Picture a typical day on a pelvic health caseload. A patient with overactive bladder arrives on an anticholinergic. A patient with chronic pelvic pain is taking an antidepressant and an opioid. A postpartum patient mentions she just started a GLP-1 medication, and an older adult with urinary urgency hands you a medication list that fills an entire page. Every one of those prescriptions can influence bladder function, bowel motility, muscle performance, pain perception, or sexual health, which means every one of them can influence the outcome of pelvic rehabilitation.

Pharmacologic agents are often a first line treatment for pelvic floor dysfunction, and most patients who arrive in a pelvic rehab clinic are already taking one or more medications. The clinician who understands what those medications do, and what they can cause, is better equipped to interpret symptoms accurately, adjust the plan of care, and communicate with the rest of the medical team.

Why Pharmacology Belongs in Pelvic Rehab Practice

Medications can be the hidden variable in a patient's presentation. Conditions commonly seen in pelvic rehabilitation, including overactive bladder, painful bladder syndrome, chronic pelvic pain, and constipation, are frequently managed with medications that act on neuromuscular function, pain processing, hormonal balance, and urologic or gastrointestinal physiology. When a patient is not progressing as expected, the explanation may not be in the muscles at all. It may be in the medicine cabinet. Direct access has also raised the stakes. As more patients enter physical and occupational therapy without seeing a physician first, rehabilitation providers carry more responsibility for screening, safety, and recognizing when a symptom pattern points back to a drug effect rather than a musculoskeletal cause.

How Medications Affect Pelvic Floor Function

Medications influence pelvic health in more ways than most clinicians realize. Common examples include:

• Opioids that slow gut motility and drive constipation
• Antidepressants that can alter sexual function, arousal, and continence
• Anticholinergics prescribed for urinary symptoms that carry cognitive and systemic side effects, particularly in older adults
• Hormonal medications that influence tissue quality and pain sensitivity
• Newer agents, including GLP-1 receptor agonists, that change gastrointestinal transit in ways that show up directly in bowel and bladder symptoms

The same drug can be both treatment and culprit. A medication prescribed to calm an overactive bladder may dry the mouth and slow the bowel, and the resulting constipation can worsen the very urinary symptoms it was meant to treat. Recognizing these loops allows the pelvic health provider to tailor interventions, modify exercise and behavioral strategies around a patient's medication profile, and flag concerns to the prescribing provider.

What the Research Shows

Provider knowledge has not kept pace with prescribing. A 2017 study by Araklitis, Thiagamoorthy, Hunter, Rantell, Robinson, and Cardozo found limited knowledge among health care professionals regarding anticholinergic load, the cumulative burden of anticholinergic medications that can impact cognitive functioning in the elderly.¹

While managing medications is not within the scope of practice for rehabilitation therapists, reviewing them is a duty. That means reviewing patient medications at the initial evaluation and on an ongoing basis, watching for side effects that mimic or worsen pelvic floor dysfunction, assessing how medications may be affecting treatment response, and communicating clearly with referral sources and primary care providers when something does not add up.

Inside the Course

Kristina Koch, PT, DPT, CLT, PCES created Pharmacologic Considerations for the Pelvic Health Provider to close this gap. Taught by live instructor via Zoom, this one day remote course covers:

• Medications used for the treatment of pelvic floor and genitourinary conditions
• Common side effects of medications routinely used for pelvic floor dysfunction
• Medications for constipation and GI dysfunction
• Medications for pelvic pain conditions including vulvodynia, chronic prostatitis, and endometriosis
• Medications and side effects in gender-affirming care for patients who are transitioning
• Drug interactions and non-pharmacologic alternatives for pelvic and reproductive health
• Communicating effectively with referral sources and primary care providers about medications

Because the course is remote, registrants can attend solo from home or the clinic, with no partner or lab group required. The material is also a strong review for clinicians preparing for the Pelvic Rehabilitation Practitioner Certification (PRPC) exam, where pharmacology is one of the tested domains.

References

1. Araklitis G, Thiagamoorthy G, Hunter J, Rantell A, Robinson D, Cardozo L. Anticholinergic prescription: are healthcare professionals the real burden? Int Urogynecol J. 2017;28(8):1249–1256. https://doi.org/10.1007/s00192-016-3258-3

{ "@context": "https://schema.org", "@type": "FAQPage", "mainEntity": [ {"@type": "Question", "name": "Who should take Pharmacologic Considerations for the Pelvic Health Provider?", "acceptedAnswer": {"@type": "Answer", "text": "The course is designed for physical therapists, occupational therapists, physical therapist assistants, occupational therapist assistants, registered nurses, nurse midwives, and other rehabilitation professionals who treat pelvic floor dysfunction and want a stronger working knowledge of the medications their patients take. It is also valuable preparation for clinicians studying for the PRPC exam."}}, {"@type": "Question", "name": "Is this course offered remotely?", "acceptedAnswer": {"@type": "Answer", "text": "Yes. Pharmacologic Considerations for the Pelvic Health Provider is a one day remote course taught by a live instructor via Zoom on Saturday, September 12, 2026. Registrants can attend solo and do not need a partner or lab group."}}, {"@type": "Question", "name": "Can rehabilitation therapists manage patient medications?", "acceptedAnswer": {"@type": "Answer", "text": "No. Managing medications is not within the scope of practice for rehabilitation therapists. However, therapists have a duty to review patient medications at the initial evaluation and on an ongoing basis, assess their impact on treatment and outcomes, and communicate with prescribing providers to ensure patient safety."}}, {"@type": "Question", "name": "What conditions does the course cover?", "acceptedAnswer": {"@type": "Answer", "text": "Course content addresses medications for pelvic floor and genitourinary conditions, constipation and GI dysfunction, pelvic pain conditions including vulvodynia, chronic prostatitis, and endometriosis, and medications and side effects in gender-affirming care, along with drug interactions and non-pharmacologic alternatives."}} ] } { "@context": "https://schema.org", "@type": "Course", "name": "Pharmacologic Considerations for the Pelvic Health Provider", "description": "A one day remote continuing education course covering medications used to treat pelvic floor and genitourinary conditions, common side effects, drug interactions, and non-pharmacologic alternatives. Taught by live instructor via Zoom by Kristina Koch, PT, DPT, CLT, PCES.", "provider": {"@type": "Organization", "name": "Herman & Wallace Pelvic Rehabilitation Institute", "url": "https://hermanwallace.com"}, "url": "https://hermanwallace.com/continuing-education-courses/pharmacologic-considerations-for-the-pelvic-health-provider/remote-course-september-12-2026", "hasCourseInstance": { "@type": "CourseInstance", "courseMode": "online", "startDate": "2026-09-12", "endDate": "2026-09-12", "instructor": {"@type": "Person", "name": "Kristina Koch, PT, DPT, CLT, PCES"}, "location": {"@type": "VirtualLocation", "url": "https://hermanwallace.com/continuing-education-courses/pharmacologic-considerations-for-the-pelvic-health-provider/remote-course-september-12-2026"} } }

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.

At Herman & Wallace, we know that pelvic rehabilitation is a dynamic and ever-evolving field. While foundational courses like Pelvic Function Level 1 and Dry Needling and Pelvic Health often get the spotlight, there are several highly valuable courses that tend to fly under the radar. These courses offer practitioners the opportunity to deepen their knowledge, broaden their skills, and better serve patients with complex needs.

Here are five underrated courses that can have a powerful impact on your practice:

---

1. Nutrition Perspectives for the Pelvic Rehab Therapist
Pelvic health doesn’t exist in isolation from the rest of the body, and nutrition plays a critical role in tissue healing, inflammation, digestion, and pelvic pain syndromes. This course introduces pelvic rehab practitioners to the fundamentals of nutrition as it relates to pelvic health.

Participants learn how to recognize when dietary factors may be contributing to issues such as constipation, bladder irritation, vulvar pain, or chronic inflammation. While not a course that trains clinicians to act as dietitians, it empowers them to screen for red flags, collaborate with nutrition professionals, and make basic, evidence-informed recommendations that can significantly impact patient outcomes.

2025 Course Date Options: October 11-12, December 6-7.

 

2. Oncology and the Pelvic Floor Series
(OPF1: Foundations, OPF2A: Male Pelvic & Colorectal Cancers, and OPF2B: Female Pelvic & Bladder Cancers)

Pelvic health isn’t just for perinatal or orthopedic populations. People undergoing treatment for pelvic and abdominal cancers face unique and complex challenges, including incontinence, pelvic pain, sexual dysfunction, and scar tissue restrictions.

The Oncology and the Pelvic Floor series offers a comprehensive framework for working with patients at every stage of the cancer journey, and provides the knowledge and sensitivity needed to support this underserved population, integrating trauma-informed care, manual therapy, exercise, and interdisciplinary collaboration.

2025 Course Date Options: Level 1 September 13-14, Level 2A December 6-7, Level 2B November 1-2.

 

3. Pharmacologic Considerations for the Pelvic Health Provider
Medications have a profound impact on the pelvic floor—often in ways that are overlooked. Whether it’s constipation from opioids, hormonal changes from contraceptives, or bladder irritation from certain antibiotics, understanding pharmacology is crucial.

This course demystifies medications commonly encountered in pelvic health practice. It helps clinicians understand how drugs can influence bowel, bladder, sexual function, pain processing, and healing. Armed with this knowledge, practitioners can engage in more informed discussions with patients and other members of the healthcare team, helping to troubleshoot barriers to progress.

2025 Course Date Option: September 13.

 

4. Yoga for Pelvic Pain
Yoga is more than stretching—it’s a mind-body practice with proven benefits for nervous system regulation, pain management, and muscular balance. Yoga for Pelvic Pain teaches practitioners how to integrate evidence-based yoga principles into rehabilitation for patients with chronic pelvic pain.

This course goes beyond asana (physical postures) to incorporate breathwork, mindfulness, and gentle movement tailored to the needs of people with complex pain syndromes. Participants leave with practical tools they can immediately incorporate into one-on-one sessions or group classes, supporting both physical function and emotional well-being.

2025 Course Date Option: September 13-14.

 

5. Rehabilitative Ultrasound Imaging: Pelvic Health & Orthopedic Topics
Rehabilitative Ultrasound Imaging (RUSI) provides real-time feedback for both clinicians and patients. It’s an invaluable tool for assessing muscle activation, motor control, and coordination - particularly for the deep core and pelvic floor muscles.

This course covers both pelvic health applications (like visualizing pelvic floor contractions) and broader orthopedic topics (like assessing the transverse abdominis or multifidus). Practitioners gain hands-on experience in using ultrasound to refine exercise prescription, improve patient engagement, and objectively document progress. Despite its transformative potential, RUSI remains underutilized in many pelvic rehab settings.

2025 Course Date Options for September 5-7: Self-hosted, Indianapolis IN, Seattle WA.

---

Don’t Overlook These Gems
Expanding your clinical toolbox with specialized knowledge can transform your patient care. Whether it’s understanding how nutrition, medications, cancer treatments, or mind-body practices influence the pelvic floor—or learning to harness the power of ultrasound imaging—these courses provide essential insights that go beyond the basics.

Ready to elevate your practice? Explore these courses and others at Herman & Wallace and continue your journey as a lifelong learner in pelvic rehabilitation.

From antidepressants and anticholinergics to GLP-1 receptor agonists and ADHD stimulants, medications can significantly impact pelvic floor function and rehabilitation outcomes. Pelvic health rehabilitation providers must stay informed about new and existing pharmaceuticals, as many conditions such as overactive bladder, painful bladder syndrome, chronic pelvic pain, and constipation to name a few, are managed with medications that influence neuromuscular function, pain perception, hormonal balance, and urologic or gastrointestinal physiology.

A strong understanding of pharmacology allows pelvic health specialists to anticipate and address medication-related barriers to rehabilitation, such as fatigue, myofascial dysfunction, or altered bladder and bowel function. By integrating this knowledge into clinical practice, providers can tailor interventions, modify exercise prescriptions, manual therapy, and behavioral strategies to align with a patient’s medication profile. For example, muscle relaxants or neuromodulators like baclofen and gabapentin may necessitate adjustments in functional training due to sedation or decreased muscle tone. At the same time, diuretics require careful scheduling of therapy sessions to accommodate urinary urgency.

Pelvic health rehab providers also play a crucial role in patient education, helping individuals understand how medications affect pelvic health and how lifestyle, diet, and therapy can optimize treatment outcomes. Many patients take multiple medications that may either support or hinder their progress, making it essential for providers to recognize drug-induced side effects that could mimic or exacerbate pelvic floor dysfunction.

Staying current with pharmacological advancements enables pelvic health specialists to collaborate effectively with urologists, gynecologists, gastroenterologists, pain specialists, and primary care providers. This interdisciplinary approach ensures comprehensive, patient-centered care, optimizing safety and treatment efficacy. By maintaining a solid foundation in pharmacology and keeping up with emerging research, providers can enhance rehabilitation outcomes, prevent setbacks, and offer more informed, holistic care.

Join Kristina Koch, PT, DPT, CLT, PCES on April 5, 2025, for the remote course "Pharmacologic Considerations for the Pelvic Health Provider" to expand your expertise in managing medications related to pelvic floor dysfunction and broader men’s and women’s health conditions. This course will equip you with the knowledge to evaluate medication-related factors, recognize potential side effects, implement non-pharmacologic management strategies, and collaborate effectively with other healthcare professionals. Strengthen your ability to enhance patient safety, optimize treatment outcomes, and confidently navigate the pharmacological aspects of pelvic health care.

 

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

Kristina Koch, PT, DPT, CLT, PCES (she/her) received her Masters 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 and 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, California 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.

Ask yourself these 5 questions:

1. Do you understand the importance of conducting medication reviews with all your patients?
2. Can you confidently discuss the medications used in the treatment of pelvic floor, gastrointestinal (GI), and genitourinary conditions?
3. Are you able to describe the common side effects of medications routinely used in pelvic health?
4. Can you analyze the impact medications may have on a patient’s complaints and their treatment plan and outcomes?
5. Are you able to effectively communicate with patients and other healthcare providers about medications?

If you answered "no" to any of these questions or are preparing for an upcoming PRPC or WCS exam, the Pharmacologic Considerations for the Pelvic Health Provider course is designed for you!

The Role of Medication Review in Rehabilitation Therapy
While managing medications is not within the scope of practice for rehabilitation therapists, it is crucial to review patient medications during the initial evaluation and on an ongoing basis. Therapists must assess the impact of medications on treatment and patient outcomes to ensure patient safety.

Why Pharmacology Knowledge Matters!
Aging Population: With an aging population, many patients over the age of 65 are on more than five medications, increasing the risk of side effects, adverse drug reactions, and drug interactions.

Informed Discussions: A solid grasp of pharmacology allows therapists to engage in informed discussions with patients and collaborate effectively with other healthcare providers.

Alternative Approaches: Understanding pharmacology enables therapists to explore recent medications, supplements, or alternative approaches that may minimize side effects, mitigate impacts on quality of life, and enhance function.

Evidence-Based Practices: Keeping current on advancements in pharmacology is essential for delivering effective, evidence-based physical therapy interventions.

Benefits of Pharmacology Understanding in Rehabilitation
Safe and Effective Treatment: A thorough understanding of pharmacology helps provide safe and effective treatment.

Optimized Rehab Strategies: Knowledge of pharmacology allows therapists to optimize rehabilitation strategies.

Patient Empowerment: Educating patients about their medications empowers them to make informed decisions.

Recognizing Red Flags: Identifying potential red flags related to medication use.

Improved Collaboration: Pharmacology knowledge improves collaboration with other healthcare providers.

Course Offering
Join Kristina Koch for the virtual course Pharmacologic Considerations for the Pelvic Health Provider on August 17th to deepen your understanding and stay up-to-date on the medications used in treating pelvic floor and women's and men's health dysfunctions. This course will provide you with the essential knowledge to confidently manage medication-related aspects of patient care, ensuring better outcomes and enhanced patient safety.

 

AUTHOR BIO
Kristina Koch, PT, DPT, MS, Board Certified Specialist in Women's Health PT (2013-2023), CLT

Kristina 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 and 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, California, 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.

Kristina Koch, PT, DPT, WCS, CLT is a board-certified clinical specialist in women’s health physical therapy and a certified lymphedema therapist. Kristina has been treating pelvic health conditions in individuals of all ages and genders since 2001 and works in private practice in Colorado Springs, CO. Kristina is a member of the HW faculty with her own course, Pharmacologic Considerations for the Pelvic Health Provider, scheduled next on February 4, 2024.

---

Why it is Important to Know Pharmacology

All rehab providers need to have a foundational understanding of pharmacology for numerous reasons, all of which contribute to providing safe, effective, and comprehensive care to their patients. In pelvic health, therapists often encounter patients who are taking numerous medications, and it is important for us to understand how these drugs may impact a patient's physical function, exercise tolerance, current complaints, and overall well-being.

Basic pharmacology knowledge includes:

1. Understanding drug classes
2. Pharmacokinetics and pharmacodynamics: how drugs exert their effect on the body and how the body impacts the drug
3. Drug interactions: recognizing potential interactions between medications and how they may affect a patient's response to therapy interventions.
4. Adverse Effects: awareness of possible side effects of medications that could impact a patient's ability to participate in therapy or contribute to their symptoms.

A more comprehensive understanding of pharmacology has clinical relevance on many fronts. The following bullet points highlight how understanding pharmacology has implications for clinical practice.

Assessment:

Pharmacological knowledge allows clinicians to conduct a more comprehensive assessment of their patients. Considering a patient's medication history as part of the overall health profile helps clinicians tailor treatment plans to individual needs and potential limitations.

Safe and Effective Patient Care:

Rehab providers often work with patients who are taking medications for various health conditions. Understanding pharmacology enables therapists to assess potential interactions between drugs and design safe and effective treatment plans.

Optimizing Rehabilitation Strategies:

Medications can impact a patient's response to exercise and rehabilitation. Understanding pharmacology enables rehab providers and therapists to modify treatment plans based on a patient's medication profile, potentially optimizing rehabilitation outcomes.

Pain Management:

Pain is a common reason our patients are seeking physical therapy. Knowledge of medications used for pain management enables therapists to collaborate with healthcare providers to create comprehensive pain management strategies for their patients.

Collaborative Care:

Clinicians often collaborate with physicians, nurses, and other healthcare providers. Knowledge of pharmacology facilitates effective communication, allowing therapists to discuss patient cases, contribute to treatment decisions, and foster a collaborative approach to patient care.

Educating and Empowering Patients:

Pelvic health practitioners and rehab providers play a vital role in educating patients about their health, including medications. Understanding pharmacology allows therapists to explain the purpose of medications, potential side effects, and the importance of compliance, encouraging patient engagement and adherence to treatment plans.

Recognition of Red Flags:

Knowledge of pharmacology enables pelvic health rehab providers to recognize signs and symptoms of adverse drug reactions, identify potential issues early, consult with healthcare providers, and modify treatment plans accordingly.

Informed Decision-Making:

In certain situations, therapists and rehab providers may need to make decisions regarding treatment plans and goals, treatment frequency, or modalities based on a patient's medication profile. A solid understanding of pharmacology contributes to informed decision-making.

Legal and Ethical Considerations:

Pelvic health practitioners need to work within their scope of practice. An understanding of pharmacology helps therapists recognize when it is appropriate to refer patients to other healthcare professionals for medication management.

Monitoring and Reporting:

Monitoring patients for signs of adverse reactions and knowing when to report concerns to other healthcare professionals or federal organizations.

Special Populations:

Pediatrics and geriatrics may require special consideration due to differences in pharmacokinetics and pharmacodynamics. Understanding how medications affect different age groups helps pelvic health therapists and rehab providers adapt our interventions accordingly.

As rehabilitation providers, we invest a substantial amount of time in direct interaction with our patients during their treatment sessions, surpassing the duration they spend with their primary care providers. This prolonged and more frequent engagement, spanning weeks or months, affords our patients an increased opportunity to communicate not only their physical concerns but also their apprehensions regarding medications and potential side effects. This dialogue exceeds what may occur with their physicians or primary care providers. Understanding the impact of medications on a patient is vital for effectively educating them about potential side effects and how these medications may contribute to their complaints, thereby augmenting the overall value of the treatment regimen.

With a solid grasp of pharmacology and insight into medications prescribed for pelvic health, therapists can engage in informed discussions with patients and collaborate effectively with other healthcare providers involved in their care. The capability to explore recent medications, supplements, or alternative approaches that may minimize side effects, mitigate impacts on quality of life, and enhance function. Remaining current on advancements in pharmacology is indispensable for delivering physical therapy interventions that are both effective and grounded in evidence-based practices.

In summary, a strong understanding of pharmacology enhances the overall quality of physical therapy practice. It ensures that physical therapists and rehab providers can provide patient-centered, evidence-based care while collaborating effectively within the broader healthcare team.

Join Kristina in Pharmacologic Considerations for the Pelvic Health Provider on February 4, 2024, to learn about the medications frequently used in pelvic health, their side effects, the clinical impact they may have on your patients, and possible alternatives to consider to improve patient outcomes and quality of life.

Kristina Koch, PT, DPT, is a board-certified clinical specialist in women’s health physical therapy and a certified lymphedema therapist. Kristina has been treating pelvic health conditions in individuals of all ages and genders since 2001 and works in private practice in Colorado Springs, CO. She has served as a guest lecturer for the pelvic health curriculum at Regis University in Denver and for the 3^rd year medical students at the University of Colorado, Colorado Springs campus. She is the creator of Pharmacologic Considerations for the Pelvic Health Provider.

 

Although it is not within the scope of practice for rehab therapists to manage medications, it’s important that we review patient medications during the initial evaluation and on an ongoing basis. Therapists have a duty to assess medications impact on treatment and patient outcomes and to ensure patient safety. The population is aging and many patients over the age of 65 are on more than 5 medications, increasing the risk of medication side effects, adverse drug reactions, and drug interactions.

Primary care providers spend approximately 14-17 minutes with a patient during a visit, and the patient gets about 5 minutes to discuss their concerns, leaving little time for medication reconciliation or discussion regarding medication side effects (Tai-Seale, McGuire & Zhang, 2007). As therapists, we tend to see our patients for longer periods of time and more frequently, giving the patient more of an opportunity to discuss their signs and symptoms. Additionally, patients referred for pelvic health issues are often seeing multiple specialty providers (Ob/Gyn, urology, urogynecology, pain management, etc.) for their care, and each one is typically prescribing medications, potentially leading to polypharmacy. Understanding a medication’s actions, its impact on therapy, the side effects, and potential adverse drug reactions, can help guide treatment and improve patient outcomes.

A recent patient example is a post-menopausal cisgender female, referred by her primary care physician, for urinary urgency and nocturia. Her past medical history was significant for breast cancer. Her medications included an aromatase inhibitor, antihistamine due to seasonal allergies, and Vitamin C. After reviewing her medications and history, I recommended a non-hormonal vaginal lubricant and within 2 weeks her symptoms were 80% improved. Understanding the side effects of her medications allowed me to educate the patient about the effects of her medication and how to manage her symptoms.

More and more patients are attending therapy through direct access. As the first point of contact for patients, it's imperative that rehab professionals have a foundational knowledge of the medications often prescribed to treat pelvic floor conditions, GI, GU, and reproductive health issues. The ability to have educated conversations with our patients and other healthcare providers involved in their care can greatly improve the quality of care and outcomes, and maintain patient safety. The ability to discuss medications, vitamins, and supplements or complementary alternatives, that can minimize side effects, have fewer impacts on quality of life, and enhance function is an integral part of comprehensive patient care.

Join Kristina on Saturday, January 7, 2023, for Pharmacologic Considerations for the Pelvic Health Provider. This one-day, remote course will discuss the importance of understanding pharmacology and medication review, the current research regarding the pharmacologic treatment of numerous pelvic and reproductive health conditions and their side effects, drug interactions, and non-pharmacologic alternatives that are available for pelvic and reproductive health. Registration information and additional details are available at www.hermanwallace.com. #hermanwallacepelvicrehab, @hermanwallacepelvicrehab

 

References:

Ciccone, C. D. (2007). Pharmacology in Rehabilitation. (4^th ed.). F.A. Davis Company.

Tai-Seale, M., McGuire, T.G., & Zhang, W. (2007). Time allocation in primary care office visits. Health Services Research. 42(5), 1871-1894. Doi: 10.1111/j.175-6773.2006.00689.x

Janes, M., & Kornetti, D. (2017). Medications: defining the role and responsibility of physical therapy practice. https://www.fsbpt.org/Portals/0/documents/free-resources/WinterForum2017Medications.pdf?ver=pf8bn4ZwoorAAg1PECZLfw%3D%3D

 

---

Pharmacologic Considerations for the Pelvic Health Provider

Course Dates:
January 7, 2023

Price: $200
Experience Level: Beginner
Contact Hours: 7.5

Description:  This seven-and-a-half hour, one-day remote learning course will discuss medications used for the treatment of pelvic floor and genitourinary conditions as well as common side effects of medications routinely used for pelvic floor dysfunction. This course will be taught by Kristina Koch, PT, DPT via Zoom. Medications for constipation and GI dysfunction, as well as pelvic pain conditions such as Vulvodynia, Chronic Prostatitis, and Endometriosis, will be covered. The course will also cover medications and side effects in Gender-Affirming Care for patients who are transitioning.

Kristina Koch, PT, DPT, is a board-certified women’s health physical therapist and certified lymphedema therapist who is the author/instructor of the remote course Pharmacologic Considerations for the Pelvic Health Provider. She has been treating pelvic health dysfunction in all ages and genders since 2001. Kristina works in private practice in Colorado Springs, CO, and has served as a guest lecturer for the pelvic health content at Regis University in Denver and the University of Colorado.

Did you know that the median length of time a primary care provider spends with a patient is 15 minutes? This breaks down to approximately 5 minutes for the patient to talk about their health concerns and 5 minutes for the health care provider to speak, with the rest being applied toward paperwork (1). After this appointment, the patient may not be seen again for several months or even a year. Medication side effects that impact the patients’ quality of life, or create new symptoms, can be easily overlooked.

I created the course, Pharmacologic Considerations for the Pelvic Health Provider because, with direct access to physical and occupational therapy services, a greater responsibility has been placed upon the therapist to take on more of a role as a primary care provider. We must ensure that all factors contributing to a patient’s signs and symptoms are considered. This includes reviewing and assessing if medications or supplements may be causative.

As therapists, we typically spend more time with our patients than their primary care providers. We are seeing them for longer periods during a treatment session and will see them numerous times throughout a month or longer. As a result, our patients have a greater opportunity to discuss their signs and symptoms with us versus their physician or primary care provider. Therefore, understanding how medications may be impacting a patient is essential. Being able to educate the patient about the side effects of the medications they are taking and how the medications may be contributing to their complaints can enhance the value of the treatment session.

By possessing this knowledge and understanding of the medications that are prescribed to treat pelvic health, therapists can have educated conversations with our patients and other health care providers involved in their care. The ability to discuss the most recent medications and supplements or complementary alternatives, that may minimize side effects or have fewer impacts on quality of life and enhance function, is an integral part of patient care.

---

Join Kristina to dive into Pharmacologic Considerations for the Pelvic Health Provider. This one-day, virtual course will discuss the importance of understanding pharmacology and review commonly prescribed medications. Kristina also spends time explaining current research pertaining to the pharmacologic treatment of numerous pelvic and reproductive health conditions, medication side effects, drug interactions, and non-pharmacologic alternatives. Medications discussed include those for constipation and GI dysfunction, pelvic pain conditions (including vulvodynia, chronic prostatitis, and endometriosis), as well as medications and side effects in Gender-Affirming Care for patients who are transitioning.

Upcoming 2022 course dates for Pharmacologic Considerations for the Pelvic Health Provider include:

• May 15
• July 9
• November 19

---

References:

1. Tai-Seale, M., McGuire, T. G., & Zhang, W. (2007). Time allocation in primary care office visits. Health Services Research. 42(5), 1871-1894. Doi:10.1111/j.175-6773.2006.00689.x
2. Ciccone, C. D. (2007). Pharmacology in Rehabilitation. (4^th). F.A. Davis Company.

Parkinson disease is the second most common neurologic disorder. When most people think about people with Parkinson disease, they think about stooped posture, shuffling gait, slow and rigid movement, balance difficulties and tremoring. Often these motor symptoms are the main target of pharmacological treatments with neurologists and many experience positive functional gains. Non-motor symptoms, however, can be more disabling than the motor symptoms and have significant adverse effects on the quality of life in people with Parkinson disease.

The pharmacologic management of non-motor autonomic dysfunction, including urinary, bowel, and sexual health impairments, is often ineffective, not supported by adequate research, or causes intolerable side effects for people with Parkinson disease. In a recent article titled “Update on Treatments for Nonmotor Symptoms of Parkinson’s Disease – An Evidence-Based Medicine Review.” Seppi, K, et al., 2019, the authors state this about use of a pharmacological treatment approach - “Before attempting any treatment for lower urinary tract symptoms, urinary tract infections, prostate disease in men, and pelvic floor disease in women should be ruled out.” It is rare to see a mention of pelvic floor within the literature that addresses helping people with Parkinson disease.

Pelvic rehabilitation specialists have a unique opportunity to step in and help these individuals improve their quality of life and many neurologists are unaware of the benefits our services could provide for their patients.

Please join me in an exciting dive into understanding the physiology of how Parkinson disease affects a person’s pelvic health and develop your skills to effectively assess and develop treatment plans to change the life of these individuals.

---

Seppi, K., Ray Chaudhuri, K., Coelho, M., Fox, S. H., Katzenschlager, R., Perez Lloret, S., ... & Hametner, E. M. (2019). Update on treatments for nonmotor symptoms of Parkinson's disease—an evidence‐based medicine review. Movement Disorders, 34(2), 180-198.

Erica Vitek, MOT, OTR, BCB-PMD, PRPC is the author and presenter of the new Parkinson Disease and Pelvic Rehabilitation course, and she is the co-author of the Neurologic Conditions and Pelvic Floor Rehab course. She is a certified LSVT (Lee Silverman) provider and faculty member, and is a trained PWR! (Parkinson’s Wellness Recovery) provider, both focusing on intensive, amplitude and neuroplasticity based exercise programs for people with Parkinson disease. Erica partners with the Wisconsin Parkinson Association (WPA) as a support group and event presenter as well as author in their publication, The Network. Erica has taken a special interest in the unique pelvic floor, bladder, bowel and sexual health issues experienced by individuals diagnosed with Parkinson disease.

Parkinson disease is the second most common neurologic disorder. When most people think about people with Parkinson disease, they think about stooped posture, shuffling gait, slow and rigid movement, balance difficulties and tremoring. Often these motor symptoms are the main target of pharmacological treatments with neurologists and many experience positive functional gains. Non-motor symptoms, however, can be more disabling than the motor symptoms and have significant adverse effects on the quality of life in people with Parkinson disease.

The pharmacologic management of non-motor autonomic dysfunction, including urinary, bowel, and sexual health impairments, is often ineffective, not supported by adequate research, or causes intolerable side effects for people with Parkinson disease. In a recent article titled Update on Treatments for Nonmotor Symptoms of Parkinson’s Disease – An Evidence-Based Medicine Review ^{Seppi, K, et al., 2019}, the authors state that “before attempting any [pharmacological] treatment for lower urinary tract symptoms, urinary tract infections, prostate disease in men, and pelvic floor disease in women should be ruled out.” It is rare to see a mention of pelvic floor within the literature that addresses helping people with Parkinson disease.

Pelvic rehabilitation specialists have a unique opportunity to step in and help these individuals improve their quality of life and many neurologists are unaware of the benefits our services could provide for their patients. Please join me in an exciting dive into understanding the physiology of how Parkinson disease affects a person’s pelvic health and develop your skills to effectively assess and develop treatment plans to change the life of these individuals.

---

Seppi, K., Ray Chaudhuri, K., Coelho, M., Fox, S. H., Katzenschlager, R., Perez Lloret, S., ... & Hametner, E. M. (2019). Update on treatments for nonmotor symptoms of Parkinson's disease—an evidence‐based medicine review. Movement Disorders, 34(2), 180-198