This is a critical step in the five step plan. So many women feel helpless when they find they have a lump.
Is it cancer?
What will my husband think?
“Oh my god, my Aunt Gertrude had one of those in hospital and that was ghastly!”
So what is the definition of a mentor.
- A wise and trusted counselor or teacher.
- An influential senior sponsor or supporter.
Who could be your mentor?
- It could be your GP?
- It ultimately might be your Uro-gynaecologist or Obs and Gynae( O&G)?
- Your local Continence and Women’s Health physiotherapist /physical therapist?
If it’s to be your GP I have come up with an acronym to assist GPs to remember what to look for when patients come for a PAP smear. This important checklist is called PIPES: A reminder at your PAP Smear.
A simple checklist for GPs to check at every PAP smear
P stands for prolapse – vaginal, rectal.
I stands for incontinence – urinary, faecal, gas.
P stands for pain – pelvic, abdominal, sexual.
E stands for exercises: pelvic floor exercises, general physical exercise for bone density, weight management, ‘pelvic floor safe’ exercises, stress and general ‘feel good’ management- (release of endorphins) If you don’t move it you’ll lose it!
S stands for sex :pain, dryness, low libido, anxiety about the look, anxiety about doing damage, relationship issues
Now of course as a physiotherapist, I am proposing that we are pretty good candidates to be the first port of call when looking for a mentor and a treatment buddy to help you with your prolapse. So what evidence is there for that. A paper presented at the 2011 ICS Conference by Hagen, Stark, Glazener, Sinclair, Wilson, Norrie, Dickson, Logan, Frawley, Moore, Walker titled “A multi-centre randomized controlled trial of a pelvic floor muscle training intervention for women with pelvic organ prolapse” concluded:
“that educating women comprehensively about the conservative management of pelvic organ prolapse by Continence and Women’s Health physiotherapists does make a significant difference in reducing prolapse symptoms, is cost-effective as an intervention and should be recommended as first-line management for prolapse. You can read more about this research on my blog- Just google Sue Croft Blog ‘Congratulations Helena’
So what would your visit to a physiotherapist consist of?
Assessment:
A thorough subjective assessment with history, the story of when the patient first felt the lump or was it drag- finding out all those things mentioned in the first blog.
Importantly Continence and Women’s Health physiotherapists will perform a thorough physical examination (which includes an internal examination).
Physical Examination:
- Visual examination
- External Anal Sphincter (EAS) contraction-strength, bearing down, co-contraction with the deep abdominal muscles (TrAb)
Vaginal palpation: Looking for
- Posterior wall bulkiness/laxity/faecal load/lumps, bumps/sensation/Levator Avulsion/Pain
- Palpate co-contraction between TrAb and the PF muscles
- Assess muscle strength
- Compare brace and cough and cough with no brace
One of the most important parts of the examination with prolapse is a standing examination.
You know I have seen this photo below in many a presentation at conferences over the years, more for the presenter to scoff at the uselessness of such an examination. But when women stand up (therefore adding gravity to the prolapse equation) then this position is invaluable for the therapist and the patient to firstly see what gravity does to the prolapse, to assess any if the vaginal prolapse descends when the patient activates her muscles and to see the effectiveness of the lifting action of the muscles.
To conclude this part of the 5 Step Plan for Managing Prolapse I would like to share an exasperating experience and why we #pelvicmafia face such an uphill battle with getting the word out about how effective early interventions can be.
Just this week I had a patient from a small country town who is young (too young for prolapse she lamented- sadly it relates more to having a vaginal delivery than age) and who had discovered a lump when exercising after her second vaginal delivery five years ago. Early after the birth, she thought she was doing the right thing by attending boot camps and doing lots of sit-ups to help her weak abdominals. But sure enough it was too much, too early and soon as she found the lump.
She went to her GP who said you have a prolapse and go and do pelvic floor exercises.
No instruction, not even a pamphlet as to how to do them correctly and no referral for help from a physio.
She went back and asked for more help when she started to have some pain. He was again pretty unhelpful “I told you last time- go and do your pelvic floor exercises”.
She was desperate. She went to the local hospital in order to get a referral to the Physio at the public hospital department for help. Sadly, because it is a small town, the same doctor was covering in Casualty. He was very annoyed about her actions. But at her insistence gave her the referral. This physio has been very helpful, but is not trained for the special area of Continence and Women’s Health and so both she and a Maternity Nurse at the hospital encouraged this young 24 year old to go to Brisbane for specialist help. The uro-gynaecologist then referred her to me.
It only took five years……………