Today’s blog is Number 300. I started my blog back in 2011 inspired by my son who was in first year architecture and had to do a blog as a part of his uni course. It’s hard to believe today, that I didn’t even know what a blog was back in 2011, considering they are so much a part of our lives these days.
My blog is not only a way to catalogue pelvic floor dysfunction (PFD) resources for my patients and maybe anyone else who may wish to read it, but it has become a personal diary in lots of ways allowing me to remember memorable (overseas) holidays and get on a high horse about things that seem a little unjust or unfair.
Thank you to anyone who has taken the time (in this day of 20 second scrolling) to actually pause and read my blogs and also thanks to anyone who shares them or adds the link to their own website. I love the ability we have these days to share information and whilst the internet has some negative aspects, it is such a wonderful opportunity to talk about things like prolapse, pessaries, incontinence, pelvic pain and sexual dysfunction in a world-wide fashion. My blog is evidence-based but it is written in such a way that non-health professionals can read it and hopefully understand it.
I wanted Blog Number 300 to be significant because I think getting to my 300th blog is pretty amazing even if I do say so myself. But enough of my self-congratulations. And on with the blog……
Health care is riddled with acronyms. Basically just about every medical condition has an acronym, which makes it very hard as you get older to try to remember what they all mean. And I am sure there are some people who are making new ones up just to confuse us oldies. Some may use acronyms as a ploy to sound important to the patients. Some acronyms are scary… like Deep Infiltrating Endometriosis – yes DIE really??? and many researchers try to get clever with their trial names and they actually become memorable and easier to remember like the POPPY Trial Pelvic Organ Prolapse PhysiotherapY (Results: One-to-one pelvic floor muscle training for prolapse by a physiotherapist is effective for improvement of prolapse symptoms)(1).
Today’s blog was inspired by two acronyms I saw in a recent post on Facebook and it took me a while to work them out – AVWP and PVWP. Anterior vaginal wall prolapse and posterior vaginal wall prolapse. Now I have read many (a million) articles on prolapse and have never as yet come across those before and I am provocatively writing this so someone (maybe ‘manyones’) will call me out and say ‘Hey, that is now the correct new terminology Sue’! (I did google the International Continence Society Terminology page and didn’t see it?)
But today a patient returning for a 6 month post-op repair surgery check up inspired my new acronym and I think this is going to catch on <insert winking emoji here>.
LRSM. And what does it stand for?
L for LISTEN
R for RESPECT
S for STOP
M for MODIFY
My patient said a little phrase that just triggered these words. It really isn’t that catchy, but I like the sentiments and it gives me chance to integrate the words into this post-op post.
We pelvic health physios teach you to LISTEN to the messages your body gives you and respond appropriately to those messages. So if you feel pelvic floor descent when you cough and sneeze, you need to counteract that descent by turning your pelvic floor on – I call it ‘bracing’ in my books but it is known as ‘the knack’. (2) If you get a bowel urge then don’t defer, make sure you try to find a toilet to evacuate your bowels using the correct position. If you are feeling pain (your pelvic floor muscles may be cramping and producing that pelvic pain), so remember to relax your tummy, pelvic floor muscles and inner thigh muscles and do some belly breathing.
The next word is Respect!
Respect the state of your pelvic floor – Has there been trauma to the muscles meaning the strength is compromised such as with Levator Avulsion (and not because you are not doing pelvic floor exercises)?;
Respect the research statistics on risk of failure of your surgery – with gynae repair surgery in general there is up to a 30% failure rate (3,4) and if the patient has partial or complete avulsion it potentially may be as high as 80% (5);
Respect the surgery that the surgeon has done and the advice she or he has given you;
Respect the money you have spent on the operation and the cost of the time you may have had off work.
The next word is stop!!
Stop and think, assess, remember your guidelines and the advice from your surgeon, pelvic health physiotherapist and in my book Pelvic Floor Recovery: Physiotherapy for Gynaecological and Colorectal Repair Surgery;
And finally modify your behaviours. Sometimes its just small adjustments – learn to exhale on effort – don’t hold your breath; paced and graduated return to exercise; do more repetitions of a lighter weight; alter the position – adjustment of position can significantly alter pressures down the vagina; but make sure your physio has helped you understand the state of your pelvic floor strength and descent so you modify accordingly but don’t stop exercising completely.
So there you have it! LRSM!
L for LISTEN
R for RESPECT
S for STOP
M for MODIFY.
Remember it, implement it and pass it on.
Do you think it will take off? Or just confuse the hell out of another ageing physio or two?
And here’s hoping I (and my brain) have it in me to do another hundred blogs and get to 400.
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(1) Hagan S et al (2014) Individualised pelvic floor muscle trainig in women with pelvic organ prolapse (POPPY): a multicentre randomised controlled trial. The Lancet, Volume 383, Issue 9919, 796-806
(2) Miller J, Ashton-Miller J, & DeLancey J(1998). A Pelvic Muscle Precontraction Can Reduce Cough-Related Urine Loss in Selected Women with Mild SUI. Journal Of The American Geriatrics Society, 46(7), 870-874. http://dx.doi.org/10.1111/j.1532-5415.1998.tb02721.x.
(3) Brubaker, L., Maher, C., Jacquetin, B., Rajamaheswari, N., von Theobald, P., & Norton, P. (2010). Surgery for pelvic organ prolapse. Female Pelvic Medicine & Reconstructive Surgery, 16(1), 9-19. 10.1097/SPV.0b013e3181ce959c
(4) Wu, J. M., Matthews, C. A., Conover, M. M., Pate, V., & Jonsson Funk, M. (2014). Lifetime risk of stress urinary incontinence or pelvic organ prolapse surgery. Obstetrics & Gynecology, 123(6), 1201-1206. 10.1097/AOG.0000000000000286
(5) Dietz, H. P., Chantarasorn, V. and Shek, K. L. (2010), Levator avulsion is a risk factor for cystocele recurrence. Ultrasound Obstet Gynecol, 36: 76–80. doi:10.1002/uog.7678