Are your patients’ medications sabotaging their rehab progress?

What if a seemingly harmless prescription were quietly undermining the very therapy intended to restore a patient's function and quality of life? Could the side effect of one medication be the missing puzzle piece in an unresolved case of pelvic pain? Might an overlooked drug interaction complicate recovery or hinder treatment progress, despite the best efforts of the therapist?

Understanding medications and their complexities is not just helpful, but essential in rehab.

What Role Do Medications Play in Pelvic Health Rehab?
Medications are everywhere in modern healthcare. But are rehab providers fully aware of how the drugs their patients take may influence treatment outcomes? For patients with pelvic floor dysfunction, benign prostatic hypertrophy (BPH), breast cancer, and those navigating the unpredictable terrain of menopause, pharmaceuticals can serve as both an ally and an adversary.

Pelvic floor dysfunction, for instance, is rarely the result of a single cause. Pain, incontinence, urgency, and sexual dysfunction are symptoms that overlap with other conditions—often managed with medications that can influence outcomes. For example, anticholinergic drugs prescribed for an overactive bladder may reduce urgency but can also cause constipation, dry mouth, and cognitive changes. Are we asking the right questions or thoroughly reviewing the medication list to fully understand the clinical presentation?

In the case of breast cancer, medication regimens are typically complex. Patients might be prescribed chemotherapy, hormone blockers, steroids, bisphosphonates, antiemetics, and more. These drugs come with a host of possible side effects including joint pain, neuropathy, lymphedema, muscle weakness, or even cardiovascular complications. How might these adverse effects alter a patient’s ability to engage in, or respond to, rehab interventions?

Similarly, menopausal symptoms—whether naturally occurring or induced by cancer therapies—are often treated with hormone replacement therapy, antidepressants, and non-hormonal agents. Each can carry risks and benefits that impact the tissues, joints, and sense of well-being.

Understanding Medication Side Effects
Medication side effects can present as a new or worsening symptom. If someone receiving treatment for breast cancer develops sudden muscle or joint pain, is it from increased activity, chemotherapy-induced arthralgia, or perhaps an aromatase inhibitor?

Consider a patient with endometriosis who is prescribed a gonadotropin-releasing hormone (GnRH) agonist to manage their symptoms. While these medications can effectively reduce pelvic pain, they can cause symptoms commonly seen in menopause. The side effects of these drugs may not only affect the patient’s comfort and daily activities but can also create new challenges in rehab, such as increased risk of bone injury or exacerbation of emotional distress. Recognizing and managing these medication effects is crucial for optimizing both patient safety and treatment success.

Drug Interactions and Rehab Challenges
The average patient with pelvic health dysfunction takes several medications, sometimes prescribed by different specialists. How are these drugs interacting, or are some combinations quietly sabotaging progress? A comprehensive understanding of medication interactions and pharmacological principles is essential for delivering appropriate patient care and facilitating effective communication with other healthcare professionals.

Pharmacologic Knowledge Empowers Rehab Providers
A deeper pharmacologic awareness enables therapists to better treat, educate, and advocate for their patients. Understanding the nuances of medication management allows therapists to adapt rehabilitation goals and strategies to the patient’s current medication profile. This knowledge also enables them to help patients recognize symptoms that require urgent attention and reduce frustration and confusion when symptoms do not resolve as expected.

Therapists with a strong knowledge of medications can communicate well with doctors and pharmacists, helping ensure safer, more effective treatment outcomes.

Real-World Challenges
Clinicians often encounter challenges in pharmacology because of the large number of drugs, ongoing introductions of new medications, and the diversity of patient responses. Many rehab providers receive limited pharmacology training, focusing more on anatomy, physiology, and therapeutic techniques. As patients present increasingly complex medical histories, it is essential for rehab providers to maintain comprehensive knowledge and understanding.

It is also common for patients to underreport, forget, or misunderstand their medication regimens. Rehab providers must ask probing questions: "Have you started any new medications recently?" "Have you noticed changes in your symptoms since beginning this treatment?" "Are you taking any over-the-counter drugs, supplements, or herbal products?"

Rehab providers can help ensure patient safety by carefully reviewing medication and supplement lists. By identifying interactions and side effects, and collaborating closely with physicians and pharmacists, therapists contribute to safer, more effective, and patient-centric care.

Join Kristina Koch, PT, DPT, MS, CLT, PCES on September 13, 2025, for the two-day, virtual course offering of Pharmacologic Considerations for the Pelvic Health Provider. Day 1 includes self-paced, pre-recorded lectures, while Day 2 is a live, interactive Zoom session for Q&A, clinical implications, and case-based scenarios.

Your patients are more than their symptoms. And the answers aren’t always in the pelvic floor—they may be hiding in the medication list!

AUTHOR BIO:
Kristina Koch, PT, DPT, CLT, PCES

Kristina Koch, PT, DPT, CLT, PCES (she/her) received her Master of Science in Physical Therapy in 1996 from Springfield College in Massachusetts. In 2001, while living in the Los Angeles area, Kristina started specializing in the treatment of pelvic floor dysfunction, including bowel/bladder issues and pelvic pain, and in 2021, she went on to earn her doctorate of physical therapy from The College of St. Scholastica. During her time in Los Angeles, she was fortunate to work with and be mentored by fellow Herman & Wallace faculty member, Jenni Gabelsburg, DPT, WCS, MSc, MTC. Kristina is a Board Certified Specialist in Women's Health Physical Therapist (2013-2023) by the American Board of Physical Therapy Specialties. She then received her lymphatic therapist certification (CLT) in 2015.

Kristina has successfully helped establish women’s health and pelvic floor physical therapy programs in San Diego, CA and Colorado Springs, CO where she currently works in private practice. Kristina treats men, women, children, trans, and gender non-binary individuals in her practice. In addition, Kristina serves as a guest lecturer for graduate physical therapy students at Regis University in Denver, CO, and provides educational lectures to medical providers and local community groups. Outside of work, Kristina enjoys spending time with her husband and two children, skiing, running, and hiking.