The Pelvic Floor Clinic

Pelvic Floor Clinic
th
1441 29 St. NW Calgary, AB
T2N 4J8
The Pelvic Floor Clinic:
Understanding Your Pelvic Floor
Pelvic Floor Clinic
Patient Education Program
Handout to Accompany Sessions 1 to 5
These education modules have been created to assist women who have been referred to our clinic. As you review them, you will
become more aware about the various reasons for pelvic floor problems, how common they are, and become more familiar with
the treatment options that are of help. You will note that many issues have no easy simple solution. Rather, often it is a
combination of lifestyle and behaviour changes that must be made by you. Review all 5 of the basic sessions. After you have taken
them all, you must follow the instructions provided to ensure you will get a clinic appointment and move forward in your care.
There are additional supplementary modules on the clinic website to further your learning, once you have completed all of the
basic ones. This booklet highlights some of the main points discussed in the education sessions. Thanks!
1.
2.
3.
4.
5.
Module 1 – Introduction to the Pelvic Floor
Module 2 – Pelvic Organ Prolapse
Module 3 – Urinary Incontinence
Module 4 – Bowel Management
Module 5 – The Next Step
page 1
page 3
page 5
page 9
page 11
PATIENT EDUCATION MODULE 1 – Introduction to the Pelvic Floor
Objectives:
1) To help you understand how your pelvic floor normally should be working.
2) To help you identify what might be happening to cause abnormal symptoms that are bothering you
3) To provide information and suggestions that might help you manage your symptoms.
4) To help you select the best treatment option for you at this time.
The pelvic floor is like the
bottom of a canister and
bears the weight of the
abdominal contents. Three
openings intersect this
group of muscles in women,
the urethra, vagina and
anus.
Reprinted with permission of Eastland Press
From The Female Pelvis Blandine-Calais Germain
page 1
A ANormal
Pelvic Floor
Normal Pelvic Floor
Uterus
Spine &
Tailbone
Bladder
Rectum
Pubic Bone
Pelvic Floor Muscles
Urethra
Vagina
Anus
© 2006 Tim Peters and Company, Inc. Peapack, NJ 07977 USA
All Rights Reserved. www.humanatomy.com
From The Female Pelvis by Blandine-Calais Germain,
Reprinted with permission of Eastland Press.
DOWNLOAD HANDOUTS FROM
WEBSITE:
Incontinence & Getting Older
How Your Bladder Works
What is Incontinence?
Women frequently develop issues with their
bladder, their lower bowel and with prolapse
- often in combination
Associated Factors
Note those you can modify and some that you cannot change.
AGING
GENETICS
COUGHING
CONSTIPATION
SMOKING
CHILDBEARING
OTHER MEDICATIONS
EXTRA WEIGHT
HIGH IMPACT ACTIVITIES
Poison & Drug
Info Service
(PADIS)
Phone Line:
1-888-944-1012
HEAVY LIFTING
OTHER MEDICAL CONDITIONS
CAFFEINE AND OTHER
IRRITANTS
page 2
Take Home
Thoughts
1. Can you understand where
the pelvic floor is and how it
should be working?
2. Can you better understand
the issues you have been
referred to our clinic for?
3. Can you identify some
associated factors that might
apply to your own issues?
PATIENT EDUCATION MODULE 2 – Pelvic Organ Prolapse
Objectives:
1. To understand what pelvic organ prolapse is
2. To become aware of treatment options for dealing with prolapse
3. To become aware of things you can do to prevent prolapse from worsening and improve
symptoms you may be having
Aging
Coughing
Smoking
Childbearing
Genetics
Extra weight Constipation High Impact Heavy lifting
TYPES OF VAGINAL PROLAPSE
© 2006 Tim Peters and Company, Inc. Peapack, NJ 07977 USA All Rights Reserved. www.humanatomy.com
page 3
Lifting Your Pelvic Floor
Treatment Options
A Normal PelvicUterus
Floor
Prolapse
Bladder
Rectum
Pubic Bone
Pelvic Floor
Muscle
Training
Spine &
Tailbone
Surgery
Protecting
Your Pelvic
Floor
Pessary
Pelvic Floor Muscles
Urethra
Vagina
Anus
9
© 2006 Tim Peters and Company, Inc. Peapack, NJ 07977 USA
All Rights Reserved. www.humanatomy.com
20
http://www.physiotherapyalberta.ca/ (Enter condition, enter city or geographic location, press “search” to locate a private clinic – fees apply)
“Exercising Your Pelvic Floor” – www.calgarywomenshealth.ca
or phone 403-944-2260 to register
DOWNLOAD HANDOUTS FROM WEBSITE:
Pelvic Organ Prolapse
Pelvic Floor Muscle Exercises for Women
Pessaries
PROTECT YOUR PELVIC FLOOR:
By: • CAUTION with certain exercises & activities
• Achieving and maintaining a healthy weight
• CAUTION with heavy lifting
• Avoid straining with bowel movements
• Avoid coughing
• Using your pelvic floor muscles prior to
coughing, lifting, any exertion with
movement - the “KNACK”
Types of Prolapse Pessaries
Open Ring
Covered Ring
Images provided by CooperCube
Surgical, Inc.
Gellhorn
Shaatz
Donut
29
Surgeries for
Prolapse
RECONSTRUCTIVE
CLOSE THE VAGINA
page 4
1) Do you have any symptoms
of prolapse?
Take Home
Thoughts
2) What changes can you make
to prevent your prolapse
from worsening?
3) Do your symptoms bother
you? – treatment is only
necessary if they are
4) Exercise your pelvic floor
muscles every day☺
PATIENT EDUCATION MODULE 3 – Urinary Incontinence
Objectives:
1.
2.
3.
4.
To better understand normal functioning of the bladder and lower urinary tract
To become aware of different types of problems with bladder and lower urinary tract
To become aware of different treatment options for dealing with these issues
To better understand things you can do to improve your symptoms
Normal Bladder Functioning
Structure of the Lower Urinary Tract
Bladder
Ureter
Normal Voiding Cycle
Storage or
filling phase
Emptying phase
Normal Bladder Function
• The bladder should hold 350 – 650 ml of urine
• It is normal to void about every 3 to 4 hours
Detrusor muscle
Inner lining
Bladder filling
Internal Sphincter
External sphincter
Urethra
Pelvic floor
muscles
First sensation
to void
Normal desire
to void
Bladder filling
• Approximately 6 to 8 times in 24 hours
• Ideally, not up at night – but 1 - 2 times not
considered abnormal
page 5
Types of Urinary Incontinence
• Stress Incontinence
• Overactive Bladder
• Mixed Incontinence
• Overflow Incontinence
• Functional Incontinence
• Nocturia
Treatment Options
Treatment Options
Overactive
Bladder
Stress Incontinence
Pelvic Muscle
Exercises
Healthy
Bladder
Habits
Pelvic Muscle
Exercises
Pessary
Medications
Healthy
Bladder
Habits
Surgery
Urge Control
Techniques
Bladder
Retraining
Pelvic Floor Muscle Training for All Types of Incontinence
Exercising Your Pelvic Floor
Lift, longer hold, relax
A Normal PelvicUterus
Floor
Spine &
Tailbone
Slow Hold
Bladder
Lift/tighten
Resting level
relax
sqeezes
relaxations
Rectum
Pubic Bone
Pelvic Floor Muscles
Resting level
Lift and quick sqeezes
Resting level
Resting level
Urethra
Vagina
30
10 exercises in a set
Anus
© 2006 Tim Peters and Company, Inc. Peapack, NJ 07977 USA
All Rights Reserved. www.humanatomy.com
27
At least 3 sets each day
32
For the rest of your life
You must BOTH contract/lift and relax completely. Practice “the KNACK” – quick squeeze BEFORE
exertion.
“Exercising Your Pelvic Floor Class” for both Stress Incontinence and Overactive Bladder:
www.calgarywomenshealth.ca
Private physiotherapy: http://www.physiotherapyalberta.ca/
(Enter condition, enter your city or geographic location, then press “search” to locate a private clinic – fees apply)
page 6
• Pessaries for Stress Incontinence
• Medications for Overactive Bladder
Prescriptions from your doctor for
Bladder Relaxants - Vaginal Estrogen
• Bladder Retraining for Overactive Bladder
Weekly – increasing time intervals for voiding
Images provided by Cooper Surgical, Inc.
• Surgeries for Stress Incontinence
Bulking Agents
• Healthy Habits for Overactive Bladder
Avoid irritants like caffeine, acidic foods/juices
STOP smoking
Try double voiding to empty better:
- Void
- Lean, stand, lean
- Lean forwards
- Void a second time
Drink 6 – 8 cups non-irritating fluids
Slings
Needle in
neck of
bladder
TVT tape around urethra
Bulking agent
injected to
plump up neck
of bladder
Overflow Incontinence
(from overstretched or
obstructed bladders)
• Timed Voiding
• Intermittent
catheterization
Functional Incontinence
• Tighten pelvic floor muscles
• Go regularly every 2-3 hours
• Use commodes or other aids as needed
www.seniors.gov.ab.ca
www.informalberta.ca (enter “CCAIL”)
Nocturia
• Limit fluids after supper
• Elevate legs in the evening
• Wear compression stockings
until bedtime
• Determine if getting up is a
habit and break it
Wear pads & products
designed for incontinence
PADS
page 7
Summary of Healthy Bladder Habits
•
•
•
•
•
•
Drink 6 – 8 cups non-irritating fluids/day
Don’t push to void or have a bowel movement
Caution with spicy foods, acidic foods, alcohol
Avoid caffeinated drinks
Avoid heavy lifting
Deal with chronic coughing
•
•
•
•
•
•
Avoid constipation & straining
Don’t smoke
Aim to void every 3 to 4 hours
Achieve & maintain proper weight
Caution with high impact activities
Take control of your bladder
• Practice pelvic muscle exercises 3X each day
DOWNLOAD HANDOUTS FROM WEBSITE
How Your Bladder Works
Types of Incontinence
Incontinence and Getting Older
Factors that Affect Your Bladder Health
Urge Control Techniques
Bladder Retraining
Healthy Bladder Habits
Healthy Habits for Your Bladder & Bowel
Pelvic Floor Muscle Exercises
Pessaries
Take Home
Thoughts
1.Understand what type of
incontinence you may have.
2.Understand what type of
treatment will help your
issue.
3. Make the changes you can
to improve your symptoms.
4. Are there any treatment
options we can help you
with?
72
page 8
PATIENT EDUCATION MODULE 4 – Bowel Management
Objectives:
1.
2.
3.
4.
To better understand the normal functioning of the bowel
To be familiar with symptoms of constipation and anal incontinence
To become aware of dietary, lifestyle, and other changes that may improve symptoms
To understand the role of physiotherapy in the treatment of constipation and anal incontinence
Things That Affect Our Bowels
Stress
Some foods
Fluid intake
Activity level
Straining Medications
Some diseases
Delivery damage
Desired Bowel Functioning
Normal range is 3 X/day to 3X/week
Want minimal effort & minimal straining to empty
Stools should be soft and formed
Should feel urge and determine if air, solid, liquid
Should be able to hold stool until on toilet
Should not wait to empty, but respond quickly
External Sphincter
8
9
Used with permission from Dr. Christine Norton – 2005
Bowel Evacuation Issues
Constipation
Anal Incontinence
Two or more of following:
• straining
• hard stool
• incomplete emptying
• less than 3 BMs/week
• having to push with fingers to start
At least 25% of the time, in last 3 months, in the last year
(Rome III criteria).
Rectocele can be caused
from chronic straining and
constipated stool and can
also interfere with normal
emptying.
- is the involuntary loss of flatus (gas),
liquid or solid stool that is a social or
hygienic problem”
The International Continence Society, 2001
Identify & eliminate irritants
Add stool thickening foods
Add daily supplement if needed
© 2006 Tim Peters and Company, Inc. Peapack, NJ 07977 USA All Rights Reserved. www.humanatomy.com
page 9
FIBER
-
Position for Bowel Movements
Found in the food we eat
Little is digested – stays in stool
Acts as a propellant
Makes hard stool softer/bulkier – drink extra water
Makes soft stool firmer – acts like a sponge
1.
Elevate feet to above hip level
2.
3.
4.
5.
Lean forwards with straight back
Rest hands on thighs or knees
Breath through pursed lips
Think of pulling belly towards spine
“Exercising Your PelvicFloor” Class
www.calgarywomenshealth.ca Or (403) 944-2260 to register
Private physiotherapy
http://www.physiotherapyalberta.ca/ (Enter condition, enter
your city or geographic location, then press “search” to locate a
private clinic). Physiotherapy fees apply.
Exercising Your Pelvic Floor
A Normal PelvicUterus
Floor
Spine &
Tailbone
Bladder
Rectum
Pubic Bone
10 EXERCISES IN A SET
3 SETS PER DAY
FOR THE REST OF YOUR LIFE
Pelvic Floor Muscles
Urethra
Vagina
Anus
© 2006 Tim Peters and Company, Inc. Peapack, NJ 07977 USA
All Rights Reserved. www.humanatomy.com
27
For more information view:
“Get it Moving;
recommendations for bowel
health using diet,
supplements or medications”
DOWNLOAD HANDOUTS FROM WEBSITE
Healthy Habits for your Bladder and Bowel
Pelvic Muscles Exercises for Women
Fiber Facts
on the Supplementary
Information Menu
Dietician Appointment - Call (403) 944 - 2270
If you have issues with your food intake (eg.
tolerances, allergies, health condition) that
you would like to discuss with an expert
page 10
PATIENT EDUCATION MODULE 5 – The Next Step
Objectives:
1. To review & summarize treatment options for prolapse, bladder and lower bowel issues
2. To ensure you have a clear understanding about what you can do to improve the symptoms you are
having
3. To give you the opportunity to consider and to select your direction for care in the clinic
4. To direct you on your responsibility to send to us your choice of treatment direction at this time so your
future appointments may be booked
Anterior prolapse – the bladder
falls down towards the vagina
Uterine/Vault prolapse – the
uterus (or top of vagina after
hysterectomy) comes down
Posterior prolapse – the rectum
pushes forwards towards the
vagina
Treatment Options
Prolapse
Pelvic Floor
Muscle
Training
Surgery
Protecting
Your Pelvic
Floor
Pessary
9
© 2006 Tim Peters and Company, Inc. Peapack, NJ 07977 USA
All Rights Reserved. www.humanatomy.com
Review Module 2 to better recall these options
Do you have pelvic organ prolapse? YES
NO - I do not have any symptoms of prolapse
If YES, how much of a bother is it for you? (Circle)
Consider – half of all women develop prolapse from
things like having babies, gaining weight, straining
from constipation, coughing, lifting heavy things and
high impact activities
None____________Some_____________A Lot
If NONE – train and protect your pelvic floor
& prevent it from worsening – wait & watch
If SOME, you may consider trying a pessary or
consider surgery OR can you improve it by training
& protecting your pelvic floor? - wait & watch
Practice PREVENTION by being careful with all
these things
If A LOT, your choice remains – trying pessary to see
If it helps for you, consider surgery – a permanent change
OR you can still choose to wait.
page 11
Do you have STRESS INCONTINENCE?
Treatment Options
YES
If YES, how much of a bother is it for you? (Circle)
None/a bit____________Some_____________A Lot
Stress Incontinence
If NONE/A BIT – Strengthen and use your pelvic floor muscles
to keep the urethra closed – practice “THE KNACK”
Healthy
Bladder
Habits
Pelvic Muscle
Exercises
Pessary
Surgery
If SOME, strengthen muscles, try a pessary, consider surgery –
always make sure your practice healthy habits
If A LOT, ensure your pelvic floor muscles are working well,
practice good bladder habits, and book an appointment for a
pessary fitting or a surgical consultation
Review Module 3 to better recall these options
Do you have OVERACTIVE BLADDER? YES
If YES, how much of a bother is it for you? (Circle)
None/a bit____________Some_____________A Lot
Treatment Options
If NONE/A BIT – Identify and reduce/eliminate irritants:
caffeine, smoking, acidic or spicy foods, alcohol, modify fluid
intake. Ensure pelvic floor muscles are strong and USE them.
Overactive
Bladder
Pelvic Muscle
Exercises
Healthy
Bladder
Habits
Medications
Urge Control
Techniques
Bladder
Retraining
If SOME – Reduce irritants and use “Urge Control Techniques”
when the urge comes: Stop, sit, wait, relax, breath, tighten
muscles and wait for urge to subside – then go in control or
wait till later. Try bladder retraining – routine of delaying trips
to toilet. Consider using vaginal estrogen.
If A LOT, make the above changes and consider an
appointment to tryi bladder relaxing medications.
page 12
Do you have BOWEL MANAGEMENT ISSUES?
Treatment Options –
Bowel Evacuation Issues
If YES, how much of a bother is it for you? (Circle)
None/a bit____________Some_____________A Lot
Bowels
Healthy Bowel
Habits
Assessment
In Clinic
Dietary
Changes
Pelvic Floor
Muscle
Training
29
Pelvic Muscle Exercise Class
www.calgarywomenshealth.ca Or (403) 944-2260 to register
Private physiotherapy
http://www.physiotherapyalberta.ca
(Enter condition, enter your city or geographic location, then press “search”
If NONE or A BIT – ensure you have healthy bowel habits
- consider your diet and fluid intake, strengthen and
train your pelvic floor muscles and strengthen the anal
sphincter
If SOME, as well as above, consider private
physiotherapy to assist you in your efforts to maintain
tight anal sphincter closure between bowel movements
If A LOT - be very careful with your bowel habits &
positioning, consider your food & fluid intake, work on
your pelvic floor training –
*You may consider visiting the dietician for extra
advice and suggestions: 403 944 - 2270
*You are a candidate for our clinic physiotherapists
– to assess and assist you in training your anal sphincter
muscles
to locate a private clinic) Physiotherapy fees apply
Review Module 4 to better recall these options
In the Clinic you may be seen by various team members:
A NURSE - for an assessment, vaginal exam, pessary fitting,
teaching, or assistance with certain tests
A UROGYNECOLOGIST - if you thinking about surgery for pelvic organ prolapse or
stress incontinence issues, for complicated problems or medical treatments
A FAMILY DOCTOR OR NURSE PRACTITIONER - if you are having
overactive bladder leakage issues
A PHYSIOTHERAPIST - if you are having pelvic muscle control issues
Please be aware that due to the limited number of patient appointments available
and the extensive wait list we have, appointments spots are extremely valuable!
We ask that you give us at least 3 days notice of changes or cancellations if possible.
Also please be aware that our no show policy may result in you requiring a new
referral in order to be seen in our clinic.
page 13
OVERVIEW OF TREATMENT OPTIONS FOR MAIN ISSUES (those in red require clinic appointments)
Pelvic Organ Prolapse:
Wait & watch
Pelvic Floor Muscle Training
Prevention
Pessary
Surgery
Now You
Decide......
Your Next Step
Stress Urinary Incontinence:
Pelvic Floor Muscle Training
Llifestyle changes
Pessary
Surgery
Overactive Bladder:
Dietary
Pelvic Floor Muscle Training
Lifestyle changes
Medications
Bowel Issues:
Pelvic Floor Muscle Training
Dietary changes
Positioning on toilet
Clinic assessment/treatment
1. Locate & review (sent to you by mail):
a) “Medical History” form (Required)
b) “Next Step” form (Required)
2. Download from Website (or given)– “Bladder/Bowel Diary”
3. Complete all forms …..then….
Other bladder/bowel & prolapse issues you have beyond these may also require a clinical appointment.
Either... Mail or Fax both forms: a) Medical History & b) Next Step (or give to instructor for in-house class)
ATTENTION: Initial Appointment Booking Clerk
Pelvic Floor Clinic, Women’s Health Center
Foothills Medical Center
1403 – 29th St. NW
Calgary, Alberta T2N 4J8
or Fax to (403) 944-5409
ATTENTION: Initial Appointment Booking Clerk
INSTRUCTIONS for Medical History Form (Required):
Answer all questions fully
Ensure all your surgeries and dates are listed
Ensure you have an up-to-date and accurate list of all your medications – prescribed or over-the-counter
(with dosages)
-and bring it to your first appointment
INSTRUCTIONS for Next Step Form (Required):
1. Indicate your two most bothersome problems with #1 and #2.
2. What are your goals? – short and simple
3. What appointment do you wish to have first?
Place a checkmark - √ - beside the ONE type of appointment you want to start with
(NOTE – you may see different clinicians over the course of your time with the Pelvic Floor Clinic and ALL of your
concerns and issues will be addressed. Call (403) 944-4000 and leave a message for the “Charge Nurse”.)
page 14
INSTRUCTIONS for Bladder & Bowel Diary (Required):
Download from Website
Please fill out – used to evaluate your current bladder & bowel patterns
- read carefully and clearly follow instructions on form
Bring to first clinical appointment and give to your clinician (do not fax or mail)
Make sure you name, birthdate, address and phone number are clearly marked on each of your forms!!
You will receive a letter or phone call with your appointment date and time.
(Call 944-4000 and leave a message for the “Charge Nurse” if problems become urgent).
What you do makes a difference
• What you drink and eat
• Bladder habits
• Bowel habits
• Pelvic muscle training
• Activities
• Your weight
Additional Links for More Information
www.Myhealth.alberta.ca - variety of health topics
www.calgarywomenshealth.ca - to book education classes
http://www.physiotherapyalberta.ca – to find pelvic floor physios
www.pelvicfloorfirst.org.au – variety of info on pelvic floor topics, including pelvic floor safe exercises
www.simonfoundation.org - variety of info on incontinence
www.mdconversation.com/secure/patients/en/pelvichealth4.jsp - find info on pelvic floor surgeries and
treatment options
www.canadiancontinence.ca – variety of info on incontinence
www.powderroom.ca – information on overactive bladder
www.cnca.ca – variety of info on incontinence
www.peeingproblem.ca - information about overactive bladder
page 15
Take Home
Thoughts
1. What is the pelvic floor issue
that is bothering you the most?
2. Are you clear on items that
you will change in your lifestyle
to improve your symptoms?
3. Are you aware of what your
options for treatment include?
4. Have you filled in your forms
and know where to fax or mail
them to?
The Pelvic Floor Clinic
Women’s Health Center/North Tower Building
Foothills Medical Center Site
1441 – 29th St. NW
Calgary, Alberta T2N 4J8
Hours: 0800 to 4:00, Monday to Friday
Phone: 403 944-4000
Fax: 403 944-5409 (forms)
Copyright©2015AlbertaHealthServices
Page 16