Teaching Your Patients About Pelvic Health

Welcome to Pelly biz podcast. I'm Dr. Kelly Alhui. I've grown my pelvic health practice, orthopelvic physical therapy, and now I'm helping pelvic health professionals do the same. Each week I give you the knowledge you need to grow your practice. Let's get into today's episode. The pelvis podcast is sponsored by Jane, an all in one practice management software that offers intuitive features like booking, charting and billing. To help run your practice, use the code puffybizonemo at Jane App Start to receive a one month period applied to your new Jane account. Today we're going to talk about how to educate your patients on their pelvis and what tools that I like to use to help with that. So let's get into it. Number one, I use a dog toy. For real? I use a dog toy. It's this coffee cup and it has three donuts in it. Thanks, Lulu. She's always helping me out. So these donuts is just. It's literally a donut and it's made of felt and it's a great hole. It has a great hole in the middle of the donut. Okay. And I wrote on her donut, on one side of the donut, it was yellow. That was the back side of it. Okay. The clock. I wrote 12 o', clock, 1 o', clock, 2 o', clock, 3 o', clock, 4 o', clock, 5 o', clock, 6 o', clock, 7 o', clock, 8 o', clock, 9 o', clock, 10 o', clock, 11 o', clock, and then 12 o'. Clock. Okay. And what I like to do is make videos in my bathtub. So I go to my bathtub, I'm able to rest my knees against the tub. Okay. So no one has to hold their legs up so they can actually relax their legs. I put a makeup mirror in front of me and meanwhile, I have my husband filming me making this video. And yes, I'm clothed, okay? But making this video. And I have the donut, like, right at my vag. I'm holding the donut at my vag. And so people can see that this is the setup that if they're, you know, have never looked down there, that they can actually have a great visual of what they need to be doing at home to understand their anatomy. And I don't go into the boring detail of like, this is the bulbo cavernosus or the ischio cav. Like, I don't say the specific muscles. We talk about it and break it down in third grade terms. And that this is part of the clock that we know at 12 o'. Clock. Let's just avoid that because that is your bladder and if you touch it, you're probably gonna have to go pee. It's okay if you touch it, but just know we're gonna stay away from 12 o' clock and you're just gonna go to 11 o' clock first. So I always start around 11 o'. Clock. You can use your finger, you can use a wand. Whatever you are comfortable with, you can have your partner do it. If you are not comfortable, you know, touching down there, that's cool. And then I just say, look, there's three different layers. The first layer of your knuckle is the first layer. The second layer of your other knuckle is the second layer. And then the third, that's the deepest layer. You can educate easily that way. And. Or you can take the wand, show them the wand and say, this much is typically the first layer, this much is the second layer. And where the hook is of the wand, that is the third layer typically of your pelvic floor. Okay. And you can educate them. And this is how you do telehealth. Guys, people are really like, like, I can't do telehealth. Like, I really need to put my fingers on them. You don't. You actually don't. You can just do lots of this education and have an amazing videos that shows them like you're there doing it with them on what they need to be doing to know their pelvic floor. Then what I like to do, besides explaining the clock, the different layers of I then educate them on. Okay, Sally, if you are someone that has pain with intercourse at insertion, then you just use the first knuckle of your finger and gently pull down at 6 o' clock and maybe even before that, you're taking the tissue externally and you're pulling at that tissue externally where the perineal body is. And right at that six o', clock, seven and four o' clock area, you, you're going to stay externally and pull at that because that's going to help with that burning. In addition, we may need a little education about where hormones are at or, you know, just what's, what's happening with that. That may be an indication that there may be some hormonal issues as well going on. So again, it's lots of education. Now once I do that, then I'll say, if you need to get deeper, then you're going to use, you know, this, and these are the bowls that this is the bowl that actually holds up your bladder, uterus, and rectum. Now take your two fingers, and I want you to find your pubic bone. And I show them in the video what the pubic bone is. Now go right above that where it's squishy. Okay, now that's your bladder. You just touched your bladder externally. Oh, okay, so that's my bladder. Okay, now I want you to take your index finger and your middle finger and put them together, and I want you to kind of make a C shape. Okay, so you guys do this. If you're listening to me, can you now cup, like, make a C out of those two fingers? If you're sitting or standing. If you're standing, prop one leg out to the side. Take your two fingers and hook on the inside part of your sit bone. So I have them feel their sit bones, and then I have them touch externally their pelvic floor. Now, from here, I have them inhale and exhale, and I ask them, can they feel anything moving? So can they feel anything moving? They're like, oh, I don't know. I can't feel anything. Okay, all right, well, then more than likely, you have some pelvic floor issues and some pelvic floor dysfunction going on. So that means that we got to continue to make the pelvic floor relaxed. Now, they still can't feel that, and they're comfortable with this. I tell them to place one finger, their index finger, on. On their anus, and then I want them to breathe. Can they inhale? And again, this is out on their clothes. This is not, you know, they're not undressed. Okay. So on their clothes, on the outside part of their clothes, they're going to inhale. Can they feel the pelvic floor drop into their finger? And on the exhale, can they feel their pelvic floor come back up and in? They can't feel that. Again, that's an opportunity to point out that is pelvic floor dysfunction. We need the pelvic floor to move dynamically so that it is like a trampoline and can absorb the force and also be able to handle that force. Okay, so with that, what's happening there? Can they tell you then? What I do is evaluate breath work. Can they put one hand on the chest, one hand on the belly? Can they inhale? What hand moves? If their top hand moves, then that means that more than likely their pelvic floor is going to be restricted and tight. If they're really taking a lot of belly breaths, then a lot of times, that means that their pelvic floor potentially is moving. But we got to test it. They got to feel it. So you either take your two fingers, cuff it on the inside part of your sit bones, or you take one finger and put it on the anus. And can they feel it drop into their. Their finger? Okay. Because most of the pelvic floor muscles hang out in and around the anus. Okay. And so you can really feel if the pelvic floor is working. Now, remember, this pelvic floor is not just one muscle group. It's like a bicep and a tricep and a quad. And there's so many different muscles down there that they all have to be trained differently. It's just not one way is the highway. So then what I like to do is then can they actually contract their pelvic floor? Most of them can. This is why that's not a problem. They actually can do, like a kegel, but there's different forms of kegel. So kegel is a very general word. I don't like using the word kegel because it doesn't mean anything. So can we cue them to use their levator ani? And that cue is, can you suck up a marble up through your anus, not squeezing your butt cheeks? Okay, can they do that? Then? Can they squeeze their sit bones together? Okay, if they can do that, that's the second layer of the pelvic floor. That's the stp, superficial transverse perineal. That is. That right there is the second layer of the pelvic floor for females. Okay. Okay. Then can they draw the clitoris to the vaginal opening? That is the very first layer. That's ischio. That's bulbo. Is that actually working? So we gotta get them to understand that there's different layers here, and it's not just all one thing. A kegel. And then if they can't do it, then they lose. I developed something called the pelvic lock. I like to have that up in my clinic. And it is a clock that I had made with all the anatomy of the bowl so patients can see it. And it has, you know, words on it so patients can have an amazing visual of. This is where they're at. This is the muscle that they're on. And it's a actual clock you could hang on the wall. Okay. So in clinic, I point to it and I say, hey, look, this is where we're at 11 o'. Clock. This is where we're at 10 o'. Clock. So they have an amazing visual that we say, we're going to take that clock and, and shine it out bright. So then that way they understand what part of the clock and they get it like that because of this. Literally this clock I developed called the pelvic lock. These are tools that I've used to help patients understand their pelvic floor. And it also actually helps me train clinicians as well because it's kind of like a cheat sheet hanging on the wall of where like, okay, so I'm at 11 o'. Clock. So that means we're on this muscle called. Hold on, the. Oh, the ischio cavernosis or whatever it may be like, it gives them a cheat sheet to really understand where they're at, where their fingers at, without having to pull out the anatomy book and being, you know, flustered. So I found that super helpful for my clinicians and patients, the pelvic clock, to understand like, this is the anatomy. Another thing I like to add on is the whole system because it's not just our pelvic floor muscles and it's also our breath. Right. So if I talk loud like this. Sorry, people have headphones in right now. If I talk loud like this, do you. My pelvic floor relaxing or contracting? I always ask that. And they're like contracting. They actually more than likely get it right. I'm like, yeah, it's contracting, it's lifting. So if someone has a high pitched voice, which most of us females do, more than likely we're holding our pelvic floor. If I were to talk like this and drop my glottis, which then actually opens my vocal cords. Okay. Which then allows my diaphragm and my belly to be more relaxed. Okay. Because I'm getting air for my belly to come up, then my pelvic floor is more than likely relaxed. So if I'm yelling at my kids all day long, then my pelvic floor is going to be tight. I explain that to them and it's like an aha moment that they have and they're like, wow, I never knew the whole thing's connected. That's crazy. So I think educating, you know, patients on that and even staff on that is super valuable because it's, it just connects all the dots for them. Hopefully this helps you guys, like help educate your patients on getting them to buy in and understand like, what the pelvic floor is, how we actually treat it and how that they can understand their pelvic floor whether or not you're doing a telehealth session. Whether or not you're in person with them or whatever it may be. We can truly help so many people out there with their pelvic floors just by the knowledge and education and these tools that we have. So if you guys are interested in learning more about the pelvic clock, let us know. The pelvic clock is something that's a tool that we have used and it's super, super helpful for both patients and clinicians. Bye guys. I consider myself a business and life coach. Are you ready to live the life of your dreams as an entrepreneur? If so, let's chat. See the episode notes below and go ahead and book a call. See you all next week.