Pelvic Floor and “Other” Issues–Speaker Notes

We welcomed Shirlea North, PT, DPT, GCS, CLT, Board Certified Geriatric Clinical Specialist and Certified Lymphedema Therapist, and Clinical Director of Rehabilitation at Virginian Rehabilitation & Wellness, Inc, to our April 7 meeting via Zoom.

A physical therapist who has worked with many people with Parkinson’s over the years, Shirlea has noticed the frequency of “other” symptoms not necessarily related to Parkinson’s in the people she treats. Some of these symptoms are due to pelvic floor issues and include urinary frequency, constipation, urinary or bowel incontinence, burning while urinating, and painful penetration or sexual disfunction. “Peeing, pooping, and sex are activities of daily living,” Shirlea said.

There are many muscles, joints, ligaments, and tendons in the pelvic area. Shirlea works with her patients on motor coordination, affected by Parkinson’s, to teach them how to coordinate relaxing and contracting their muscles. For example, we need to relax to urinate and contract to hold in urine and stool.

The pelvic area is part of our core, with the diaphragm on top, the pelvic floor on the bottom, the abdomen in front, and the gluteus in back. Parkinson’s can affect all these muscles.

Treatment for pelvic floor issues can be as simple as looking at hydration. As a general rule, we need half of our body weight in ounces of fluid per day. If you weigh 150 pounds, for example, you need to drink 75 ounces each day. Shirlea recommends making any changes gradually. She suggests drinking a glass of water with coffee and wine as well as in-between meals. Water lubricates the lining of the bladder, reduces the concentration of urine, and softens stool.

“Once postpartum, always postpartum,” Shirlea said. “There can be a personal aspect to pelvic floor dysfunction.” She treats the whole person, checking posture, position, hydration, and fiber intake. If someone has low back pain, for example, she addresses that first so the alignment of the pelvis will help with pelvic floor function.

Physical therapy for pelvic floor dysfunction can be done once-a-week, alone or in conjunction with other physical or occupational therapy. A strong pelvic floor can improve posture, balance, and even voice as it assists in voice projection.

Another symptom Shirlea has noticed in people with Parkinson’s is lymphedema, or fluid retention. Optimally, the venous system recirculates the “junk” it has filtered in through the lymph nodes, depositing it in the kidney to be urinated out. Over time that system can become inefficient. This can be due to surgery to remove lymph nodes, past radiation or chemotherapy, or as a side effect of medication, including some Parkinson’s medications. Treatment with diuretics won’t work if someone also has bladder issues.

Shirlea often sees the edema that results from lymphatic fluid retention in the lower extremities. True lymphedema does not go away and is progressive. Shirlea treats with an individualized mobility program that includes hands-on therapy, similar to massage, as well as compression garment therapy. Manual techniques jumpstart the muscles to act as a pump to move the fluid up and out of the body. Initial treatment is intense and, like the BIG program, requires three-to-five-times a week for the first few weeks, before moving into the maintenance phase and less frequent visits.

In Virginia, physical therapy is direct access and you can self-refer for an evaluation. Shirlea then submits the evaluation to your doctor. Medicare allows her 30 days to receive the doctor’s order for PT. She cautions, however, that especially with private health insurance it is better to get the order from your doctor first.

Shirlea splits her time between their two locations, one in Fairfax at The Virginian and the recently opened one in Chantilly. Both have special ventilation systems; Chantilly’s is a state-of-the-art air filtration system. All their physical therapists are vaccinated, and wear masks and gloves. They have seen patients throughout the pandemic. Shirlea does evaluations and treatments for pelvic floor issues and lymphedema in private rooms. She has done some evaluations and assessments via telehealth and has even gone to some of her clients’ homes.

Shirlea said to feel free to contact her with any questions or for more information snorth@vaoptherapy.org

Virginian Rehabilitation & Wellness, Inc

Fairfax:    9229 Arlington Blvd, Fairfax, VA 22031       703-277-6611

Chantilly:  4299 Chantilly Shopping Ctr, Ste 104, Chantilly, VA 20151                         703-844-0690

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