Improving pelvic health in Veterans

For instance, trouble with bladder control, bowel control, or sexual dysfunction can be sensitive topics in the lives of those who experience such symptoms which, unfortunately, tend to be common and very inconvenient. According to research on pelvic floor dysfunction (PFD)1, approximately 50 percent of childbearing women and 16 percent of men have been identified as having PFD. With the number of people identified with PFD in the US growing, learning about pelvic health and pelvic floor physical therapy has become all-the-more important.

Pelvic floor physical therapy, or pelvic floor rehabilitation, is a lesser-known treatment option available to Veterans eligible for VA health care at the Cincinnati VA Medical Center (VAMC). Physical therapists specialized in pelvic floor rehab evaluate and treat conditions resulting from strained, weakened, tense, or painful pelvic muscles, in addition to educating Veterans on self-care and exercises that can be done at home.

According to Allison McKay, Cincinnati VAMC Rehabilitation Care Line physical therapist, Veterans experiencing three or more of the following symptoms or conditions could have PFD:

• Pelvic pain (in genitals, perineum, pubic, or bladder area)
• Pain with urination
• History of injury to the pelvic area
• Accidental loss of urine
• Feeling unable to completely empty bladder
• Difficulty starting or frequent stopping/starting of urine stream
• Often or occasionally needing to urinate two or more times at night
• Increased pelvic pressure or the sensation of pelvic organs slipping down or falling out
• History of lower back pain, hip pain, tailbone pain or sciatica
• Loss of bowel control
• Feeling unable to completely empty bowels
• Straining or pain with a bowel movement
• Difficulty initiating a bowel movement
• Pain or discomfort with sexual activity or intercourse
• One or more symptoms exacerbated by sexual activity
• Erectile dysfunction
• One or more symptoms increased by prolonged sitting

There are a multitude of reasons for why people experience PFD, including aging, childbirth, illness, surgery, and sexual trauma. The good news is there's likely a solution to ease symptoms by receiving help from a pelvic floor physical therapist.

Veterans interested in participating in pelvic floor rehab can expect to have an initial conversation on VA Video Connect or in-person with either McKay or Courtney Kindler, Cincinnati VAMC Rehabilitation Care Line physical therapist, to discuss medical history, the symptoms they're experiencing, and treatment options. 

"The pelvic region houses some of the most intimate parts of our bodies, so it's important for me to ensure our Veterans feel comfortable with discussing their symptoms," McKay said. "While we can meet with Veterans in-person for our initial conversation, I like starting with a video call for Veterans who aren't as comfortable because it offers a boundary that can put them more at ease and increase their willingness to discuss their health concerns."

For some Veterans it may be necessary to complete a physical examination that includes an internal pelvic exam to assess for weak or tense muscles and lack of coordination; however, there are alternatives to the internal exam for those who have a preference, McKay added. 

Once McKay or Kindler determine an appropriate treatment plan, Veterans can expect to continue physical therapy sessions at the main campus, the Dearborn Community-Based Outpatient Clinic, or over video call. Treatments can include muscle strengthening, relaxation, or coordination exercises and electromyography biofeedback. Since pelvic health encompasses the muscles that control the bladder and bowels, it may be necessary to involve a nutritionist who can educate Veterans about healthy eating habits as another tool to relieve symptoms of PFD.

"Sometimes when pelvic floor dysfunction is associated with sexual trauma, we'll offer Veterans the opportunity to speak with a peer support specialist, which is another Veteran who is equipped to help patients navigate other services available to them, like mental health, or just be a shoulder to lean on," McKay said. "We're a team at the VA and our primary goal is to ensure Veterans receive the care they need and deserve."

For more information about pelvic floor physical therapy at the Cincinnati VAMC, call 513-861-3100 ext. 206546 or contact your primary care provider.

[1] Grimes, W. R. & Stratton, M., Pelvic Floor Dysfunction (2021): https://www.ncbi.nlm.nih.gov/books/NBK559246/