Dr. Melissa Nassaney joined Performance Physical Therapy in 2017 as its first Director for Women’s and Men’s Health and Pelvic Rehab. She currently sees pelvic floor physical therapy and women’s health patients at our East Greenwich location and in the next few months, she’ll take over a new clinic in East Greenwich that will be focused solely on just those patients.

On a recent afternoon, Dr. Nassaney sat down to explain what pelvic rehabilitation is for, why it’s important, and how she’s helping raise awareness about pelvic rehabilitation and its positive effect on people’s lives.

(You can scroll to the bottom to see a video of Dr. Nassaney describing the most common pelvic floor issues you can see a pelvic floor physical therapist for.)

 

Okay, let’s start with the basics. What is pelvic floor physical therapy and who needs it?

Pelvic floor physical therapy is a focused area of practice of physical therapy that addresses and treats a variety of diagnoses that are not your typical joint pain or back injury. I work with patients with a range of issues, including: female and male urinary leakage and fecal incontinence, overactive bladder, vaginal or penile pain and muscle spasm especially during and after sex, constipation, low back and hip pain, core weakness, pre-post pelvic radiation muscle weakness, musculoskeletal issues effecting preconception, pregnancy and post-partum, pain post-abdominal and pelvic surgery and much more.

“Studies have shown that by the time a person gets to pelvic physical therapist, patients have seen about five to seven specialists…Sadly by the time the patient is sitting in front of me, they tell me they think their pain will stay forever or their issue must all be in their head.”

Many patients and doctors don’t know that these kinds of issues can be improved with physical therapy. Instead, patients often seek out specialists and doctors refer patients to urologists, OBGYNs, colorectal surgeons, gastroenterology specialists and others.

Studies have shown that by the time a person gets to pelvic physical therapist, patients have seen about five to seven specialists. All along this track, they’re having possibly unnecessary diagnostic imaging or tests, waiting for appointments with specialists which could take up to 3 months, and reading blogs that could have a negative impact on their hope for recovery. Sadly by the time the patient is sitting in front of me, they tell me they think their pain will stay forever or their issue must all be in their head. Then, it’s my job to tell the person a) you’re not a alone, b) I may be able to help you, and c) we’re going to work on this together.

 

Why did you become interested in providing pelvic floor physical therapy?

When I was pregnant with my first child, I had really severe pain in the front of my pelvis, but none of my doctors knew what it was, or could explain why I was having this issue. They just told me it was “rare” and would probably pass once I delivered. Well, it did not pass after I delivered and was painfully worse, getting out of bed, walking and infant care was unbearable for months. Thinking that there was nothing I could do for it, I suffered through it.  I felt really lost and mostly scared that this would not get better.

“…it’s been part of my personal mission to get the message out there that women’s health and pelvic floor physical therapy exists, that it’s an effective option and that it can be life-changing.”

Years later, when I was taking a women’s health physical therapy course, the instructor was teaching about this increasingly common type of pelvic girdle pain women can have during pregnancy called pubic symphysis dysfunction (PSD), and how it could be treated effectively by a physical therapist.  At that moment, I realized that’s what I had! And I just thought, this is not right. Why wasn’t this offered to me when I was in such pain? Then I got angry, feeling that women shouldn’t suffer in silence and that we should be informed by our doctors of possible treatment options.

Please remember, I did not have a computer back then! I got my information from a parenting magazine and the “What to Expect When You’re Expecting “book.

Since then, it’s been part of my personal mission to get the message out there that women’s health and pelvic floor physical therapy exists, that it’s an effective option and that it can be life-changing. It is important to know that it is not necessary to wait for your condition to “get better over time.” Thankfully, I did get better, but it did take years – I was even scared to get pregnant again and waited 5 years to try again!

 

What happens when a patient comes to see you? What should people expect?

Every evaluation and treatment session is in private, but the patient can definitely bring a support person if they’d like.

By the time people get to me, they are often nervous or they don’t believe that physical therapy will work for them. Pelvic floor physical therapy is just not talked about in general, so it’s really a mystery to most people — they don’t understand it what is all about.

So, in addition to listening to the patient tell me what brought them to my office, I also spend time during their first appointment talking about what pelvic floor physical therapy is, where their pelvic floor is and how it may be a factor in what they are experiencing. I talk about how necessary the pelvic floor is to the body and its unique functions. It’s involved in so much, so I try to explain that a bit.

Once I know what has brought a patient in, I’ll do an evaluation that’s based on the patient’s specific issues and how they’re feeling. I’ll generally do an orthopedic screening where I look at their range of motion and strength in their spine and hips, assess their abdominal strength and abdominal wall and general muscular integrity and any post- op incisions. I check their functional mobility specific to their complaints and identify any limitations. Most importantly, I will examine the pelvic floor muscles and how they function.

There are several methods for performing this assessment, and the method I use depends on what is most comfortable for the patient at the time and which will provide me with the most relevant information. From there, we discuss findings and plan out the treatments according to the patient’s goals.  They are usually excited to get started.  And there is always homework!

 

Do most doctors know that pelvic floor physical therapy exists? How do I get an appointment with you, or a referral to you?

In the last ten years, there’s been a major increase in awareness about pelvic health physical therapy and women’s health physical therapy. I’ve seen discussions evolve, where now nurse practitioners and midwives are interested in knowing more about pelvic floor physical therapy. We are even seeing national organizations that address issues like pelvic pain bringing physical therapists to the table, or having them on their boards or even leading their boards. The International Pelvic Pain Society is one of those organizations.

But in terms of doctors, both PCPs and specialists, there’s still some work to do to help educate on treatment options and what conditions and diagnoses that pelvic floor physical therapy can help with. I enjoy guest lecturing to students of medical programs such as  Physician Assistant and Physical Therapist Assistant programs in Rhode Island about pelvic floor PT and the feedback has been really positive so far.

One of my goals is to make sure patients and doctors know what rehabilitation for the pelvic floor is and to be able to confidently ask for it or offer it as an option in order that the patient does not have to experience a long delay getting the appropriate treatment and hopefully avoid costly specialist visits and imaging or testing.  Potential patients are becoming more savvy about their healthcare, they want to get the most out of their healthcare dollars.

“We just need to shift the mindset that not only is physical therapy a conservative and effective care, it should also be first choice in treatment.”

We have national organizations such as American Urological Association and the American College of Physicians identifying pelvic floor exercise and  intervention as the first line of treatment for urinary incontinence and overactive bladder. We just need to shift the mindset that not only is physical therapy a conservative and effective care, it should also be first choice in treatment. I also hope to get folks comfortable talking about these issues with their health care provider.  They will ask if they know it will help them, but the discussion needs to go both ways.

In terms of needing a referral, occasionally, a patient’s insurance might prefer a referral to come in to see me. The scheduling staff at Performance can help the patient navigate this if necessary. If patients think they may need physical therapy, they can call the scheduling staff (401-726-7100) and provide their insurance information – the scheduler will call the insurance to check.


Dr. Melissa Nassaney discusses the most common pelvic floor issues physical therapy can help with. 


Dr. Melissa Nassaney is Performance Physical Therapy’s Director for Women’s and Men’s Health and Pelvic Rehabilitation, and a physical therapist at our East Greenwich location. She has an associate’s degree from CCRI through their physical therapy assistant program, a Master’s of Science in Physical Therapy from the University of Rhode Island, and a Doctorate of Physical Therapy from the MGH Institute of Health Professions. She is board certified in Women’s Health Physical Therapy, and has received a certification of achievement in Pelvic Physical Therapy Program Levels I, II and III.