017: Why Kegels Don’t Work

Resources

• How to do a kegel
• All About The Pelvic Floor
• NAFC’s 6-Week Pelvic Floor Health Program
  
  

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 today is Steve Gregg, the Executive Director of the NAFC. Welcome, Steve. 

Steve Gregg: Thank you Bruce. Great to be here. Looking forward to talking to Melissa and learning more about how she can help those with pelvic floor issues and hopefully stop leaking.

Bruce Kassover: Yeah, she’s going to be a really insightful guest for us. It’s Melissa Nassaney. She’s a pelvic health physical therapist, the founder and owner of Full Circle Pelvic Health in Warwick, Rhode Island, and she’s really a specialist in treating both women and men who have incontinence issues through the use of physical therapy. So, welcome, Melissa. Thank you for joining us today. 

Melissa Nassaney: Thank you, Bruce. It’s great to be here.

Bruce Kassover: Excellent. So maybe you could tell us a little bit about how you got into physical therapy. 

Melissa Nassaney: Sure. I’m, I’m happy to do that. I originally started out as a physical therapist’s assistant. I really loved exercise and working with patients or clients who wanted to get back to their optimal activity levels and just get back to doing the fun things they want do in life.

And I did that for several years, but then I was really interested to the point where I wanted to have more understanding of the diagnostic aspect of physical therapy and I went back to school and I became a physical therapist a few years later, which was really exciting. And during that time we got to learn a lot about neurology, orthopedics, but we did have a special guest that came in and talked about pelvic floor physical therapy and women’s health particularly. So this was something really new to me. I’ve never heard of this area of practice before in physical therapy. And they touched on a lot of topics that I thought were definitely aligned with what I was doing in my before physical therapy… I was an exercise specialist, I was training women and working in environments where I was talking about their health and how to get stronger and this just seemed to just click for me. A lot of the topics talked about urinary incontinence recovery during pregnancy and postpartum, and those were just things that I was like, why didn’t I know about this earlier?

Bruce Kassover: And I imagine if, if you didn’t know about it earlier that a lot of your patients probably had no idea that physical therapy could be a benefit to them either. Right? 

Melissa Nassaney: That is so true. So a lot of times a patient will come in and, you know, the first thing that that they say to me is, “I never even knew this existed. I’m not sure if this is the right thing for me…”

And so, you know, right off the bat, we really need to kind of find out, you know, where they are at that moment, you know, what brought them here and what is the, the areas of interest that they’re really needing to work on. Sometimes they’re not even sure; they say, you know, “my doctor just sent me here because I’m leaking and I don’t, I’ve done keels before. They don’t seem to work.” So it’s can be a little bit of a challenge to kind of pull that patient over to the pelvic health side. They’re pretty excited about knowing all the aspects that we do cover, it’s because it’s not just about keels and then they find out, you know, it’s really about their goals and then they’re really excited to participate.

Bruce Kassover: You know, that brings up a good question. I was just going ask you if, is it really all about keels or. Is it something more than that? I did see, I was looking on your Twitter feed and I saw that you had shared an article that you said had a surprising title. It was called “Why Kegels Don’t Work.”

And I’m wondering if you want to give us an idea of what sort of, well, first of all, why Kegels do or don’t work. Do they really work and, you know, what’s the sort of breadth of different sorts of exercises and therapies that you do beyond those? 

Melissa Nassaney: Yeah, sure. So when we evaluate a person, we do, if they can perform that pelvic floor muscle contraction, can they do that Kegel? So it is an important part of our assessment, but it’s not always our go-to approach. So, for instance, if somebody has overactive bladder, it might be because their pelvic floor muscles are too active, they’re hyperactive, and we actually have to teach them what the Kegel feels like to let go of that Kegel or to relax that pelvic floor.

And then for other people, you know, if they just can’t isolate the pelvic floor muscles and they’re really having a challenging time contracting the muscles, then we do start there, and then the Kegel, you know, is one part of the exercise program that’s appropriate. But then, you know, the Kegels are your pelvic floor muscles. The Kegel is the actual exercise name, but it’s, what it is, is contracting the pelvic floor muscles. So the pelvic floor muscles, I always tell my patients they are, they work with the core. They are part of the core. So when you’re doing Kegels, you’re activating a part of your core. And a lot of times people aren’t aware that it’s considered a part of the core.

Bruce Kassover: And are they as hard to do as you sometimes hear people say? 

Melissa Nassaney: Yes, they can be really difficult. I actually think they can be difficult the way I teach them too, because I’m really asking the patient to be mindful of feeling that contraction and then being aware of feeling that complete relaxation, or we call it the reverse Kegel. So the thing I do hear a lot of times when we’re doing some exercises is like, wow, I really have to focus. 

Bruce Kassover: So Melissa, is this all really focused on women or do you treat men as well? 

Melissa Nassaney: That’s a great question. I am excited to be able to say yes. I do treat men as well as women, and they absolutely need pelvic floor physical therapy.

And they really, they really get excited about knowing that they have the ability to work on their pelvic floor issues. And a lot of times I see, I do see men who are post prostatectomy. And then I also see men with male pelvic pain. Both of those areas of practice are very specific and they actually present differently than women.

Bruce Kassover: You know. That does make me think though, is that speaking as a man, it is a pretty sensitive topic. Do you have a lot of people who are, who come to you reluctantly or who you have some difficulty getting them to open up and be frank and honest about what issues they’re dealing with? 

Melissa Nassaney: Yeah, well you would, you would actually think that, but when I’ll get a male patient, they really want to take charge of getting themselves better.

So whether it’s incontinence, they, you know, they are very good at doing the exercises, noticing the difference, they make very strong commitments to their health and wellbeing, particularly with male pelvic pain, they are also very, very much a, active participant in their, their care, and they do do well, and they do well quickly.

So it’s always a, it’s always a good thing because they are definitely hesitant at first, but excited too. Because they’re like, “I’ll do whatever it takes.”

Bruce Kassover: Now I’m, I’m getting a sense of, maybe I’m just reading into things that, from the way you answered, that there may be a difference between the emotional component that men and women bring to you.

Do you find that women maybe have a different type of reluctance or have more reluctance than men? Or is there, is there some sort of a an emotional component that you see from women who you treat? 

Melissa Nassaney: Yeah, so a lot of times, when women are coming to physical therapy, unfortunately sometimes it’s like the last ditch effort.

They’ve seen a lot of other physicians first and then still really haven’t gotten resolution of their symptoms or, or maybe, you know, their situation has been prolonged for so long. They kind of feel, I don’t want, I hate to say the word hopeless, but they feel like, well, this is not going to work. You know, I’m not sure if this is going to do what I need it to do.

So yeah, we always have to try to work on getting that initial buy-in, unfortunately. But again, you know, I try to bring it right back to, you know, this is your anatomy. This is, this is what’s happened. Here are the changes that are going on, and these are the things we can do to work on improving that. And then, you know, they start to see the light, you know, and then, I also try to make sure that they know that, you know, you don’t have to carve out dedicated time to do the things we’re talking about. It’s things that you can just add into normal areas of your daily routine. And I think they feel relieved because a lot of times they feel like they’re already stretched thin on their day-to-day life and duties and to add one more thing can be overwhelming for a lot of women. 

Bruce Kassover: So I guess when you say you’re a physical therapist there, there’s a little bit of a therapist-therapist in there as well. 

Melissa Nassaney: There is, yes. Bruce, that’s a good point, yeah.

Bruce Kassover: So with that being said, what sort of results do you expect to see if people are really diligent about following your direction?

Melissa Nassaney: So they can get really good results. And a lot of times patients will come and they’ll say like, “I didn’t really follow through and I’m still leaking,” but the big thing is that they know when they do do it and they are, they do stay on task, that they see an immediate improvement. So It’s always helpful and it does help keep pulling them back to doing the exercises.

The folks that are very faithful in doing the exercises, they can sometimes see improvement within the, in the same week, you know, and it depends on what aspect we’re treating at the, at the moment, you know, endurance versus strength. So both of those components can take a long time to see some changes, but generally speaking, when it’s behavioral techniques, they can implement those techniques right away. One of them is like an urge suppression technique where they try to remain calm when they feel like their bladder is screaming at them to go to the bathroom. So they, there’s a technique where you just try to stay calm. You do some Kegels, you take a deep breath, you try to distract the brain a little bit, you try to just let the, the nervous system go through it’s 911 panic mode, but you’re just staying calm and they realize, well, wow, I didn’t really need to go to the bathroom. So again, it can be an improvement immediately or it can take a few months. 

Bruce Kassover: So if I’m listening to this and I hear, wow, there can be some, some improvements, some noticeable improvement on a pretty quick scale… I know I’ve been having issues with urgency, with leaks, you know, some of the sorts of incontinence challenges that people listening to this might be facing, what should my next steps be? Should I just, you know, open up the yellow pages? Well, I guess yellow pages don’t exist anymore. Should I go onto the internet? Just find a physical therapist, give them a call? Should I make an appointment with a physician? How do I go about exploring whether physical therapy makes sense for me? 

Melissa Nassaney: Yeah, that’s a great question. So we would hope that people would ask their primary care provider, you know, about pelvic floor physical therapy.

However, if they’re not getting enough information from that, then the internet is a good resource to understanding what pelvic floor is and what it has to offer. Even, you know, your website, the National Association for Continence, is an amazing resource for providers and potential clients and just patients, people who are seeking more information. And then, once you kind of get an idea of what pelvic floor physical therapy is and how it relates to your particular issues, it is good to maybe even ask around your friends, because believe it or not, one in four women have pelvic floor issues.

And so there’s a good chance that somebody who know has already been to a physical therapist. 

Steve Gregg: Melissa, we hear a lot of patients tell us that they struggle getting to somebody who is qualified on the physician side, but when a patient goes in and talks to their physician, most likely their primary care, is there anything they can do to accelerate getting to a physical therapist like you or encouraging them to refer? How do we make sure that process is as easy as possible? 

Melissa Nassaney: Yeah, that’s a great question, Steven. My ultimate goal would have everybody be able to be screened by their primary care physician for pelvic floor disorders so it can be addressed right away. But if that’s not the case, it’s really important for the patient to bring it up to the physician, you know, in the sense that, “you know, this is, this leakage is really starting to affect my activities of daily living. I’m not able to exercise. I’m nervous about going out in public places because I’m afraid I’m going to leak.” There’s definitely a fear factor when it comes to having issues with incontinence and, you know, this isn’t even just bladder incontinence. It’s, you know, fecal incontinence as well. So it’s, it can really stigmatize a person and hold them back on living their best life. So it’s important that patients have that discussion with their physician. And then, you know, I think what it does is, it teaches the physician that, you know, I should be asking this of my patients more often because if it’s impacting this person, it’s got to be impacting others.

And then that can start to roll the ball on, you know, the physicians seeking out pelvic floor physical therapists in their area that they’re aware of or specializing in this area of practice. And then they can have that nice network of a referral source to help assist patients get to the care that they need to work on their incontinence and other pelvic floor issues.

Bruce Kassover: You know, that brings up a question about the practicalities. Is physical therapy usually, sometimes, never covered by insurance, either private insurance or Medicare, Medicaid, things of that nature? 

Melissa Nassaney: Yeah, so because pelvic floor physical therapy is physical therapy, a lot of times it is covered. So I can’t speak to the exact percentage because you know, different areas of the country have different payers and so, you know there could be issues in some areas, but I know here in the Northeast it is covered and very well promoted. 

Bruce Kassover: Very good. Now, one other thing I wanted to thank you for, you mentioned the National Association for Continence’s website at NAFC.org, and one thing that we always recommend to people who are starting to explore the symptoms that they’re experiencing, who are looking for potential treatments, is to visit the pelvic floor health center at NAFC.org. And I know that you were heavily involved with the creation of that. And I’m wondering if you could talk a little bit about what your goals were when you helped put together the information that’s on the site and you know, what you hope that women can get out of that.

Melissa Nassaney: I was really excited to be able to participate in that area of the website. My, my biggest thing was I wanted to, and I know this is a bigger scale, but I want people to be able to look up the information and feel comfortable reading the information. So I wanted it to be present in basic terms, but also very thorough.

I think that’s the thing. A lot of times when we just randomly look up, you know, pelvic floor physical therapy or treatment for incontinence, you’re just getting a script written. The Pelvic Health Center has exercises. It has really good information about specific diagnoses. And then it gives you other options that are not related to pelvic health, physical therapy. There’s other ways of managing incontinence. And so it’s a really robust center to really kind of just tap into a bunch of different pieces of information, because a lot of times if we think that, you know, oh, I’m leaking, that’s my only pelvic floor issue. But then they start reading and they realize, oh wow, maybe I’m going into the bathroom way too much, you know?

And so they realize, oh, maybe I have overactive bladder. And they start to read about that and then read about, you know, what, what are some causes for that? And so that kind of gives them a little insight. And when they do learn about that, it might intrigue them to go ahead and seek out a physical therapist in their area, but then they’re already a little bit prepared for that first session, which is nice because it just brings the, the nervous factor down a little bit.

Bruce Kassover: Thank you. I appreciate… all of us at NAFC really appreciate all of the input you had and your help shaping that. And we do hope it’s a great resource and anybody who’s interested in exploring it can find it a NAFC.org.

So thank you, Melissa. I really appreciate you spending the time helping us get a better understanding of physical therapy and the role that it can play for those who are experiencing symptoms of incontinence. And thank you for joining us today.

Melissa Nassaney: Thank you, Bruce. This was wonderful. Have a wonderful rest of your day.

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.