Change

I refer patients to certain blogs over and over during their treatment session and so have created this Articles section for patients to access easily. This blog on Change incorporates a number of important concepts integral to my treatment approach. I encourage all patients to read it.

Today I saw two patients who have sort of encapsulated everything I wanted to get across when I wrote this blog on Change back in January. I have changed the patients names for the obvious reasons. The first lady, Nancy, had a serious urethral sphincter injury from childbirth, actually pushing out the balloon holding the catheter in situ during labour. She loved her running and has been devastated that this very serious injury is causing her significant leakage with just simple walking, let alone with the high impact of running. She has an important job and the leakage issues have been very stressful for her. I have encouraged her over the last couple of months to think about a different form of exercise such as cycling, which will be kinder to her bladder and pelvic floor but still be capable of releasing the endorphins to deal with her hectic life.

Today was her third visit – after her second visit there was hardly any improvement in her leakage and she was very dispirited. But we talked about Change and the mindset needed to go about something like giving up running and today she came back and reported that the leakage was much better (albeit with a Contiform in) and most importantly she had bought two mountain bikes and she, her husband and her baby were really enjoying their new exercise/ family outing!

The second lady, Monica has a new and different sport – pole exercising- which she has equally loved and been devastated when I have suggested it isn’t compatible with her pelvic floor dysfunction. She presented with dramatic drag, ache and heaviness following a hysterectomy and after assessment I said I felt she would have to give up the pole work. She went away, tried the strategies such as pelvic floor muscle training, bracing (engaging her pelvic floor prior to increases in intra-abdominal pressure), regular use of a super tampon to act like a splint and defaecation dynamics and came back saying after a month and said the drag and pressure was significantly better. She was still very emotional about her loss….and it is a loss when you have found something you adore and which gives you such strength, empowerment and stress release and achieved a high level of skill over five years and you are advised to let it go. But she has bravely decided that it wouldn’t be sensible to go back to it because of the tremendous downward forces pole dancing / exercising has on the fascia and muscles of the pelvic floor.

So lets re-visit the Change blog

Last night my son was busy making a special farewell card for Jane, a colleague at his work who was leaving. Interestingly his theme of the card was Change– lots of ‘change ‘ quotes over the front of the card – which got me thinking about how crucial my skills in encouraging, enabling and facilitating change in my patients actually is. For without change in behaviour, beliefs and what are almost rituals not much is going to improve with people’s incontinence, frequency, urgency and other bladder and bowel conditions.

Rather than wishing for change, you first must be prepared to change.” Catherine Pulsifer

Well by contacting a Women’s and Continence Physiotherapist the client has taken the first step – which for some people is like climbing Everest. Admitting there are continence issues is a big thing – it’s a personal thing – and they have moved beyond wishing for change to the next level.

But unless patients have heard from a friend about what is involved when they come to see a Continence and Women’s Health Physiotherapist, they are often surprised at the amount of education that is involved in the consultation. What’s more they are shocked (and sometimes appalled) at some of the things they are learning!

Change to decaf?! Change from hovering (to void…wee)?! Change from going just in case?! Change from straining for bowels every time?! You have got to be kidding. Some of these behaviors are almost etched in stone, mainly because our mothers have taught us these and handed down from one generation to another.

“Everyone can think of the one thing that would make life better for them. But people are not so quick to answer the second question: ‘What are you doing to make that change come true.” Catherine Pulsifer

No one likes to leak urine but we are also keen for things to be done to us, or for there to be a tablet to take, or an operation to be offered. Changing old bad bladder habits takes willpower, exercise, discipline, letting go of the easy old way – things that are definitely not easy and comfortable. But interestingly patients are tickled pink when their hard work starts to pay off and they can hold on longer, they are drier and they regain some sense of control with their bladder!

“Change is as inexorable as time, yet nothing meets with more resistance.” Benjamin Disraeli

How do you empower patients to make these changes? Well certainly not by ordering them to do it! I say to patients – I will give you the information, teach you the science… But you are an adult and have to be the one to make the decision about the intervention. Try the decaf for a month and assess – is there improvement in the amount of leakage, the degree of urgency, the severity of the frequency? And if there is then you make the change.

“Never stop learning, like never stop changing and growing in your life – learning helps you adapt to change more easily.”

Even 80 year olds can implement change – as long as they have the mindset that they can still learn new things and improve their situation. If they are fixed in their attitude then it will be hard to inspire them. But that comes back to the therapist – we have to sell this message that what we are teaching is not rocket science -although it does involve maths (angles of how you should sit for defaecation and emptying your bladder) and physics (counteracting forces from above, such as with cough and sneeze, with a force from below…contracting your pelvic floor muscles).

“You cannot change your destination overnight, but you can change your direction overnight.” Jim Rohn

We as therapists have to nurture, empower, cajole, encourage, listen, console, praise – in order to help the patient on this journey in a new direction to their different destination.

“If you resist change, you will face challenges on a daily basis. If you consciously refocus your attitude to see the benefits of change, your outlook becomes positive and life becomes easier.” Catherine Pulsifer

Patients often relapse and sometimes a refresher such as a short return visit and re- reading their handout and book, can easily bring them back to where they should be. They are often relieved that some minor refocusing, such as encouraging more pelvic floor exercises, remembering the concept of bracing, changing their general posture as well as their posture for defaecation and voiding, some local oestrogen if it’s required – can return them to a continent state.

“No action, no change. Limited action, limited change. Lots of action – Change occurs.” Catherine Pulsifer

Ah the crux of all this change talk. What you put in will be reflected in your result ( mostly………. this is for all those hard-working patients who do struggle to conquer their incontinence). The pelvic floor muscles thrive on attention (unless there has been some levator avulsion or significant nerve damage) and getting into a routine of daily pelvic floor exercises will make a difference. Kari Bo, A physiotherapy researcher, has shown that the levator hiatus – the internal dimensions of the vagina- can be decreased and prolapse elevated ( to a certain extent and of course depending on the severity of the prolapse ) from a programme of pelvic floor muscle training. So don’t delay – start today, make the first step. Contact your local Continence and Women’s Health Physiotherapist today and learn how to contract those muscles correctly.

And now to finish, just because amongst all those change quotes I really like this as a good piece of advice for all of us – to help us deal with the complexities of modern work and life:

“To focus on the people who do not like you and the things you cannot change is like climbing an infinite mountain; instead focus on the people who love you and the things you can change and you will find you can move mountains.”
Michelle Ghislaine Ambler.