The Truth About Menopause and How Pelvic Health Physical Therapy Can Improve Your Quality of Life

Physical therapists are musculoskeletal experts and should see menopause as an opportunity to use their skills to help women ease this life transition.

Menopause is a normal part of aging and is defined as the point in time 12 months after a woman’s last menstrual cycle. It generally occurs between the ages of 45 to 55 and can last for seven to 14 years. It can also be caused by a hysterectomy or surgical removal of the ovaries. Menopause can result in hot flashes, trouble sleeping, pain with sexual intercourse, incontinence, moodiness, and depression.

As a pelvic health therapist, I often treat women who are menopausal for urinary incontinence, constipation, pain with sex, pelvic organ prolapse, and pelvic pain. These women generally have pelvic floor dysfunction, which occurs when the pelvic floor muscles are not working optimally. Pelvic floor muscles function like a sling between the pelvic bones and provide support for the pelvic organs, stability for the lower back, and sphincter control for the bladder.

Let’s look at each of these concerns associated with menopause to determine how pelvic health physical therapy can you achieve your desired goals and return to daily tasks without limitations.

Urinary Incontinence

Urinary incontinence is not caused by menopause. As a woman ages, if her pelvic floor muscles are weak it can result in urinary incontinence. Many women experience leakage of urine with a sneeze, cough, laugh, while lifting, or with exercise which is called stress urinary incontinence. If urinary leakage occurs with an urgent event on the way to the toilet it is defined as urge urinary incontinence.

When a patient has both stress urinary continence and urge urinary incontinence it is called mixed urinary incontinence. Many women may also state that they have difficulty emptying their bladder, which can be related to increased tension in the pelvic floor muscles.

Pelvic floor muscle training can be an effective way to eliminate urinary incontinence and allow a patient to resume all desired activities. Typically, a patient can see improvement in one month and with consistent performance the results can be long-lasting. A pelvic health physical therapist can evaluate you to determine if you need to relax or strengthen your pelvic floor muscles to regain bladder control.

Constipation

There can be many causes of constipation. It is common to experience constipation during menopause due to shifts in hormones, but it can also be related to side effects of medications, lack of physical activity secondary to fatigue and arthritis, fluid intake, and diet. Over time with excessive strain people can develop tension in their pelvic floor muscles making having a bowel movement more difficult. With excessive strain you can also put more pressure on the pelvic organs. If the pelvic floor muscles are weak, this can lead to prolapse. Seeing a pelvic health therapist can help you determine if your muscles are tightening versus relaxing with a bowel movement to reduce strain and prevent additional concerns.

Pain with Sex

With a decrease in estrogen, women can experience vaginal dryness, irritation, and pain with sexual intercourse. The use of vaginal lubricants (which are available without a prescription) can decrease friction and increase your tolerance. The use of vaginal moisturizers can help improve or maintain vaginal moisture, especially in women who have vaginal atrophy or thinning of the tissues.

Pain with sex can also be caused by low back and hip pain secondary to limitations in range of motion for positioning. A pelvic health physical therapist can perform manual therapy to ease tension and pain, prescribe exercises to increase range of motion and flexibility, and educate you on self-care techniques for desensitization to improve your tolerance.

Pelvic Organ Prolapse

With the loss of estrogen during menopause, there is a weakening of both pelvic floor muscles and vaginal tissue leading to a sensation of heaviness. This weakening can result in a prolapse of the colon, uterus, or bladder into the pelvic canal resulting in pressure and pain.

Women who have had at least one vaginal birth are 50% more likely to experience a prolapse which may or may not be symptomatic. A pelvic health physical therapist can evaluate you for pelvic organ prolapse and also determine if you have pelvic floor muscle weakness to assist you in gaining strength to further support your prolapse and prevent worsening of your symptoms.

Weight gain can also contribute to pelvic organ prolapse. Weight gain is common during menopause as the loss of estrogen results in redistribution of weight to your abdomen. Exercise can become uncomfortable leading to lack of physical activity. A pelvic health physical therapist can also assist you in creating an exercise routine focusing on gaining not only pelvic floor strength but core and hip strength to assist with an improved tolerance for both daily tasks and exercise.

Pelvic Pain

There are many causes of pelvic pain. It can be related to inflammation, infection, or trauma. It is generally caused by a combination of things. A pelvic health physical therapist will evaluate your pain for your pelvic region externally but possibly internally if consent is given to determine the cause.

Again, with menopause there is a depletion of estrogen causing the tissues to thin and get more easily irritated. Pelvic organ prolapse can also lead to sacroiliac joint pain which is pain located in your lower back to buttocks. A pelvic health physical therapist can assist you in eliminating this pain with manual therapy, exercise to strengthen the pelvic floor, core and hips for stability and stretching as needed to reduce tension. They can also educate you on proper body mechanics to reduce strain with your daily tasks including those for your home, work, sports or with exercise.

It is never too late to seek out a pelvic health physical therapist to assist you with these concerns. They can create a plan of care designed especially for you to achieve your goals during this transition. They will help you to determine which type of exercise will allow you to achieve your best outcome. Exercise has been shown to improve a person’s quality of life and help them to achieve an ideal weight which can lead to both a decrease in the severity and length of their menopausal symptoms.

 

Amy Hauerstein is a Physical Therapist who specializes in Pelvic Health in the outpatient clinic setting.  She has extensive experience and combines her passion for wellness with physical therapy, addressing the physical and emotional limitations of men and women.  Over the past 20 years, Amy has lived all around the US working as a physical therapist in a variety of healthcare settings. Three years ago, she changed the focus of her practice to pelvic health. She started taking courses with the APTA’s Academy of Pelvic Health and received her CAPP-Pelvic in July of 2021.  She enjoys working in this specialty and seeing first-hand how much Pelvic Health can improve someone’s quality of life.

Meet Carroll Nelligan

Tx:Team turns 40 in 2023!

Founded in 1983, Tx:Team will celebrate a big anniversary in May, 40 years in business. Because it is such a major milestone, we felt we should celebrate this achievement throughout the year.

Thank you to all Tx:Team associates throughout the decades for his or her part in our success.

Meet Carroll Nelligan, President and Chief Operating Officer, and hear her story of her time with Tx:Team:

 

Ask an Expert: My Speech is Fine, Why Do I Need to See a Speech-Language Pathologist?

My speech is fine, why do I need to see a Speech-Language Pathologist?

A Speech-Language Pathologist (SLP) works with individuals from birth to end of life while focusing on swallowing, voice, communication, and cognitive disorders as well as enhancing speech skills.

An individual may be referred to a SLP because:

  • Their voice is not as strong as it used to be and they are unable to communicate with loved ones at a family gathering.
  • They may begin to experience difficulty while chewing their favorite food and/or coughing while drinking a glass of water.
  • They may have difficulty recalling the birthdays of their family members.
  • They are unable to express their thoughts to participate in a meaningful conversation.

A Speech-Language Pathologist aims to enhance an individual’s quality of life to participate in daily activities that require more than just their speech.

 

Johanna Ebbs, MS, CCC-SLP, LOUD® Certified

Speech-Language Pathology…Because Communication is Important

May is National Better Hearing and Speech Month, which is an opportunity to raise awareness about not only communication disorders, but also the treatments available.

Millions suffer with brain fog, difficulty eating and drinking, and general speech and language problems – and these issues were only amplified in the years following COVID.  These problems can affect a person’s quality of life. Speech Language Pathologists treat a wide range of disorders in both adults and children. With early identification and intervention, clinicians can help to improve communication, increase confidence, and help patients return to the activities and daily life they enjoy.

Many people aren’t aware of how a speech-language pathologist can help.

Speech-Language Pathology, or what is commonly known as Speech Therapy, assesses and treats speech disorders and communication problems. It helps people develop skills like comprehension, clarity, voice, fluency, and sound production. Speech Language Pathologists, or Speech Therapists, can treat childhood speech disorders or adult speech impairments caused by stroke, brain injury or other conditions. Speech-Language Pathologists work with their patients to identify areas for improvement and work to develop each patient’s individual goals.

Speech therapy offers skilled treatment designed to assist and restore speech and language problems caused by illness or injury that may affect:

  • Cognition, comprehension, memory
  • Swallowing and other oral motor problems
  • Communication and hearing
  • Expression

Does Speech Therapy make a difference?

Adult patients can improve the quality of life with speech therapy after a stroke or traumatic injury as well as those patients diagnosed with Parkinson’s Disease or Alzheimer’s. For children, speech therapy is most successful when started early and practiced at home with a parent or caregiver.

Some of the speech improvements that patients experience are a louder and clearer voice, better speech intelligence, a more natural rate of speech, and more robust facial expressions.

If you or someone you know could benefit from Speech Therapy, find a Speech Language Pathologist in your area.  Why?  Because communication is important.

April is Parkinson’s Awareness Month – #Take6forPD

According to the Parkinson’s Foundation, every six minutes someone is diagnosed with Parkinson’s Disease in the United States.

April is Parkinson’s Disease (PD) Awareness Month and along with the PD Community, we are encouraging everyone to take six minutes in an effort to raise awareness, advance the research, and become knowledgeable of the available treatments for this disease. With someone being diagnosed every six minutes, that totals 90,00 people per year in the United States alone.  Let’s be advocates.

Beyond awareness comes treatment. At Tx:Team, we have Physical, Occupational, and Speech Therapists who are trained and certified in treating patients with PD. One treatment program which has been proven beneficial is the LSVT BIG® and LOUD® Program.

How do the LSVT programs benefit Parkinson’s patients?

Parkinson’s can impact function in everything a person does at home, at work, and in their community recreational pursuits. The LSVT programs help patients to maintain movement and voice for normal function in everyday life beyond medication and repetitive, non-direct task training exercises utilizing principles of neuroplasticity backed by years of research. It takes all 16 visits (four times per week for four weeks) to achieve carry over so that by the end of one month, patients know how to move BIGGER and be LOUDER all the time.   

A unique feature of LSVT BIG® and LOUD® is that it recognizes there is an internal cuing proprioceptive issue in individuals with Parkinson’s such as softer voice and smaller movements, in people that are unable to recognize their deficits the majority of the time.   

What is the focus of LSVT BIG®?

  • Faster speed  
  • Greater arm swing   
  • Longer steps  
  • Overcoming difficulty getting through the doorway  
  • Longer distance  
  • Faster clothing donning  
  • Grasping materials during meal preparation  
  • Legible handwriting  
  • Amplitude of movement when showering  

What is the focus of LSVT LOUD®?

  • Louder voice that is not hoarse  
  • Improved facial expression   
  • Reduction of monotone speech  
  • Improved emotion  
  • Using more words  

Who would benefit from BIG® and LOUD®?  

Patients who have a decline in the amplitude of their movement, voice, posture, and balance in addition to reduced speech intelligibility are motivated to participate in all required sessions.  

Why are these programs so important to this patient population?  

LSVT BIG® and LOUD® assists this patient population in maintaining, enhancing, and slowing progression of Parkinson’s Disease, which in return facilitates their ability to maintain a level of independence with the following skill sets essential for daily living:   

  • Changes in cognitive function. People with PD can still learn, but it might take longer and require more repetition of practice. As a patient progresses, the therapist will work on dual tasking so you can keep moving bigger and being louder while doing something else at the same time. For example, getting dressed and talking, walking while carrying something, or tapping your leg while reading.
  • Changes in movement amplitude. Commonly, people with PD have difficulty with activities they didn’t before. As a patient progresses, utilizing larger movements helps patients return to these activities without cues and assistance. 
  • Changes in communication. People who have PD have soft speech and feel that they are talking WNL while others “need a hearing aid.” However, people may begin to feel embarrassed with social isolation. As a patient progresses with continuous use of a loud voice, they are able to participate in conversations without feeling excluded while maintaining their dignity.
  • Changes in emotional regulation, pacing, attention, cardiovascular health, sleep, and confidence can also be seen!  

If you have any more questions about the LSVT program for BIG® or LOUD®, find a certified therapist in your area or visit this website.

 

Nidhi, Alita, and Johanna are all experienced therapists in the Outpatient Clinic setting in Frederick, MD.  They work collaboratively together to support and treat patients with a variety of neurological diagnoses. Nidhi, Alita, and Johanna enjoy the relationships they foster with their patients, and they love to help them achieve their functional goals.

Nidhi Talpade, PT, DPT, BIG® Certified
Alita Borkar, MA, OTRL, BIG® Certified
Johanna Ebbs, MS, CCC-SLP, LOUD® Certified.

“Home is Where the Heart Is” and the Place Where My Patients Heal

“The magic thing about home is that it feels good to leave, and it feels even better to come back.” – Unknown
“Home is a shelter from storms – all sorts of storms.”-William J. Bennett

For many of us, our home is the place we most want to be, especially while we are recovering from surgery, a hospitalization, or experiencing a decline in our ability to care for ourselves. In-home rehabilitation services have been offered through home health agencies for years. Patients are being discharged from hospitals sooner and sicker, and more patients are declining rehab placements after discharge from the hospital. The home health team becomes an important step in the care continuum. As an Occupational Therapist in home health, I am an important player on that team.

How Does Occupational Therapy Work

As an Occupational Therapist, I work on all those things that occupy your time, from getting dressing, getting up and down from the toilet, taking a shower, making a meal, doing the laundry, driving, working, and enjoying your hobbies or leisure activities. After I assess someone’s abilities, I determine the areas that need to be improved and design a program that addresses those areas. The program could involve interventions in many different areas such as, therapeutic exercise, self-correcting balance training strategies or cognition/thinking skills.

I address Activities of Daily Living (ADLs) and mobility in the home, sometimes recommending adaptive devices to improve independence. Think of me as the “gadget girl.”  I especially enjoy seeing how the right piece of equipment can make all the difference with someone’s independence. Equipment recommendations include the trialing and training on the use of the equipment, which is an important part of the job in the home. No matter how good a simulation in a clinic is, it can never replicate their home. Trialing the equipment in the patient’s actual home ensures the appropriate piece of equipment is obtained.

The Role of Home Health Occupational Therapy

Home Health OT plays a huge role in the prevention of re-hospitalization. Home health clinicians wear many hats. I am an OT but at any given moment, I may have to function as a PT, Social Worker or RN. Some days it seems that I spend half of my time talking to physicians, other clinicians and family members trying to problem solve what will work best for my patient.

As with anything, there are aspects of my job that I love as well as the ongoing challenges that require creative resourcefulness to complete my job to the best of my abilities. I enjoy the intimacy that comes being in someone’s home, connections seem easier to establish. I enjoy seeing people’s family photographs, the things they collect, from stamps, vintage Pyrex, perfume bottles, or teapots. I enjoy being able to use things like pet or plant care in my treatment sessions. I am happy that my personal confidence with driving, navigation and parking has improved. The challenges of my days include scheduling, finding clean bathrooms, communication with coworkers who I rarely see, traffic woes, and caring for an increasingly sick population.

I feel that the rubber meets the road in home health. I see how people actually live, not just what they or their family report. When my primary care provider and I have talked shop during my visits, I have told her that if she could make home visits it would change the way she practices medicine. Seeing patients in their home, is that powerful, and for an OT, is completely natural and just makes sense.

“Home is where the heart is,” and it is where my patients heal.

Monica Laird is an Occupational Therapist in the Home Health setting in Frederick, MD.  In her 35 years as an OT, Monica has worked in a variety of settings including subacute rehab, outpatient rehabilitation, acute care, and now home health. She is married, has 2 adult sons, and a 14 year old carnival goldfish. When she isn’t on the road seeing her patients, she enjoys crafting, traveling, and going out to dinner with friends. She does not enjoy gardening or yard work and avoids those activities as much as possible.

Meet Scott Benedict

Tx:Team turns 40 in 2023!

Founded in 1983, Tx:Team will celebrate a big anniversary in May, 40 years in business. Because it is such a major milestone, we felt we should celebrate this achievement throughout the year.

Thank you to all Tx:Team associates throughout the decades for his or her part in our success.

Meet Scott Benedict, Chief Executive Officer, and hear his story of his time with Tx:Team:

O Comes Before P But Not Always in Therapy

Typically, most places will list departments in alphabetical order; however, not in the therapy world.

Though “O” alphabetically comes before “P,” you will rarely see Occupational Therapy before Physical Therapy. I believe this is because the majority of the public is more aware of what PT actually is. I have jokingly referred to OT as being the “other” therapy. I get so excited when I meet someone who actually understands what OT is and what I do.

I’m a bit jealous that my fellow PTs don’t have to constantly explain what they do or feel the need to justify the benefits of their services. The name itself, occupational therapy, really doesn’t give the average person a good idea of what OT encompasses. I have worked in the geriatric setting for over 25 years and have heard it all. “Oh, honey, I’m retired. I don’t need you.” Well, actually you do, and let me tell you why!

What is Occupational Therapy?

OT focuses on the whole person with the ultimate goal of maximizing a person’s independence. Trying to get someone to view their occupation of living, what does that entail? What physical aspects (mobility, vision, limited ROM, or neurological movements) are preventing someone from being more independent?  What cognitive aspects (STM deficits, dementia, perceptual deficits) are holding them back? Are there any environmental factors, such as a cluttered area, poor spacing, fall hazards, or ergonomics? There are so many things that we do on a daily basis that we automatically perform. However, when someone is sick or injured, that is when these “occupations” get challenged.

How Can Occupational Therapists Help?

As occupational therapists, it is our job to help identify the factors that limit our patients to perform their daily routines. Whether that includes simple ADLs, figuring out ways for the patient to continue employment, or problem solving ways to continue to pursue activities of interest. To be a part of someone’s success in improving their independence and quality of life is one of the reasons that I love being an OT.

Sometimes all it takes are adaptations to make life easier. Use of adapted equipment, modifying the environment, and compensatory strategies are all techniques specific to OTs. Having been in the assisted living/independent living setting for almost four years now, I have been able to grow relationships with my clients and have enjoyed watching them in their daily occupations. Even after discharge from OT, it is great to be able to engage with them and make sure they are succeeding. However, it is also great to be able to observe any regressions and to help them identify when therapy may be warranted again.

I love it when I receive referrals from my former clients regarding other residents. Not only did I help one person improve, that person is now more aware of what OT is and looks out for others. I feel like I am doing my best to let others know what OT is and how it can potentially improve someone’s independence and quality of life. Now, if only I can get the “O” to come before the “P.” Okay, okay….now that’s just crazy talk!

Kate Beaty, OTR, is an Occupational Therapist in the Senior Living setting for Tx:Team.  She has spent the majority of her career in the geriatric setting, whether in nursing homes, assisted livings or sub-acute rehabilitation.  She really enjoys the relationships that she fosters with her clients and loves to help them achieve their functional goals.

How Can OT Help with Low Vision

What is low vision?

Low vision is permanent vision loss from an eye disease or condition that cannot be corrected by standard treatments like glasses or contacts, medications, or surgery. With impaired vision, it becomes very difficult to complete tasks such as reading, navigating home and community environments, managing medications, managing calendars and appointments, managing finances, preparing meals and snacks, driving, recognizing faces for social participation, using household appliances like dishwashers, washing machines, and microwaves, and so much more.

What can one do to prevent low vision?

The best way to prevent low vision is to have routine checkups with an optometrist or ophthalmologist and, if diagnosed with an eye condition, adhere to the prescribed care plan laid out by the doctor. The three most prevalent conditions resulting in low vision are macular degeneration, glaucoma, and diabetic retinopathy. If one has a family history of eye conditions, it is crucial to have routine eye exams. It is also important to manage your health conditions, for example, controlling blood sugar is extremely important in preventing diabetic retinopathy. Once these eye conditions are present, they cannot be reversed, but further impairment can be prevented. This is why it is so important to follow the doctor’s instructions once diagnosed with an eye disease.

How can therapy help?

Since low vision is permanent, occupational therapists are not able to restore lost vision, but we can help those with low vision best utilize their remaining vision to be as successful and independent as possible. Occupational therapists perform home assessments to identify potential hazards and make appropriate modifications for safety and success. Some examples include adjusting lighting, removing clutter, and adding a contrasting color to doorways, steps, or thresholds. Occupational therapists may also modify the task, teach new skills, and utilize technology to improve daily function. Visual scanning and tracking techniques may be taught to better utilize remaining vision or, one may be introduced to adaptive tools and technology.

Each condition resulting in low vision impacts the visual field differently and have their own unique set of challenges. Occupational Therapists understand these conditions and how they impact the visual field. Occupational Therapists combine this knowledge with an individualized approach in order to provide training and modification in the client’s home and immediate surrounding community for optimal performance of the activities that are meaningful to the client.

Anna Pung, OTR is an Occupational Therapist in the Senior Living setting.  She has a Master of Science in Occupational Therapy from the University of Alabama at Birmingham (UAB) and Bachelor of Science in Psychology from Mississippi State University.  Shespecializes in low vision, dementia, fall prevention, orthopedics, and neuro rehab. Anna is very passionate about working with individuals throughout the aging process to maintain independence and high quality of life.

Meet Bob Haan

Tx:Team turns 40 in 2023!

Founded in 1983, Tx:Team will celebrate a big anniversary in May, 40 years in business. Because it is such a major milestone, we felt we should celebrate this achievement throughout the year.

Thank you to all Tx:Team associates throughout the decades for his or her part in our success.

Meet Bob Haan, Vice President of Clinical Operations and Quality, and hear his story of his time with Tx:Team: