Wellness Wednesday with Dr. Xela Oyer from The Valley Health System

Joanna from iHeartRadio in Las Vegas and Sunny 106.5 talks with Dr. Xela Oyer from The Valley Health System about pelvic health physical therapy.

Episode Transcript

(00:00):
It's well on this Wednesday, righthere on Sunnay when I was six point
five sponsored by the Valley Health System. On with me this week is doctor
Sila or You're welcome, Thank youfor having me, Thank you for being
here. Now, doctor Sheila,you are a physical therapist at the Valley
Health Specialty Hospital specializing in pelvic healthphysical therapy for females, males, and

(00:22):
non binary individuals. Now, I'vebeen hearing more and more talk and just
seeing more articles focusing on pelvic health. So it's very important and I want
to dive into this a little bitmore. First off, tell me,
really what encompasses pelvic floor health.Yes, we have. I feel like

(00:42):
with Instagram and different social media's there'sbeen a lot more traction within the pelvic
health world. Right with that.Essentially, it's a specialty of physical and
occupational therapy okay, that specializes workingwith all individuals like you just mentioned that
have any issues within the pelvis orspecifically the pelvic floor muscles, okay.

(01:03):
And so essentially it's a group ofmuscles that attaches at the front side at
our pubic bone and then wraps allthe way around back to our tailbone and
It literally acts as like kind ofa hammock within our pelvic cavity to hold
up not only our pelvic organs,but it's a huge part of our core
musculature. It supports everything from theunderside of our pelvis, and it's a

(01:26):
huge, huge player within the realmof bowel, bladder and sexual function.
And so because the urethra runs throughit, because the rectum runs through it,
because our regina runs through it,it does play a huge factor into
those functions as well. Yeah,very interesting stuff there. Now for people
getting to know more about this topic, let's talk about pelvic health therapy and

(01:49):
how does that differ from other typesof physical therapy. We can kind of
look at it a little differently thanother physical therapists because they're really just looking
externally, right, they're looking atyour you know, your hips, your
back, all those things, whichwe're also peaking at those things as well,
along with postural changes maybe where yourspine sits in alignment wise within your

(02:13):
pelvis, especially when people get pregnant, you know that SI starts to move
your sacral joint and so looking atalignment of that things like that. So
we are looking externally, but whatthere's a huge internal component, ok,
where we are checking to see howthose muscles are working internally. So usually
it's a digital exam, either transvaginallyor transrectally, depending on the client's needs,

(02:36):
and essentially we're looking for tone ofthe muscle. If someone's muscles we
touch and they're really really really tight, oftentimes that could lead to pain or
even leakage things like that because theirmuscles can't contract when they're trying to stabilize
because it's already stuck in a shortenedstate. And so these are like your
type A people you think of wherethey're just go, go go all the
time and may not even know they'reholding stress or tension with in their pelvic

(03:00):
floor muscles. So we're looking atthat, or they might have a low
resting tone where this you see alot either postpartum with lower estrogen levels or
during menopause. During with low estrogenlevels as well, you'll see kind of
these muscles feed off of estrogen,so when that starts to deplete, they
start to kind of like weaken anatrophy a little bit as well, And

(03:21):
so that person we might work onmore strengthening rather than releasing of the muscle
tissue. So we're looking at alldifferent factors along with strength, along with
endurance of this muscle. What happenswhen we sneeze or cough and what do
these muscles do. That's a verycommon thing after pregnancy, right, sneeze
and cough and now I peed myselfand I know that world very well,
so exactly, so getting that coordinationand control back of that muscle and awareness

(03:44):
and coordination is a first step.Oftentimes people walk around and they don't even
know they have a pelvic floor.Males. I always educate like, yes,
you have a pelvic floor too.So a lot of it is dealing
with the internal and external factors,kind of bringing it all into what are
you seeing in the person in frontof you holistically and how can we make

(04:05):
an impact both externally and internally.No, that's great. What are some
of the most common symptoms or issuesthat indicate someone might benefit from pelvic floor
therapy? Absolutely so, really,any urinary bell or sexual changes are the
biggest things we hone in on.But with urinary we're with excuse me urination,

(04:26):
any urinary urgency. I have somany clients like, oh my gosh,
I have to go to the bathroomright away when you get that urge
and you got to go otherwise you'releaking or it's going to be a problem.
Right any frequency if you find yourselfsearching for bathrooms everywhere you go,
or if you're on a road tripand you're like, oh my gosh,
where's the nearest bathroom? If youhave more increase in frequency, normal void
times to pee should be within twoto four hours. So if it's more

(04:49):
often than that, chances are wemight have to look at something and see
if there's something we need to address. No, that's good to know.
Now, this is a newer topicfor a lot of people. I think
listening to what does the initial assessmentfor pelvic floor therapy typically look like?
And how do you proceed with that? You know, what could a potential
new patient expect during their first visit. Yeah, so usually our first visits

(05:13):
are going to be within forty fiveminutes to an hour, and essentially I'm
just getting to know them to startoff with. So a lot of like
back and forth kind of we're doingright now of just okay, well,
what are some you know, pastmedical history that we need to address.
What are some maybe habitual changes thatthey've started to do that have maybe caused
more of their symptoms on set.Is there trauma abuse that we need to

(05:34):
delve into as well, any sortof bowel bladder sexual history. We want
to know it so then we cankind of move forward. Have they had
births? Are they vaginal c section? All of those things we want to
know prior to even getting my handson the patient. And then after that
then we're looking at more of anobjective. So like I am looking at

(05:54):
posture, I'm looking at their standingthey're sitting postures. I'm looking at you
know, their hip strength, theirhit mobility, their core strength. I'm
looking at the way the abdominal fashionis moving. Or if there's any changes
like scars that you know have beeneven years and years down the line,
those can absolutely impact the way likeeven your GI system moves, because deep

(06:15):
to those scars sit your intestines.After a C section, a lot of
times you know that bladder sits rightback behind there too, So oftentimes people
will get a lot more urinary changesbecause that bladders try and expland that it
hits a wall of scar tissue andit can't move anymore. So kind of
mobilizing those tissues can make a bigdifference in just the way things are moving

(06:36):
right inside right, And so Ialways say, you know, your scar
might look like a nice, littlepretty scar on the outside, but then
deep to that there are seven layersthat are impacted or you know, you
don't know what kind of adhesions havestarted there, So definitely that, and
then usually towards the end, thenwe're moving into an internal assessment, like
I said, either transvaginal or transdigital, just depending on the client's needs,

(06:59):
and then just assessing like how arethose muscles feeling, do we have
strength, do we have awareness ofthose muscles? What's our endurance? Like
we're do prolapse checks often, especiallyyou know with your more elderly population or
even younger population after maybe they've hadfour or five vaginal births, you know,
and now we have just a lotof pressure and decreased strength to that

(07:20):
muscle. Wow, where those organscan start to drop down. So we're
just assessing to see what is happeninghere and what can we start to address.
And then with pelvic pain patients oftentimeswe're looking at maybe the nerves as
well, how are the nerves glidingthrough that fascia or like connective tissue because
I always say nerves are divas.They hate to be compressed or attractioned or

(07:41):
pulled too much, so they lovetheir little happy zone. And so oftentimes
if the muscles or connective tissues tootight, that's going to impact over all
the way those nerves are moving too, which can lead to nerve pain or
issues like that as well. Reallyinteresting stuff. Now, can you discuss
more some of the techniques or exercisesused during pelvic floor therapy and how they

(08:03):
may contribute to a patient, youknow, receiving like an improved lifestyle after
Yeah. Absolutely, I woulds saylike the medical side of things, they're
addressing just getting you feeling better,right, or like addressing the issue at
hand, they're not really thinking aboutthe aftermath, which is where we come
in to start to give you yourquality of life back. And that's the

(08:24):
biggest impact that we can do withclients. But a lot of manual therapy
and I think that's oftentimes what's missingfor a lot of especially pelvic pain patients,
Yeah, is the hands on stuff, right, Like I can give
you all the things to go anddo home, but if I'm not putting
my hands on you really feeling whatthese tissues are. Like, it's really
really hard to get major improvements.So a lot of manual techniques like stretching,

(08:46):
like joint mobility work. How area hip moving, How is our
low back vertebrae moving? Maybe there'ssome compressions there that need to be addressed.
Like I said, scar tissue ishuge normally just on the abdominal area,
but I see it a lot withlike after women or males that have
any sort of hip replacement, Okay, that scar can make a huge impact

(09:07):
and way those hip stabilizing muscles fireand activate and so oftentimes that you know,
it can lead to years down theline some other pelvic floor issues because
now their hip isn't working appropriately.So definitely addressing scar tissue is huge,
huge, huge, and we havea lot of different ways to kind of
address that my own fashion work.So I was kind of talking about connective
tissues. So it's essentially a layerof connective tissue on top of all of

(09:31):
our bones, ligaments, tendons,muscles that essentially holds us together. And
so with that, again, withany scars or any like imbalances of the
way the muscles are it's going toimpact the way that connective tissue moves as
well, and so that's a hugearea that we can start to impact the
way the muscles and ligaments tendons functionunderneath that layer. So that's a really

(09:52):
great way to start to get likeI said, especially anyone with pelvic pain.
That's one of the biggest things I'vefound that can really make a huge
difference the quality of life. Wemay not be able, for example,
endometriosis. Yeah, we're not ableto impact whether those lesions are there or
not. Right, they're going tobe there, and you know, obviously
the medical side of things, there'sthings that they can do to kind of
eventually remove those, but it's tome, it's like we can impact the

(10:15):
muscle and the fascia to help atleast when they do have those periods to
be a lot more manageable with theirpure right and so we may not address
the actual issue, but at leastwe can get them feeling to the point
where they can live their life againand exactly have a better quality of life.
I mean, as we're talking hereand you know some of the things
that you mentioned, you know,I'm a sea section mom and myself,
and I've never felt the same senseexactly, but I wouldn't even know where

(10:39):
to start or not even have knownabout this after, you know, until
learning about this, And I thinksomebody like me could benefit from pelic health
physical therapy. Absolutely. I alwayssay, really, anyone that has had
like a sea section or any sortof grade two to grade four terror during
a vagual birth shows get a consultationright from a peblic health therapist because so

(11:01):
often they aren't even told about scartissue work, no things like that.
And now here we are ten yearslater and I have ladies that are like,
oh, it's always been numb throughthat I've never had sensation back.
I'm like, this is not okay, ye, So yeah, that's me
exactly. So you know, it'sdefinitely one of those things that I feel
like we as females are just like, Okay, Grenn and Barrett, we

(11:22):
just deal with it. It's movingon right. But it's absolutely some things
that can be super helpful, andI feel like if people don't address it
right away, it can manifest intoissues down the line. That's a great
reminder. Now, are there anycommon misconceptions about pelvic floor therapy? That
you want to mention and then howdo you address those things with your patients.

(11:43):
Yeah, so some common misconceptions arethat if you have a c section,
your pelvic floor is not involved ordoesn't have a dysfunction. And so
that is one that I see alot of times. But I always say,
you know, you have nine monthsof pressure on these muscles, right,
and like decrease course strength after aC section. So they I have
a lot of women that again yearslater may not have even felt their muscles

(12:05):
activate again, right because of thattension through those areas, and so getting
them to activate their core again buildingthe strength back up there, because if
the strength isn't in the abdominal region, it's going to push pressure through that
pelvis and it can lead to pelvicfloor issues down the line, because if
something else is weaker within that pelviccavity, the pelvic floor has to make

(12:26):
up for it, and it sometimeshas to hold on for dear life until
we gain strength and kind of addressthose imbalances within the pelvis. So that's
a big one I see a lot. Another one is all we do is
kegels. So that is definitely amyth. Like I said, it just
depends on the client. So evenif I have a postpartum client, I

(12:46):
may just have them just keegling forthe first few weeks just to get the
baring muscle connection back and you knowexactly, and then after that we're working
more on functional strengthening and getting themback to like, how are we lifting
baby, how are we lifting carci? What are some things that we can
maybe tweak or address there that's goingto help them not continue to repeat these

(13:07):
patterns. Okay, so that's youknow, it's important to get that brain
muscle connection back, but we alsowant to then take it and make it
functional for the patient and like howdoes it impact their daily life? Oftentimes
with pelvic pain patients, it's nota again a weakness issue, it's more
of a tightness issue, and sowith those patients we might be doing what

(13:31):
we call reverse kegels, where we'reactually focusing on the release and the relaxation
of the muscles the contraction of themuscles. So and then usually then we
can start to release the muscle,then we can start to strengthen within a
more full range of motion of themuscle, and we're not going to get
those pain effects as frequent. Wow, so yeah, some interesting stuff.
I know I'm going to be bookingmy appointment to get evaluated and really to

(13:54):
focus more on pelvic floor health.I'm glad we're talking about it today,
and thank you doctor share Oil forcoming on and discussing more. I think
the more people start talking about pelvicfloor health, you know, the less
embarrassed they may feel. Right importantthing for sure. Totally agree. Thank
you for being on a Wellness Wednesday. Thank you for having me. I

(14:15):
appreciate it. Hear more interviews withdoctors from the Valley Health System at Sunny
one of sixty five dot com searchWellness Wednesday