On Point : My Path to Pelvic Health

Written by Ilka Felsen, PT, DPT

I first learned about physical therapy when I was dancing with a ballet company as a teenager in San Diego. I gained more exposure to the field when I went to college and minored in dance at Duke University. I worked closely with a Physical Therapist to create a pre-physical therapy association for Duke undergraduates. Many of my dance colleagues, however, sustained chronic foot and ankle injuries, and were subsequently sidelined for months at a time. Similar to the Section on Women’s Health’s tight-knit community of hard working professionals, the ballet community in general is also a group of close and accomplished women (and men!), and unfortunately, injuries are part of the landscape due to the intense nature of training. I met two Physical Therapists during my dance training who educated me about conditioning and rehabilitating my body. I admired these women who understood the rehabilitative needs within the dance community, and went above and beyond their clinician duties to encourage me, teach me how to condition properly, and inspire holistic wellness in an otherwise intense climate. Despite my commitment to dance, I also loved the sciences—physiology and anatomy were my favorite courses—and I also loved talking to people about their lifestyle needs. Physical therapy has been the perfect way to marry my interests in anatomy and physiology, interacting with people, solving problems and keeping both myself and my patients active!

During physical therapy school, I met a Physical Therapist who owns a women’s health private practice. She has been a special mentor throughout my career, and encouraged me to take Pelvic Health Physical Therapy Level 1, Level 2 and Level 3 and OB Fundamentals, which I’ve completed.

I have been working for three years now at Zuckerberg San Francisco General Hospital (ZSFG), a level 1 trauma center and community hospital located in the heart of San Francisco. I am one of two pelvic physical therapy providers within the entire Department of Public Health in the city and county of San Francisco. Approximately 75% of my pelvic health patients are Hispanic, and 90% of these patients receive their insurance through Medi-cal, California’s low income health insurance plan. Before I started practicing at ZFSG, there was no pelvic rehab program at ZSFG, and many of my patients had been waiting more than five years for pelvic services. I worked closely with our department supervisors to establish a pelvic health program, and have also worked closely with the gynecology clinic and our Spanish interpreters to provide equitable care for women with pelvic dysfunction. I have started several initiatives, which include:

1. staffing the gynecology clinic to provide accessible PT services immediately after medical consultation
2. creating an ongoing pelvic pain class and patient-friendly, multilingual handbook on management of pelvic pain
3. providing several in-services to physicians and other therapists about urinary dysfunction
4. starting a program called the “Incontinence Initiative,” which has included patient and staff education and a community incontinence class.

My future interests include learning more about pelvic dysfunction around pregnancy and cancer recovery, so that I may offer more skilled and comprehensive treatment for our San Francisco patients with more complex diagnoses. I’m also interested in treating breast cancer survivors, and addressing their upper body mobility restrictions as well as resultant effects on the pelvic floor.

I see pelvic PT evolving from a specialty service to a primary care service. The patients I treat are low-income, often non-English speaking, and have a variety of comorbidities. They learn about pelvic PT through their OB/GYN providers, and many have told me they were not educated about pelvic floor treatment in their native countries, nor unfortunately in our hospital, until they were referred to see me. I would like to change this climate of low access. I have provided several in-services and created educational materials for our primary care providers, and I plan on continuing my outreach and collaboration with our providers.

I would also like to improve my skill set. As a level 1 trauma center and community hospital, our patients are often more complicated, and we see a larger percentage of high risk pregnancies and complex, polytrauma pelvic cases. I’ve treated patients in both the inpatient and outpatient setting, and some of the cases I’ve seen a pregnant female with pelvic and femoral fractures, complicated by a stroke during her hospital stay, as well as a homeless female with pelvic pain, pelvic organ prolapse, and a history of sexual abuse as well as active polysubstance use. The first patient was out of our hospital network and without a safe discharge option that would qualify her for acute rehab placement, so I treated her for several weeks during her inpatient stay. The second patient has required multidisciplinary intervention and more creative ways to work with her impairments.

A typical outpatient pregnant patient or patient with pelvic pain that I see may be non-English speaking, obese, have gestational diabetes, and either be late or come with her children because childcare can be challenging in San Francisco. As a specialty practice provider, I am frequently consulted by other Physical Therapists within our department to advise on inpatient trauma cases that involve pelvic dysfunction or pregnancy, and I see most of the outpatient cases that involve pelvic dysfunction. These cases involve high risk medical diagnoses, neurological complications, and traumatic orthopedic injuries that I strive to be more competent in addressing.

References:

• Dunbar A, Ernst A, Matthews C, Ramakrishnan V. Understanding Vaginal Childbirth: What Do Women Know About the Consequences of Vaginal Childbirth on Pelvic Floor Health? JOWHPT. 2011 May; 35(2):51- 56.
• McLennan MT et al. Patients’ satisfaction with and attitudes toward vaginal delivery. J Reprod Med. 2005 Oct;50(10):740-4