Episode 1617 - Talking prolapse with your patients

Dr. Rachel Moore // #ICEPelvic // www.ptonice.com

In today's episode of the PT on ICE Daily Show, #ICEPelvic faculty member Rachel Moore discusses how to better educate patients on prolapse, including a three-step framework focusing on education, risk factors, healing timelines, and empowerment.

Take a listen to learn how to better serve this population of patients & athletes.

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EPISODE TRANSCRIPTION

INTRODUCTION Hey everyone, this is Alan. Chief Operating Officer here at ICE. Before we get started with today's episode, I want to talk to you about VersaLifts. Today's episode is brought to you by VersaLifts. Best known for their heel lift shoe inserts, VersaLifts has been a leading innovator in bringing simple but highly effective rehab tools to the market. If you have clients with stiff ankles, Achilles tendinopathy, or basic skeletal structure limitations keeping them from squatting with proper form and good depth, a little heel lift can make a huge difference. VersaLifts heel lifts are available in three different sizes and all of them add an additional half inch of drop to any training shoe, helping athletes squat deeper with better form. Visit www.vlifts.com/icephysio or click the link in today's show notes to get your VersaLifts today.RACHEL MOORE Good morning, PT on ICE Daily Show. My name is Dr. Rachel Moore. It is Monday morning, which means it is pelvic day on our podcast here. So, we are going to dive in today. Our topic is using words that heal to talk to our patients about prolapse. So we want to make sure that when we are talking about our patients that have prolapse or maybe have been given this diagnosis of prolapse, that we're using words that are going to empower them. So we're going to dive into that today. Before we do that, a couple of housekeeping things, just letting you guys know the courses that we have coming up within our pelvic division. So we are done for December, nothing left in 2023, but we are kicking off 2024 strong. We've got two courses on our live docket in January. So we've got one January 13th and 14th in North Carolina. We've got one January 27th and 28th in Hendersonville, Tennessee. And then February 3rd in Bellingham, Washington. So we've got three chances within the first like month-ish of 2024 to catch us on the road. um on the those live courses that's where you'll be taking your certification test if you're interested in having that pelvic certification which includes taking all three we now have three of our pelvic courses our next online level one cohort starts january 9th and the sign up for our level two is now officially open so if you want to hop into that cohort it starts april 30th and that will be the first cohort of our level two so Really excited to kick that off and just kind of get that rolling.

TALKING PROLAPSE So without further ado, let's dive into our topic of the day. We talk a lot about ICE or talk a lot at ICE about using words that heal, not harm. We preach it a lot and sometimes it can be really tough to figure out how to explain like difficult diagnoses. Especially things that are maybe controversial when it comes to the postpartum space and we're gonna see that with things like diastasis or prolapse and a lot of times our patients are coming in and maybe they've been given this diagnosis by another provider and it's not really explained very well and so they go down this scary Google rabbit hole and they come in and with all of these preconceived notions um oftentimes mostly negative preconceived notions from all of this research that they've done and they feel like they're empowering themselves with knowledge but in reality there's a ton of negativity and fear-based messaging about these topics so today we're going to talk about prolapse later on in a future episode we're going to talk about diastasis and i really just wanted to talk about some actual quotes that i use with my patients or kind of an outline or a framework of how we can break these scary diagnoses down, especially if you're newer to the pelvic population, you haven't had a lot of reps practicing talking about this, so that we can make sure that all of our patients are leaving their sessions feeling very empowered and excited to be working with you.

EDUCATE So the first step of our three-step framework is going to be educate. I can't tell you how many times I have people come into the office and they're sitting there and they're squeezing their legs together because they are so terrified that if they aren't constantly contracting their pelvic floor and squeezing their legs together that their bladder is going to fall out of their vagina because they've been told that they have a bladder prolapse. with no other explanation this happens so often people will go to a provider the provider maybe will be doing a well women's exam or a check for whatever reason postpartum follow-up whatever and they tell them you have a bladder prolapse or you have a rectal prolapse and then that's it and they don't really tell them anything else and maybe they don't even really prescribe them physical therapy and they just wander into your clinic um on their own but there's not a lot of follow-up in most cases. So the very first thing that I'm doing when I'm sitting down with patients is breaking down. Okay, you were told you have a prolapse. Did anybody explain to you what that is? And usually that's followed with no, I went on Google and I saw a bunch of scary things. I'm like, okay, great. Like we're going to undo all of that. And even sometimes if they were explained, it maybe was using a very medicalized definition that can be, again, terrifying if you don't really know what's going on. So I'll bust out a whiteboard and I will draw out the pelvic organ. So if you're watching on Instagram or YouTube, you can kind of see with my hands, but if you're not listening, just visualize. I'll draw out, like, here's our bladder, here's our uterus, here's our vaginal canal, and here's our rectum. All of these organs sit within our pelvic bowl. When we have pelvic organ prolapse, essentially what that means is there is a descent of one of these organs or a drop down that pushes onto the walls of the vagina. at this point usually i'll take a minute to explain to people that the vagina is not a hollow tube it does not look like this it actually looks more like sides of soft tissue coming together most people don't realize that because every picture we've ever seen of a vagina in a textbook in anatomy books anything Looks like a hollow rigid tube. So a lot of times even letting them know like hey your vagina is not like this It's like this you'll see a light bulb moment where they're like, oh Okay, so maybe that's not a prolapse that I'm seeing maybe that's actually just my vagina. So that alone can be really helpful We'll talk about the fact that the vagina is not a hollow tube and that it is soft tissue and with that it is influenced by other things around it and so then we'll kind of break down here's your bladder maybe you have a descent of your pelvic organs and we see this kind of drop down if vaginal canal is here and our bladder is dropping down slightly and pushing onto that vaginal wall what we may see is a slight drop down of that vaginal wall oftentimes we're doing this test on our backs Oftentimes gravity is pulling everything down a little bit more and so when we take this person who's upright like this and put her on her back, our bladder drops down and we can kind of see and maybe feel that drop down sensation. When we layer in gravity with standing, we're upright, we drop down, we can sometimes feel that heaviness sensation from the vaginal wall not necessarily supporting that drop down quite as well. It is really important to highlight and differentiate an organ falling physically out of the vagina which can happen if we have a uterine prolapse where the uterus is dropping down into the vaginal canal versus an anterior wall or a bladder or a posterior wall or rectal prolapse where it is not the physical organ dropping down, it is just the wall of the vaginal canal dropping inwards. That education is huge. You will see people have this like weight lifted off of their shoulders knowing that their organs are not actually falling out of their bodies. Education is important.

DISCUSSING RISK FACTORS Talking about risk factors is also incredibly important. Letting them know what the top risk factors are. Genetics and connective tissue immobility, BMI, chronic constipation, which comes along with that straining, that consistent straining mechanism where we're bearing down repeatedly over time, pregn