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Pelvic Health Table

Post-pelvic Surgery
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?

1. What are some of the common symptoms?

Pelvic surgeries include, but are not limited to, bladder suspensions, urethral suspensions, rectocele repair, cystocele repair, urethrocele repair, uterine prolapse, partial hysterectomy, total hysterectomy, oophorectomy (surgical removal of one or both ovaries), Bartholin's gland removal or marsupialization, episiotomy site repair, endometriosis, D&C, ablation (the removal, especially of organs, abnormal growths, or harmful substances), uterine fibroid surgery, tissue repairs or fistula repairs. Some of the common symptoms may include, but are not limited to, pelvic pain, vaginal numbness, vaginal tingling, swelling, penile pain, testicular pain, testicular swelling, pain with sitting, pain with urination, pain with defecation, difficulty starting urine stream, feeling of incomplete emptying with urination or defecation, frequent urination, frequent defecation, urinary retention, urine loss, loss of bowel, pain with sexual activity, pain with tampon use, pain with gynecological exams, pain with erections or an overall decrease in strength and endurance.

2. What are some of the common causes?

The skillset of the surgeons today is amazing and they are a very dedicated group of professionals. It does not matter how good your surgeon is, you will have some issues after your surgery. It is unsure why pelvic surgeries are viewed differently than orthopedic surgeries, in terms of the need for post-surgical physical therapy. We’ve had patients say, “I thought that I if I had surgery, it would fix everything – I can’t believe that I’m not 100% after surgery.” Our response to this is if you had a knee surgery or a hip surgery you wouldn’t expect to walk right out of surgery and be 100% upon waking from you anesthesia. Why do you have that expectation from a pelvic surgery? Surgery is surgery and just like after a knee or hip surgery, you will need physical therapy to aid in your recovery.

Some of the common causes of the symptoms are the development of scar tissue, which is a normal healing process but some people scar worse than others. Another cause is irritation to the surrounding nerves. Also, during pelvic surgeries, the organs may lose their ability to move and function properly due to scar adhesions or fascial restrictions. A change in the position of the organs as a result of surgery can also be a cause. For example, when certain prolapsed organs, like the bladder, are tacked back up to their original position, it may cause more loss of urine. This is due to the fact that when the bladder was tipped back in to the vaginal canal, it created two reservoirs that stored. So the full weight of all the urine was never right over top of the urethra. Due to this, urine loss may not have existed until after the surgery when there is only one reservoir right above the urethra. Now the muscles around the urethra and under your bladder need to be strong enough to hold back your urine.

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?

Every patient responds differently to pelvic surgery. There are many treatments that may be utilized during physical therapy. Sometimes you don’t have any symptoms after surgery, but we strongly urge you to come to therapy. We will help support the surgical site and research shows that those that have physical therapy after their pelvic surgery have surgeries that last longer and are more successful. Again, would you even dream of having a hip or knee or ankle surgery and not doing the prescribed therapy after the surgery? Of course not, so why your pelvic surgery any different? Some treatments will include scar mobilization, visceral manipulation, myofascial release, connective tissue manipulation, internal vaginal releases, internal rectal releases, nerve mobilizations, and some sacroiliac corrections (see manual techniques page). Once the pain has subsided and the scar tissue has been released then we start strengthening to support the surgical site. Strengthening will include exercises for deep abdominal muscles, deep back muscles, deep hip muscles and pelvic muscles. Techniques for supporting the surgical site during lifting, sneezing and coughing will also be taught. You will be set up with a home exercise program to do while you are enrolled in physical therapy and this will be modified for when you are finished with therapy.

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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