LOUISVILLE Sixteen years ago, Susan Dunn, PT, launched her private physical therapy practice and began treating a subset of patients that often go unnoticed and under-treated – those with pelvic dysfunction. Perhaps because conditions such as constipation, incontinence, and painful intercourse are often spoken of in whispers rather than in broad forums and public awareness campaigns, the treatments for these conditions are also lesser known.
Dunn did not set out to specialize in pelvic dysfunction in physical therapy school. In fact, it’s not something that is part of any regular PT curriculum, but her work with female athletes soon shed light on a host of pelvic floor issues she was ill-prepared to treat. She sought out a fellowship in pelvic dysfunction, and it changed the course of her career.
Dunn and her fellow therapists have become advocates and champions for these services that can make a tremendous difference in a person’s quality of life. “Every single therapist within the practice will say at least three or four times a week they have a patient say, ‘I didn’t know these services existed.’”
Those services include therapy for a variety of pelvic dysfunction, such as pelvic pain, painful penetration, urinary incontinence, fecal incontinence, constipation, and prenatal and postpartum issues, issues that are vastly more common than people realize. “Constipation is epidemic,” says Dunn. “In the United States, we have the worst statistics for constipation and subsequent hemorrhoids, fissures, and prolapse,” says Dunn. Similarly, chronic pelvic pain affects an estimated one in seven women.1
Women make up the largest percentage of the practice’s overall pelvic patient population, but they also treat men and children. The practice also treats general orthopedic rehab needs in addition to pelvic issues.
Dunn’s practice model has always included individualized, private treatment, in part because of the sensitive nature of her patients’ problems. “Everything is one-on-one with our patients, but that’s not the norm for outpatient rehab unfortunately,” she says.
Her passion for serving this population has driven her to keep pace with the latest technology and treatment solutions. She describes her practice as “fully equipped,” including biofeedback, anal manometry balloon training, and live ultrasound imaging.
Biofeedback is a form of surface electromyography and pressure perineometry used to assess and strengthen pelvic floor muscles.
Anal manometry balloon training was added to the practice a year ago, after one of Dunn’s therapists completed special training at Marquette University. The technique uses a balloon catheter inserted anally to simulate pressure and analyze muscle performance. For those who have bowel dysfunction, it teaches them how to feel when the bowels are full and how to use the muscles to expel. “Amazingly, it is extremely modest. It is extremely comfortable, and it’s not as awkward as you would think,” says Dunn.
The clinicians are also trained in the practice of ultrasound imaging, which is used to visualize pelvic floor and abdominal wall musculature to help teach patients how to recruit those muscles. “If I’m asking for a particular type of recruitment from the deepest level of their abdominal wall or from the pelvic floor, it’s so hard for these people to proprioceptively get and feel it. To use live ultrasound imaging and be able to point that out on screen so they can see what they’re doing is huge,” she says.
Although women may be top of mind when we think of pelvic floor issues, Dunn says children and men are an important part of their population. “We have a program that’s 100 percent dedicated to pediatric pelvic issues,” says Dunn, which can include bedwetting, giggle incontinence, fecal incontinence, constipation, and pediatric pelvic pain. “It’s life-changing for these kids because you have a seven-year-old who wants to do sleepovers, and they can’t because of the symptoms that they’re having,” she adds.
Rounding out the practice, Dunn contends they also have the highest concentration of therapists treating male pelvic function in the Louisville area. Male patients include those with prostate issues but also young athletes with pelvic pain or pudendal neuralgia.
Growing Her Niche
In the past two years, the practice has grown from six therapists to 10. It currently includes two locations, although their office on Dutchmans Lane will soon move next door to gain 600 square feet for more private treatment rooms. Dunn hopes to add a third location in the next 12 to 18 months that better serves Southern Indiana and Louisville’s South End.
While the need is great, Dunn’s approach to growth is calculated. She refuses to compromise her guiding principle of one-on-one care, even when her waiting list begins to grow. But finding qualified practitioners to accommodate increasing volume can be difficult. Therapists must seek out specialized training in pelvic dysfunction, and that takes time.
So, Dunn’s hiring process is very selective. “Every PT in the practice specializes; none of us are general practitioners,” she says. Out of 10 therapists, one is dedicated full-time to pediatrics, two are dedicated to lymphedema care, and the remaining seven see adult pelvic dysfunction patients plus a specialized area of orthopedic rehab patients. For instance, Dunn is a pelvic and spine therapist.
Dunn may be a private practice owner, but she is quick to note how important it is to collaborate with referring providers. “Ninety-nine percent of the time this is a team approach. We are always working with other healthcare providers, our care complementing what they’re doing. What they bring to the table is different than what I bring to the table, and most of these patients need a team approach,” she says.
It is that carefully cultivated team and their passion for treating a specialized, underserved niche that continues to propel the practice forward successfully. “I’m really so proud of what we have here. I’m 16 years into being a private practice owner, and it’s like raising a child … My name is on the practice, but I’m often giving credit to the crew that surrounds me because they are amazing,” concludes Dunn.
1 Mathias SD, Kuppermann M, Liberman RF, et al. Chronic pelvic pain: Prevalence, health-related quality of life, and economic correlates. Obstet Gynecol. 1996
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