What is the Patient’s Role During Pelvic Floor PT?
|June 28, 2013||Posted by Stephanie and Liz Prendergast and Rummer under pelvic floor physical therapy|
We’ve talked a great deal over the past year on this blog about the PTs role in treating pelvic pain/dysfunction, now it’s time to turn the spotlight on the role of the patient in his or her treatment. This is an important post because pelvic floor PT is most successful when patients are active participants in their treatment. Period. There’s no getting around it. And if you think about it, it makes perfect sense. Typically, PTs are with patients one, at the most two hours per week. That’s out of 168 hours in a week.
After much discussion amongst ourselves and with a handful of patients, we came up with five important tenants that describe the patients’ role during pelvic floor PT. Take a look at our list, and if you can think of any others to add, please do so in the comment section below!
Communicate Communicate Communicate!
While it is the job of the PT to work to educate patients about their conditions and the therapeutic methods they are using during PT, for a variety of different reasons, patients may not get all of the info they need to fully understand what’s going on with their treatment.
Plus, the dynamic between PT and patient can sometimes be tricky. Oftentimes, patients are hesitant to question their PTs for fear of insulting them or disrespecting their expertise. Therefore, they may feel too intimidated to speak up when they have questions or concerns about their treatment.
This lack of communication can be detrimental when it comes to pelvic floor PT for many reasons, not the least of which is that for some patients, successful treatment will require a major time and emotional commitment. So if a patient is confused or frustrated about treatment, he or she might ultimately decide to throw in the towel and discontinue PT even though therapy may in the long run be the best treatment option for them.
For another thing, full understanding about the treatment process results in less anxiety surrounding PT and symptoms in general. Not to mention that research shows that educating folks about the ins and outs of their pain actually plays a role in healing.
Indeed, in their book, Explain Pain, authors David Butler and Walter Moseley explain that learning about pain physiology reduces the threat value of pain, which in turn reduces the activation of all of our protective systems: sympathetic nervous system, hormones and compensatory movement patterns. This in turn helps restore normal immune function; therefore, inflammation decreases.
When it comes to PT for pelvic pain, its vial that patients understand both what is going on with their pelvic floors and their PT’s treatment approach. So at any time during the process, if you as a patient have a question or concern, definitely bring it up with your PT. Any PT worth his or her salt wants you to be a participating member of your treatment team, so he or she will welcome your desire to be totally in the loop.
Another important area of communication between patient and PT involves patient feedback. Patients must be sure that during their treatment they are providing their PTs with necessary and important feedback. For example, if what the PT is doing is providing relief, it’s important that the patient share that with the PT. Conversely, if treatment is causing increased pain, it’s important for patients to speak up and to describe in as much detail as possible exactly what they’re experiencing.
This type of feedback helps PTs evaluate their patient’s progress as well as helps them to determine if they need to make any treatment modifications.
Lastly, it’s important that patients inform their PTs of any relevant occurrences between appointments, and that they answer their PTs questions to the best of their ability. Again, this information enables the PT to evaluate and modify his or her treatment plan throughout the treatment process.
“Home Treatment” is a Must
Typically, patients will see their PTs for one-hour appointments each week. That’s four hours a month— four hours out of approximately 720 hours a month! So in order for a patient’s treatment to be as successful as possible, he or she must take matters into his/her own hands.
This will mean different things to different patients. As a patient, your job is to figure out what “home treatment” means for you. For instance, some of our patients regularly use dilators at home. Others learn how to manually treat themselves internally and externally. Still others bring their partner to a PT session so that they can learn how to administer connective tissue manipulation on the patient at home.
It’s important that you as a patient talk to your PT about what you can be doing at home to compliment the PT you’re receiving. And this is a conversation that you should be having throughout treatment because the answer might change depending on where you are in the treatment process. And we recommend if you’re going to be doing either internal or external work on yourself, that you ask your PT to take some time during an appointment or over a few appointments to show you exactly how to self-treat. (This is one of the reasons that we keep a hand held mirror in our treatment rooms.)
While each home treatment program is different, over the years, we have come up with a few rules of thumb that we’d like to share with you regarding self-treatment.
• If manual, internal treatment is a good fit for your home treatment program, use non-latex gloves and a lubricant that will not irritate your skin. We recommend Slippery Stuff
• If you are not getting relief from your home treatment techniques or if they are making your symptoms worse, discontinue and reassess with your PT.
• Using increasing sizes of dilators is good if you are working to desensitize tissue, however, they can (not always) be counterproductive if you have impairments such as
trigger points, fissures, tissue that is lacking in estrogen (for female patients), or muscles that have increased tone.
• The therawand, which is different than the above-mentioned cone-shaped dilators, can because of its curved shape and somewhat pointed tip, serve to treat trigger points and help lengthen tissue internally.
• Tennis balls are a great tool for self-administering connective tissue manipulation on the legs, thighs and buttocks.
• A foam roller is a useful tool for tight back, leg, and buttock muscles.
• Working up a sweat is great for connective tissue impairments.
• Meditation is wonderful for quieting the central nervous system.
In addition, your PT will likely give you certain at-home exercises or stretches to do, such as pelvic floor drops. Do them. Doing your homework will hasten your healing. That’s a guarantee.
In fact, when it comes to pelvic floor PT for incontinence, if you don’t do the home treatment program that your PT recommends, your symptoms will not improve. It’s that important.
Become a Pelvic Floor Expert
On this blog, we’ve gone to great lengths to paint a realistic picture of how pelvic pain is currently diagnosed and treated. But, to reiterate: the reality is that it’s a challenge for patients to get treatment that is consistent. Therefore, if you are a pelvic pain patient, in order to best advocate for yourself, you must educate yourself.
This means becoming informed on the anatomy of the pelvic floor and all of the different treatment options available to you. Thanks to the Internet, there are many great resources now available on the topic of pelvic pain. Take advantage of them, and arm yourself with all of the knowledge you’ll need to be your own best advocate.
Ask for Support
This one may seem a no-brainer. But, if you’re a patient reading this blog post, you know all too well how as time goes on, those around you tend to forget that you are in pain. After all, you’re dealing with a pain condition that is invisible to those around you. So, often patients fall into a trap where they’re left to soldier on.
Ultimately, this will catch up with you. So instead of giving into temptation, and ignoring your reality, be honest with yourself and those around you by asking for help and support, as you need it. As with all of the other items on this list, this one will help to hasten your healing.
Take Good Care of You
In addition to home treatment, self-care is vital during pelvic pain PT. And as with home treatment, this will mean different things for different patients. For some, it will mean taking a hot bath after a long day at work to help those pelvic floor muscles to relax. For others it will mean avoiding certain foods and beverages that you know aggravate your symptoms. For some, it will mean sitting on a cushion. And for others, it will mean going to a yoga class or getting out and taking a walk. Take the time to figure out all of the different ways you can take care of yourself and follow through as if you were taking care of any of your loved ones.
We hope this blog is helpful. If you have anything to add to this super-important list, please leave the info in the comments section below. We’d love to hear from you!
All our best,
Liz and Stephanie