As you all know I am very active on Twitter and Facebook – but in a (mostly) professional way with respect to my career, my passion, my children would say …my obsession – of course it’s the pelvic floor. And we have a new group on Facebook which is for us Physios who are afflicted with a similar condition- we are called #pelvicmafia. We have a uniform thanks to Jess McKinney who went to the trouble of designing a black T-Shirt with #pelvicmafia on the bottom (I wish I knew where it was amongst the other 853 black T Shirts in my wardrobe). We also send the word out if someone has a query with respect to a patient and yes we all dive in and offer advice and support. If only the patients realized that their issues are being contemplated and resolved by a worldwideweb of talented Continence and Women’s Health Physios!
Well the latest query came from a concerned Physio who wanted to know how quickly patients should be back doing their daily activities at home, back to exercising and back to sport post vaginal reconstruction surgery. That’s exactly why I wrote my book Pelvic Floor Recovery: A Physiotherapy Guide for Gynaecological Repair Surgery – to provide a guideline for therapists and patients to answer all those questions and also provide basic bladder, bowel and prolapse advice and an understanding of pelvic floor muscle training and protecting their surgery to optimize outcomes.
It is interesting how casually we can sometimes take vaginal repair surgery. If a footballer injures his ACL and needs reconstruction surgery there’s no way his surgeon would let him back on the footy field at 6 weeks post op. There would be extensive rehabilitation, strengthening of the key muscles and after a lengthy period of time he would be back into training and much further down the track, back playing football. But when women have major repair surgery sometimes they are told: Yep back to whatever…. wait 6 weeks and then you’re good as gold…sure you can run, yep mind the grandkiddies- no worries, scrub the shower floor -yeah go for it.
The things women do at home place tremendous load onto the pelvic floor and the repair surgery they may have recently had. The good scar tissue or fibrosis that helps hold the surgery up is not ‘solid’ until 12 weeks post op, so it is always worthwhile to wait and be slow and steady with return to household tasks and general exercise.
Some general guidelines:
- Wait until 6 weeks post-op before commencing pelvic floor muscle training unless otherwise instructed by your surgeon
- From immediately post-op definitely brace or in other words activate your low tummy (Transversus Abdominis) and pelvic floor muscles prior to any increase in intra-abdominal pressure-cough, sneeze, bending etc to protect against those early downward forces.
- Move well, log-rolling through your side to get in and out of bed (forever).
- Avoid repetitive bending, and don’t lift anything more than 2 litres milk in each hand in the first few weeks. Avoid lifting over 15 kilos forever.
- Once you are home and feeling like the initial soreness is settling you can start walking but stay close to home and PACE yourself. Short distances initially and then once you have assessed how you feel the next day and there is no drag or heaviness then slowly increase the distance.
- No cleaning bathrooms or vacuuming until after 6 weeks but if you can organize help and avoid doing these chores till 12 weeks, then better still.
- Definitely manage your bowels very effectively (see earlier posts) as straining at stool brings down operations.
These are just few of the ideas that are in my book. The feedback from patients, surgeons and GPs about the book has been excellent and understanding about the preparation needed, the process in hospital such as catheter care and voiding once the surgery is over and what are safe abdominal exercises to undertake to assist post-op rehabilitation ensure a confident recovery and a better chance at having a good surgical outcome.
The book is available on my website www.pelvicfloorrecovery.com for AUS $20 plus postage and handling. A small investment when you consider what you have paid for your operation.
The new reprint of my book is happening as I write this blog with lots more on prolapse, so keep an eye out for it. Dymocks Bookstore at Indooroopilly Shoppingtown is now stocking my books as well as Riverbend Bookshop at Bulimba and The Avid Reader at West End.