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Pelvic Health Table

Pelvic Organ Prolapse: Women
1. What are some of the common symptoms?
2. What are some of the common causes?
3. What can I expect my first day of therapy?
4. What can I expect my ongoing therapy to be like?
5. How long can I expect my therapy to last before I begin to see improvement?
6. How long can I expect my therapy to last before I am healed/cured/fixed?
7. What are the credentials of my uro-gynecological physical therapist?


There are 6 types of organ descent in the pelvic area, all of which are treated at Kirk Center for Healthy Living. These six types are cystocele, rectocele, urethrocele, enterocele, rectal prolapse and uterine prolapse.


1. What are some of the common symptoms?

Cystocele is a condition where the bladder is bulging back into the vaginal canal. Some of the symptoms may include feeling a bulge when wiping on the toilet or when showering, “falling out feeling,” pelvic pressure, recurrent urinary tract infections, feeling of incomplete urination, dribbling upon standing after urination, pain with sexual activity, inability to wear a tampon or hitting something when inserting a tampon.

Rectocele is a condition where the rectum is bulging forward into the vaginal canal. Some of the symptoms are feeling a bulge when you wipe or when showering, “falling out feeling,” pelvic pressure, feeling of incomplete defecation (pooping) like the bowel movement is getting stuck, splinting for defecation (using your finger in the vagina to push back on the rectum or using your finger between the vagina and the anus and pushing upward and backward to get the stool out), loss of stool during sexual activity or pain during sexual activity.

Urethrocele is a condition where the urethra has dropped out of its original position. Symptoms may be feeling a bulge where the urine comes out, urinary urgency or urinary frequency.

Enterocele is a condition where a part of your small intestine drops between the rectum and the vagina. The symptoms seem to be the same as a rectocele and only your doctor is capable through special testing to tell the difference between the two. However enteroceles tend to be more painful than rectoceles.

Rectal prolapse is a condition where the rectum is coming out of the anus. The main symptom of this condition is a feeling that the rectum is coming out of the anus with defecation. Sometimes you will have to push the rectum back up in the body. Other symptoms are a “falling out feeling,” pelvic pressure or feeling a bulge at the anus when wiping.

Uterine prolapse is a condition where the uterus is falling down the vaginal canal. Common symptoms of this condition is a “falling out feeling,” pelvic pressure that gets worse as the day goes on, if you’re on your feet a long time or with lifting, feeling a bulge with wiping or showering, pain with sexual activity, especially deep vaginal penetration, inability to wear a tampon or hitting something when inserting a tampon.


2. What are some of the common causes?

Pelvic organ descent has various causes and medical professionals are always arguing about the true cause. However there are some things that we know put you at risk for this condition. Heredity plays a part, so if your mom and grandma had a problem, you should be screened for this condition regularly. The other causes are childbirth, especially if it was traumatic (episiotomy, tear, vacuum, forceps, long labor or too short labor) or if it was a large baby, heaving lifting, chronic coughing or sneezing, obesity, ligament laxity (you are extremely flexible), after a hysterectomy (removal of the uterus) due to the fact that the top of the uterus use to deflect pressure from reaching your other pelvic organs, so when it’s gone the pressure directly hits the rest of your pelvic organs without any protection. Scar tissue (possibly from past pelvic/leg surgeries) can also pull an organ down, breathing difficulties can increase the pressure on the pelvic organs, chronic constipation can increase the pressure on the pelvic organs and poor posture can contribute as well.


3. What can I expect my first day of therapy?

It helps to write down all of the questions that you have about your condition and therapy. If we do not answer your questions during our evaluation process, you will be prompted by your list to ask your questions at the end of your first session.
Once in the treatment room, your therapists will ask you numerous questions pertaining to your condition. Then they will analyze your posture, balance, back and hip motion, pelvic alignment and scar integrity. They will explain the anatomy of the pelvis using an anatomical model. Then your therapist will give your privacy and ask you to get undressed from the waist down. A sheet will be provided for you to cover yourself, as you lie back on the treatment table. Your therapist will exam the perineum (the area covered by your underwear), and possibly perform a vaginal and/or rectal exam. This is only done with your consent, but can provide very important information used by your therapist to create your Plan of Care. Your therapist will use non-latex gloves and lubrication during this part of the exam, which will make the exam more comfortable. Once this part of the exam is finished, your therapist will give you privacy to dress. Your therapist will then explain their findings and what your Plan of Care should be, as well as answer any questions that you still have.
Please arrive 30 minutes early for your first day of therapy. There will be paperwork for you to fill out and we do not want to eat into your hour of evaluation time with your therapist. Also please bring a list of medications, a list of your past surgeries and list of your conditions. If you downloaded the forms and filled them out in advance of your appointment, you can arrive 15 minutes early, as there are still a few forms to handle in the office. Please bring a photo ID and your insurance card.


4. What can I expect my ongoing therapy to be like?

The treatment for pelvic organ descent focuses on strengthening all of the muscles around and inside the pelvis to help support the organ from further descent and help to decrease your symptoms. These muscles include your pelvic muscles, deep abdominal muscles, deep back muscles and deep hip muscles. We also provide education on how to prevent/protect from increased pressure on the organs which is what pushes them out of the body. This may include lifting techniques, protection techniques with sneezing/coughing/getting up from a chair and providing education on specific intercourse positions to either decrease discomfort or prevent pressure on the affected organ. Manual therapy may utilize scar tissue manipulation, myofascial release, connective tissue manipulation or visceral manipulation as appropriate (see techniques page for details on manual therapy techniques).


5. How long can I expect my therapy to last before I begin to see improvement?

Since every patient is unique, it’s hard to answer this question. We have seen some patients acknowledge improvement in just two visits, while others, although rare, may need months of therapy before seeing improvements. Usually some improvement is seen within 4-6 visits. Your participation in your own healthcare can also have a big impact. This means that you have to take some responsibility for your own health and do what your therapist asks you to do outside your treatment sessions. You are your therapist are a team. Improvement rates also depend on the severity of your condition and how long you have been suffering from it. The longer you’ve had your problem, and the more severe it is, will increase the time needed for treatment before you see improvements.


6. How long can I expect my therapy to last before I am healed/cured/fixed?

Again, each patient is unique, so this time frame can vary greatly. Research shows that it takes at least three months of treatment to create a permanent change in the body. We most often request a frequency of once a week for 12 total visits. That is why our office staff will ask you to schedule all 12 of your sessions before starting therapy. If you need more than 12 sessions, your therapist will discuss this with you after you have completed 12 visits and you will decide together whether continuing with therapy would benefit you or not. If so, your therapist will reevaluate you and send a progress note to your physician requesting an extension.


7. What are the credentials of my uro-gynecological physical therapist?

At Kirk Center for Healthy Living we are very selective in our hiring process. We take great care in selecting the most skilled therapists we can find. We also require that they attend multiple post-graduate continuing education courses every year, predominantly with the Herman & Wallace Pelvic Rehabilitation Institute and the Barral Institute, in addition to receiving one hour of one-on-one training with the owner of Kirk Center, Brandi Kirk, PT, BCB-PMB.
All licensed physical therapists have had to apply and be selected to attend Physical Therapy school. It is a very competitive process and only those will the highest grades and best potential are selected. Physical therapists have invested a minimum of 5 years into their undergraduate and graduate training at universities. Once they graduate, they have to sit for a State Board Exam and pass to receive their license to practice. In order to keep their license active, they must dedicate a certain number of hours to continuing education each year.
Uro-gynecological physical therapists have done everything listed above, but have also become a specialist in the field of pelvic health. As a specialist, all continuing education is focused on the conditions that we treat at Kirk Center. Some physical therapists have multiple letters after their names, indicating a license and/or certification in an area of study. Uro-gynecological physical therapists have been trained in internal vaginal and rectal evaluation and treatment techniques and by our state license we are legally allowed and qualified to perform these procedures.
   
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