by Sue Croft Physiotherapist
Adapted from author’s original blog first published Mar 8, 2014 at SueCroftPhysiotherapist.com.au
Step 2 is a critical step in the five-step plan.
Why a mentor matters in pelvic health
So many women feel helpless when they first discover they have a lump or are told they may have a prolapse. They may think or ask themselves,
“Is it cancer?”,
“What will my husband think?”,
“Oh my god, my Aunt Gertrude had one of those in hospital and that was ghastly!”.
A mentor can be defined as:
- A wise and trusted counsellor or teacher.
- An influential senior sponsor or supporter.
What does “mentor” mean in pelvic health care?
Who could be your mentor for managing prolapse?
- Your GP
- Your Uro-gynaecologist or Obstetrician Gynaecologist (O&G) or
- Your local Continence and Women’s Health physiotherapist / physical therapist
The PIPES Checklist for GPs at Cervical Screening Tests (CSTs)
If your GP is to be your mentor, the below checklist PIPES: A reminder at your PAP Smear (now Cervical Screening Test or CST) was created to help GPs remember what to look for when patients come for a PAP smear / Cervical Screening Test. The acronym PIPES and what the GP can check for is explained below:
P prolapse – vaginal, rectal.
I incontinence – urinary, faecal, gas.
P pain – pelvic, abdominal, sexual.
E exercises – pelvic floor exercises, general physical exercise for bone density, weight management, ‘pelvic floor safe’ exercises, stress and general ‘feel good’ management- (release of endorphins) If you don’t move it, you’ll lose it!
S sex – pain, dryness, low libido, patient anxiety about the appearance, anxiety about causing further damage, relationship issues
What is the evidence for Women’s Health physiotherapists as prolapse mentors?
A paper presented at the 2011 ICS Conference by Hagen, Stark, Glazener, Sinclair, Wilson, Norrie, Dickson, Logan, Frawley, Moore, Walker titled “A multi-centre randomized controlled trial of a pelvic floor muscle training intervention for women with pelvic organ prolapse” concluded:
“… educating women comprehensively about the conservative management of pelvic organ prolapse by Continence and Women’s Health physiotherapists does make a significant difference in reducing prolapse symptoms, is cost-effective as an intervention and should be recommended as first-line management for prolapse”.
What to expect in a Women’s Health Physiotherapy Assessment for prolapse
Your initial Women’s Health physiotherapist assessment will typically consist of:
A detailed health history
A thorough subjective assessment of health history (Refer to our blog A 5 Step Plan for managing prolapse – Step 1)
Internal and external pelvic examination
Physical Examination:
- Visual examination
- External Anal Sphincter (EAS) contraction-strength, bearing down, co-contraction with the deep abdominal muscles (TrAb)
Vaginal palpation to assess:
- posterior wall bulkiness/laxity/faecal load/lumps, bumps/sensation/Levator Avulsion/Pain
- co-contraction between TrAb and the PF muscles
- muscle strength comparison of brace and cough, and cough with no brace while standing (i.e. a standing examination)
When women stand up (therefore adding gravity to the prolapse equation) this position is invaluable for the therapist and the patient to firstly see what gravity does to the prolapse, to assess any if the vaginal prolapse descends when the patient activates her muscles and to see the effectiveness of the lifting action of the muscles.
Why early intervention makes a difference in management of prolapse
It is not uncommon for women who—after a vaginal birth(s)—think they are doing the right thing by attending boot camps and doing lots of sit-ups to help strengthen their weak abdominals. Unfortunately, too much, too soon can result in a vaginal prolapse.
Many women then experience delays from when they first express concerns regarding a prolapse to a health provider, to when they receive expert care for prolapse. Delays for obtaining appropriate treatment may prolong discomfort and impact quality of life.
Accessing specialist women’s health physiotherapy early can help manage symptoms and provide education tailored to your needs.
