What Matters in the End: A Closer Look at Healing from Pelvic Floor Dysfunction

Photo by Grant Ritchie

It's the age old saying: You don't know what you've got until it's gone.

When it comes to health, it's not uncommon for people to take pain-free days for granted until they experience what it's like to live with life-altering conditions (which we see more often than not within pelvic floor dysfunction.) A life of physical freedom becomes one of compromise, suddenly dropped in a foreign space of the unknown and the underrepresented. There's certainly frustration in:

• Being unable to sit through a movie with your loved ones;
• Altering your workout routine to accommodate for unmanageable urinary urgency and frequency;
• Changing (or cancelling) travel plans because of your inability to sit for any given period of time; and
• Struggling to enjoy intimacy with your partner. 

Faced with the challenge of acknowledging, researching, accepting, and eventually fighting against difficult pelvic health diagnoses, it's important to step back and look at these healing journeys through a wider lens. Doing this begs the question:

With pain or without, what does it mean to just be?

A recent podcast episode by Krista Tippett, founder of On Being, touches on What Matters in the End. In it, Tippett interviews citizen physician Atul Gawande on the potential of human agency and meaning in light of what modern medicine makes possible.

What does a good day look like?

This question, though fundamental, was powerful enough to change Gawande's practice of medicine. In his writing in The New Yorker, and in his book Being Mortal, he’s opening a new conversation about what dying has to do with living.

Gawande touches on the idea that clinicians play an integral role in the community, and have for thousands of years. This piece resonates with us here at Sarton Physical Therapy because our passion for pelvic healing runs immeasurably deep. We want to share our favorite takeaways from the interview, in hopes that you will be able to contextualize the impact of pelvic floor dysfunction as it relates to living a fruitful, powerful, and deserving life.

On Mortality

Mortality is unavoidable, and brings into question our alignment of priorities. Dr. Gawande shares,

"...it’s not do we fight, or do we give up? It’s what are we fighting for? People have priorities, besides just surviving no matter what. You have reasons you want to be alive. What are those reasons? Because whatever you’re living for, along the way, we’ve got to make sure we don’t sacrifice it; and in fact, can we, along the way, whatever’s happening, can we enable it?

Someone said to me, “Well, I want to take my children to Disney World, my grandchildren. One thing I want to make sure I’m able to do is take my grandchildren to Disney World.” And she was telling that to me in the hospital, emaciated, on her last days. She would die 48 hours later. And we had missed that. We had failed. We had never asked her, to know that might have mattered to her, because we could have made that possible for her a month before...And so it wasn’t about do we fight or not? It’s that we missed the fight. The fight was to make sure, among other things, that she got to go take her grandchildren to Disney."

It is Sarton PT's mission to enable, support, and fight for whatever it is that our patients are living for. Beyond the technical aspect of pelvic floor physical therapy, we see and fully understand the equal importance of a movie with your family, or a healthy sex life with your partner. It is not about the diagnosis—the new "restrictions" that have been placed on your life. It is about the adjustments you make while keeping these new guidelines in mind, optimizing your best life the best you—and with our help, we—can. This, we've found is actually the opposite of restricting. Defining your best day is defining your own freedom.

On the Purpose of Medicine

From the perspective of a health professional, Dr. Gawande reminds listeners: 

We think our job is to ensure health and survival. But really it is larger than that. It is to enable well-being. And well-being is about the reasons one wishes to be alive. And it’s not just about prolonging life. 

Laura Carstensen, a psychologist from Stanford, conducted a study where she followed people across the course of their lives. She has a cohort of some 300 people, from ages 18 to 94 when they started in her study, and she’d followed them all the way to the end of their life.

And what was interesting to me was that as they got older, they became less healthy — no surprise — and they had some loss of function along the way. But they also had increasing sense of fulfillment in their life, despite all of that. And some other studies, that after age 65, people were more likely to have love in their life. They were less likely to have anxiety and depression. They were focused less on acquisition and having all the material stuff.

How we spend our days is how we spend our lives. So, instead of saying, “What’s the next treatment we can try?” aim for, “All right, what is the next treatment we can try? But also, what’s possible today? What can we do today that also makes sure we’re not missing the chance to enjoy the time we have?”

On Moving Upstream

We are all about alternatives to mainstream medical options whenever possible. That's why we are constantly trying to communicate to our patients that surgery or other quick fixes are certainly not always the best option, and that physical therapy can be more affordable and effective.

Try defining your variable in this sentence: "My good day is 'X.'"

If you start feeling like medicine or surgery is going to take that good day away, then stop it. Dr. Gawande notes that even in cases where patients undergo chemo treatments that they decide are taking away from their ideal "good day," they feel better after they stop. 

Chances are that you might even do better for longer, because we, as clinicians, are increasingly optimistic about the power of what we can do for you as the patient.

The Sarton Summary

Being—and living—is more than just talking about physical aches and pains. It's about asking on a deeper level, "How is your spirit?"

“If I told you, half an hour after you die the world would blow up with everybody you know in it, would that matter to you?” And for the vast majority of people, it would matter. And the reason why it matters to people is that it feels like it takes away — that the meaning of your life would be gone; that we’re not all, at core, totally self-interested creatures, that we have things we live for that are larger.

Now, that’s not the only piece of evidence. There’s lots of others that he goes through and then others you can think about, along the way. But that, for me, is part of that idea. It’s the closest thing I come to, to being able to recognize that idea of spirituality and connection and meaning that rises above your own life.

-Dr. Atul Gawande