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Around December and January I often see quite a few patients for review – either they haven’t been for many years and have made a promise to themselves to come back and sort out their continence/prolapse/frequency/urgency problem out before Christmas or have included a visit back to me as one of their New Year’s resolutions. Others just schedule a yearly or two yearly review around the holiday season as it’s just easy to remember! One of the recurring themes (and this is reflected in the research as well) is that women are no longer doing their pelvic floor exercises or remembering to brace or doing the other strategies that help to keep their pelvic floor world in balance.
One of the challenges we Continence and Women’s Health physiotherapists have to solve is how to get patients to comply with a regular programme – for the rest of their lives?
The stories of the patients I have seen for these ‘check-ups’ are all very similar – in fact a couple of patients in my first two days back this week had been to see me seven and ten years ago. So firstly congratulations are needed for returning at all! Secondly there’s no point frowning and rebuking the patients for confessing that they had probably stopped doing their exercises a couple of years after they first saw me. Their symptoms didn’t actually deteriorate immediately – it was quite a few years and a slow gradual slide back to leakage, urgency and frequency.
Sticking to any long-term programme – whether it be regular general exercise, a rehab programme for the pelvic floor or what I struggle with on a daily basis – weight control- takes dedication, discipline, repetition, motivation, self-control, willpower, habit, but most importantly an understanding of the need for constancy. I would like my patients to think about how basic and regular following a pelvic floor programme needs to be. And I ask them to think of it just like they think of applying moisturizer to their face, or cleaning their teeth or washing their hands.
Would any of us dream of one day just stopping getting up in the morning and applying moisturizer to their face?
Would any of us dream of going to bed or getting ready to go to work having not cleaned their teeth?
Would any of us dream of not washing their hands after using the bathroom? (Don’t tell me if you answer yes to this one)
Yes! That’s how basic and important regularity with your pelvic floor programme should be – and for some girls and women who have pelvic pain – their programme may be one of down-training or relaxing their pelvic floor muscles rather than constantly doing repetitions and tightening the muscles. And what is the reward at the end of your life – a chance to have continence, confidence, comfort, companions, company, cohabitate congenially…………….and the ability to walk the magnificent Wilson’s Prom in Victoria without fear of there being no toilets there.