Since 2012, Dr. Tara Sullivan, PT, PRPC, WCS, IF, has exclusively specialized in pelvic pain and treating pelvic floor dysfunction (PFD). Previously, she worked as a massage therapist while attending college to eventually receive a doctorate degree in physical therapy from A.T. Still University. Sullivan continued her education to earn a Pelvic Rehabilitation Practitioner Certification (PRPC), which showcases her expertise in the field of pelvic rehabilitation. She also serves as a fellow of the International Society for the study of Women Sexual Health and is a board-certified clinical specialist in women’s health.
Sullivan established the pelvic health program at HonorHealth in Scottsdale, Az., which now has nine locations. She mentors 11 pelvic physical therapists locally and also teaches other physical therapists throughout the country about pelvic health as a member of the faculty team at Herman and Wallace. Sullivan passionately educates both the public and other health care providers about PFD and its treatment through her own website. She recently took time to share some of passion about pelvic floor health with us, including misconceptions about PFD, how she’s treating it and what she’s excited about for the future.
What changes have you seen in the 11 years you’ve been treating PFD?
“The best change I’ve seen is that there’s more awareness from the medical community that pelvic therapy is beneficial for more than incontinence,” Sullivan said. “It used to harder to get referrals for patients from doctors to pelvic therapy. They didn’t know we existed or they thought we only taught patients how to do Kegels.”
Nowadays, though, Sullivan said more and more doctors have begun to recognize the role pelvic floor physical therapy can play in treating patients with IC. Patients are benefitting from more public awareness and medical recognition about pelvic floor physical therapy.
“We can help patients with most bowel, bladder and sexual dysfunctions and pelvic pain,” Sullivan said. “People don’t have to live with these debilitating conditions.”
What are some misconceptions IC patients have about PFD?
Sullivan often encounters patients who think IC is a very specific diagnosis separate from the pelvic floor. However, for IC patients without Hunner’s ulcers, the bladder is not usually the only cause of their symptoms, including pelvic pain.
“Patients and doctors don’t recognize the relationship between the pelvic floor and the bladder,” she said. You might think it’s your bladder but pelvic floor dysfunction can also cause urinary symptoms of frequency, urgency, pressure and/or pain.
What treatments for PFD are you utilizing most right now?
Sullivan has two main components to treating PFD: bladder retraining and manual therapy.
“We do bladder retraining to teach the brain to not misinterpret a signal that it received from the bladder or nearby structures,” Sullivan said. “When you have IC, there are a lot of sensations that are being misinterpreted by the brain.”
The ultimate goal with bladder retraining is teaching patients how to discern between an IC urge or pain versus a normal bladder sensation. “We’re tapping into the neural loop that’s teaching the brain, the bladder and the pelvic floor what is what,” Sullivan said.
Manual therapy is an in-office component of her treatment for PFD. She works externally on fascial training as well as intravaginally and intrarectally to help muscles release their tension. With a variety of techniques, Sullivan helps patients to down train — or learn to relax — their pelvic floor muscles. She uses dry needling to help release those same muscles or trigger points and to down train the nervous system as well. A needle similar to ones used in acupuncture, is inserted right into a trigger point in a tense muscle. Sullivan said needle insertion may be uncomfortable, but many patients report feeling calm and a release just after insertion as the muscle begins to relax.
How does nutrition play a role in pelvic floor health?
“What we eat and drink causes inflammation,” she said. “Sugar, spicy and other acidic food and beverages increase inflammation in the body, especially the bladder.”
A normal amount of inflammation is healthy for healing; however, too much inflammation can have the opposite impact. While a non-ICer may be able to tolerate the inflammation from certain foods without as much repercussion, it may be more than an IC body can manage. Sullivan said if we picture inflammation in the body as being a cup, we’re fine as long as the cup doesn’t get overfull.
“That cup is constantly not getting too full,” she said of a healthy body. “It’s emptying, filling, emptying, filling. Our body is finding that balance. With patients who have IC, think of that cup as finally full and it’s overfilling.”
What might be a normal amount of inflammation for someone without IC will be more than the IC body can handle. Sullivan said diet modifications are a big component of her treatment of PFD patients. She has patients stick with a diet of foods and beverages that won’t increase inflammation.
“We have to empty the cup and then teach the body to be more balanced so that they can tolerate those [inflammatory components] in the future,” Sullivan said.
What research are you most excited about for the future?
“A huge component that we keep overlooking is the effect of birth control on our overall body, but our bladder as well,” Sullivan said, mentioning she’s had many IC patients feel significantly better once they stopped oral contraceptive pills. “There’s a hormonal component to IC as well. The bladder likes estrogen which is suppressed with hormonal birth control. I’d like to see more research on how birth control is related to IC.”
She also hopes to see breakthroughs in is the neurological pain science connection to IC. She said research has already shown that the brain interprets symptoms of IC, not the bladder. As such, she’d like to see that research expounded upon.
Where can patients go to find a good pelvic floor physical therapist near them?
Finding a physical therapist trained in pelvic floor physical therapy is important. Fortunately, more and more facilities offer pelvic floor physical therapy. Sullivan said she recommends patients check a site run by Herman and Wallace that helps patients find qualified pelvic floor physical therapists in their area.
