#PTonICE Daily Show – Monday, October 30th, 2023 – Prolapse intervention

In today’s episode of the PT on ICE Daily Show, #ICEPelvic faculty member Jessica Gingerich discusses simple, but often overlooked interventions for treating patients with symptoms of pelvic prolapse including the Kegel, unilateral hip strengthening, and proper breathing & bracing.

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

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Welcome to PT on Ice Daily Show. My name is Dr. Jessica Gingerich and I am on faculty here at Ice with the Pelvic Division, which means that it is Monday again. We are getting super close to Halloween. I’m really excited. I’m definitely a Halloween girly. Today we are going to talk about what may be missing during the plan of care when it comes to prolapse. So this is another hot and relatively scary topic for a lot of mamas, but also for a lot of clinicians in this space. So we’re going to talk about a few housekeeping items before we get started. We are currently in our last cohort of the year for the online course. This is something we are gonna put the pedal down come January. We’ve got a lot of exciting things coming up. So if you have not signed up for this course, head over to ptonice.com, just sign up. We also have a few more courses, live courses, to round out the year. So, if you’re looking to dial in your internal assessment with that kind of higher level population, that athletic population, head over to PTOnIce to sign up there as well. My hope after this podcast is that you guys want that. You want to sign up for that live course. You want to dial in your internal assessment, dial in your interventions, and just guns a-blazin’ out in this population. For those of you in the ICE Students Facebook group, you will hear more about the revamped certifications from Jeff tonight. Otherwise, stay tuned to Hump Day Hustlin’ emails for details. So if you haven’t signed up for Hump Day Hustlin’ emails, again, that’s all on the website. It’s free. We just want to get out as much information to you guys as we possibly can. So we have some really fun new certifications coming up that Jeff is gonna dive into later tonight. So as we begin our PT careers, a lot of us prefer a specific population, right? We want to treat the older adult, the pregnant person, et cetera. We want to dial in our skills. And we love to see that, right? Like that, I love that. I want to get really good at that one thing. I want to go to the provider that is that provider. I am the person that you want to see if you are experiencing X, Y, and Z. We hear that a lot as faculty, especially in the pelvic space is, you know, well, I only want to kind of treat this type, this, the urinary incontinence or, you know, low back pain. And as a faculty, we’ve all kind of experienced those same thoughts and feelings. Again, it’s intimidating when you get into this space. Well, we quickly learned that you can’t just pick and choose. If you have someone that’s experiencing urinary incontinence, they also are likely experiencing something else as well. If you are in the pelvic space, you’re going to see all things.


The ones that are at the top of the list, at least that we hear about as faculty, are the ones that are scary are pelvic pain and prolapse. So today we’re going to focus on treating prolapse and specifically what we may be missing in our plan of care. It is going to be outside of the scope of this podcast to talk about the assessment of, um, like the subjective or objective assessment of prolapse. So if you are unfamiliar or you feel like you’re just kind of shaky on this, again, that live course is waiting for you. Once we know the pelvic floor is strong or weak, or that it’s a timing issue, or that they may or may not be tender to palpation internally or externally. And when I say externally, I mean hips as well. And that they may or may not have objective signs of prolapse. we then get to develop our plan of care. Now notice that I said may or may not because these clinical patterns are not identical. You will see so many different clinical patterns when it comes to symptoms of prolapse. So let’s just say your patient comes in with feelings of heaviness, pressure, or dragging, and it feels like they may be sitting on something. That’s something how they’re describing it. When they’re in the shower, they feel, as they’re bathing, they may feel something physically. The heaviness gets worse after they have a bowel movement, void, go to the gym, or have been on their feet all day. So what’s your next plan of action? Well, first and foremost, we wanna encourage you guys to stop focusing on the biomechanical components of a prolapse. Of course, there is that person or that type of prolapse. We’re maybe talking about surgery. That does happen, but it doesn’t happen without needing that pre-physical therapy, the stuff that they’re doing beforehand, getting stronger, learning how to poop and pee. learning how to brace. So all of this stuff is still happening, even if surgery is part of the discussion. So first and foremost, let’s stop focusing on the biomechanical components. Let’s start focusing on the symptoms. So understanding what makes the pressure heaviness better, what makes it worse. Can we, part of their plan of care, ramp up the things that make it feel better and ramp down the things that make it feel worse? That has to be followed with this is not gonna be your forever. This is not gonna be you never doing that thing because it ramps up your symptoms and always having to like sit and be immobile because it ramps down your symptoms. We have to think about this on an irritability scale just like we do with pain. We have to be able to bring down their irritability, so then we can make them better by loading them. So now that we know that, I’m gonna give you four points to go home with today that are great points to start with. When you have that person come in with a script that says pelvic organ prolapse, or doesn’t say that, it says pelvic pain, but then you start asking them questions and you’re like, hmm, they may have symptoms of pelvic organ prolapse.


We have to remember the Kegel. This is number one, the Kegel. It has gotten so much hate over the past few years, especially on social media. I don’t think that was anyone’s intent to just say never do Kegels, but it matters. Teach your client how to do a Kegel. Lift and squeeze, shut off the holes, come to the attic. But we have to remember the relaxation component to the Kegel. Teach them how. to relax. Have them focus on this. A lot of times people feel like they can multitask a cubicle. If they are new to this and they don’t know and they didn’t even know they had a pelvic floor, they need to go in a room where it’s quiet with no kiddos running around and focus on the up and the down component of a cubicle. Something that I love to say in the clinic is the relaxation component of a Kegel is sometimes more important than the contraction. Everyone always thinks we need to go up, up, up, up, up. And when I say everyone, I mean typically our clients. And they forget that this actually has to happen as well. Or, not that they didn’t forget, but they think that they may be in that relaxed position and they’re not. and that’s where that internal palpation can be golden. Again, people tend to focus on the contraction, so being constantly contracted can also lead to symptoms of heaviness. So maybe their symptoms of heaviness are coming from this versus actually symptoms of prolapse.


Number two, single-sided hip strengthening. get their hips stronger, always, but even here, get their hips stronger. And I don’t mean with a TheraBand. Throw it out. If you want to warm them up with it, great. But we’ve got so many options. Step downs, step ups, we’ve got single leg RDLs, we’ve got variations of that. We have Core stuff that we can do, like the options are endless. We can do side planks, we can do hip thrusters. Don’t forget about strengthening their hips.


Number three, teach them how to brace. Symptoms of heaviness can happen due to faulty bracing strategies. Bracing is not only for lifting heavy either. We need to prepare mom for the demand of life. And mom is holding Johnny who has a runny nose and she’s trying to wipe his nose and he’s flinging his head back. She’s going to be bracing her core and she’s not even gonna think about it. So let’s prepare her for that. Number four is find and encourage frequent rest positions that ease or make their symptoms go away. This could be lying on their back. This could be seated, this could be laying on their stomach, it could be leaning over the counter, anything that makes their symptoms ease. Again, follow this up with this is not forever, this is a for now, we wanna get those symptoms, the symptom irritability down. And once we get those symptoms down, what can we do? Everything that we just talked about in one through three. So to recap, find the symptom aggravators, find the things that make their symptoms go away or ease. There may be multiple clinical patterns to prolapse-related symptoms. Prolapse can be scary to a lot of women. It is, if they’ve Googled it, they are gonna come in wide-eyed, or if the doctors told them that, there might be tears. But it can also be really scary to clinicians if we don’t know how to treat this. You have four places to start. The Kegel. Gets a lot of hate, but we need to start using it. Don’t forget about the hip. The hip muscles are gonna be supporting structures to the pelvic floor. Bracing is not only used for heavy lifting, and using positions that ease symptoms to lower irritability, which will increase our loading capacity. That is it. Start there. So team, I hope this helps. I hope you have a great week and enjoy your Halloween and we’ll see you next time.


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