Women's Health Physical Therapy

Featured Speaker

Anne Cooke, PT, MS, CAPP-Certified

Anne Cooke, PT, MS, CAPP-Certified

Anne Cooke, PT, MS is certified in pelvic floor physical therapy and obstetric rehab. She brings advanced training and clinical expertise in assessing and treating pain for patients of all ages at Aspirus Keweenaw Hospital and Clinics. In addition to women’s health services,she provides quality care in inpatient and outpatient settings for patients with orthopedic, neurological and vestibular dysfunctions.

About this Podcast

Pelvic floor disorders can affect a women's quality of life in many ways.

Anne Cooke, PT, MS, CAPP-Certified, discusses pelvic physical therapy and how it can help to relieve pain from many women's issues such as incontinence and pelvic pain.


Melanie Cole (Host): Each year pelvic floor disorders affect millions of women but many don’t seek help. They may be too uncomfortable talking about their symptoms or think it’s just a normal part of aging. My guest today is Anne Cooke. She’s a physical therapist and certified in pelvic floor physical therapy and obstetric rehab at Aspirus Health System. Anne, tell us a little bit about the pelvic floor. What is it? What does it do?

Anne Cooke (Guest): So the pelvic floor is basically the whole support system of the abdomen and the pelvic organs and it’s lined with muscle and really just a lot of tissue that helps give that system some support.

Host: Then explain a little bit about pelvic floor disorders, what are the different conditions that you see?

Anne: Yep, I see a lot of women with a lot of different disorders going on. I see a lot of women for urinary incontinence or pelvic pain and I do see a lot of women either during pregnancy or postpartum.

Host: So when you talk about pregnancy, and so many women have issues of course with incontinence and such after being pregnant, are pelvic floor disorders a normal part of aging as I said in the intro that many women think?

Anne: I would say they are a normal part of aging, but they don’t have to be something that you need to live with. They are usually all very treatable with conservative treatment, which means you don’t need to have surgery to fix them, and a lot of times they’re actually missing links for if you have back pain or hip pain as well.

Host: Then let’s talk about pain, pelvic pain, it’s kind of hard to diagnose isn’t it? What are some of the causes of pelvic pain?

Anne: Some of the causes might be a muscular imbalance. There also might be scar tissue present in the pelvic floor. You might end up with very low back pain that can be due to pelvic floor pain as well.

Host: And what about incontinence? What are the main causes of that because so many women suffer pretty silently from incontinence and they’re – you know they’re not sure if it’s just something they have to deal with.

Anne: Right, incontinence can happen for a variety of different reasons. The first thing that is easy to blame it on is actually vaginal deliveries. Another issue that occurs with women is sometimes we just lose that brain to body connection, and that can also cause some bladder leakage.

Host: And as I said in the intro, Anne, you’re certified in pelvic floor physical therapy. Tell the listeners, what is that?

Anne: So that’s basically a specialized form of physical therapy that’s very directed to the pelvic floor. So I have had some special education in that focused area and it means we address any issues once that area is looked into a little more.

Host: Then let’s talk about what that would look like, and first of all Anne, is it only for women, pelvic floor physical therapy, or can men maybe that are going through prostate surgery or prostate cancer, can some of them benefit from pelvic floor physical therapy as well?

Anne: Yes, that’s an excellent question. Men can definitely benefit from pelvic floor therapy. Our approach is a little bit different, but I do see quite a few men who have undergone prostatectomies or have struggled with prostate cancer that have also had some bladder leakage following those procedures.

Host: So what would you do with someone? What is an evaluation like because this is a very sensitive area, it’s a very hard area to identify the muscles, to work the muscles, so tell us what your evaluation is like and what’s some treatments that you might try with people?

Anne: Yeah, I evaluate the patient usually from head to toe. Our core is sort of built like a cylinder and the side of those cylinders are the back muscles and the belly muscles. The bottom part is the pelvic floor and then the top part is the respiratory diaphragm. So I actually look at all three of those pieces to see if they integrate well with each other to give us the maximum support, which will translate into overall function and then we kind of put all of those pieces together and tailor a very specific exercise program for women or patients and sometimes we actually do biofeedback which helps to train the specific targeted muscles. There’s also a fair amount of manual treatment that I do to help release scar tissue or trigger points or things like that, that can effect the function of the pelvic floor.

Host: What about Kegel exercises? People hear, women hear we’re supposed to be doing these. They really don’t know what they are and the majority of the time, women may think that they’re doing them and they’re not really doing them correctly. Explain a little bit about this exercise and how we can do it in our daily life and get sometime really good out of it.

Anne: Right, Kegels are, they are an important part of pelvic floor therapy and they’re certainly something that I include but they’re not the be all end all. So part of the evaluation is to access whether that person or patient is doing a Kegel exercise correctly, and once that’s determined, then we can integrate that as part of the exercise program, but there is a lot more to it than just Kegels. So we do look at things like abdominal strength and lower extremity strength and things like that that might be beneficial to give that whole system some extra support and stability.

Host: And because again it’s a little bit of a sensitive area, when you say you want to make sure they’re doing them correctly and getting the most out of their treatments as possible, how do you do this without making people uncomfortable? You know it’s sort of confidential, compassionate, it’s a very caring profession that you’re in, helping people and patients with a difficult situation that they may not want to talk about. How do you go about that part?

Anne: Yeah well we have a very private treatment area. I do assess the pelvic floor, which means going through a pelvic examination, so usually I talk to the patient about that and discuss whether they’re comfortable with that, and once that’s done then we can really again put those pieces together and really tailor it towards each individual patient.

Host: Is it something that a person needs a referral to see a pelvic floor physical therapist?

Anne: Usually my patients come in with referrals but at our Holton Clinic, we do a free consultation program where I’m happy to meet with you and discuss what’s going on to see if physical therapy might be a good fit for you before we do any form of a physical evaluation.

Host: And as you wrap it up with your best advice about the fact that you do deal in this very sensitive topic and that you’re very caring about the privacy about the individual, give us your best advice about what we can do maybe at home to manage any pelvic floor disorders that we might have and really good information about coming in and exploring the options that women do have.

Anne: Yeah, the best advice that I can give you is to not let it go too long. If you’re having any pelvic floor issues or bladder incontinence or pelvic pain, the longer you let it go, the more compensations and harder to address those issues it might become. So I would encourage you to either give myself a phone call or discuss this with your primary care provider so that we can help put those pieces back together again.

Host: Thank you so much Anne for being with us today and for telling us what pelvic floor physical therapy really is all about and how women and men should not be embarrassed to discuss this with their provider because it’s something many of us go through and it’s something that you can get help for non-surgically, so thank you again for joining us. This is Aspirus Health Talk. For more information, please visit aspirus.org, that’s aspirus.org. I’m Melanie Cole, thanks so much for tuning in.