Uterine Prolapse

[Laura01]

I mean to educate the different types of fibres responsible for each type of contraction. Fast twitch fibres are activated for instance in a quick reaction type situation where for example you cough or sneeze and have a sudden increase in intra-abdominal pressure which needs to be counter balanced. So this exercise I would and very politely ask the patient to imagine that they were about to pass wind and wanted to prevent this from happening!I would then ask them to squeeze the muscles around the back passage and take the contraction all the way under the pelvis to the front to the muscles which stop you passing water. I would then tell them they should feel everything lifting up inside. i would double check that they are not holding their breath. I would ask them to do this exercise squeezing up and then letting go over a count of two repeating 10 times then do 3 sets or so. Next the slow twitch fibres responsible for maintaining fluid in the bladder over the course of the day without the immediate sensation of wanting to void so these are the endurance fibres if you like. This is the same action but this time hold the contraction say for 5 secs. The length of time your patient will be able to hold the contraction will vary depending on their strength. If they are struggling, start with 2 seconds then build up but they should always be able to feel the contraction release if no they have lost it long ago or maybe don't get it. Work towards holding for 10 or 15 seconds with 10 repetitions Also get them to try the exercises in different positions remembering that if the patient is standing then they are having to work against gravity and the exercise will be harder. On the contrary some women find this position better since they get more feedback from the muscles. You can try crook or side lying to start with. try to combine the pelvic floor action with deep abdominal contraction and breathing is very important. Some women really struggle to identify the pelvic floor and whether it is working or not I normally explain it is like a hammock holding all the abdominal organs so they can see how it can become a problem, also that if any of these organs are removed as in hysterectomy it can alter the stabilty.
hope this helps!

[alophysio]

Hmmm,

Just thinking that her back passage is probably ok - I see a lot of problems from people who are overactive in the posterior pelvic floor.

Also, there is nothing to suggest that she has pelvic floor insufficiency - no incontinence. So in fact, her pelvic floor might be just fine but unable to cope with excessive intra-abdominal pressure.

If you really want to assess this lady, then glove up, put some KY jelly (without lidocaine!) on 2 fingers (middle and index) and insert into the vagina. Then have her use her pelvic floor muscles. Try to assess if she is pushing down into your hand or squeezing circumferentially etc.

An alternative method may be to get her to sit. Either you or her could then put the palm of the hand on the seat under the perineum - it would be like holding her genitals while she sat on your hand. Then ask her to use her pelvic floor muscles. Normal is a nice gradual lift away from your hand (try it now!!) Abnormal / increased intraabdominal pressure / "bearing down" would be pressure into your hand.

As i stated before, i am willing to bet she is excessively active in her abdominals and pushing that uterus out with excessive IAP.

If you choose to do the internal examination, i think it is only prudent to advise her EXACTLY what you are doing, why you are doing it and why it will help. That is why i don't do it - not only because i am a man (which really shouldn't have anything to do with it - there are loads of male OBGYNs - but because my wife wouldn't like it if i was doing these assessments! There are too many good physios around who do this sort of thing every day. I don't need to do it!).

Hope it helps

[junior_physiotherapist]

Hallo All,

Regarding Mr alophyio & Laura,really many thanks for ur so kind and informative posts ,really i'm so happy for these information.

Once again ,many thanks..

Regards

[alophysio]

Hi Junior_physio - i just noticed you are located in Palestine - is there actualy any women's health physios where you are?? For some reason, i thought you were based in the UK

[junior_physiotherapist]

Hi Junior_physio - i just noticed you are located in Palestine - is there actualy any women's health physios where you are?? For some reason, i thought you were based in the UK

Hallo all,

Regading to ur question..AAAAm!!actually in Palestine generally we have very few woman's health phsios so some times we have to go back to some experinced phsios via internet or any type of communications ,books,informative magazines,conferences,..
and usually we've to keep in minds that to give patients correct and useful physical therapy cares

Thank u sir for ur intersts
Regards

[alophysio]

Hi,

Have you tried the internal examination or the other things mentioned in one of my posts above?

How is the patient going?

[junior_physiotherapist]

Hi,

Have you tried the internal examination or the other things mentioned in one of my posts above?

How is the patient going?

Thanks sir once again ...
Really this patient is my close relative so frankly I'm so shy when i'll do test of perineum so,i told her this test of alternative method the second one then she did it by her self (may i'm wrong to let my patient to do the test by her self but really i cann't do this to her by my self ...) so her test was negative and then i advice her to strenghten her pelvic floor she felt well when do that excercises but her main promlem (pain felt down)still increase when she being nervous...

Regards

[alophysio]

ok. I guess it is difficult when it is a relation!

Good luck with it all

[junior_physiotherapist]

ok. I guess it is difficult when it is a relation!

Good luck with it all

Hi all


Regarding Mr alophysio thanks alot of sir for all of ur appreciated information...

Kind Regards