Yet another gem from the brilliant Albert Einstein
If I can’t explain the complexities of bladder, bowel, pain science and pelvic floor dysfunction simply to patients then basically I haven’t done my job very well.
One of my sayings when doing talks to health professionals and the public is:
“What we teach is science-based but it’s not rocket-science”.
What that means is sometimes what we teach can sound very complicated and difficult – and health professionals can be really bad at making things sound complicated and sometimes to even bamboozle the patient. But it is really important to break down into key points and tackle things one at a time – and one of the things that we use at Sue Croft Physiotherapy (Megan, Jane, Alex and Martine and of course myself) to help make the message clearer are analogies, similes and metaphors.
I have often spoken about the three Explain Pain courses that I have attended over the years and Dave Butler and Lorimer Moseley are the masters of metaphors when teaching their Explain Pain courses. Lorimer has written a fabulous book – called Painful Yarns– which brilliantly outlines some stories to simplify pain messages. Metaphors and similes may help patients remember some of their treatment strategies rather than simply trying to recall a whole lot of information. (Of course we give extensive literature to read so there is no need to have to remember everything at the first session).
Goldilocks provides a useful analogy. We all know the Goldilocks fairy tale about the porridge not to hot, not too cold but just right; the chair too hard, the chair too soft and the chair just right. I often say we want the Goldilocks stool consistency- not too hard, not too soft but just right– firm but with form (otherwise it can be too difficult to evacuate completely if too soft).
Another saying I often use with kids and adults, mostly women, with regard to voiding (urinating) is:
“If you make the time to do a wee, you must take your time.”
So many kids and women rush when they go into the toilet and it results in an incomplete empty of the bladder (and the bowel). So teaching them to listen for the message, is your bladder actually full? (If you chronically defer the bladder message you can in fact over-stretch your bladder). If you are going in, don’t hover! Sit with the correct posture and wait till the flow is finished – no straining, no hovering.
When I want to teach a transversus abdominis contraction (the fourth layer of the abdominal muscles), I say to pull in at the pubic hairline “like a mouse”. Everyone is always going to try exceptionally hard with their physio – doing a much too strong contraction, so exaggerating the image of gentleness (like a mouse would do it) helps to explain to the patient the intensity required and then often that word springs into their head when they repeat the contraction.
When teaching pelvic floor and abdominal muscle relaxation I ask patients to think of a knob of cold butter sitting on a plate in the warm sun, and imaging the slow melt that would happen – now try and relax and let go of your tense muscles as though they are melting. There are so many analogies for muscle relaxation: eg a jelly fish in the water; the ripple effect of throwing a stone in the water.
Patients over the years have come up with their own little sayings such as one little gem from a patient: ‘Gas means go’.
All too often men and women pass gas, but if the stool is too loose it can mean there is some soiling and my patient’s little saying is easy to remember. I use it all the time with children when teaching them “the poo messages’. Parents are often mystified why children don’t feel their poos sneaking out and almost always believe it’s a behavioural issue – but it almost always isn’t. Young children can get what I call stealth constipation. It sneaks up on everyone. They might be doing a little bowel motion every day but there is in fact significant constipation, with stretching of the rectum (mega-rectum) and colon (mega-colon), stock-piling bowel motion until the child cannot feel any bowel motion messages and the motion comes around the bulky firm stool and soiling happens regularly. They can also get constipated if they have a significant pain incident which then leads to stool with-holding.
So teaching them the poo messages which are:
- the poo is knocking at the back door;
- fluffs (farts);
- gripes or grumbly tummy
and telling them to answer the poo message by going straight to the toilet will help with soiling (faecal incontinence). While we are on toddlers and toilet training, please always give foot support for them so they are able to sit in the correct position, with good bottom support with a toddler seat and achieve good relaxation of their tummy and their pelvic floor muscles. Much angst can be prevented with effective education regarding this.
Finally a little plug: some patients have found such help from my books they have been known to call them The Bathroom Bible – now I do love that – not to be disrespectful to the real bible but for the patients to treat the information in my book with a certain reverence makes me happy – because I know they are going to follow the rules and listen to their body and their bladder, bowel and pelvic health will be better for it.