People with Pulmonary Fibrosis (PF) can experience a variety of symptoms, including pelvic pain, urinary incontinence, and Irritable Bowel Syndrome (IBS). Since May is Pelvic Pain Awareness Month, we interviewed a specialist to learn more about natural therapies that can help with any or all of those symptoms.

Debbie Callif (OT, BCIA-PMDB) is an occupational therapist who co-owns a clinic called the Continence and Pelvic Wellness Clinic. Since 1996, she has been successfully treating patients with difficult bladder, bowel, and chronic pelvic pain conditions. She advocates for natural medicines and alternative therapies, and provides advanced training to therapists seeking biofeedback certification for the treatment of pelvic floor muscle dysfunction. 

An abbreviated transcript of our interview with Debbie is included below: 

PF NOW!: Can you tell us about your clinic? What are your credentials, and how long have you been practicing? 

Debbie: I’m an occupational therapist by training, and I’ve been specializing in pelvic floor muscle dysfunction – which means I work with people who have bowel and bladder dysfunction, and pelvic pain. I’ve been doing that for 25 years. I’m in private practice with another occupational therapist, and we’ve had our clinic for 17 years. 

PF NOW!: Why did you open your clinic? What was the need for it, and what kind of patients do you see?

Debbie: There are a lot of people who have urinary and bowel dysfunction, and pelvic pain. At the time, therapists were starting to do biofeedback for this. I jumped in because I knew the biofeedback very well, but I didn’t know the anatomy. When I started, there weren’t many courses teaching this. Now, thankfully, there are a lot more resources, and my colleague and I actually teach courses. 

PF NOW!: Can you describe what biofeedback is, and what you do?

Debbie: Biofeedback is a term used to help us see the physiological function of our bodies, and retrain our muscles by creating new feedback systems. Similar to how EKG looks at the electrical activity in your cardiac muscle and EEG looks at the electrical activity in your brain, EMG or biofeedback looks at the electrical activity in your skeletal muscles. 

So what we do is use biofeedback to look at the pelvic floor muscles. Pelvic floor muscles are the “floor” of your pelvis. They are deep in your body, forming a hammock from your pubic bone to your tailbone. Even though patients can’t see their muscles moving, through biofeedback, they can see on a computer screen the way that their muscle fibers move. There are different sensors or electrodes we can use to help people see what their muscles are doing internally – and with that information, we can help people change old patterns and heal. 

PF NOW!: Have you worked with patients who have Pulmonary Fibrosis? From your perspective, why do so many people with PF also struggle with incontinence?

Debbie: Everyone has a breathing diaphragm and a pelvic diaphragm, and the two have to work together. Let’s say somebody is coughing a lot, or they’re trying to clear a lot of secretions. In that case, there’s a lot of banging on the pelvic floor muscles, and it’s like any other skeletal muscle: if we don’t exercise them, they atrophy and become weak. There are movements that I teach my patients to do to help activate their muscles. 

For people who have PF or any other lung disorder, they might not have coordination between the breathing and pelvic diaphragm. They might be taking short or shallow breaths, and that’s stressful on the body, which gets the sympathetic nervous system going. They also might not be physically active, which again impacts muscles. All of this can contribute to incontinence. We really want to quiet down your body, and get your bowels, bladder, and pelvic diaphragm talking to each other. Everything is so connected. 

PF NOW!: Many people with PF, get out of breath during activity and exercise which prevents them from doing more without supplemental oxygen. We recommend pulmonary rehabilitation, and it gets them in better shape and they are able to do things. Your explanation ties this all in, it’s amazing! Do you have any stories from patients you can share?

Debbie: I saw a patient who, when she was 11 years old, got on the waiting list for a double lung transplant. When she came to me she was in her early 40s and was using supplemental oxygen. She’d need to cancel at the last minute sometimes, because she just couldn’t get out and come to the clinic. She came to me because she was coughing, and she was incontinent. 

I teach patients like her about the breathing and pelvic diaphragm, because of the way the anatomy works. When we inhale, as our diaphragm descends, our pelvic floor muscles do too. When we exhale, our diaphragm goes up and the muscles do too. It’s a beautiful dance, but she didn’t have that coordination yet. So I was focusing on her breathing diaphragm, to help her with her pelvic diaphragm. 

When she went to her transplant doctor for a 6-month checkup, the doctor asked her, “What have you been doing?” She said, “What do you mean?” and he told her that this was the first time in 30 or so years that he saw someone whose lung capacity had increased! And it was just from her work with me. I hadn’t even been addressing her lungs because that’s not my area of expertise, but once again, everything is connected. It just blew me away and to this day makes me tear up. 

PF NOW!: What’s your favorite breathing exercise or mindfulness practice that people can do at home?

Debbie: I don’t have a favorite – I have a ton of favorites! I will share a breathing exercise and two guided meditations for your blogs. I also like to ask people, “What’s one thing you could do today to take better care of yourself?” Appreciating yourself and others can make a big difference in quality of life. 

PF NOW!: What advice do you have for people who are nervous or embarrassed to talk about urinary incontinence? 

Debbie: I think everybody who comes to our clinic feels embarrassed at first. And it’s okay to be embarrassed, but please don’t let it stop you, because there is help out there. If you hurt your back, you probably wouldn’t be embarrassed – so try to think of urinary incontinence as just another thing that can happen to a human body. 

Also, remember that healthcare providers are trained in the genital, urinary, and gastrointestinal systems. If anxiety is keeping you from talking openly with your healthcare provider, you can write down your questions on a piece of paper ahead of time and hand it to them instead.

PF NOW!: What if someone can’t find a provider or specialist in their area? What are things they can do to help themselves?

Debbie: There are many certified pelvic floor therapists both nationally and internationally, and now with telehealth it’s become easier to connect. The International Pelvic Pain Society has a tool on their site to find a provider. I do think it’s important to reach out for help, but there are always things you can do from home to help. I will share a few simple exercises that you can publish in a blog. 

PF NOW!: We know that May is Pelvic Pain Awareness Month, and that people might not even know that professionals like you exist. How can we increase awareness so more people in the public and in the healthcare field can know about pelvic pain, incontinence, and bladder and bowel dysfunction?

Debbie: Here are some resources that people can share with friends, family, and your healthcare providers:

There are many readings available for people who’d like to learn more: 

I’d also be happy to connect with anyone who’d like to learn more. 

PF NOW!: Thank you so much for sharing your time, expertise, and advice with us. We’re really thankful and this will really help our participants. People can post comments on this blog or contact us directly if they’d like to reach you. We’ll be sure to keep you posted and stay connected. 

Debbie: Thank you too. What you do is really amazing and I’m grateful I could help.

To connect with people who can relate: join our online community forum, and attend our virtual support groups on Zoom for people with or impacted by PF.

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