015: Introducing FLYTE, a New Type of Pelvic Floor Strengthener

Transcript

Bruce Kassover: Welcome to Life Without Leaks, a podcast by the National Association for Continence. NAFC is America’s leading advocate for people with bladder and bowel conditions, with resources, connections to doctors, and a welcoming community of patients, physicians, and caregivers, all available at NAFC.org.

Welcome back to another episode of Life Without Leaks. I’m your host, Bruce Kassover, and joining us again today is Steve Gregg, the Executive Director for the National Association for Continence. Welcome Steve.

Steve Gregg: Thank you, Bruce. I’m glad to be here.

Bruce Kassover: Excellent. And also joining us today is Shravya Kovela. She’s the business development manager at Flyte, that’s F-L-Y-T-E. You’re going to hear a little bit more about them in a second. But she’s also a doctor of physical therapy with a specialty in pelvic health, and she’s an orthopedic clinical specialist. So welcome, Shavya. Thank you for joining us today.

Shravya Kovela: Thank you for having me. I’m excited to be here.

Bruce Kassover: I know that one of the things that we wanted to talk with you about today, because Flyte is a company that, that develops products to help with pelvic floor health is, how do you know if a pelvic floor product is the right choice for you? Maybe you could tell us a little bit about what types of pelvic floor products are even on the market and how you might start to go about making that decision.

Shravya Kovela: Absolutely. So as a pelvic floor physical therapist, I think that it can be challenging as someone who maybe hasn’t been exposed to the pelvic health world to really know where to start, right? A lot of us don’t even quite understand, okay, is this normal? Is this what I should be feeling? And then what do I do about it?

And that can be really overwhelming. It’s absolutely wonderful that there are more resources out there for all people, women, men, people of all genders. And so we are seeing just this boom of technology coming out and a lot of information that’s coming to people about, “Hey, this is a pelvic floor product that can help you.” That can be overwhelming when we don’t really know where to start.

There are a couple different pelvic floor products out there. Of course, this is probably not all encompassing, but if I were to name the main ones that are out on the market, you will often see biofeedback or Kegel trainers is what some products will call themselves. Another will be electrical stimulation.

And then a third kind of new product out there, which is actually Flyte, is mechano-therapy. So those are the pelvic floor products that exist out there that you’ll probably most commonly hear about. And the question is really, like you said, Bruce, how do you determine which product is right for you? So I would always say to begin with understanding and educating yourself with what exactly you are dealing with, what are the symptoms that you’re dealing with? You know, we hear a lot of people come in to the clinic who are like, “Hey, I have this urinary incontinence that I’m dealing with,” and not maybe fully having the language to understand, okay, there’s stress urinary incontinence, so incontinence that might be occurring involuntarily with sneezing, coughing, laughing. You might get some leakage during those activities. Jumping, exercise, there could be urge incontinence that feeling like you gotta go, you gotta go right now, and running to the toilet. Maybe not making it to the toilet in time.

Mixed incontinence. There’s even other types of incontinence. Where, you know, maybe your mobility is impaired and it, and it, you’re leaking yourself and leaking urine because it’s really challenging for you to get up from the chair and make it to the toilet in time. So understanding, you know, what kind of incontinence you have.

Looking at if you’re dealing with other pelvic floor dysfunctions, what kinds of symptoms you’re dealing with, and maybe just doing some research, whether that’s online listening to podcasts like this, you know, and, and really educating yourself so you can advocate for yourself, I think is step one. After that, I would say, really looking at if you find a product online and you’re interested in it, I think the main things that I recommend to patients would be, one, look into the research behind it.

And I think that’s something that a lot of people who are not scientists or clinicians by nature or not in the healthcare field, that’s not something we totally think about, but it is something that is important. So going to their website, maybe reaching out to their customer service and asking questions like, “Hey, have you studied how this product works for people like me?”

You know, people who are dealing with this specific type of incontinence that you’ve now educated yourself about to learn more about, and getting that information so you can, again, you may not fully have to read the paper and understand it all, but understanding, hey, this is the number of people that they looked at in their clinical study and what were the outcomes…

Can they describe that to you, I think is very important. A second piece of advice that I give people is you want to feel supported and you want to feel heard. So if you’re calling the customer service at whatever product that you’re looking at, making sure that the people that you’re talking to have the credentials to be giving you the advice that they are. So at Flyte, all our customer service are pelvic floor physical therapists, they have their doctor of physical therapy. That’s something that is important to me as a clinician. And so wherever you are calling, just making sure that they are well credentialed to be understanding what it is that you’re saying, thinking outside of the box of their product, right? If anyone tells you that their product is the cure-all, it’s great for every single person out there, you should probably put the phone down and look to another product out there. There’s never going to be a pelvic floor device or product that is right for every single person. That’s just not reasonable. We all have different medical histories; we all have different bodies, different needs, different goals, and so being able to have that conversation to understand, “is this really something that is appropriate for my situation?” And understanding that if it’s not, you know, getting that conversation going with them, can they help guide you to somewhere else?

Or is the conversation kind of constantly this, “oh this, you know, we think that this will be best for you,” without really giving you more context or information or answering your questions. I think is an important.

Bruce Kassover: That makes a lot of sense. So now tell me, you mentioned that there are three general categories of pelvic floor products that are out there.

There are biofeedback products, there are those that use electrical stimulation, and a more mechanical sort of product. Maybe you could talk a little bit more about what those different categories really entail and why they’re different, and maybe even if, if there’s a sense of which forms of incontinence some of them might be more appropriate for.

Shravya Kovela: Definitely. The first category that you mentioned, the biofeedback or Kegel trainer, what that looks like, and there’s many different types out there on the market, but essentially what that might look like, for example, is using an internal probe or wand that is inserted into the vagina that will be able to then send signals to, whether it’s an app or a monitor, to tell you if you are contracting your pelvic floor muscles and whether you’re relaxing them properly.

So essentially doing a Kegel. And that’s basically what a Kegel trainer is. It shows you what’s going on with your muscles in real time. It’s not a treatment, it’s not applying any, delivering anything like electrical signals or mechanical signals, which we’ll get into in a minute. But it’s just kind of a representation of what is going on with your muscles, whether it’s – usually by measuring the amount of pressure that’s placed on the wand or probe that’s inserted into your vagina. So that can be really helpful to give you some feedback because these muscles, they’re not on the outside of our body, and it’s tough to know what muscles on the inside of your body are doing when we can’t really see them.

That’s kind of one big category out there. The next one would be electrical stimulation. So, electrical stimulation, and either of these, they can use internal, an internal device, so it might be like a certain product that is shaped in a way where you can insert it vaginally, there are some that you can also insert anally, and that could be one way that this looks like. Another way that some companies will do it is they’ll use external electrodes. So that entails not inserting anything into the vagina, but instead maybe putting them in that area to get, capture some muscle activity. Those tend to be not as accurate because, for example, if I told you to do a Kegel and then I did a Kegel, who’s to say we’re doing the same thing? Right? If we we’re not measuring, we could be, I could be squeezing my glutes and you could be doing it properly. So having that internal device is usually more accurate, but there are different options out there.

So electrical stimulation involves the use of electrical signals, and that is a passive modality. So what I mean by that is, If we are delivering some electrical signals to a muscle group, for example, your pelvic floor muscles, what that does is it actually causes your pelvic floor muscles to contract or to squeeze without you having to do anything. This can be a weird sensation. As a pelvic PT, I’ve tried all of these different things. It can definitely be a strange situation, but what electrical stimulation is doing is it’s causing the muscles to contract and what clinicians will often use them with patients for is if, for example, someone has very little activation of their muscles. So if you are trying to do a Kegel and the muscles are not even turning on, if someone were to feel those muscles maybe in a pelvic floor assessment, they wouldn’t feel the muscle activity and that could be an indication for electrical stimulation because it’s almost like we need something to wake those muscles up, to get those muscles to be able to contract again.

The challenge with electrical stimulation is the studies don’t show great durability with it. And what I mean by that is that it’s not… the studies generally show that it’s not going to be sustainable results. People don’t see results long time, and really the biggest reason we think that might be is because again, it’s that passive modality. The electrical signals are getting the muscles to activate for you, versus you actually practicing that and learning how to do that, getting that muscle coordination, control involvement together. But electrical stimulation can be a great tool, especially for those muscles that are just not turning on at all and might need that kickstart.

The last group is something that’s very new on the market and that is what Flyte is doing, and it’s using mechanical signals or mechano-therapy. Really, really fancy word, essentially just to say the use of, like, mechanical pulses.

In this case it feels like a light vibration. And what Flyte does that uses this – it’s the only pelvic floor product that uses mechano-therapy – but the technology of mechano-therapy has actually been used for different muscle groups before, so the research is there; we are just the first ones to apply to the pelvic floor. And what that looks like is there’s an internal wand that is inserted into the vagina.

That wand is going to lightly vibrate or lightly oscillate, and it’s going to do that while telling you to perform a Kegel or a pelvic floor contraction. So while you are performing your contraction or your Kegel, the wand is lightly vibrating. It’s really gentle, it feels more comfortable than usually electrical stimulation can be kind of jarring and can be kind of painful depending on your sensitivity to it.

With mechano-therapy, it’s a light oscillation, light vibration. It’s paired with a Kegel, and then as you relax your contraction, the vibration continues throughout that. The way that this works is, the easiest way I can kind of describe it is let’s put out a scenario of you want to be able to lift things off the ground easier. Let’s say you’re moving houses and you’ve got a bunch of moving boxes and you’re like, “I know I have to be lifting heavy boxes soon. I really want to get stronger in a squat so I can be able to do this.” How might you do that? You might go to the gym or at home, start practicing some squats.

You want to make sure that your muscles are doing not only the right activity, but with the right form. You want to choose the right exercise, but also have the right form. Make sure that you’re doing the exercise correctly, using the right muscles to do so. You’re not compensating. You want to be developing strength so that you can get strong and lift the moving boxes without issue.

So that might look like you start doing just body weight and then progressively overload your muscles. Fancy way to say that you start light and then over a course of weeks you gradually increase that amount of weight so that you can get stronger. And as we do that, what happens to our muscles is we break down muscle cell tissue, which sounds scary, but that naturally does happen.

When we are strengthening our muscles, we’re breaking down our muscle tissue and our body responds to it by repairing or regenerating at a cellular level. And that is what then leads to us to become stronger and have improved muscle tone. So bringing that back to Flyte, what Flyte is doing using mechano-therapy is it’s essentially adding that progressive load to your pelvic floor muscles, so those light vibrations of the wand as you do your Kegel, it’s actually breaking down muscle cell tissue, again at a cellular level, and your body then is responding to it by causing your pelvic floor muscles to recruit better, so they’re turning on better. They are building improved muscle tone and muscle strength over time. Now, it doesn’t feel really hard for you to do it right. It doesn’t feel like you’re lifting a bunch of weight with your pelvic floor. It actually feels the same, but this is happening at a cellular level and just by incorporating this light vibration or mechanical therapy into your Kegels, we’ve actually found that that increases the impact of one key goal by 39 times. So that is very effective, and that leads us to know that using a mechano-therapy treatment for just five minutes a day is really effective. It’s not something you have to do for a really long time because it’s increasing that impact by such a huge degree, by 39 times. So there are a lot of different products out there, and as you can see, they kind of have different mechanisms of how they work.

For biofeedback trainers. Again, that’s kind of a representation of what your muscles are doing, so they’re not necessarily a treatment. So when we’re talking about, you know, what type of incontinence that might be best for, it could be useful for all of them. But what we do know from the studies is generally using biofeedback trainers or Kegel trainers without an individualized program is not going to be as effective.

So for example, If you were to see a pelvic floor physical therapist or a specialist who could then assess you and give you some guidance on how to use the Kegel trainer in a program that’s appropriate for you, then that makes sense. Right? It’s kind of like, you know, If you work with a personal trainer, you’re expecting them to give you a program that’s specific to you, meets you where you are, and builds you up appropriately.

So that’s really where the Kegel trainers can work the best when you have some very specific individualized guidance or a program for you, which not everyone does. For electrical stimulation, again, the best place where that is really going to be is where the muscle tissue or the muscles are not turning on at all.

So that’s an appropriate time to really kickstart those muscles. And there has been some good research with electrical stimulation looking at urge incontinence. So that might be somewhere where, you know, people will look at electrical stimulation for, but really we’re looking at if pelvic floor muscle strength or tone or activation is important and you have nothing going on, the muscles are not turning on, then that would be a good spot for electrical stimulation.

For mechano-therapy, the really, the research there has been specifically for stress urinary incontinence. We have some really great research looking at that. So that’s where I would say mechano-therapy can be great for incontinence. However, the research is also looking at anytime there’s really pelvic floor weakness that is driving a pelvic condition, then mechano-therapy can be a really great option there.

Bruce Kassover: Now that’s really interesting, but it does sound like it’s probably really helpful to have some assistance, a guide help you as you try and sort of explore what options might be the most successful ones for you, either a physician or like you mentioned, a physical therapist. I would imagine that you’re probably a pretty big advocate for physical therapy in conjunction with whatever method you happen to choose. Does that sound right? Also?

Shravya Kovela: Yes, I’m probably biased, but that sounds correct. And I would say exactly, I think that’s why it’s important to, you know, talk to the customer service or interact with the people behind the product, and whether it’s a pelvic PT or a urologist or a physician or someone else who has that additional training and, and can interface with you, I think is really important. At Flyte, we have an ask a physical therapy, ask a PT service. It’s totally free. And people who are interested in purchasing Flyte for their condition, they can call. We’ve had people who don’t even have incontinence and just have questions about their pelvic health and call, and we are never going to turn anyone away.

If we feel like Flyte is appropriate for them, we are more than happy to share that with them and why. There are times where we say, “you know, Flyte can be great for you, but we think that you would also benefit from seeing a provider and let’s get you set up with that.” Or sometimes we say, “you know it, we don’t think it’s the right thing for you, and we can help refer you to a pelvic PT or a physician in your area.”

So I do think that, again, I’m biased. If, in a perfect world, everyone would have access to pelvic PT, every person who is giving birth would automatically get a pelvic floor evaluation, I mean, there are so many things, right, in a perfect world that could happen, but what we need to do is be really good advocates for ourselves so that we can gain access to the right options for us because it’s great to have more resources out there, but we just need to be educated consumers.

Bruce Kassover: That makes a lot of sense. And unfortunately because it’s not a perfect world, do you have any thoughts or recommendations for people who might not have access to a PT either because they’re maybe in a more rural area where there just aren’t a lot of PTs around that they could, could interact with, or if they’re having a difficulty affording them, either insurance won’t cover it or, you know, money is just an issue. You have any thoughts on that maybe?

Shravya Kovela: Yeah, absolutely, and it’s such a, that’s such a good question because that is, common, right? I mean, the number of specialists in the pelvic health field, even the number of pelvic PTs out of all the PTs in the country is a very, very small percentage – it’s around 1% – so that’s absolutely something that can happen. And in cases like that, I think these types of resources like pelvic floor products, that’s why it’s so fabulous that we have these. I think, again, being a good advocate for yourself and interacting with. Is important so that you can really make some good decisions.

I think especially if you don’t have access to a provider or maybe it’s tough to afford, you know, additional treatment, whether sometimes people have insurance and even with insurance, the copays can be very high. There’s a lot of, unfortunately, barriers out there. That is really, I think more, even more of a reason that we should be, I don’t want to use the word “critical,” but we should be looking at what it is that we’re investing in.

Right. And understanding that, yeah, you know, using pads might seem like a good idea today, but we know that over a year you’re probably spending a lot of money on pads versus maybe investing in something that you feel more confident is right for you and is going to take care of the issue long term. So that’s definitely kind of a, a line, line to toe there.

But I would say there are some resources out there if you’re looking for a provider that can be helpful. Going to pelvicrehab.com is one that I often recommend to people. And you just type in where you live and it will give you a list of some pelvic PTs who are within your area and usually, you know, you can set kind of the distance that they are you want from your house and things like that.

It’s going to be not a comprehensive list because it’s people who have gone to the website and registered their practice, but it can be a great starting place. The other thing I encourage people to do is, virtual care is so huge these days. I think Covid launched us all into virtual and digital health, so that is absolutely an option available to many people. If you live in a rural area of the state, maybe there’s a, a pelvic PT or a provider who lives in a different city, a bigger city in your state but can still treat you virtually, and there’s a lot we can do virtually as well. So that’s, that’s definitely an option. And then thirdly, I think make use of free resources.

You all, NAFC, you guys have some amazing resources online, things like podcasts with this great education involved. We at Flyte, as I mentioned, have been an ask-a-PT program. It’s totally free. We don’t pressure you into doing anything at all. We don’t clinically treat, but you can call and we can give you some guidance and some resources that are specific to you. So I think definitely taking advantage of those free resources and education out there can be really helpful.

Bruce Kassover: Now, one other thing that I was thinking about as you were discussing all these different options that are out there and all the different types of devices that are available, is that it sounds like a lot of these are really focused on helping people do Kegels properly.

But I also understand that there are some people for whom Kegels are not really appropriate. So how would you know if you are one of those people and what other options might be out there for you if maybe a device of this nature isn’t one that makes sense.

Shravya Kovela: I love this question. This is a great question. Yes, absolutely correct. There are definitely people out there who should not be doing Kegels. So question number one was, “How can you tell if you might be in that category?” And there are a couple things that you can think about in terms of your history and your comfort that might give you some clues as to whether you have some “high pelvic floor muscle tone,” which is what we call it. So maybe some tightness of these muscles. And so, kind of, one that is easy to reflect on is if you’ve have had any pain or pelvic pain with any type of insertion or penetration vaginally. So that might look like inserting a tampon. It might look like being at the gynecology office and getting an assessment or a pap smear where they’re using a speculum, seeing, you know, if you’ve had a history of pain or discomfort there, that can be very telling. Pain with intercourse, that can definitely be telling, of having some tight pelvic floor muscles.

And again, it’s not a, “this is applicable to every single person out there,” but these are trends and common things that we see. Other things that could contribute to that is really having kind of different types of pain just in general associated with the pelvic area can be possibly be related to having some increased pelvic floor tightness or clenching of those muscles.

So that can be something. We’ll help guide you, but you’re absolutely right. Sometimes we don’t really know. I mean, you know, urinary incontinence could be contributed to by weakness of pelvic floor muscles. It could be that your pelvic floor muscles are strong, but you are just not using them properly.

And it could also be that they’re too tight and maybe not able to function properly because they are too tight. So in those cases, I think it’s important to connect with someone to get an assessment individualized or just to be able to kind of share your history. And they’ll be able to ask you some questions about, you know, have you had experience with X, Y, or Z?

And that will give some guidance as to whether you might be appropriate for their, their product. And there are absolutely some great products and companies out there that focus more on people who are dealing with pelvic floor pain or some tight pelvic floor muscles. There are things like pelvic floor wands, which I like to kind of say they’re like a foam roller for your pelvic floor. You can use those on yourself to help stretch some of these muscles. There are some vaginal dilators out there, which are tools that help stretch your pelvic floor muscles to different degrees based on what your goals are.

And so there are absolutely resources out there, and I think, kind of talking to someone who can give you some guidance with that, whether it’s, you know, a specialist in a doctor’s office or one of these free resources or just, you know, assessing yourself from maybe what we’re saying here today and then going to those websites of these products if it’s, that’s a decision that you choose to pursue, and reading more about, you know, who they might be appropriate with interacting with the people behind the company to get some guidance, looking at their credentials, making sure that they have experience in what they’re selling to you and moving forward from there can be really helpful. I’ll, I’ll also add that sometimes, let me add it this way, most of the time it’s not so black or white, right? It can be that maybe you have tighter muscles because you have been clenching without realizing it. Maybe you’re clenching your abs all day, or your glutes, or you’re holding your breath. Sometimes when we’re anxious, that can cause us to have some tighter pelvic floor muscles, just like we clench our neck or our shoulders up to our ears when we’re stressed.

Sometimes we might be doing that with our pelvic floor, so there are sometimes opportunities to work on just breathing, relaxation. There’s programs out there online that can help you with that too, which can be more accessible than maybe going into a clinic if that’s not available to you. But then you know it, and like I said, it’s not black and white.

If you get to a point where your pelvic floor muscles are more relaxed and you’re feeling confident about that, it can then be an opportunity to invest in something that is going to help you. Really be able to control these muscles properly and have good muscle function and good muscle tone and strength.

So that might be where you look at some of these other products that can help you do that from the comfort of your home or if you’re able to go into a clinic and get that assessment and that treatment there.

Bruce Kassover: That’s awesome. Now let’s talk about those people who have heard what you had to say and are thinking that Flyte might be a good product for them to consider.

I’m wondering if you could tell us how do you get it? I mean, is this something that you can go online and order? Do you have to get it through a doctor’s prescription? How can I, if I were someone who was interested, how would I be able to take advantage of that?

Shravya Kovela: Yeah, absolutely. It’s super easy. You can just go to www.Flytetherapy.com. It’s F-L-Y-T-E and you can just order it right there. You don’t need a prescription, so you can go online and simply check out if you have heard about us from your doctor or you know, anywhere else that might have a discount code. I mean, I’m all about discounts. So if you have that available to you, you can put that in and they’ll give you a code to get a discount there.

We have one with NAFC. So if you were to use all caps NAFC at checkout, you would get $25 off. So it’s really easy. You just check out online; it’s $395 and with a discount with the NAFC code, for example, you’ll get it for $370. And we have payment plans available if that number is a little too much in this month to handle, you can do it over the course of multiple months and break that payment down.

And then we also offer a performance back money guarantee, and really that’s because we really believe in what I talked about, where, you know, it’s, we have the research behind Flyte that it’s going to be really fabulous for people who it’s appropriate for and they’re going to see awesome, awesome results.

And then there are going to be people out there who may not, you know, fully benefit from Flyte. And that’s okay. That’s, that’s the nature of us being different humans and having different conditions. So if that’s the case, you know, we have our free PT service. We will reach out to you, we’ll work with you, give you tips, guidance if you would, are open to that.

You don’t have to use that, but yeah, we do have a performance back money guarantee. So if you use it and you’re using it over the course of six to 12 weeks, our research shows an average of using Flyte for five minutes a day for six weeks is going to strongly, like, hugely improve your stress urinary incontinence, improve your pelvic floor muscle strength.

But if that’s not happening for you, it’s likely that there are some other things that are going on that you might benefit from some additional or different treatment from. And so we will fully refund you and we’re not going to just let you go. We’ll, even, if you are interested in it, you can always reach out to us and we can give you some guidance and next steps to help you out, because we are all pelvic floor physical therapists who will be talking to you.

Bruce Kassover: I love hearing that and I really love the, that’s a great policy, and I also was excited to hear that your offer code, you have the NAFC offer code, because you guys are a Trusted Partner for the National Association for Continence and you know, we really appreciate that relationship.

Certainly we only recognize people as Trusted Partners who are offering products that we believe are, you know, genuinely of real clinical value and can make a real meaningful difference for people. So that’s something that we’re definitely excited to see and happy to, you know, help you get the word out about how Flyte can be beneficial to people out there.

Shravya Kovela: Absolutely. Yeah. Thank you so much.

Bruce Kassover: Shravya, thank you so much for joining us on the podcast today. Really appreciate you telling us all about Flyte and all about the range of products that are available out there, and I look forward to people exploring a little bit more about what options might be right for them.

So, so again, thank you. Really appreciate it.

Shravya Kovela: Thank you.

Bruce Kassover: Life Without Leaks has been brought to you by the National Association for Continence. Our music is Rainbows by Kevin McLeod. More information about NAFC is available online at NAFC.org.