Interview with Sarah Haag Pelvic Health PT: Private Parts and Water Works

Since I am the naked physio I thought it was about time that I would bare all…….. on a topic that can be pretty sensitive for some people – Pelvic Health. I had the absolute pleasure (it was titillating) of interviewing the lovely Sarah Haag a Pelvic Health Physical Therapist (that’s physiotherapist for the rest of us :-p) based in Chicago in the United States. Sarah has been practicing for well over 10 years as a Pelvic Health PT. So without further ado let’s get into talking private parts and water works.

TNP: Hi Sarah, thanks for joining me on this beautiful day, I can hear and see the birds and the bees singing and courting! How very appropriate as we are discussing Pelvic Health. Have you had much experience with the birds and the bees?

SH: (laughs) A girl never tells!

TNP: (laughs) Ok fair enough let’s get onto more serious chat. You are a Pelvic Health PT can you tell me a little more about why you became one?

SH: Sure, I have my gran to thank for that. I come from a family that has a medical background, my Mum is a nurse and my Dad works in the bio-med department in the hospital so I grew up around medicine. I didn’t want to be a doctor or a nurse, so my gran suggested a Physical Therapist. I got really lucky falling into a profession I love and Pelvic Health came along after. I joined a practice that introduced an education programme about Pelvic Health. After my first class I thought this is amazing! In physical Therapy school they seemed to skip past the pelvic region, so I saw an opportunity to work with people who find pelvic health difficult to talk about and that they didn’t realise they could get help for Pelvic Health issues. I mean c’mon how awesome is my job I get to help people to pee, poop and have sex! That’s awesome right?!

TNP: (awkward shift on seat) yeah sounds awesome! (big thumbs up!) Having never had Pelvic Health issues I can understand how it would be a big deal for both Men and Women.

TNP: Talking of Men, Are their lots of men in your life or just one?

SH: (laughs) Well there is only one man in my life, but clinically I have lots of men in my life!

TNP: Of course…… clinically….. yes…….What sub groups do you see?

SH: Well I see a lot of men pre and post prostatectomy, so once the prostate has been removed sexual function is a big problem but probably more concerning is the urinary incontinence and I have found that most men are willing to do almost anything to stop peeing their pants.  So men are really interested in anything what they can do to minimise it, prevent it, make it better all those things. Actually…… and this is a clinical observation……… Men will tend to overdo an exercise rather than the suggested amount because well if you do it 20 times and that makes it good then doing it 72,000 times is gonna make it a whole lot better.

TNP: So exercises do you like get men to drape towels on their penises?

SH: (laughs) No I don’t but there is a new thing called private gym, I’ve not found a gent willing to try it out for me, shall I send it to you? I assumed you are a bit of a naturist being the naked physio?

TNP: There is something very liberating about being naked Darn that Eve taking the apple off the tree! Sure send the private gym and I’ll trial it for you I could be the figurehead of entropy-physio.com

SH: Seriously though when it comes to incontinence in men following prostatectomy they can suffer with a lot of pain and are desperate to get it sorted. However like doing any muscle exercise overdoing it will cause muscle soreness so we are very mindful about education and emphasis on goals.

TNP: Awesome Sarah, it sounds like it’s just as big a deal for guys as it girls. It seems you see an even number of men and women. So let’s talk about women, a forward question but being a Pelvic Health PT do you just look at Vaginas all day?

SH: (laughs) Hmmm actually I don’t, It’s kinda funny, I get so many people who have had so many examinations where nothing has been found as a cause of their pelvic health issue, so I will get people coming in where we don’t work on their pelvic floor for the first few sessions so I can literally go for weeks and not see a vagina, unless of course it’s my own… then….thats kind of on a regular basis. Actually I’m seeing more men than women at the moment and tend to look at bums.

TNP: So what about hair? do you have a problem with hair? Do you get guys to shave their butts?

SH: I don’t judge, and I don’t make people self-conscious about anything.

TNP: That is a very professional answer.

TNP: I feel that you will answer this next question professionally, will sex ever not hurt?

SH: The answer to that is yes, it’s absolutely possible, it’s a matter of identifying why it’s hurting? Is it a tissue issue, is it a compatibility issue, or is it something that can’t be addressed with pelvic PT?

TNP: Isn’t Pelvic Health PT just kegel exercises and what’s the deal behind stopping yourself through mid-flow?

SH: Yeah that’s a really good question, First though Pelvic Health PT is not just about kegel, it is important but there are many other factors that feed into why we may have issues with incontinence or sexual dysfunction. So it’s important that you inform your Pelvic Health PT of other non-associated issues. As for stopping yourself mid-flow the jury is kind of out on that there are other schools of thought and some recent twitter conversations about the whole stopping mid-flow thing.  So i’ll tell you my thoughts on it. If you practice stopping the flow of urine, it won’t kill you so it’s perfectly OK to try stopping the flow of urine and see if you’re ‘getting it right’. However practicing it this way all of the time can disrupt the normal reflex activity we need to urinate. Normal Micturition Reflex, which is a complex reflex so I won’t go into the neurophysiology of it, but the short version is the bladder stays relaxed as it fills, sphincters including the external urinary sphincter turn on with a pelvic floor muscle contraction so are activated to help you stay continent. The bladder fills up which is normally between 300-500 mL in healthy adults and you’ll then get a signal that it’s time to empty, giving you time to get to an appropriate place. The sphincters relax – the detrusor, which is your bladder muscle contracts emptying your bladder.  The all important word – TEAMWORK!!

We often use pelvic floor contraction to decrease bladder contractions that are a little over eager.  (see my video here.)  CynicalPT says the production is crap, but it gets the point across.

TNP: Woah I think that got the point across thank you so much I feel invigorated and reassured that my pelvic floor is in safe hands.

SH: These are very skilled hands and incredibly gentle so yes if you do need any help you know who to ask!

Thanks very much to Sarah Haag for a very entertaining and informative interview.  Sarah has said that if you have any questions you want to ask her  concerns you may have about your private parts or water works you can contact her or her colleague at Sarah@entropy-physio.com or Sandy@entropy-physio.com

Thanks for having a read, please leave a comment or comment on twitter or contact Sarah Haag direct.

TNP