I recently had the special honor of conducting an interview with pelvic floor physical therapist Dr. Julie Sarton, PT, DPT, WCS. She is the owner and founder of Sarton Physical Therapy in Orange County, California, and considered an expert in pelvic pain. Before founding her own practice, Julie founded and served as Director of the Pelvic Floor Physical Therapy program and on faculty at the University of California, Irvine. Here she shares part of her story, and what pelvic floor physical therapy encompasses.
1. What made you decide to become a physical therapist, specifically a pelvic floor physical therapist?
When I think back there were two people who had the most influence on my professional life. My brother inspired me to become a physical therapist. He has battled a complex seizure disorder and severe learning disabilities his entire life. Watching him and my parents struggle to find resources to help him lit the fire for me to serve a population that is under-treated in general. After discovering my love of learning for anatomy and the brain (neuroanatomy) in undergrad, I decided physical therapy was my calling and headed off to grad school to get my doctorate in the field.
Once in physical therapy school my late uncle, Dr. James Carter, planted the seed for me to become a pelvic floor physical therapist. He was an OBGYN in South Orange County, a founder of the International Pelvic Pain Society (IPPS), author of dozens of articles and a pioneer in his field.* One of the things I respected most about my uncle was that he thought outside the box and looked at his patients holistically.
My uncle noticed that many patients in his practice with pelvic pain, specifically endometriosis, would often continue with their pain even after he surgically removed the “problem.” Digging deeper, he recognized that a musculoskeletal component existed with these patients. He found and read Travell and Simons’ Trigger Point Manual and honed in on the chapter about the pelvic floor and thought, “This is what’s happening with my patients!” He contacted the authors and asked if there was anyone in the country applying this work internally to the pelvic floor musculature. He was put into contact with the brilliant physical therapist Rhonda Katarinos and brought her out to Southern California into his clinic on a Saturday to evaluate 13 of his patients. Rhonda, my uncle and Joan Brown (another brilliant therapist I mentored under locally) went case by case through all these patients and they were able to 1) identify a myofascial/neuromuscular component in all of them, and 2) help each one of these patients who had experienced no relief with traditional therapies or surgery.
All of this occurred while I was in physical therapy school, and I repeatedly heard my uncle speaking about this population of women (and men) who were suffering terribly, with very few practitioners available to help them. This resonated with me, especially after my experience with my brother growing up—my uncle’s passion become my passion. A few years after I received my doctorate I made the move to Orange County, mentoring under him at the South Orange County Pelvic Pain Center and Joan Brown at Marguerite Physical Therapy Clinic. Absorbing everything I could learn, I quickly found that pelvic floor physical therapy was my calling. I am incredibly blessed to do what I love each and every day, and it means a lot to carry on my uncle’s life mission in my own unique capacity.
*The 2015 annual International Pelvic Pain Society meeting is in San Diego. For more information, visit PelvicPain.org. There will be a memorial lecture for Dr. James Carter on Saturday titled Models of Muscle Pain: Transmitting the Message. Julie gets the honor of introducing the speaker and paying tribute to her uncle at this next meeting.
2. How long have you been practicing pelvic floor physical therapy?
I graduated in 1996 from Creighton University’s physical therapy program and was honored to be part of the nation’s first physical therapy doctorate program. During school, we received a single lecture on incontinence and nothing on pelvic pain, women’s health, or pelvic floor dysfunction! All my pelvic floor training was post-grad and took several years. Immediately upon graduation, I practiced neurologic physical therapy for four years, treating many stroke patients and others with neurologic disorders, before moving into pelvic floor physical therapy when I felt I was ready. I have been practicing pelvic floor for 16 years, making me one of the most experienced (and oldest!) pelvic floor physical therapists in California. I was also part of the very first class to receive my Women’s Clinical Specialty (WCS), the Board Specialty in pelvic floor physical therapy, and have been very proud to see how that program has grown.
3. What is pelvic floor physical therapy? How would you describe it to someone who has never heard of it?
The pelvic floor is a term for the muscles, ligaments and connective tissue that support the pelvic organs, which are hugely important in the human body. They play an important part in urination and waste elimination, sexual function, the stability of the body, and many other functions. Pelvic floor physical therapy focuses on these muscles and the fascia, connective tissue, ligaments, soft tissue, and associated organs.
Pelvic floor physical therapy then focuses on any of the multiple dysfunctions that present within or related to the pelvic floor. These are wide-ranging, but can include incontinence, urinary urgency, constipation, pelvic pain syndromes (interstitial cystitis, vestibulodynia, pudendal neuralgia), sexual pain, pelvic prolapse, and pre- and post-natal issues. We also see and treat many patients with low back pain, hip pain, or other orthopedic pain that is associated with the pelvic floor.
Pelvic floor dysfunction is unique because it can present and manifest in such different ways. Conditions can be difficult to diagnose for a physician or general physical therapist, because a patient might have urinary urgency and frequency, along with constipation and sexual pain. It is tempting to try and treat these symptoms one at a time, but the underlying problem in the pelvic floor is causing all of the issues. Unless it is addressed the patient will rarely improve.
These conditions also require that we look holistically at the patient. Many of our patients have been in chronic pain for many years, which actually changes the brain connections and makes them more susceptible to experiencing the pain. We try and determine whether the pelvic floor is “the driver of the problem or the victim of the problem,” to truly find and address the underlying issue for the patient.
Pelvic floor physical therapy is undergoing a rapid and expansive growth, and will eventually become the standard of care for patients with these conditions. In Europe the profession is even further along, and many women are routinely required to see a pelvic floor physical therapist during and after pregnancy to prevent or treat any problems that may arise. As they learn more about what can be done, physicians will start asking directed questions, looking for red flags in patients that have potential pelvic floor issues and do a baseline pelvic floor muscle exam with every annual exam.
What makes pelvic floor therapy different than general physical therapy is the extra added component of internal work that is done. For a lot of people that can be scary until they understand the anatomy and start to experience relief. We always teach our patients that they have skeletal muscles that exist on the inside just like on the outside of the body. It’s not weird or abnormal. We are fortunate to have the ability to access and treat those muscles internally. While it can be intimidating for patients at first, we make sure to spend time educating the patient and making sure they are comfortable with what we will be doing. Once they understand that the pelvic floor is the cause of their chronic pain or other symptoms, and that it can be reached and directly helped, it makes all the difference in the world. If I could encourage your readers in any way, if you think you may have a pelvic floor condition or symptoms, don’t put off an initial visit to at least understand your condition and how it can be helped.
For more information about Dr. Julie Sarton and Sarton Physical Therapy, check out their website at PelvicHealing.com. You can also contact the clinic directly at (714) 770-8222.