Protecting Your Pelvic Floor With NAU Urology Specialists' Dr. Kendel Lipe

Thanks for tuning in to the Armor Men’s Health Hour Podcast today, where we bring you the latest and greatest in urology care and the best urology humor out there.

In this segment, Dr. Mistry and Donna Lee are joined by NAU Urology Specialists' new partner, pelvic floor physical therapist Dr. Kendel Lipe. Dr. Lipe has a doctorate in physical therapy and works closely with Dr. Angela Treadway, our longtime specialist in pelvic floor physical therapy. Together, they help our patients regain much of their lost functionality and address chronic pain through physical exercises and manual manipulation. Today, Dr. Lipe explains how she approaches patients who often present with potential prostate problems, but who are actually suffering from issues with their pelvic floor. Symptoms to watch out for include  urinary issues (urgency, frequency, splayed urine stream, dribbling after urination, etc.) as well as sexual dysfunction (ED, pain with erection, premature ejaculation, etc.). If you or a loved one is struggling with these or other urologic complaints and would like a thorough and holistic evaluation that includes pelvic floor physical therapy as part of the treatment toolbox, please call us today! 

This episode was previously aired on Dec. 19, 2020. Don’t forget to like, subscribe, and share us with a friend! As always, be well!

Dr. Mistry is a board-certified urologist and has been treating patients in the Austin and Greater Williamson County area since he started his private practice in 2007.

We enjoy hearing from you! Email us at armormenshealth@gmail.com and we’ll answer your question in an upcoming episode!

Phone: (512) 238-0762

Email: Armormenshealth@gmail.com

Website: Armormenshealth.com

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Transcript

Speaker 1: Welcome back to the Armor Men's Health Hour with Dr. Mistry and Donna Lee.

Dr. Mistry: Hello and welcome to the Armor Men's Health Hour. I'm Dr. Mistry, your host, here as always with my extraordinary sound engineer co-host and practice manager, Donna Lee.

Donna Lee: I would like everybody out there listening to know that when he makes that sort of crack, that means I've messed something up...if you couldn't tell already.

Dr. Mistry: No, no, no. For those of you who don't know, she's perfect in every way.

Donna Lee: I'm not a sound engineer.

Dr. Mistry: We get so many people calling us just to like talk to you.

Donna Lee: Yeah, because I'm more awesome than you.

Dr. Mistry: It's a little insulting.

Donna Lee: It's the Dr. Donna show featuring Dr. Mistry.

Dr. Mistry: Sometimes I turn on the radio and I'm not even on the show.

Donna Lee: Well, because you step away all the time.

Dr. Mistry: It's like that fight club where like the guy doesn't realize that there were fight clubs in other cities. And I was like, "Wait a minute. She recording without me? That's my show . What the hey-who?"

Donna Lee: Well maybe you should show up more often.

Dr. Mistry: I'm a board certified urologist and the temporary co-host of the show, apparently. This show is brought to you by NAU Urology Specialists. We're a urology practice that was founded in 2007, first with the moniker, "state-of-the-art, close to home," because people, they were willing to drive from Round Rock. Now, now we don't need to tell them that anymore.

Donna Lee: North Austin Urology.

Dr. Mistry: That's right. That's what we were .

Donna Lee: That's what the "NAU" is. Somebody asked me yesterday, what is that "NAU" thing you talk about on the show?

Dr. Mistry: Just some, some reason that some marketing person told me to do something with my website.

Donna Lee: I think I'd like to say "I told you so" at this point. Continue.

Dr. Mistry: Yes . Yes. Well, we're doing our best. And we're all over the place now. Huh, Donna?

Donna Lee: Mhmm. All over the world.

Dr. Mistry: We're worldwide.

Donna Lee: We're, Dr . Worldwide...with his cohost , Dr. Donna!

Dr. Mistry: How do people get a hold of us?

Donna Lee: You can call us during the week--I am not a doctor. I don't want to get sued--(512) 238-0762 is our phone number during the week. You can ask for Dr. Donna and I will answer, although I'm not a real doctor, I'm just one on the radio. Our website is armormenshealth.com and our email address, so you can ask all these amazing questions and we will answer them anonymously, is armormenshealth@gmail.com. You can also check out our podcasts wherever you listen to podcasts. They're free. They're magical. They're award-winning, and they are all over the world.

Dr. Mistry: You know, the awards for the podcast are given by ourselves.

Donna Lee: Mhmm. It's right here, my Junior High School award.

Dr. Mistry: But the podcast, but the awards for our practice are given by other people.

Donna Lee: Like Austin American Statesman...

Dr. Mistry: And Austin Monthly.

Donna Lee: That's right.

Dr. Mistry: That's right. They put us at the top of their list for doctors and men's health practice. We're very proud of those awards and try to live up to it. And one of the reasons that we have been given the meritorious distinction of "best men's health..."

Donna Lee: I'm sorry , what was that ? Meritorious?

Dr. Mistry: Anytime it's over three syllables , you always give me so much grief.

Donna Lee: He's got such a big vocabulary.

Dr. Mistry: I know four words. So the reason we qualified in that category was because people realize we do more than just basic urology. We really care about the whole person.

Donna Lee: Head to toe, knees , nipples to knees.

Dr. Mistry: Knees to nipples.

Donna Lee: Nipples to knees.

Dr. Mistry: Depends on which direction you want to go. So one of the reasons that we are so comprehensive, or what we are recognized as being so comprehensive, perhaps that we've been doing so since almost the beginning of the practice is the inclusion of pelvic floor physical therapy in our treatment programs in a more expansive way than I think even people would envision.

Donna Lee: Right. Well, I didn't know until I started with you that there was a such a thing called pelvic floor physical therapy.

Dr. Mistry: And I thought to talk about it, our newest physical therapist , Kendel Lipe--she joined us about six months ago and has been an incredible addition to our practice. Someone that who has a doctorate in physical therapy and just has a passion and a real enjoyment for what she's doing here. Thank you so much for joining us today, Kendel!

Dr. Lipe: Glad to be here.

Dr. Mistry: So Kendel...

Donna Lee: She's an actual doctor.

Dr. Mistry: She's an actual doctor . That's right . "Two doctors and a Donna." That's what I should've named the show...

Donna Lee: Dr. Lipe, Dr. Mistry, and Dr. Donna.

Dr. Mistry: So , pelvic floor physical therapy, where it really came for me is when I was a resident, we had a patient who had his bladder and prostate removed and he would drive from an hour and a half outside the medical center and drive all the way into the medical center and park with all the painfulness in Houston, come up, sit in an hour in the waiting room so that he could get his prostate massage through a rectal exam. And he said that when he had that done his pelvic floor and everything felt so much better. And the other doctors where I was training treated it like a joke, like, "This guy is coming for a rectal exam once a week and he doesn't have a prostate." And that really got me thinking, "What is actually happening in that guy's life?" But for you, you would naturally say, "Yeah, that guy had a major operation, his pelvis. Of course, doing something to his pelvic floor is going to help."

Dr. Lipe: Of course. Yeah.

Dr. Mistry: And so what do you think was really happening with that guy?

Dr. Lipe: I would say he probably, because of the trauma and maybe some of the things that led up to the surgery in the first place, had a lot of pelvic floor tension or felt pelvic floor dysfunction, and it could be tight, weak, have trigger points--any combination of those things. And so oftentimes just a little bit of intentional manual touch to the area, almost like a trigger point release like you'd have in your shoulder can help that whole muscle, because it forms like the whole bowl on the bottom of your pelvis, to relax and really decrease a lot of that pain intention sensation.

Dr. Mistry: People might find that a little awkward and invasive to have to do a rectal exam to massage that, that muscle. But that's how I explain it. Just because your shoulders, they feel good when they're massaged. But that shoulder is easier to massage, you know , sitting right next to your head.

Donna Lee: And you can do it in public.

Dr. Mistry: That's right. The pelvic floor is a little harder to massage because it's surrounded by a bony pelvis. So if you just rubbed on the hips, you wouldn't get to it.

Dr. Lipe: Exactly. But one thing I do like to tell men that are a little bit scared to come see me: You know, the pelvic floor muscles have three layers, but they all kind of function as one. And especially on a lot of men, I would say the majority of the men I treat, I don't actually need to do internal rectal work. I can work on the superficial muscles and the scrotal region. And if you release the trigger points there and just use the right cues, use the right breathing techniques, work a little bit above the pubic bone, you can often get the internal muscles to release without actually having to do anything internal.

Dr. Mistry: So this patient who had his bladder and prostate removed is kind of a real extreme example. The kinds of things that I'll see that I'll to you today with the quintessential patient is the 42 year old guy who comes in with frequency and urgency, maybe a splayed urine stream, maybe some dribbling after he pees, and he's convinced he's got an enlarged prostate. And sometimes they'll already have procedures for their prostate. They'll have been on Flomax for months or years and they're not working. And I look at them and I'm like, "This guy obviously doesn't have an enlarged prostate."

Dr. Lipe: Definitely. I've seen that repeatedly.

Dr. Mistry: He's too young. There's not like that many 42 year old guys... And so the questions that I ask--and I'd love to hear your questions--when I talk to them, I always ask them about their youth, any history of pelvic trauma, any history of pelvic floor instrumentation, and especially bedwetting or chronic constipation. What kind of questions do you like to ascertain whether there could be a pelvic floor etiology?

Dr. Lipe: I will ask some of those questions , but for me, I can often look more at just their current symptoms and then when I do touch them, their symptoms with pain, not just in the pelvic floor muscles, but the inner thigh muscles in the abdomen are very interconnected and work symbiotically with them. So pain and tension in one tends to equal pain and tension in the other. But honestly, as much as it could be like a specific trauma or bedwetting that kind of ties in that chronic stress response with the pelvic floor, which can cause problems later...people with high stress, both men and women, even if they're just sitting all day at a desk job like they're not used to, don't have the proper back support they're guarding all the time...I find that often is really what leads to it. There's not one thing I can point to.

Dr. Mistry: I feel like I'm being judged every time she's looking at me on how I'm sitting. You know what I'm saying?

Donna Lee: You do slouch.

Dr. Mistry: She's, you know, I can, I can tell. I'm being judged.

Donna Lee: You need to sit up straight.

Dr. Mistry: It's a tough one. And so, and so a lot of times guys want to come to us--men like quick fixes to things.

Donna Lee: Do they? Never heard that before.

Dr. Mistry: Well, you know...and so...

Donna Lee: Or they don't go at all .

Dr. Mistry: And I think that although men will come and tell me they don't want to take medicines, when they go to the doctor, they'd say, "Okay, well he told me to take a pill. I'm going to take it." But when it comes to these types of urinary issues, pelvic floor physical therapy can obviate the need for medications in the future and really help where medicines really have no role.

Dr. Lipe: I sure hope so, because a lot of those medicines have some serious side effects and these men are young and shouldn't have to continue to take them their whole life.

Dr. Mistry: So when the pelvic floor is not working, and you mentioned that it can be too tight, it can be too weak, it can be strained, it can be injured...We talked about main kinds of patients I see with urinary issues. What are some other symptoms that patients with very similar types of injuries? Well , what are some other symptoms they can present with?

Dr. Lipe: So a huge one is sexual dysfunction. So that's always one of my first go-to's that I ask when people are having bladder symptoms. I'll dive a little bit into, "Are you having any sexual complaints?" You know, whether it's premature, erectile dysfunction, pain with erection, they could have a psychological trauma kind of built up around those things that can lead to that, that tension, and that kind of that disconnect between the brain and healthy function of the pelvic floor. Constipation and GI issues are a really big one that I often see go hand in hand, low back pain. The pelvic floor is a huge part of your core. I always talk about the core as an abdominal cavity that, like a Coke can...and a Coke can, if all of it are strong is really, really hard to compress. But if you have a slit in any side of the Coke and including the base, it's really weak and it can be compressed easily. And then all of your, all of your extremities and your muscles from it, your movements from it are going to be less weak and coordinated .

Dr. Mistry: It reminds me of a joke about being shaped like a can of corn, but that's for another day. So, another one that I'd like to add to that one is going to be testicular pain. Testicle pain, unilateral, or bilateral. We consider pelvic floor etiology to be a real go-to for that. And so I think a lot of our listeners may not have ever even thought of pelvic floor as a part of their treatment strategy. At our practice is going to be a central part of so many different things we're doing. And we've had some exceptional success and Kendel, so, so thankful that you've joined our practice. I think that you're gonna do great things for us. And you are in partnership and in addition to our long time pelvic floor physical therapist, Dr. Angela Treadway, and I think you guys make a great team.

Dr. Lipe: Me too. I've been so excited to be here. It's been great.

Dr. Mistry: All right , Donna. How do people get a hold of us? How do people get ahold of Kendel?

Donna Lee: You can call us and or Kendel, and we will give you a meritorious experience when you call us at (512) 238-0762.

Dr. Mistry: You're just making up words.

Donna Lee: I'm just picking up the words you made. I think I used it in the wrong sentence. That was the word...Our website's armormenshealth.com. And you can email us at armormenshealth@gmail.com. Thanks so much Dr. Lipe!

Dr. Lipe: Thank you.

: 10:26

The Armor Men's Health Hour will be right back. If you have questions for Dr. Mistry, email him at armormenshealth@gmail.com.