"How Long Will It Take Me to Get Better?" How Do You Reply To This Question?

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Transcript

Lindsey Vestal Have you ever been asked by a client How long will it take me to get better? How do you reply to this question? Especially in Pelvic health. This is what we're going to get into today. New and seasoned OTs are finding their calling in Pelvic health. After all, what's more adult than sex, peeing and poop? But 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, OTs. We are out of the box, OTs. We are Pelvic health OTs. I'm your host, Lindsey Vestal, and welcome to the OTs and Pelvic health Podcast. Let's kick off today's podcast with a story. So I've had a client whose name is Reggie. She was about a year and a half postpartum. She had a vaginal birth, a long second stage labor of about six hours. And there was a lot of mention of a possible C-section throughout the labor. So she came to see me elated that she had avoided it. But she was coming to me with a diagnosis of a prolapse, which was a grade two req to seal. She was given the diagnosis at about six months postpartum. Now erect, a seal is the bulging of the front wall of the rectum into the back wall of the vagina. It can be caused by many things such as trauma from vaginal delivery, a history of constipation, chronic straining with bowel movements and various surgeries. Now males can also develop rectal seals, but they're less common and they're often associated with a prostatectomy. So Reggie was coming to pelvic floor therapy because her functional experience was that she was having stress urinary incontinence with stepping off of a curb, lifting grocery bags or her toddler off of the floor. And she also was reporting a lot of pain with intimacy, specifically with initial penetration. And she was having incomplete emptying with her bowel movements. Now, Reggie shared that surgery was the only option presented to her by her practitioner. But she had heard about pelvic floor therapy from a neighbor who happens to live on the same street as her. And she was a formal functional pelvis client. So when Reggie was diagnosed about six months ago, she developed a habit of checking her prolapse to see where it was. She was checking it on average, I don't know. I think it was somewhere between like ten and 12 times a day. Every time she peed, every time she had a bowel movement, every time she had stress, urinary incontinence. And before intimacy, in her words, she felt like she had to keep it all in. I asked her when the symptoms had started and she said that the stress urinary incontinence and that pressure that she was experiencing started about a month or so postpartum. But the painful sex started when she got her prolapse diagnosis. She was hyper focused on making sure the prolapse wasn't worse and checking on it throughout her day was kind of her way of keeping track of it, right? Making sure that it wasn't getting worse. She was absolutely preoccupied with knowing what caused it to be better or worse, what made it better, What made it worse? And what was her role in that? Do you have clients who are hyper focused on their prognosis and on their progression? I find that many pelvic health clients, especially with a new diagnosis of something like prolapse, definitely can fall into this category of what makes it worse, what makes it better? And when were they going to get better? And in fact, that was one of her first questions to me was how long will it take me to get better? And that's why I wanted to go there today, because I think that anyone in occupational therapy gets this type of question whether you're seeking a hand therapist, whether you're going to someone for, you know, a hurt knee. But definitely with Pelvic health, we definitely hear this question a lot. It's an esoteric part of the body and we don't always know if it's getting better because progress can happen slowly. So Reggie also wanted to know was she going to be able to have more kids? And this question in particular is really hard, especially for newer therapists. But honestly, it's hard for all of us. Our initial response is that we want to be incredibly supportive and scream, Yes, I'm so glad you're here. I am so glad you're going down this route of better understanding your body. But here's the thing. We need to be honest with our clients and ourselves. We can't actually see the future, right? We don't have that predictive ability to be able to answer their question with 100% assurance. We can help them, though. And while we can't promise 100% promise that everything is going to be magically better in six weeks or some arbitrary amount of time, we need to give them hope. Without promising to know their outcome, so much of their outcome is dependent on so many factors outside of our control, such as whether or not they're doing their home exercise program. Are there any genetic predispositions that can affect their progress? These aspects of our job, quite frankly, is really hard toeing that line between being optimistic and being realistic. This is one of the reasons why I started our OTs and Pelvic health Facebook group to have a place where we can address these nuances of our work as pelvic floor OTs. It's also why I value the directory that I have on this Facebook group where we not only list practitioners throughout the country who are seeing clients, but there's also a mentorship directory there so that if you're feeling in a silo, you're feeling alone, you're feeling like you're struggling with some of the answers to these questions. Lean into our group, lean into the directories and find someone you can chat with about these things. You know, it's like we can have all the training in the world to help our clients, but the ability to support them without promising the world to them is a tall order. Do you ever feel this way? Is this something you can relate to? So. So how did I answer her question about how long it would take her to get better? How would you answer this question? Take a moment. Take a moment. This is a podcast, so I can't I can't let some dead silence last for too long. But pay attention to that quick initial response that you might have had when I asked you the question of how you would respond to her. Lean into it a little bit. I'm going to share with you my response. But I think it is really an important thing to pause and reflect on the way we're supporting our clients and how we're toeing that line between optimism and reality. Right. So I personally was supportive of her. I shared with her the statistics of the number of people who have prolapse. I shared with her that I personally have one, right. These things really help our clients to feel less alone and and that there isn't something wrong with their body. I think that's what a lot of our clients feel, that their their body let them down. I told her that if I could read the future, my waiting list would be triple the time that it already was. I also shared with her that our body has an innate ability to heal and that so much of our work together will be about deepening her understanding around body literacy and the role of habits and routines, and how simple adjustments in behavior can make a big difference in her symptoms. I held space for her concerns, and I remained hopeful and honest. Now, let's go back to the case study just a little bit, because I found that Reggie was keeping her belly and her pelvic floor kind of sucked in tight all the time in that effort to keep it all in. Remember, that was the phrase she used to me, that she felt like she had to keep it all in and that her body was supporting that effort. She was squeezing her abs in tight and which is very common with our pelvic floor clients. Also lifting and tightening her pelvic floor. She was innately scared that it was going to get worse. Her mother actually had prolapse and did have surgery for it, and the outcome wasn't the best. And Reggie didn't want this for her future. So we start it right there with that, right? We start it right there with that habit. The importance of not keeping or keeping her, but her belly and body tightly held in all day. And how that could actually be counterproductive. We talked about the importance of full range of motion and a responsive, flexible pelvic floor and breath system. And we started to address how her story was not her mother's story. This is an important one. I referred her to an attorney who specializes in cognitive behavioral therapy or CBT for a more dedicated focus while building in the CBT concepts throughout my sessions with her as well. I thought that a CBT focused session would be very helpful for her outside of our session together to kind of help her address some of the other habits and routines that were starting to show some of that kind of obsessive quality and protection of her prolapse. So leaving room for our clients to make the connections between their stories and experiences and someone else they know or are related to is such an important part of our work as an occupational therapist. Spending time with them, having eye contact, asking really good questions. Truly listening and holding space. Sometimes this means putting the pen down. Being present and not jumping forward in your mind with all of the things that you want to do in the evaluate the sequence that you hope to follow. You know what treatment sessions are going to look like. We all go there. We all try to plan ahead and make sure that our time is valuable and that we're really showing up for the client. But what I want to suggest today in this episode is that there are other ways to be valuable and show up for the client. And besides the ideal treatment sequence, being there, being present, being on rushed is first and foundational in their steps to recovery. There is time to layer in all of those other pragmatic aspects of therapy, but addressing the psychosocial aspects of those physical issues. This, my friends, this is what makes our approach so unique and so incredible. If you want to hear more about the O.T. approach that is so incredibly unique. Head over to www.otpioneers.com. This is my flagship course that I have at the honor of supporting OTs since 2018. It launches a couple times a year. I'd love for you to get on the communication list and hear about when my next launches. Let's head back to the podcast now. I heard an interview with Neil Pearson recently where he asked the following question Is it more important to get rid of danger or more important to foster safety? When I heard this question, it made me think about the distinction of asking where the dysfunction is versus. Where are you? Resilient. So what's wrong with me versus what's right with me? I have some super exciting news for you. O.T. Pioneers 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 OTP'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. And I also love thinking about with this symptom that you're experiencing. What if your body is trying to help you? What if this is information so that you can pivot and change a habit or a postural behavior? Right. So thinking about our body as an ally and as a support system really helps so much with a therapeutic process. Because remember, Reggie was wondering what was wrong with her. And it's sort of like why her body was letting her down. And when we spent a little bit of time fostering resiliency and perhaps giving them an opportunity to change their outlook and their assessment of what's happening in their body, I find that that is there is a world that can create a world of difference in the way they're approaching their healing journey. Right. So building on resilience, building on the support, the innate support that our body has in our best interest is such an incredible way to catapult into that positive, curious state versus that very pessimistic, judgmental feeling let down state, which it's very hard to recover and to trust your body when you're having those feelings. So I find sharing with our clients that nothing is wrong. My clients will say to me, my body, you know, a body gave up on me. And this is when talking about our body doing the most intelligent thing that it could, its response was, Serving an important function is likely what happened, right? So saying things like thank you for doing the best you could to support me. But maybe I don't need that response anymore. It's time to revamp. It's time to reinvigorate. Maybe. Maybe I don't need to squeeze my belly in anymore. Maybe I know that this pressure of trying to keep it all inside and all together is bigger than prolapse symptoms. Maybe I need to start a conversation with my partner around support and getting some help around this new role of becoming a mother. Very often our physical experiences mirror our mental ones, so I couldn't help but think when she said to me, I'm trying to keep it all together, that there were some other implications there. Right. And holding space for that, not only in our sessions, but when she went to that O.T., who specialized in CBT, was an incredibly holistic way to help her explore some of these topics. Have any of you read the book Burnout by Emily Nagorski? I'm going to link to it in the show notes. It's all about completing the stress response. So this came up in my mind a lot because remember, the client had almost had a C-section, and so I was also sensing a fair amount of a stress response regarding her being able to process that experience. Right. And so how much of that was still going on? And we know that the nervous system is incredibly impact by stress and trauma. So when we educate our clients and share with them how the stress response works, we're empowering them with choice and we're collaborating with them. Right. We view our work together through strength and resilience, fostering an opportunity to help them choose for themselves. We start to see ourselves as being on the same team as our body. Right. Pain is important, right? Anything from a burn to an ankle fracture to the pain of heartbreak, to the pain of losing a loved one. These are all opportunities. Are there breakthroughs there? Breakthroughs for innovation, for deep wisdom, for asking for help, and potentially even the power of taking a break. And so pain is there to send us a message. Pain is there to tell us that we may need to take a pause and look at things a little bit differently. You know, the universal danger response is facing the danger. Fighting or flighting the danger. Freezing from the danger. And there's even a fourth response, which is called fawning, which is more of a people pleasing response. So these are all ways that our very intelligent, nervous system responds to not feeling safe. And this response, whichever one of these four we choose, are actually involuntary. Our body chooses the one in like less than a second. There's no conscious thought involved. It chooses quickly. Which one will empower us the most in that moment. We are not wrong for the response that we our body chooses. Our body is going into a sort of survival mode, and the way we respond is our body's way of protecting itself. Knowing this can take the pressure off of ourselves for judgment or blame or going, you know, why did I go there? Why did I think that blaming myself was the best approach? It's our body's innate wisdom that often takes us there. Trusting that process, thinking that process, and then reminding ourselves that now that we've identified that we now have a choice, we can now choose to think about it in a different way, way, a way that is now we're empowering, a way that is able to provide a supportive, conscientious choice around our next steps. So back to the case study with Reggie. I. During the course of our evaluation together, I definitely saw that she had an overactive pelvic floor. So one that was in a tightened, constricted state most of the time. And she had a grade two rectal prolapse. So even in even in the standing evaluation, which I highly recommend you do when you check prolapse. I also encourage you to do a standing evaluation with functional tasks to really see what's happening. So there's no way around it. A standing check is awkward. But when we let our clients know why we're doing it and how we care so much about really checking in with what they're experiencing when they're not lying on their back, when they're living their life in that functional way, they really value that and they really appreciate that we're taking the time to be so thorough. So I did a check that incorporated lunging and I did it. Prolapse check where she went from sit to stand. Now for her, I took out a little step stool and I had her step on and off of it because curbs were an issue for her when she was experiencing her stress urinary incontinence. It was often when she was stepping on and off a curb. So I encourage you to try your best to mimic an activity in this space where you're seeing your client that most closely mimics where they are when they're having their symptoms. So we are looking at the recruitment patterns of the muscles. We're looking at the breath patterns and functional tasks. And for this particular client, for Reggie, this was huge. She did something so interesting in functional tasks that I would have never seen in Supine. Reggie was bearing down in an effort to stabilize. She spent most of her time in a key goal in that like, overactive, tight state to keep it all in. And her stress urinary incontinence was brought on by her pushing down or bearing down in an opposite direction of that, Titan lifted Kegel in an effort to be strong and supportive, and her go to was significant. Breath holding. So our work together focused on really building that appropriate reception of the contraction and that proper reception of the release and of bearing down. And not breath holding. So feeling the rhythm of how the pelvic floor responds to the breath. When inhale, the pelvic floor relaxes and exhale, it comes back up, asking her, What does it feel like when you bear down? Do you notice anything else in your body happening at the same time? What does it feel like to Keyhole? Do you notice it in other places? In your body, your jaw, maybe your shoulders or your belly? I really find that building in those inroads and connections to her whole body really helps her get in touch more with her pelvic floor. Building in this propria reception with someone who is hyper vigilant with checking prolapse is challenging, right? So there needs to be a lot of education around how this isn't an obsessive act. It's more like a stopping to listen and be gentle with ourselves and how this ultimately can get her inner core team coordinating and on the same page. Now, we also talked about how that pain happened with intimacy with the onset of her diagnosis. Remember, the pain only started when she got her diagnosis, not before, like her stress urinary incontinence. I asked her if she felt whether that was related. She took some time to answer that question, but she ultimately told me that, yeah, it was related and that she was scared that physical intimacy was going to make her prolapse worse. So we talked a lot about how communication was key and that physical intimacy could likely actually help her pelvic floor. It will increase blood flow and that buoyant response of her pelvic floor, which is the foundation of a strong one. So help her relax and indulge and lean into relaxation. And intimacy is ultimately relaxation of the pelvic floor. So it could actually help her as long as she kept that communication open with her partner and was willing to try different positions and just keep open to the experience. Now, she had a desire to be intimate with her husband. And you can tell you could tell that our conversation was so liberating for her. And I always think about this as clients. How are we supposed to find this information out, especially when we have a surgeon who is telling us that surgery is the only solution? You know, the lack of education in our overall health care system leaves so much room for improvement. And I feel like one of the most rewarding aspects of our job as a pelvic floor occupational therapist is exactly that education, encouragement, optimism and holding space for them. 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.