It Takes a Village: A Multidisciplinary Approach to Pelvic Health
By Rebecca Slape
Pelvic Health Physical Therapist
I’m sure many of you have already tried several methods to address your pelvic floor concerns. You may have started with your primary care provider, been sent to a specialist (urologist or gastroenterologist), trialed several medications or procedures, tried pelvic floor physical therapy, chiropractic, acupuncture, or massage, and are on the cusp of giving up.
While you have seen a variety of practitioners, you’ve seen them all serially – one after another. Many disciplines have been involved in your care, but in their own silos, not able to touch on the work of the other. For some of you, that might work, but for those of you with complex, chronic or multifactorial cases, it simply doesn’t add up to recovery.
Some examples I’ve heard from my patients:
- I was working with a pelvic floor physical therapist for pelvic floor dysfunction and saw a lot of improvement, until I had a bad IBS flare up and went right back to baseline. Frustrated, I gave up on pelvic physical therapy and went back to my gastroenterologist.
- I tried PT before and got a few days of pain relief from manual therapy each session, but returned to baseline between each session. So I tried acupuncture and got a few days of pain relief, but returned to baseline after each session. So I tried massage….and so on.
So what would a multidisciplinary approach look like?
In the example of my patient with IBS and pelvic floor dysfunction, a truly multidisciplinary approach would have them doing pelvic floor physical therapy to improve coordination, range of motion and strength of their pelvic floor. They would also be working with a dietitian to address IBS trigger foods, and making sure they were getting adequate nutrition. A mental health therapist would help them identify stressors and improve their ability to manage the demands of their daily life.
For the patient with chronic pelvic pain who only got a few days of relief at a time, they might do pelvic floor physical therapy Mondays, acupuncture Thursdays, and go for a massage Saturdays in order to bring their pain level down long enough to make headway with their mental health therapist for stress reduction, mindfulness training, etc. They might also work with a yoga instructor/therapist to integrate mindfulness into movement, expand their experience of pain-free movement and improve their exercise resiliency.
In the multidisciplinary approach, patients are seeing these healthcare professionals simultaneously so they can build upon the work being done by the others. If permitted by the patient, they can even discuss their case together in order to better serve their needs, transforming the multidisciplinary into the interdisciplinary.
Why would someone not take this approach?
Working with multiple practitioners simultaneously does require considerable time, effort and motivation on the part of the person seeking care. It can also be a financial burden as copays for specialists can be quite high, and many allied healthcare professionals are not covered by insurance at all. However, insurance coverage for acupuncture and massage has expanded in recent years. Additionally, there are often wellness programs for nutrition, yoga, mental health and support groups offered by insurance plans. You can also ask your primary care provider if they know of any low cost or free resources available in your area or online. Mental health care, in particular, has been identified as essential to improving outcomes in endometriosis, as well as other disorders affecting the pelvic floor.
I have the great fortune of working within a multidisciplinary space at Rose City Sexual Health Collective. I’ve collaborated with Certified Sex Coach Kristine D’Angelo on helping a mutual client with primary anorgasmia, and with Certified Sex Therapist Alana Ogilvie to help a patient overcome pelvic floor dysfunction. These patients and many more have benefited from having multiple providers working with them on the same issue at the same time, but from different perspectives.
It’s nothing radical, but this shift toward collaborative care can make the difference between just improving your condition and embracing wellness.
If this approach interests you and you’d like to learn more, my colleagues and I are offering a 3 hour workshop, Overcoming Pelvic Pain Holistically, on Apr 22 from 1-4p available to attend in-person in Portland, Oregon or virtually from the comfort of your own home.
Click here to learn more!
Dr. Rebecca Slape is a licensed Physical Therapist specializing in pelvic health. She works with adults of all genders and body types to maximize well-being and give her patients the tools they need for ongoing self-management.