often send them to see me. Usually, people aren’t necessarily disclosing some of those issues when you’re seeing a physiotherapist because they don’t know that there’s treatment for it.
[00:03:00] Oftentimes, those that I see that have. Seeing regular physiotherapists or chiropractors, it’s usually because their pain hasn’t resolved, or are they a mixture of some of the bladder issues, bowel issues, and pain with intercourse. And then we ended up treating, some of the pelvic pain and some of those other things they might be experiencing.
So if somebody comes in and see you, what is your typical appointment look like?
So typically, I book 75 to 90 minutes and honestly, most of that time, about 45 minutes of it is taking a history of what’s going on. So, we’ll be talking about, um, bowel and bladder and sex. But I also ask a lot of questions about pain, childbirth, and some of those other things, cause they’re all relevant to what might be going on.
[00:03:46] After that, then we do just a typical external exam that you might see that you might get seeing a regular physio or chiropractor. And so, it’s checking core strength, checking, range of motion, other things like that, checking joint mobility. And then the thing that sets pelvic physio apart from a regular physiotherapist is an internal vaginal or rectal examination.
[00:04:10] And that’s kind of our gold standard and like I said, what sets us apart because that allows us to actually feel the pelvic floor muscles. Check to see if people are doing a proper pelvic floor contraction or Kegel. We can check for pelvic organ prolapse and some of those other things that might arise that people don’t realize are going on from physio, right?
[00:04:31] So once we do the internal and the external assessment, we come up with a treatment plan. So, depending on what’s going on, we might be doing a ton of education. That’s usually the biggest thing that I do. And then some lifestyle management and then treatment. So, I’ll often do traditional physio treatments or soft tissue massage.
[00:04:52] I’m doing joint mobility things. And then I can also do internal treatment. So I’ll actually release the pelvic floor muscles and do a lot of retraining to strengthen those muscles. I’m able to check those muscles internally. So, use one finger and I checked federally of the contractions. I’ll have people do a pelvic floor contraction while your fingers in their vagina. And so most people, I would say, most women are doing a Kegel improperly. And so, if you’re trying to help with incontinence, so if you cough, laugh, or sneeze and leak urine.
[00:05:37] Or if you can’t quite make it to the bathroom and you’re trying to engage those muscles, oftentimes they’re doing it incorrectly. So sometimes it just takes a little bit of retraining and queuing those muscles verbally so that they can learn how to engage them, which can often be helpful in helping them close around that a urethra to keep their urine.
And do you see that common in menopause or perimenopause? Women?
[00:05:52] Yes. So that’s quite common. Stress incontinence is a type of incontinence where if you cough, laugh or sneeze or there’s increased pressure that you’ll leak urine or even physician changes. So getting up from a chair or walking snd then urgent continence is that urge to go to the bathroom and you just can’t quite make it any lose control of your battery bladder. And so those are common. And then pelvic organ prolapse is really common. So oftentimes I’ll see that in both, perimenopause and menopause because it’s usually in relation to childbirth or someone who’s quite overweight, just because there’s extra pressure on the pelvic organs.
[00:07:02] So typically once you’re reaching menopause, your estrogen levels are dropping and that affects the lining of your vaginal wall, and the lining of your vaginal wall actually helps to support your bladder. So, if that starts to, then you can separate from pelvic organ prolapse. You can also suffer from pain with intercourse because of that. If your pelvic organs are falling down and you’re having penetrative intercourse, it can be painful or it’s just painful just due to dryness and friction.
And when do you start seeing that vaginal dryness picture in a woman’s life?
[00:07:37] Um, it ranges. It’s usually when there’s going to be big hormone fluctuations. So, I’ll see it. Postpartum, that’ll be one of the first times just because they’re, they might be breastfeeding or they’ve gone through pregnancy and there’s a lot of hormone changes. And then you’ll often see it, depending on the person. Cause some people go through menopause at different stages, but usually I’ll see it in the older population. So those people that are already well into that class.
Would you have a lubricant that you recommend for people to use with their partners?
So there’s a couple different kinds. It depends on what the person’s using it for. So there’s three main categories. There’s water-based lubricants. There’s hybrid lubricants and they’re silicone-based. So the water-based are going to be the typical ones that most people are familiar with. You can get them at the drug store. So K Y is a typical water-based brand. They’re not expensive and they’re safe to use with condoms and things like that.
And then there’s hybrid lubricants. The drawback of these ones is you have to typically get them from the sector. Toy stop shop or online and they’re kind of a hybrid between a silicone and a water based. And so they’re safe to use with condoms and they’re safe to use with like Sex, toys, different things like that, and there’ll be a little bit more slippery. And then silicone-based lubricants, those ones are really, really thin. They are a little bit more comfortable to use, but they, you must clean them off. They can stay in your sheets.
And are you worried about the silicone particles retaining in the vagina?
That’s where people have to make decisions. Because if they’re more comfortable as one and not the other, then then they might want to go a more natural way.
[00:10:02] So there are natural options such as coconut oil, vegetable oil those types of things. However, they can be irritating and they, you know, they can affect the pH. It’s creating more opportunities for infection. And they aren’t necessarily safe to use with condoms. So if you’re trying to practice safe sex, then it’s not a great idea for that.
[00:10:23] But those are easily available but that’s something people have to consider when they’re choosing one and you end up having to try them off multiple. So often trying to get like samples or smaller. Sizes and things like that to see if it’ll work for you. And if you’re worried about irritation and things like that, you can put a little bit on your form, see if you have a reaction raised.
What are the top three common pelvic conditions that you see in menopause women and perimenopause women?
So this is a, this is tough because as I said before, people are kind of going through the different times.
[00:11:04] Most pelvic conditions are usually related to childbirth. It doesn’t. You don’t necessarily have to have how children, and it doesn’t happen right after childbirth, but usually, that’s a pretty big risk factor and things like prolapse. So the common three ones are going to be prolapsed, incontinence and pain with intercourse.
[00:11:24] They can typically affect people at any age. Basically. The one that, like I said, is mostly reserved for menopausal women is going to be that vaginal dryness. They’ll typically have more issues with intercourse.
Do you have a set of exercises that you can show us that a woman can do at home to strengthen their pelvic muscles or relax her pelvic muscles?
So one of the biggest misconceptions is that we have a weak pelvic floor. And so, a lot of people are doing tons of kilos trying to strengthen in it. And as I mentioned before, most people are doing them incorrectly.
[00:12:03] Or if you have a really tight public floor, this can increase the tension in the pelvic floor muscles and actually cause more issues with it. Take all the floor is usually, those people typically have stress incontinence, pain with intercourse, leaky bladder, different things like that.
[00:12:20] So if you’re doing a bunch of Kegels, you might be making things a bit worse, but if you’re not sure and you want to try some, the best way to do that would be to, if you think about your pelvic floor, like a diamond. The top would be your pubic bone. The sides are your sit bones, and the bottom is your tailbone.
[00:12:37] You’re trying to engage all of those muscles together. What people typically do is they engage around their rectum, so they’ll engage those muscles, but not the rest of their pelvic floor. So again, if you’re trying to hold in pee and you’re missing the muscle that actually closes around your urethra that might be part of the issue. So the best way to do a key goal is to think about that diamond, and I’ll have a patient go through engaging the front. So it’s almost like you’re going pee and stopping mid flow. Another cue that I’ll use is I’m trying to suck up a grain of rice to engage that front part. If they feel like they have strong urge to go or they think they might leak urine if they’re coughing or sneezing, they call that the locker, the knack, and I’ll have them forcefully engage that front muscle. So that can be really helpful.
[00:13:27] And if you’re going to do a Kegel, then you would do that front muscle. And then the middle muscle between the sit bones, and that’s done by trying to imagine that you’re talking of a ping pong ball through your vagina and in the back part around the tailbone is again squeezing around your rectum or trying to lift your tailbone.
[00:13:45] Then you combine those together. So you would be doing the front muscle, the middle muscle in the back muscle all together, and that would be a proper Kegel. But if you think you might have some issues related to a tight pelvic floor, then I typically discontinue cables for those persons and that those people, that might be an indication that you do need to see someone for treatment because we can release those muscles.
[00:14:07] So for someone who’s trying to practice more Qigong but doing it erroneously, they could be contracting just the rectal part, like the hind part. And that can cause things like constipation, tailbone pain and anything else. The other thing too is a lot of people will do them all day, all the time.
[00:14:30] So they’ll do them when they’re sitting in the car when they’re standing in line. But general strengthening principles, you need to give those muscles a break. You also need to fully relax them. So often have people follow with some stretches and do some things like that and almost do it in a planned exercise session versus just engaging them all the time because you wouldn’t do that with any other muscle.
[00:15:17] And then the exercises for prolapse, I’ll have people do Kegels if they need to, because typically our pelvic muscles aren’t helping to support those organs. And then we do a resting position for that and then for incontinence there, so the bladder training as well.
How many sessions do you think somebody coming into see you for any condition will require to get through there or get over their pain or discomfort.
So generally, if it’s just purely incontinence, oftentimes that’s only anywhere from a two to three visits. And often we can resolve it in that amount of time. Pelvic organ prolapse is typically anywhere from three to five. Pelvic pain gets tricky, because if they’re needing ongoing treatment, sometimes I’ll refer them to some of our other physiotherapists once we’ve resolved types of the pelvic floor issues. But generally those people are going to be more like the eight to 10. Usually people have a mixture of everything, so sometimes it’s hard to gauge what’s going on, but. Well, typically see how they do with some of the treatments are meeting where they are. Yeah. But the average is about three to five.