Pelvic physio misery and confusion

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Good morning to you all, I have just been for my 3rd pelvic physio session.

I had a proctogram in October and saw the urogynae consultant in December. She said that the proctogram showed a paradoxical muscle contraction and she would not do a re repair while this was going on as the repair would fail again. She would refer me to the colo-rectal team as this was more of a bowel issue than a urogynae. So I'm still waiting of rht ecolo-rectal appt to come through (I'll be on my pension before it does me thinks)

?So off to pelvic physio with the miserable physio to day who is treating me fo rstress incontinence. Unfortunately for her she said that at my last visit I was feeling a bit discouraged and were things better. Well cue a rather long rant on my part here. No I'm not feeling better. This is 16 months since I first saw a urogynae, one failed surgery later and I still no further on. I appreciate that the situation is not life threatening but having to constantly wait 12 weeks between appointments means years of my life are going by with no solution in sight. So..........

?She did an exam of my bowel and feels there is no paradoxical muscle contraction. My pelvic floor is sluggish and does not "let go" quickly enough. I explained I was not, never have been constipated (even though she said the procotogram showed I was - I disagree - unless it's stools caught in the bulge).

?I am to carry on with the pelvic floor exercises - these are the pelvic floor ones not ones for paradoxical muscle problems.  Nothing was said about the stress incontinence - but I think I had overstayed my welcome!.

?She feels there is only a very small prolapse. So what the heck is hanging out of my vagina /perineum at a bowel movement I don't know. She doesn't knwo why the surgeon said she wouldn't reapir if I had the paradoxical muscle going on and also doesn't feel this contributed to the failure of the first repair. For me it's not that the reapir failed it's more of a new prolapse - it's in adifferent place.

?She did agree with me that the proctogram is unnatural in that they ask you to strain - which I don't. I splint every bowel movement. But she did say that splinting can cause the puborectalis muscle to contract as I'm not letting the muscle loosen because I'm splinting. Seems to me that it's a bit of a catch 22 situation  - if I splint it affects the muscle - if I don't I would have to strain.

?So her top class suggestions are to make a noise like "shhhhhhhh" or "mmmmmmmmmmmm" when having a bowel movement, to sit properly on the loo (I do). Less lifting and carrying (like that's realistic) 

?So I have come out in tears yet again - no further on at all. She is going to write to the colorectal team. Apparently the urogynae surgeon hasn't written to the colo-rectal team - well there was no copy in my notes - but I have been discussed at the MDT.

Sorry this is a really long post - just very, very depressing.

On a good note she is going off onmaternity leave so hopefully I'll never have to see her again and shse has transferred me over to her other colleague.

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  • Posted

    trizwizz don't apologise for a long post because how can we understand what you're going through if you don't explain it fully. There seems as though there are several discrepancies here which is clouding professionals judgements and a clear diagnosis and treatment. An huge issue for me is the possibility you haven't been referred to the colorectal team and until that happens you aren't going to move any further forward. I would be extremely unhappy. I hope you are seen in that department very soon because your life is on hold until this happens. I can only imagine how you feel, it's not acceptable for you to be treat this way xx

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    • Posted

      Thank you matron - yes I said to the physio there is more than one paradox going on here - but she has zero sense of humour! She annoys me intensely as I reported what the consultant said and she replies that she doesn't think that was what was said. Well hang on  - I was the one who was there. I also repeated back to her what she said to me last time  - about having a substantial prolapse which she said she didn't say either. Well I may be the size of a small elephant but I also have the memory of one! She also has the irritating habit of saying "does that make sense?" after every statment she makes. I did point out to her today I am a reasonably intelligent and educated person but to no avail.

      ?Anyway - yes I agree there is some discrepancy . The urogynae definitely said she ould not attempt another repair unless colo-rectal gave her the go ahead (inspite of what Missy physio says she said) The consultant did pick up her dictaphone while I was there. There was no copy of her letter in my notes though. But I had been discussed at MDT - so I am presuming she did refer or how could I be discussed at MDT?

      ?Ithink I will take a picture of the bulge with my phone when having a bowel movement to show  - hey a new type of selfie/belfie!! - I di dnearly this time round but didn't. Then at least they can see what is happening in real time not in the unnatural surroundings of the proctogrm.

      Missy physio also told me I could only give subjective opinions whereas the proctogram is objective. My reply was that I felt my opinion was objective as it's about my body. We don't get on well!......

      ?Physio also said she didn't undrstand why a paradoxical muscle would hinder repair or cause a prolapse to fail or reoccur.

      ?As to chasing it up, I could see my GP - I don't know the colo-rectal team or their secretary. Every gynae appt I've had - or not had I've had to chase up so no change there either.

      ?In your experience matron what about this paradoxical muscle malarky? I don't actually know if I do have  aprolapse - the physio said there was a small bulge but nothing significant. When I have a bm there is certainly something significant at the edge of the vagina/perineum - much lower place than before.. It's not horrendous at other times but I cannot have a bm without splinting. NOw I wasn't like this before I had the prolapse no twas I like this for about 3 weeks after surgery. So something is definitely awry.

      ?Sorry long post again. Mr Trizz is not home from work yet so you are taking all my venting - he's in for a good evening!

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    • Posted

      At least you still have a wonderful sense of humour trizwizz 😂I agree it sounds as though you have been referred to the colorectal consultant, I think they've just not put a copy of the letter in your notes.

      Ot is annoying when a health professional tries to tell you that you didn't really hear something. She wasn't there and as an intelligent woman it's deeply insulting and she shouldn't be so patronising.

      If you're splitting then your rectocele prolapse is at a stage where it needs dealing with. I had to do it and it's just horrible. Tell Mr Trizz to have a lovely evening 🤣

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    • Posted

      Hi Trizwizz, I understand you very well and am very sorry for the suffering you are going through. I think most of the ladies here in the forum have felt frustration many times. I'll tell you about my experience with physios. I had a rectocele (post surgery right now). When I told my physio that I thought I had a rectocele, He told me to lay down and he put the ecography end on my vagina and anus (I don't know how to explain it better, sorry) and he told me that I didn't have rectocele. But yes I had it! He told me that my left anus elevator muscle was broken (which was true) I told him that if I was lying down how could he see it? He told me then: ok, stand up. And put the ecography end on my vagina/anus and asked my to strain and then he could see the rectocele very clearly on the monitor. The rectocele couldn't be seen on repose, only while straining.

      What I want to mean with my experience is that if you have to splint you have a rectocele, it is not a subjective feeling! My physio also wanted to make a proctogram but I said no (I knew that the rectocele was there). But I didn't escape from the balloon test (I couldn't push it out).

      Let me tell you that your comment about the BM selfie has been very funny!!!! 😂😂 I have thought of a post-op vagina selfie many times but too shy to do it!!! 😂

      Hope that you can have the colorectal team opinion soon...

      by the way if you don't mind to explain what's a paradoxical muscle?

      hugs!!!

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    • Posted

      In fairness to Missy physio she did examine me lying on my side and also standing up. It was first thing in the morning though so I hadn't had a busy day at work, I'd also had a bowel movement so perhaps not as "full" or low down as I might have been.

      ?I think once I see the colorectal team I will have the balloon test also.

      ?I will try to explain the paradoxical muscle. I'm don't have any medical knowledge though so please remember this.

      So the pelvic floor has muscles that go fron to back (if you imagine your body cut in half - like a cross-section) one of the muscles is a puborectalis, this 'slings' the bits up. The rectum has a natural kink - above the anus - in it which acts as a continence aid for our bodis. When we need a bm the puborectalis muscle loosen and the kink straightens out which allows you to pass a motion. (which is why ladies are told to raise their knees when on the loo as this aids the kink to straighten also - avoiding straining)

      So the paradox is that, instead of relaxing when going to the loo, my puborectalis muscle is actually contracting more causing the natural kink to become more pronounced and thus harder to pass a motion.

      ?Physio said on examination that she didn't feel this was so and the proctogram is an unnatural test. You are also asked to strain greatly which is not a natural thing to do - constipation and straining is not  a problem for  - whiich can lead the muscle to unnaturally contract - though it may not normally. Though physio did say that my loosening or relaxing of the muscle was sluggish which doesn't help - but it wasn't a paradoxical contraction. She also said that splinting is not necessarily a good thing as applying the pressure can cause the muscle to contract as that pressure shouldn't typically be there (well obviously the vast majority of people don't use their hands in their vagina to have a bm!) As I said to physio I don't strain because I splint - if I didn't splint I would strain so catch 22. She said she would rather I splinted if that was helping than not.

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    • Posted

      Thank you - feeling mildly better this morning. I normally bounce back quickly!

      ?If I take a velfie - my new name for the photo - I said to Mr Trizz I'll have to be a bit careful as my phone is sync'ed to my tablet which randomly chooses pictures for a slide show when it's idle. Well that would be a test of the mother-in-laws cataracts wouldn't it if that flashed up!

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    • Posted

      Good explanation Trizwizz, completely understood!!!

      Good luck with your app with the colorectal team! Hugs!!!!

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    • Posted

      Yes some do indeed. In fairness to Missy physio - it is what she does all day everyday so I do understand she has an indepth knowledge. And perhaps gets to know her patient's bodies better in her consultations than those with a consultant as I think perhaps her appointments are longer than those with a consultant. I was in for 50mins+ yesterday - but she was fairly busy constantly picking up the teddy I was constantly throwing out of the pram!!!  Much longer than my 10mins with the consultant!

      However my objection to her is she states that what the consultant said to me was either not said or was said something different.

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    • Posted

      The problem with the velphies is that the phones have too good resolution and we could have the temptation to zoom and see the scar and stitches much bigger!!! Scary! BTW I also have my iphone synchronized with my desk computer!!! 😬

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    • Posted

      No there woudn't be any zooming! That's for sure. Though I reckon we could give Kim Kardashian a run for her money!!!! Just aphoto fo the bulge on the day then a definite "press delete" !! Though knowing me I'd probably drop the phone down the toilet!

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  • Posted

    Hello Trizwizz,

    I'm sorry you had such a rotten appointment, when you wait for so long to be seen then it goes badly it's sooo frustrating.

    It's the problem of the gynae & colorectal departments not working together again isn't it?

    Personally I don't think the proctogram MRI scan gives a true picture as you are flat on your back - who goes to the toilet like that?! I've been told mine's not that bad but I have to splint each time too.

    I hope your new physio will be better. I know it's so hard having to try & explain things to different people in different departments, you feel like you are going around in circles & not getting anywhere. All you can do is keep copies of any info/results etc in case they lose them & keep chasing people up. Don't give up it's their job to look after you.

    Best wishes. Xx

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    • Posted

      This is the third time I've seen this physio - and she hasn't got any better - still it's the last time I see her now off to her colleague who can only be better!

      ?Interesting you say abou the proctogram being on my back - that's what the physio said happened bu tno - I did lay down but then the whole bed tilts and lifts up and I slid down towards the toilet bit so it wasn't a too unnatural position. I was sitting much as on a toilet. To be honest I don't mind people being around - I can cut them off as it were and understand they have a professional interest only - they are not viewing it as seeing someone on the loo!! I have issues with the amount of straining I was asked to do - that is totally unnatural for me.

      ?The urogynae did say she and the colo-rectal dept work closely together - well I don't know that yet do I!! No evidence so far.

      Missy physio did say she would write to colo-rectal and say that on examination she felt there wasn't a paradoxical muscle contraction present.

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    • Posted

      That scan sounds much more sensible I was shut in a tiny claustrophobic tunnel that made loud clanging noises while they communicated with me through headphones - just like my bathroom at home really! Ha! I didn't find it embarrassing I'm way past that & the staff were really lovely actually. I just think, in my case, the prolapse didn't show up as that big as I was horizontal. Yours sounds like you would get a better result.

      I really hope your hospital departments talk to each other, surely it's in everyone's interest. We can then get on with the rest of our lives, mine's been on hold for 3 years now.

      Keep pestering them! X

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