Balloon Training for Bowel Issues 101

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Transcript

Lindsey Vestal I would love to introduce you to my guest today, which is Kayla Heagy. Kayla is a mom. 

Lindsey Vestal Of three, soon to be four beautiful children. She has lived in Pennsylvania her whole life and has been an O.T. for over eight years. She recently opened up her private practice in Pelvic health. 

Lindsey Vestal In 2021, and her passion lies in helping pregnant and postpartum people not only heal. 

Lindsey Vestal From pelvic floor dysfunction, but to thrive and feel their best. I can't wait for you to hear today's conversation. 

Lindsey Vestal New and seasoned oats are finding their calling in Pelvic health. After all, what's more adult than sex, peeing and poop? So here's the question What does it take to become a successful, fulfilled and thriving O.T. in Pelvic health? How do you go from beginner to seasons and everything in between? Those are the questions and this podcast will give you the answers. We are inspired Oats. We are out of the box Oats. We are Pelvic health Oats. I'm your host Lindsey Vestal and welcome to the Oats and Pelvic health Podcast. 

Lindsey Vestal Kayla, thank you so much for being a guest on the OTs for Pelvic health podcast. I'm really excited to get into our topic today. 

Kayla Heagy Absolutely. Thank you so much for having me. I am honored to be here and and excited to chat. 

Lindsey Vestal So we're going to be talking about something that I'm not so sure we talk enough about, which is rectal balloon training and really like its role in Pelvic health and how it can really help our clients. And I'm so appreciative that you're going to demystify this topic with me today. I think it just makes so much sense to just start off with like, let's let's talk about what rectal balloon training is in a nutshell for those of us that may not be as familiar with it. 

Kayla Heagy Yeah, absolutely. So rectal balloon training is basically what I consider a form of biofeedback and bowel retraining, basically to help improve the patient's normal sensation, to have a ball movement and improve the coordination of the rectum and the posterior pelvic floor and our breathing muscles to have a successful bowel movement. So it will it helps to improve patient awareness to basically the appropriate amount of stool in the rectum versus being hyper sensitive and noticing the store too early or being hypo sensitive and noticing it too late or not noticing it there really at all. It can be really effective to have to help patients have successful bowel movements. Part of the training that we do is expelling the balloon after each treatment at different levels of air inside the balloon. Some practitioners will have patients do this while they're on the treatment table, but I like to have them use an actual toilet so we can practice the things we talked about like breathing, posture, positioning, etc. And I find they feel a lot more comfortable practicing in the private bathroom that's attached to the treatment room versus, you know, laying there on the table. So that's kind of the general gist of the rectal balloon treating. So, yeah, I'm excited to dive into it. 

Lindsey Vestal Yeah, you brought up a really great point already, Kayla, which is it is is it true that it's used for people who are both under aware and over aware, like hyper and hypersensitive to the sensation of stool filling the rectum? 

Kayla Heagy Yes. Yes, absolutely. 

Lindsey Vestal Okay, So it's it's so. Yeah. Okay. That makes that makes so much sense. So it can be used for a myriad of of diagnoses. What in particular are you seeing in the clinic. Which, which diagnoses is it most helpful with. 

Kayla Heagy So I, I find it helpful with really a lot of different things. I would say most commonly I would try it with patients who are experiencing fecal incontinence, fecal urgency and frequency, constipation, difficulty passing stool or fully emptying their bowels and patients with dishonored defecation. So they may have a paradoxical pelvic floor contraction or an inability to fully relax the pelvic floor so they're not emptying efficiently. I also have used it with patients who have experienced perineal tears during birth. So usually those grades 3 to 4 that are impacting the anal sphincter in general, these patients, like you said, are either typically hyper sensitive or hypo sensitive. So with the hyper sensitive patients, a lot of times you'll see that with irritable bowel syndrome, basically patients who are experiencing a lot of urgency frequency, feeling like they they could just have bowel movements all day. And the goal for them is for them to be able to tolerate more volume of air with less urgency. And then for the hypo sensitive patients, I see this a lot with constipation and or, you know, they might have pelvic floor weakness, they might have higher pelvic floor tone. Their external anal sphincter might be impaired. As far as that that reflex, that sensation. And the goal for them is more increased sensitivities at. Lower thresh thresholds, lower volumes of air. 

Lindsey Vestal That makes so much sense. Do you use it every session? Like. So let's take, for example, a client who has had a peroneal terror, you know, potentially grade three. Would you use the book, The balloon training? Every session? 

Kayla Heagy I usually will start with working with the patients, talking a lot about toileting habits, posture, breathing, diet, water intake, you know, those kinds of things. And I will bring it up to the patient as a possible treatment tool. So I never do it, you know, obviously at the evaluation or anything like that. But just, you know, telling them how it can be helpful for them. And when we do start the treatment, I usually do use it every session for, you know, a certain amount of weeks depending on on progress and whatnot. But I don't know, I don't always start with it. And also just looking at, you know, not only those toileting habits and breathing in that kind of thing, but also making sure that they first are not overly tense in their pelvic floor or, you know, not having those severe paradoxical contractions. Because when we're when we're doing the training, it's important to have them be able to contract, relax, you know, work with their coordinating their diaphragm and their pelvic floor. And if they if they're not able to do that, then we we work on that first. So yeah, I hope that answers the question. 

Lindsey Vestal Yeah. I mean, it's it sounds beautiful because it's just a tool and it's part of your arsenal. Like it's part of the, the many things that as OTs and Pelvic health were already incorporating. And it just becomes yet another tool for brain and body, for muscle and brain to really be able to coordinate again. And, you know, when it's internal like that, you know, and when when that that feeling of either hyper or hypersensitivity happens, you know, there's there's I don't I would be hard pressed and correct me if I'm wrong, I would be hard pressed to believe that there's really any other way that could as effectively help retrain your clients, you know, in modulating the sensation, whether it's underactive or overactive, than the balloon. 

Kayla Heagy Yes, I totally agree with you. It's it's a really great treatment tool that I would never use completely alone by itself. But with all the other things, like you said, that we work with our patients on, and I find it to be really effective for patients. 

Lindsey Vestal This is kind of a funny logistics question, but when you have your clients sitting on the toilet, which by the way, I love, I love that you do that. I love that you mimic the natural environment that's going to carry over when they get home, when they're sitting on the toilet, like, where is the balloon go? Do you have a hand in the commode? What's going on there? Yeah. 

Kayla Heagy Yeah. So the balloon is attached to a syringe and I just when they're ready, I just give them the whole syringe attached to the balloon and just let them know, you know, work on all the things that we've been talking about as far as proper posture and breathing and the lengthening of the pelvic floor. And they will hold on to that syringe so that the balloon doesn't actually fall in the toilet. But and then I just have them, you know, maybe wrap it in a paper towel and bring it out to me. So, yeah, it does. It doesn't go in the toilet. But, but it, you know, they, they're practicing on the actual toilet so that they can have that real sensation of having a bowel movement. 

Lindsey Vestal I love it. I love it. You know. Kayla, would you be able to kind of step into some role playing now where you are? I am your client and you're introducing this to me for the first time. I'd love to kind of model this for our listeners because it's one of those things where I have definitely heard, you know, I've I've had the pleasure of supporting close to a thousand OTs in Pelvic health getting their start with my online course on Pioneers. And when we talk about balloon training, definitely one of the hesitations that comes up is like, Gosh, how do I even talk about this as a possible tool in our treatment? Like, how do we introduce it? Would you mind giving us a little a little sample of how you do that in the clinic? 

Kayla Heagy Yeah, absolutely. I like to let them know that, you know, this training is. It's noninvasive, it's not painful. It's really an effective and helpful tool to help retrain their bowels so that they can improve their toileting habits, but really overall just improve their quality of life. Because I find that these bowel issues and symptoms really can be life consuming for a lot of these patients. So I just tell them I will guide you every step of the way. You can absolutely stop treatment at any time. And I do let them know that they will feel the sensation that they need to have a bowel movement. That's the goal. But it's also very sometimes surprising and uncomfortable for patients. I've never had anyone actually have a bowel movement during treatment. It's usually the belt. The balloon comes out clean and everything like that. But just to let them know that this is an environment that's nothing is TMI, nothing is awkward. Yes, it is very up close and personal, but it's going to be really helpful for their improving their quality of life. So. You know, we we use internal biofeedback to make sure they can properly contract, relax, lengthen their pelvic floor and that they have good coordination. So we've worked on all of that. So they're confident in their ability to follow those cues as we're working with the balloon, really incorporate their diaphragmatic breathing and just, you know, try to make them feel as comfortable as possible because it's it's it is, like I said, up close and personal and intimate, but an extremely helpful and effective tool to use. 

Lindsey Vestal Fantastic. Fantastic. When when is it not appropriate to use this tool again? Can you give us an example of when you would stop treatment? 

Kayla Heagy Yeah, So I would I wouldn't. I guess I'll start by saying I wouldn't start this treatment if somebody had. 

Lindsey Vestal If you're enjoying the conversation with Kayla today about rectal balloon training, please know that every month in pelvic Tpz United, I bring an expert guest just like Kayla, to roll up their sleeves and help us understand how we can deepen our treatment options with our clients. In fact, in November 2023, Kayla is coming to Pelican TPP's United. 

Lindsey Vestal To speak on this. 

Lindsey Vestal Exact topic. In the shownotes, you'll find a link to join us on this conversation. 

Lindsey Vestal And also Publico TPP's United has its own private podcast. I look forward to being able to support you at Pelvic or TPP's United. 

Kayla Heagy Severely impaired sensation in the rectum, or if they had really those paradoxical contractions. So sometimes patients will. When I asked what I'm doing, my internal assessment and I ask them to contract and relax and lengthen and coordinate that with their breathing, it's initially, you know, completely opposite of what their pelvic floor should be doing. So using manual therapy, breathing biofeedback to retrieve that ability to properly contract and relax. Also, you know, if somebody has really high tension or tone in their pelvic floor or severe scar tissue, that's limiting mobility. I would do some manual therapy again, work with breathing and that kind of thing to establish more normal levels of muscle tone in the pelvic floor. There are some contra indications also that you wouldn't want to do it with a patient. So if they had any, you know, acute things like active rectal bleeding, an active infection, active tumor, or if they recently had rectal surgery, I wouldn't do it, you know, unless or until they were cleared by their doctor. So those are the some of the situations where it would either be best to delay starting the treatment or hold off altogether. 

Lindsey Vestal That makes that makes a lot of sense. Kayla, in general, what are your goals of rectal balloon training? What are some of the things that you're really hoping to achieve? Perhaps both. If you don't mind answering the question in two parts. One for like an overactive rectum and then one for maybe an underactive. 

Kayla Heagy Yeah, absolutely. There's you know, there's a lot of studies with norms for these rectal balloons as far as first sensation to have a bowel movement or first urge or maximum urge. I don't necessarily base my goals off of those norms, but more patient specific to improve functional gains, which like you said, are different based off of if they're, they're more hypo or hyper sensitive. So for the hypo sensitive population, more basically improves their spontaneous sensation to have a bowel movement. Again, most of these patients are constipated, so improving their frequency, but also just their ability to have a full bowel movement without straining. So those norms vary a lot too. It could be, you know, up to three times a day versus up to three times a week. And that's that's really patient specific. It's more about, you know, can you empty efficiently without having to sit on the toilet for an extended period of time and without extreme effort, whereas the hyper sensitive population, it might be to decrease their fecal incontinence, to decrease fecal urgency and frequency. So just feeling like these, you know, these patients often feel like. Our whole day is just based around having bowel movements or feeling that sensation that they're leaking or whatnot. So decreasing those episodes. 

Lindsey Vestal For that, I, I really I really appreciate this conversation. You know, I had a three and a half degree tear with the birth of my first daughter and you know, is a vacuum assist delivery. And I have to say that the rectal balloon training that I did was absolutely pivotal in my journey. I, I don't think I'd be the person I was today if I if I hadn't gone through that. So I can be. 

Kayla Heagy I can be. 

Lindsey Vestal The first testimony for for this work and just how life changing it can be. 

Lindsey Vestal I have some super exciting news for you. O.T. Pioneer's Intro to Pelvic Floor Therapy. Is opening for enrollment January 13th through the 17th 2025. This is your chance to dive into a 100% online course. With lifetime access, you'll get five group mentoring calls with me and two free months inside our off social media private community Pelvic Atp's United. Plus, we're hosting an optional in-person lab in Cleveland on February 21st and 22nd. Please come join over 1500 other OTs who have already taken the leap. I can't wait to see you inside OT Pioneers Enrollment January 13th through 17th 2025. 

Kayla Heagy That's awesome. Thank you for sharing that. That's it's, it's amazing how when you start talking about it, how you know, different people and patients, they're really once they start feeling comfortable, it's kind of like, okay so this, this can be helpful for me or it was very helpful. And I have a patient very similar who had a similar tear and, and we found it to be super helpful not only for her bowel functioning, but also for her confidence and going into future pregnancies and births and deliveries with managing, you know, not only the scar tissue, but her overall awareness of her pelvic floor and having an efficient bowel movement. 

Lindsey Vestal So I'm not sure if you if you know, but I have a course called Elevate the bio psychosocial approach to colorectal conditions. I got my start actually in Pelvic health because someone was willing to give me a job even though there had been a job requisite out there. Specifically specifically for us, it had been open for over a year. So as a result my resume kept getting overlooked by h.R. Because I didn't meet the core requirement of being a physical therapist despite their long standing need to fill this position. Well, i ended up circumventing h.r. And i went directly to the hiring manager who very promptly. I think it was like on a Thursday, very promptly said come in on Monday. We're going to we're going to get started with you. Which of course I was like beside myself giddy. But the reason they hired me was because the the director really felt like OTs had incredible training in the bio psychosocial model. And she really believed that clients with those issues could really benefit from this model. Now, I believe that every client could benefit from this model, but I certainly understand, having gone through my own experiences, just how incredibly paramount that is. So I'm really grateful to have to have had that shot and to have had so much experience my first couple of years in practice with helping this this community in this population or helping people with these types of diagnoses, I should say. And one of the questions that comes up as I'm helping people through my online course so to elevate is how long does it take to get comfortable? Right? So so we all go to our weekend courses and I know that this type of training would really be most beneficial to happen in person, I'm sure. And you know, you you work on a bunch of bodies and you practice and then you show up to your job on Monday. I'd love to know, Okay, What was your journey and what was your experience in getting comfortable with doing this on your clients? 

Kayla Heagy Yeah. So first of all, that's I that is an awesome story. It's so inspiring. I feel like as OTs, we're always, you know, trying to in the in the world of pelvic health trying to prove, you know, that we, we either fit in or we can do it. And really, it's just, it's such a wonderful niche for us to, you know, the toilet in sexual functioning, you know, all of those things is just it's just perfect in the world of OTs. And just I think that's so awesome that you you just went in there and did that and, you know, showed them. This is actually the perfect position for me and I'm the perfect person to do it. But as far as getting comfortable with doing rectal balloon training specifically, I, I took a course through Herman and Wallace. It was about course and I actually just did a lot of self study, I'll say. And then I did contact a pelvic floor therapist in the area who I knew had been doing this treatment. We met and had a wonderful conversation and I just ordered a balloon for myself and I was working with another pelvic floor therapist at the time. And she, you know, there was nothing tme or awkward between us. So we practiced on each other. And it's it can be kind of intimidating, especially when that balloon goes in and, you know, when you're practicing with the balloon right in front of you, you can see it inflating and deflating. And but when the balloon is no longer visible, you have to know you're doing that syringe correctly and the stopper and all of those kinds of things. So just practicing on each other was really helpful. And yeah, just really getting to know that balloon really well before I actually used it with a client. So those are kinds of kind of the things that I did to help prepare myself. 

Lindsey Vestal And then what advice would you have, Kayla, for, you know, people listening to you, our chat today, it was like, okay, I've I've done those things and I'm still really apprehensive. As much as I recognize this could be a tool that will be life changing for my clients. Like what are, what are some what advice would you give someone who is still, you know, a little bit apprehensive about trying it on a client despite their their practice? 

Kayla Heagy I would say, you know, just take a deep breath and see if the patient is open to it. A lot of times these symptoms are really overly consuming these patients lives, and they're actually any patient that I've brought it up to has been really more than willing to try it. So, you know, even if you might not feel the most comfortable in doing it, it's it's worth asking the patient. And again, they're they're more than likely going to say, hey, you know what, I would I'll try anything at this point, you know, and just take a deep breath, put one foot in front of the other, like you said earlier, and and give it a go. And and I find that, you know, even if the rectal balloon training specifically is you're not you're wondering, you know, is this effective? Is it working? Am I doing the right things? Those conversations and the educational pieces that you're having with your patients beyond the balloon training. So working on breathing and posture and talking about diet and toileting habits and retraining, those are all going to be helping the patient as well. So the patient will, you know, more than likely have great progress with what you're already doing. But then adding in that rectal balloon training is just kind of the icing on the cake sometimes. 

Lindsey Vestal Is that Kayla or is there anything else that we haven't chatted about that you would love to share with our listeners about rectal balloon training work? 

Kayla Heagy I would say just really thinking about each patient specifically and not getting too hung up on trying to achieve certain numbers or certain norms and just really looking at the patient and how they're functioning in their day to day life and what their specific goals are. And I feel like as OTs, that's just our specialty is just, you know, how can we improve you functional, how can we improve functionally and improve your quality of life? And that's sometimes looking beyond the numbers and the norms and, you know, just focusing really on the whole patient versus the technical aspects of the balloon training has been something that's been really helpful. 

Lindsey Vestal I love that you brought that up. I think that depending on our personality type, I think very often when we learn a new skill or learn a new tool, we can get very fixated on the parameters and the techniques and as you said, the objective measurements. And those are really helpful. They're there for a reason. But I really do believe and encourage every practitioner in pelvic health out there to lean into the intuition of the client in front of you. And sometimes that means really focusing on that. And in my experience, especially with my clients in New York City and even in Paris, for me, it has actually been not focusing on those objective measurements so much, but really bringing the client back into their body and that really somatic way. Because at the end of the day, learning, learning more about the way our body works and what tension feels like and what ease feels like and what coordination really is at the end of the day, what that feels like in that very introspective way, I have found, is what translates best to function, because they're not going to have, you know, that data and and that and that the ability to have those measurements taken when we discharge them. So it's really being able to embody what function feels like. And for me and in my practice that has most often meant not really always looking so much at those numbers. 

Kayla Heagy Yes, exactly. I couldn't agree more. I, I usually when I'm doing this, I don't even I don't even talk to them about their numbers. I just, you know, we talk about how are you feeling, what sensations are you feeling? You know, can you can you take a deep breath and relax that pelvic floor as opposed to, you know, okay, we're at 40ml, you know, that kind of thing. So I totally agree with you. 

Lindsey Vestal I am honored that you joined us today and really appreciate you sharing your journey with us. Before we hit record, both you and I were sharing a little bit about how being an pelvic health is really a lifelong journey and, you know, feeling like you've arrived or that you're an expert, you know, I think is a very elusive term. And so I really want to appreciate I really want to applaud you for for showing up today and sharing your wisdom with us. Because at any point in our career, we're still evolving. But I think that I say this often, but I really believe in our clients are our best teachers. And by continuing to show up and just, you know, demystify the work that we're doing can help not only our clients so much, but ourselves and our colleagues who are on the fence and maybe not sure if they wanted to get into Pelvic health. So I really appreciate our conversation today and you sharing your experiences with us. 

Kayla Heagy Yes, absolutely. I am so honored and glad you asked me to have this conversation. And I hope it's it's helpful for those that are listening. And it's just been a really great experience. And and I'm grateful. 

Lindsey Vestal To be also want to mention that in November, you're going to be our expert speaker at the at the pelvic Atp's United membership, which is my new membership community. We are off social media and we meet weekly to roll up our sleeves and really meet in a very curated forum to kind of, I don't know, really quiet down and learn more of our craft together. So I am super excited for you to come and speak to my members in November. Kayla I'm excited and, and wish it was tomorrow because you've already just inspired me so much with our conversation today. So I'm really grateful for your time. 

Kayla Heagy Yes, absolutely. And I am really looking forward to it. 

Lindsey Vestal Thank you for being my guest today, and I'll talk to you soon. 

Kayla Heagy All right. Sounds good. Thank you. 

Lindsey Vestal Thanks for listening to another episode of OTs and Pelvic health. If you haven't already, hop on to Facebook and join my group OTs for Pelvic health, where we have thousands of OTs at all stages of their Pelvic health career journey. This is such an incredibly supportive community where I go live each and every week. If you love this episode, please take a screenshot of this episode on your phone and posted to IG Facebook or wherever you post your stuff and be sure to tag me and let me know why you like this episode. This will help me to create in the future what you want to hear more of. Thanks again for listening to the OTs and Pelvic health podcast.