Sat 30th Jan 2021.
After a few presses of the snooze button, I rolled out of bed, put on my onesie (dare I admit owning one!), treated my bed hair to a quick brush, let our dog run around the garden to empty her bladder, made some tea and set up my laptop and headphones! All ready for the inaugural Pelvicroar Conference – very excited! Organised by the amazing Pelvicroar team consisting of “Squeezy” Myra, “Gusset Gripper” Elaine, “Why Did No One Tell Me?” Emma, “Pelvic Floor Scanner” Jane, “Roses” Annette & “Mind the Gap” Grainne 😊 With great sponsorship from EVB, Renew Medical and Efemia, £12500 has been raised for ‘Well Being of Women’ wellbeingofwomen.org.uk and ‘Halo Project: Break the Silence’ haloproject.org.uk. Further money has since been raised for Stoma Chameleon's just giving page for Birth Trauma UK - justgiving.com/fundraising/stomachameleon
What a fantastic achievement and all amid a Pandemic- amazing!
For me, a significant theme evolved from the day – that of holistic care and listening to the patient. The first session embodied this in Yoga form, reminding us that a little time out with a focus on breathing, posture and relaxation is important for all. This seamlessly led into Maeve Whelan’s presentation regarding the high tone pelvic floor. Maeve reminded us of what hypertonicity and overactivity are and the multiple factors that can result in a hypertonic pelvic floor ranging from posture, breathing, MSK issues, emotional state and bladder & bowel dysfunction. Maeve also questioned the use of the PERFECT scoring system, especially endurance / repetition testing of the pelvic floor, within the first assessment.
A move away from traditional biomedical assessment styles also came across with Bill Taylor’s philosophical presentation regarding pelvic pain. I must say, at this point I was very pleased I had my headphones on and my children couldn’t hear the presentation content 😊- especially the Q & A section! Perhaps virtual conferences should be age rated – this would have definitely been an
Bill talked us through the concepts of the biomedical model, the biopsychosocial model and the potential future Ecological Emergent Complexity model of health care. We were encouraged to consider ‘chronic’ pelvic pain as ‘complex’ pelvic pain as ‘complex’ implies an ability to improve. The key being a “wholist” vs “holistic” approach that considers the ecosystem complexity and that n = 1 ie every individual is different and that the most important part of any assessment is the patient’s story:
“Listen to your patients as your patients will tell you what’s wrong with them; listen a bit more & they will tell you how to treat them”
(One of Bill’s Uni lecturers!)
The “listen” message & “thinking beyond the biomedical model” was also delivered by one of the “Newbies” (Let’s talk about post-natal sex) along with the importance of education and remembering the basics.
Long Covid is an excellent example of n=1. We were reminded by Dr Amal Hassan that n=1; every patient is different and individual in their response and presentation. Research into the impact of Covid on long term health factors and, the aptly named “Long Covid” is in its infancy. However, Dr Amal Hassan introduced us to the research being conducted via sports and exercise medicine. In specific relation to pelvic health, long covid appears to affect females more than males (although Darren Brown gave a wonderful personal presentation on his own experience of long covid) and presents the following specific risks:
Alterations in menstrual function that may affect fertility.
Early / triggered perimenopause / menopause
Breathing dysfunction with associated possible impact on pelvic floor muscle function and the abdominal cylinder
Reduced activity levels and hormonal changes which increase risk of osteopenia / osteoporosis, cardiovascular disease, dementia & metabolic health.
Further research is clearly needed to consider recovery patterns and optimal rehabilitation. However, it is felt that rehabilitation needs a specialist and multidisciplinary approach, and clinicians need to be alert for serious medical sequelae.
Regarding perinatal care, Marie Fell presented her findings regarding an online post-natal pelvic health screening tool – a cheap, simple and easy to complete tool that facilitates immediate and effective triage of patients’ post-natal pelvic health symptoms but also allows patients to self-select and self-refer if required. This mirrors some service development work I have been doing and I hope that Marie and I can work together to move this forward. A fabulous example of how virtual conferences can still allow effective networking and subsequent enhancement of research and development.
The products from the conference sponsors are further examples of supports that can aid symptom reduction, overcome exercise barriers and improve quality of life. Elaine Millar introduced us to the Efemia – a vaginal insert that is new on prescription and works in a similar fashion to a TVT in overcoming SUI with exercise. Yvonne Brady presented on the EVB shorts and leggings. Yvonne presented various research activities illustrating that the support structure of the EVB garments, compared with generic sports-wear, gave women greater support and confidence whilst exercising and reduced leakage in those suffering from SUI. As Siobhan indicated with bra’s: “the bra may cover the breast tissue well but not support it”; the same can be said for exercise leggings and shorts. Finally, Debbie Gordon taught us about the Renew Medical bowel management range. The Renew Inserts can be useful in preventing bowel leakage whilst active and therefore may be another useful tool in overcoming such exercise barriers. The Renew Aquaflush Irrigation systems help the patient to achieve self-management of bowel emptying / clearance and, combined with or without the inserts, further aid the prevention of leakage which can lead to increased confidence in activity involvement.
Continuing with the theme of support, Myra Robson & Gaynor Morgan presented on pessaries and ironically made a comparable to the underwired bra! However, I was most pleased to hear Gaynor use the term “internal scaffolding” as I anecdotally find that patients can relate to this. Pessary fitting is a growing field and is considered an extended scope / advanced practitioner role. However, pessaries can be a great, low-cost treatment for prolapse and improved QOL. Pessaries can be viewed as a lifestyle management tool and different pessaries may be needed for different occasions. Gaynor explored the different types and, although I personally knew there were several pessaries available, I felt naïve regarding the extent of the range and wonder whether sufficient exploration of pessary application is applied before the decision of surgery is made in many patients. Supervision and competency sign off is essential for this role and an experienced gynaecologist or specialised GP is required to be the supervisor. Gaynor runs pessary fitting courses (visit Pelvic Angels); the Irish CSP and the Australian organisations both have good, extensive guidelines; and POGP are working on guidelines on how physios can fit pessaries – watch this space, hopefully out soon! (Edit! – the UKCS & POGP Pessary Guidelines have now been launched!! – redeployment, homeschooling and organising a virtual bowel study event, has slowed down this blog).
Paula Igualadez Martinez provided a very detailed presentation regarding birth traumas. This began with some wonderful revision of the pelvic anatomy and then some evidence-based facts and figures regarding the injuries that can occur and their incidence rates along with subsequent symptoms and impact on pelvic health. Paula raised the issue of the importance of educating ladies of the potential birth injuries during the antenatal period / throughout the perinatal period. By better informing ladies of these risks antenatally, they can be better prepared both emotionally / mentally and physically, know how to access support in a timely fashion if required, can prehab and commence rehab within optimal timescales and are more likely to be compliant and engaged in their own care. Paula promotes physiotherapy input throughout the perinatal period (not just post-natal); good education of the midwives for collaborative working; and good consideration of the patient’s expectations regarding their post-natal recovery. A presentation on ‘Exercise in Pregnancy’ also supported the important role physiotherapists can have in the antenatal period. Collaborative working with the midwives & fitness professionals, to identify important contraindications and precautions, as well as good education and guidance to ensure appropriate exercise levels throughout pregnancy, are key.
Menopause! Menopause (peri and post) can be a time in many ladies lives where multiple symptoms can affect QOL and act as barriers to exercise. PositivePause are a good example of how a holistic approach and good education & support may be key to a HappyPause 😊
Regarding dietary management, Jackie Lynch provided a very informative insight with a take home message of: “Protein and fibre at every meal; Manage blood sugar levels”. We are directed to Jackie’s ‘Happy Menopause’ book for more dietary advise – this is certainly on my reading list this year. Also, visit positivepause.co.uk for an online community supporting women through the peri and post menopause stages of life; and look out for the launch of their ‘Menopause Movement Community’ later this year – a MDT digital learning platform – fabulous!
In a follow up webinar to the conference, Siobhan presented on the impact of breast size & weight on female health & physical activity, along with the importance of correct bra fitting and support, continued the theme of holistic care. The impact of breast size and weight on the MSK system as well as mental health is something both MSK and pelvic / women’s health physiotherapists, along with other members of the MDT, need to be aware of. This is perhaps a good example of treating the source of symptoms (rather than just treating the symptoms) via good advice regarding bra fitting / support alongside posture education. Good support goes hand in hand with improved posture which, consequently, leads to improved diaphragmatic activity; respiratory function; abdominal activity; digestive, bladder and bowel activity; and mental well-being (clear parallels with both Maeve’s and Bill’s presentations). This is perhaps also a good example of how input beyond the pelvis can be so valuable in pelvic health care. It raises the question whether programmes, such as the Maternity Transformation Programme, should broaden the developing “Perinatal Pelvic Health Pathways” to “Perinatal Physical Health Pathways” to be reflective of this. This will also enhance connections with the “Perinatal Mental Health Pathways”, our MSK colleagues and community providers in terms of bra fitting, baby sling fitting and so forth.
What a day!
Jam packed with great information, research and fun 😊
Big big thank you to the Pelvicroar team, I can’t wait for the next one 😊
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