Not a Laughing Matter

Transcription

1 Not a Laughing Matter How to Incorporate Pelvic Health Rehabilitation into your STAR program Nancy Corvigno MSPT PRPC Certified Star Clinician

2 STAR Program at Griffin Hospital Survivorship Training and Rehabilitation (STAR). Focuses on improving the lives of survivors who suffer from side-effects caused by treatments. Provides coordinated cancer rehabilitation supported by team of certified clinicians. Patients receive individualized, comprehensive cancer rehabilitation evaluation and treatment to improve symptoms affecting daily function and QOL. Typical impairments addressed through cancer rehab: pain, weakness, fatigue, shoulder problems, balance and gait, memory and concentration issues, swallowing and speech problems and lymphedema

3 Your Pelvic Floor is a Muscle Too Muscle weakness and pain are commonly reported by cancer patients during and after their course of treatment. Your Pelvic Floor is made up muscles and tissue from the abdomen to the low back. They are directly effected by treatment for Prostate Cancer Gynecologic and Colorectal Cancers They are indirectly effected by treatments that bring women into early menopause or medications linked with side effects like constipation.

4 Your Pelvic Floor

5 Forms of Incontinence STRESS URGE MIXED OVERFLOW FUNCTIONAL

6 Stress Incontinence Defined as a loss of urine with increased intra-abdominal pressure during exertion or an activity. It can result from weak pelvic floor muscles that do not close tight enough to tolerate that increase in pressure. Such activities can include laughing, coughing, sneezing, walking, running, jumping, getting up from a chair or out of a car.

7 Urge Incontinence Urge Incontinence can be defined as a situation when there is a strong need or urge to go to the bathroom with an inability to wait, accompanied by an involuntary loss of urine Frequent use of the bathroom (> 8 x in 24 hrs, less than 3-4 hr intervals) Frequent nightly bathroom visits A sudden urge with certain activities unlocking your door after taking a drive/trip seeing/feeling water, the cold Many JICs - just in case trips to the bathroom

8 Mixed Incontinence Mixed Incontinence is the combination of both stress and urge incontinence. Symptoms can include a combination of urgency and loss of urine combined with laughing, coughing, sneezing or a certain activity.

9 Overflow Incontinence The urethra is narrowed or blocked (by scar tissue or an enlarged prostate), not allowing the bladder to empty completely. The bladder is constantly filling allowing pressure to continue to build, until the muscle can no longer prevent urine leakage.

10 Functional Incontinence Defined as the loss of urine due to inability to physically not getting the the bathroom in time. IE: legs can t get me there fast enough, my hands can t get my pants off fast enough

11 Other Pelvic Issues: Pelvic Pain and Muscle tightness Dyspareunia Constipation Pain or difficulty with urination Lymphedema in the pelvic region

12 Treatment Options Behavioral Nutritional Medications Conservative: Physical Therapy Alternative therapies: naturopathic, acupuncture Surgical

13 Life Style Modification Stop smoking Address allergies Weight Loss Look at medications with your doctor Address bladder irritants Bladder retraining (increase bladder capacity, decrease frequency and incontinence) Valsalva prevention ADLs, BMs/squattypotty

14 Bladder Retraining Decrease bladder irritants Decrease/eliminate fluids 2-3 hrs prior to sleeping Increase water intake during the day Use urge suppression techniques Decrease JICs Practice your Kegels/ find a physical therapist

15 The KEGEL Find it, love it, use it To find your pelvic floor muscles image you are trying to stop your flow of urine or stop passing gas. Remember there are 2 types of muscles that make up your pelvic floor ( fast and slow twitch fibers ). So you want to do short and long hold contractions/kegels Once you ve got it then use it with your everyday activities.

16 Beyond Kegels Therapists trained in pelvic floor rehab also address muscle tension/pain and fascial restrictions. Utilizing soft tissue massage and myofascial release techniques muscles can be relaxed, pain decreased or eliminated and restoring strength and function can begin. Remember to address breathing, posture, technique and patient education to fully empower our patients with tools they need to improve their quality of life. The Box Concept The SquattyPotty

17 Now you know. Now what

18 Ways to Establish and Grow your Program Identify your target population Identify your referral source Identify your target clinicians

19 Target Population Post prostate surgery Post gynecological cancer surgery Post breast cancer surgery Those going through or post menopause Assess those with mobility issues for functional incontinence Ask and you shall receive

20 Utilize the assessment process Many people with incontinence or pelvic floor dysfunction live in silence. Don t be afraid to ask: Do you leak when you cough, laugh sneeze? Do you have frequent urges to go to the bathroom? Can you make it there without leaking? Are you happy with your sex life? Do you have pain of difficulty with sex with your partner? Remember the pelvic floor muscles are part of the core.

21 Target referral sources From a Pelvic Floor Program Perspective Urologists Gynecologists Colorectal surgeons GI From a STAR Program Perspective Oncologists Surgeons Nurses: Oncmed Radiation therapist Naturopaths Therapists: OT, PT Educate those at your weekly and monthly meetings.

22 What they need to know Research supports Pelvic Floor Rehabilitation Recent studies show physiotherapy for continence was beneficial following prostatectomy. And those within 3 months s/p found more benefit than those referred at later intervals (Rajkowska-Labon et all 2014) A study by Marchiori et all 2010 found a post op radical prostrate personal training program of pelvic muscles reeducation supported by a physical and nurses experienced in pelvic disorders have a benefit in future continence. Jones et al 2015 found Women who undergo treatment for vulvar cancer may benefit from treatment of side effects such as pain and fatigue to improve their reported quality of life. Rutledge et al 2014 showed pelvic floor muscle therapy improves UI and QOL after surgery and chemotherapy for gynecological caners. Yang et al 2012 found pelvic floor muscle training could improve UI and sexual dysfunction for survivors of gynecologic cancers. Lin et al 2015 patients post rectal surgery had a decrease in incidence of fecal incontinence after performing a supervised pelvic floor program.

23 Target your Clinician Seek out those interested PT, OT, Nursing Nutritionists Psychologists

24 Resources Continuing education Herman and Wallace(hermanwallace.com) APTA - section on women's health and oncology sections Both offer Certications for Specialization PRPC, Women s Health Specialist Support groups

25 References Herman and Wallace.com APTA Rajkowska-Labon et all Efficacy of Physiotherapy for Urinary Incontinence following Prostate Cancer surgery Marchiori et all 2010 Pelvic Floor Rehabilitation for Continence Recovery after Radical Prostatectomy Jones eta all 2015 The impact of surgery for vulvar cancer one health-related quality of life and pelvic floor outcomes during the first year of treatment Alappattu et all 2015 Clinical Characteristics of patients with Cancer referred for Outpatient Physical Therapy Bernardo-Filo et all 2014 The relevance of the Procedures Related to the Physiotherapy in the Interventions in Patients with Prostate Cancer Smith 2004 Female Pelvic Floor Health

26 Any Questions? A SPECIAL THANKS TO ALL YOU HAVE HAD THE COURAGE TO SPEAK UP AND FOR THOSE WITH THE COURAGE TO LISTEN.

27 Thank You!!!!