Tara Sullivan, PT, DPT, PRPC, WCS, IF is on faculty with Herman & Wallace. She created Sexual Medicine in Pelvic Rehab and co-created Pain Science for the Chronic Pelvic Pain Population which she instructs alongside co-creator Alyson N Lowrey, PT, DPT, OCS. Tara started in the healthcare field as a massage therapist, practicing over ten years including three years of teaching massage and anatomy and physiology and has specialized exclusively in Pelvic Floor Dysfunction treating bowel, bladder, sexual dysfunctions, and pelvic pain since 2012. Join Tara in her next on September 23-24 in her remote course Sexual Medicine for Pelvic Rehab.
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's 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 healthcare providers about PFD and its treatment through her own website. She recently took the time to share some of her passion for 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 be 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 of 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. Pelvic floor dysfunction can mimic and trigger the urinary symptoms associated with IC/BPS.
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 of 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 the 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 out PelvicRehab.com a site run by Herman and Wallace that helps patients find qualified pelvic floor physical therapists in their area.
Special thanks to Tara Sullivan and article author Stacey A. Shannon for allowing Herman & Wallace to share this article. The original post can be found on the IC Network site here: https://www.ic-network.com/getting-to-know-the-experts-dr-tara-sullivan/.
Sexual Medicine in Pelvic RehabSexual Medicine in Pelvic Rehab - September 23-24, 2023
Price: $450
Experience Level: Beginner
Contact Hours: 15
Description: This two-day, remote continuing education course is designed for the pelvic rehab specialist who wants to expand their knowledge, experience and treatment in sexual health and dysfunction. This course provides thorough introduction to pelvic floor sexual function, dysfunction and treatment interventions for males and females of all sexual orientations, as well as an evidence-based perspective on the value of physical therapy interventions for patients with chronic pelvic pain related to sexual conditions, disorders, and multiple approaches for the treatment of sexual dysfunction including understanding medical diagnosis and management.
Lecture topics include hymen myths, squirting, G-spot, prostate gland, sexual response cycles, hormone influence on sexual function, anatomy and physiology of pelvic floor muscles in sexual arousal, orgasm, and function and specific dysfunction treated by physical therapy in detail including vaginismus, dyspareunia, erectile dysfunction, hard flaccid, prostatitis, post prostatectomy; as well as recognizing medical conditions such as persistent genital arousal disorder (PGAD), hypoactive sexual desire disorder (HSDD) and dermatological conditions such as lichen sclerosis and lichen planus. Upon completion of the course, participants will be able to confidently treat sexual dysfunction related to the pelvic floor as well as refer to medical providers as needed and instruct patients in the proper application of self-treatment and diet/lifestyle modifications.