What does the first urogynaecological physiotherapy consultation at Medfemina look like?

WHAT DOES THE FIRST UROGYNECOLOGICAL PHYSIOTHERAPY CONSULTATION LOOK LIKE

AT MEDFEMINA?

The first consultation with a physiotherapist at Medfemina involves a series of examinations, functional tests and analyses in order to find the cause of the problem with which the patient comes to us. The first consult can be also treated as a preventive physiotherapy visit to check the correct functioning of the body in terms of pelvic floor muscles, adjacent structures, abdominal functions and breathing. This consultation is recommended for patients after childbirth (irrespective of type of delivery) in order to check and examine whether all postpartum body structures are working properly, whether muscle functions are preserved, whether physiological reflexes are correct or if there is anything to improve. This is a very important consultation, often a preventive one, which can provide a great deal of valuable advice and guidance which, if incorporated into everyday life, can be very helpful in the time after the birth and can help to reduce any post-natal complications that may arise. It is to be kept in mind that prevention is easier and less costly than the treatment process itself. The first diagnostic consultation is based on tests and examinations. During the first urogynaecological physiotherapy consult we carry out:

1. DETAILED MEDICAL INTERVIEW

It is essential to ask the patient a series of questions. The more information is collected, relevant to the problem reported in detail by the patient, the easier it is to create a basis for drawing first conclusions and detecting the causes. This certainly makes it easier to diagnose and then set up the physiotherapy treatment process. The interview is intimate, takes place in a relaxed atmosphere with full confidentiality and respect for the patient. It is respected if the patient does not want to share some medical details.

2. EVALUATION OF BODY POSTURE + FUNCTIONAL TESTS

This is a crucial element of the entire diagnostic process. Our body is a whole and a change of alignment or contracture in one part of the body impacts structures further away, which can undoubtedly have an effect on, for example, the cause of incontinence, problems with the abdomen after childbirth, reduced statics of the reproductive organs, or the healing of a scar after a caesarean section or episiotomy. We will assess the posture in a standing position, the kind of posture that the patient adopts on a daily basis. We will then assess the way she sits (at the desk, at home), the way she carries her child or feeds her child. From this perspective, we will carry out some simple functional tests that can confirm the hypothesised body disorders (functional tests in standing, lying position). The next necessary step is the correction of patient’s posture (patient is guided and taught the correct posture). We will talk about it, show the interrelationships arising from the body’s function in space and how this affects the problem the patient is presenting to us. Often, in this way, we can even act preventively so that the problem does not arise in the future. We believe that if we paid attention to the details of every day activities and perform them in a correct manner, we may succeed in eliminating the issue.

3. EXAMINATION OF ABDOMINAL INTEGUMENTS – ABDOMINAL INTEGUMENTS ULTRASOUND TO ASSESS RECTUS ABDOMINIS MUSCLE DISTATIS TOGETHER WITH FUNCTIONAL TESTS

The functional condition and tension of the abdominal muscles during movement, their compatibility with the respiratory diaphragm and the work of the pelvic floor muscles is an important factor that we always take into account. The coherent functioning of all these elements is an extremely important factor for working with dysfunctions such as urinary incontinence, abnormalities of the reproductive organ, or scar tissue. During the diagnostic ultrasound consultation and functional tests, we assess the function of the rectus abdominis, external and internal oblique and transverse abdominal muscles, i.e. how each muscle behaves when mobilised. The linea alba and the width of the semilunar folds are also assessed under ultrasound (at 4 measurement points, we measure the width of the linea at rest and in movement). The linea alba, as an important stabilising element, is examined in terms of its stability at movement and at rest, its width, its tension. These parameters also indicate whether there is a distation of the rectus abdominis muscles or whether the condition is correct and physiological. The patient sees everything on the ultrasound screen. Both physiological and dysfunctional parameters are explained to the patient. This greatly increases our patient’s awareness, which provides the basis for joint and effective further work. Under ultrasound, we preliminarily assess the hernias present on the linea alba. If there is a suspicion of a hernia, we are supported by a consultation with a surgeon so that the diagnosis is confirmed by our specialist and possible joint measures are taken to eliminate the disorder. The behaviour of the linea alba is also palpated both at rest and during movement. Its elasticity and behaviour during movement (e.g. bulging, collapse) will already give us a basis for assessing the degree of stability for the body.

An additional examination for abdominal integuments is FUNCTIONAL TESTING. It is done to observe the behaviour of the abdominal walls during movement and during physiological reflexes, such as coughing. For this purpose, we ask our patient to perform a few simple movements, which will allow us to definitively determine the normal or abnormal behaviour of the abdominal wall.

4. EVALUATION OF THE QUALITY OF PELVIC FLOOR MUSCLE FUNCTION – PER VAGINUM, PER RECTUM

The most important part of the examination to determine the condition of the pelvic floor muscles is the assessment of: the quality of contraction, the endurance of the muscles for prolonged work, the strength of contraction, the muscle structure in terms of tissue quality, the quality of relaxation after contraction, symmetries and asymmetries, hypotonia and hypertonia and physiological reflexes. This part of the examination is carried out by palpation per vaginam or per rectum, and because the muscles of the pelvic floor are numerous, it is particularly important that palpation is carried out slowly and carefully in order to identify muscles and fascia that are working properly from those that may be dysfunctional. In the cough and push test, the statics of the reproductive organs is examined (also using a speculum). An additional test in the evaluation of statics is transabdominal and endovaginal ultrasound, which is helpful to determine the statics of the reproductive organs in coughing, pushing, in movement, and ligamentous stability. The examination is based on the international Perfect, Oxford and POPQ classification.

It is important that the patient comes to the consultation with a full bladder, as this allows us to visualise under transabdominal ultrasound the activation of the pelvic floor muscles, compensations, possible defects in the statics of the reproductive organs or to determine bladder capacity. It is therefore best that the patient drinks about 500 ml of water up to one hour before the consultation and does not empty the bladder just before the appointment.

5. EXAMINATION OF PELVIC FLOOR MUSCLE FUNCTION UNDER LOAD AND IN MOTION BY EMG / BIOFEEDBACK TESTS

In this part of the examination, we perform a diagnostic test to assess the quality of pelvic floor muscle tension (slow twitch and fast twitch muscle fibres), coughing, precontraction reflex, muscle relaxation skills and the compensations. We use the latest generation PHENIX LIBERTY equipment and self-adhesive abdominal and perineal electrodes ( or vaginal probes ) for the examination. The patient is asked to tense the pelvic floor muscles following the track that appears on the screen. The two curves shown on the screen, illustrate in real time the quality of tension from the pelvic floor and from the abdominal walls. This evaluates the quality of muscle function and allows the patient to understand and visualise what the movement is, what the strength is and where the abnormality is. The test takes 4 minutes, is painless and has a playful form. It is performed in a supine position (lying down) and in a physiological position (i.e. standing up). The test is an excellent indicator of your therapy progress. It is saved in the system and can be re-examined. If conducted after a certain period of time, it can be compared how things were before the start of therapy and what progress has been made after the therapy and home assignments.

6. EVALUATION OF THE RESPIRATORY PATHWAY

Our daily breathing is a continuous and simultaneous interaction of several elements. It is the movement of our entire respiratory cavity in which our viscera and pelvic organs (i.e. uterus, bladder, rectum, vagina, urethra) are distributed. This mutual proper cooperation takes place between the respiratory diaphragm, urogenital diaphragm, the mobility and flexibility of the thorax and the flexibility and capacity of the abdominal and spinal muscles. The normal cooperation of all these structures conditions us to maintain the correct intra-abdominal pressure. The correct breathing pathway and the correct cooperation of all the elements of the respiratory cavity is a very important factor in avoiding, for example, urinary incontinence or lowering of the reproductive organs. Therefore, the way we breathe and how other body structures respond to this will have an impact on the disorder that occurs. The physiotherapeutic assessment will include an evaluation of the patient’s breathing pattern, chest mobility and how the muscles of the pelvic floor and the entire posture relate to this. Restoring lost respiratory function (i.e. a disturbed breathing pathway) and minimising the disorder will then be one of the goals of physiotherapy. Our body is one whole – one lost function or a disorder affects all the remaining structures of the body. Thus, the cause of the disorder may find its source somewhere else.

7. REVIEW OF THE CONSULTATION/PHYSIOTHERAPY PLAN

Once all the tests, examinations, medical history and analysis are completed, it is time to review the consultation. We want the patient to know exactly what has been done, what is working properly and where and why the abnormalities are. An important factor here is to educate and raise the awareness of our patient, because only then can the proposed physiotherapy plan and the establishment of joint actions bring improvement and success in therapy.

8. HOME ASSIGNMENTS

Each patient will be given home assignments to do after the consultation. The tasks (exercises) are always individually tailored to the patient and always matched to the outcome of the tests.

9. REVIEW OF THE DAILY LIFE ERGONOMY AND CHANGE OF EVERYDAY HABITS

A very important factor which completes the physiotherapy plan and can have a huge impact on the positive effects of the therapy. This is the forgotten ” cherry on the cake”, which is often underestimated, but which can make a significant difference in terms of improvement or future problems. Here we are looking at the way the patient performs her daily activities, i.e.:

– the way of sitting at the computer, during meals, when feeding your child

– the way of standing

– the way of defecation and micturition

– the way of lifting objects

– the way of lifting weights during training

Together, we analyse the patient’s habits and select what is most important and the healthiest for the patient in terms of her abilities and physiology.

To find out more call us at 512 897 055, 512 897 255 or write to us: recepcja@medfemina.pl