Beyond the Kegel: An Interview with Physical Therapy Instructor Barbara Cooper

Barbara Cooper , adjunct clinical instructor in Steinhardt’s Department of Physical Therapy, teaches ‘Integumentary and Other Systems,’ which offers students an insight into the treatment of urinary incontinence in pelvic patients. A graduate of the Steinhardt School (BS ’79), Cooper currently serves as coordinator of women’s health services at Physical Therapy for Women in Trumbull, Connecticut. For the last four years, Cooper has studied thetreatment of blocked milk ducts in conjunction with Quinnipiac University, and recently completed a research study demonstrating the treatment’s efficacy.

How common is urinary incontinence? Are we having an epidemic?

Barbara Cooper: Urinary incontinence is surprisingly common. It is believed to affect 25 to 50% of women overall and 27% of men 60-85 years old. It can even affect young women who engage in vigorous activity such as athletes and women in the military. There are a number of risk factors that predispose women to this problem, which include age, obesity, smoking, pregnancy, as well as vaginal delivery. Because age is a risk factor, there are predictions that this problem could reach epidemic proportions as the population continues to mature. Happily, it is estimated that 80% of common bladder control problems can be improved or cured with appropriate physical therapy intervention. Although my office Physical Therapy for Women in Connecticut treats only women, there certainly are therapists who treat pelvic floor muscle dysfunction in men as well.

Are there any other problems associated with the pelvic floor?

Barbara Cooper: Absolutely! The pelvic floor is actually composed of layers of muscles. Just as a person can develop muscle weakness, spasms, and pain in any other muscle of the body, they can develop symptoms in these muscles as well. Therapists who specialize in treatment of pelvic floor dysfunction assess and treat all types of musculoskeletal issues in the pelvic floor.

How did you get into this line of work — was this something that grew out of your practice?

Barbara Cooper: My first interest was in orthopedics, especially the spine and sacroiliac region (lower back). When I started working at PT for Women, I learned how important the pelvic floor muscles are in relation to the spine, postural issues, and core stabilization. That led to my taking courses and focusing more on treating women with pelvic floor dysfunction. It’s very rewarding work because the patients are usually very well motivated and so happy to be able to receive help.

What kind of training do you give physical therapy students?

Barbara Cooper: At NYU, I give students a solid understanding of the anatomy and function of the pelvic floor muscles, as well as common types of dysfunction. My goal is to assure that the students understand the role the pelvic floor plays in core stabilization and its relationship to lower back pain and many other common problems.  I want them to be cognizant of the pelvic floor whether they are working with the elderly or with young professional athletes. Finally, I teach students to know when it is appropriate to refer one of their patients to a physical therapist who specializes in pelvic floor dysfunction or to another medical professional for further work up.

Would you say this is a routine part of practice? What kind of treatment beyond Kegel exercises is there for incontinence?

Barbara Cooper: Working directly with the pelvic floor is not a routine part of practice for most physical therapists. It definitely goes beyond Kegel exercises and requires advanced training courses. For anyone searching for a physical therapist specializing in urinary incontinence, the American Physical Therapy Association (APTA) provides a list of pelvic therapists in each state. They also provide courses for any therapist who wants to learn more about the pelvic floor.

Lately we see advertisements for medication to treat urinary incontinence. What can treatment by a physical therapist offer that traditional intervention cannot?

Barbara Cooper: The medicine we see advertised generally targets only one specific type of incontinence, urge incontinence. Research actually indicates the best results for urge are generally achieved with the combination of medicine and physical therapy.  Another common type of incontinence, stress incontinence, is usually due to muscle weakness; physical therapy directly addresses this weakness, which medicine can’t. Of course, physical therapy is a safe approach, with no danger of drug interaction or other negative side effects. Patients really appreciate this safe, natural and effective approach!