By Alex Papale, PT, DPT
As of August 2018, I’m practicing as a pelvic health and orthopedic physical therapist, but, if you’d asked me even two years ago at the start of my PT program where in the physical therapy field I would end up, I had no idea.
Pelvic health wasn’t front of mind and, honestly, I wasn’t totally sure what pelvic health PT even meant. Wasn’t it just for older folks or pregnant people? I’d never gone to PT myself, and it took me almost until I graduated from PT school to learn that pelvic floor PT was the answer to what I’d been struggling with for *years*.
Surviving symptoms in college
I probably should’ve known something was off the day I walked home from class and found myself sprinting to my dorm bathroom, but couldn’t get my pants down fast enough to pee. If that didn’t do it, any of the million times I woke up in the middle of the night in my freshman dorm totally unable to make it to the bathroom in time could’ve clued me in.
After work one night, I was walking to my car and had such an intense urge my only option was to pee right there on the deserted sidewalk. Which I did. While on the phone with my dad.
At the worst, I would have burning, painful urges leaving me rushing to the bathroom constantly. This would go on for a day, a week, sometimes longer. The pain and sensitivity on its own would affect my ability to wear certain pants, cause me to skip classes, plans, obligations, you name it. I was starting to choose clothing for the day with the thought of “what if I really have to go suddenly?”
The truth is that I knew something wasn’t right, but didn’t know what to do about it and, when I told other people, I got mixed messages. Once, during my college cross country season, I leaked a slow dribble for the last two miles of an intense race, worsening the harder I ran, and the closer I got to the finish line. When I told my teammate, they high-fived me and said it was a sign of hard work, and it happens to everyone.
I wish I’d told my younger self to see a doctor sooner. But, as a queer (and very anxious) person, I spent most of my life avoiding going to any doctor for any reason after a few less than ideal interactions. When I was 20 years old, I outed myself as queer at my first appointment with a gynecologist, and he responded, “Well when you decide to have sex with men again…”. Needless to say, I never felt comfortable going back.
I did brave the doctor a handful of times when my symptoms were the worst. I’d do a urine test for UTIs and leave with a prescription for antibiotics before the test results even came back. Every time, in spite of my anxiety around doctors and medical spaces, I asked if they had any recommendations to prevent these seemingly unending UTIs from happening, instead of treating me after one had already disrupted my life. Mostly, I got polite shrugs, followed with a “maybe try some Kegels?” Of course I tried them (I would’ve tried anything) and found them to be no help at all. I now know that I’d needed someone to teach me how to relax my pelvic floor, not strengthen it.
From doctor to patient
As a PT student, one of my first patients on my clinical rotation was a young, athletic woman complaining of chronic stress incontinence, significant pain with sex, and other symptoms she’d thought were due to chronic UTI’s. Sounds familiar, right?
Over the course of a few PT sessions, I addressed her tight, spasmed muscles and educated her on breathing techniques and body awareness exercises to decrease her pain and anxiety. She got significantly better and was eventually discharged symptom-free. Treating her was a lightbulb moment for me.
Sure enough, the next time I experienced pelvic pain and leakage I turned to my mentor and fellow pelvic health PT, and my pelvic floor was finally given the care and attention it deserved. After a few sessions, the worst symptoms I’d ever experienced were almost completely resolved.
The answer to my symptoms is so obvious to me now. But if it took becoming a pelvic floor physical therapist for me to finally figure out what I’d needed for so many years, what about everyone else? How would anyone else know that pelvic floor PT can treat all these symptoms that get dismissed as “normal”? What about the queer community, the folks who never go to doctors for a simple check-up for a variety of reasons, never mind something as intimate as pelvic health? I wish I’d known in college that pelvic health PT was a treatment option for me but, today, I’m proud to work in a profession that strives to eliminate the stigma surrounding pelvic dysfunction.