Case Study: Building Self-Efficacy with a 24 Year Old Marathon Runner Who Leaked

Show Notes

• OTs in Pelvic Health Summit
• OT Pioneers: Intro to Pelvic Floor Therapy for Occupational Therapists
• OTs In Pelvic Health Facebook group
  
  
• Lindsey + Lara Desrosier's Trauma Informed Pelvic Health Certification
• Lindsey's Upcoming Case Studies BookSurvey
• Bristol Stool Scale

My email: Lindseyvestal@functionalpelvis.com

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Transcript

Lindsey Vestal New and seasoned OTss 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. One of my favorite ways of learning is through case studies. And I'm actually in the middle of creating a case study book right now. It's 2023, and as far as I know, it's going to be the first 80s in Pelvic health case studies book. And I'm doing this because I feel like it really highlights our special sauce and the way we think and the myriad of approaches that as an O.T. specializing in Pelvic health, we can really approach a client with a particular diagnosis in so many ways. So showing the breadth and width of the way that we can care for our client spins off so many ideas. I remember my first job in an outpatient setting at lunchtime, sitting around the table in our 20 minutes that we had golfing down my chili or my sandwich and thinking, my gosh, could this last forever? I wanted to hear all of the stories. I wanted to hear all of the rationale, all of the questions and all of the exacerbations that my fellow practitioners were experiencing. And so that's what inspired today's episode. This podcast on a case study for a client that is near and dear to my heart. Now, she was a 24 year old client who was training for the New York City Marathon. She was referred to as the Functional pelvis because her fitness trainer, who she had been working with for years, she shared with her that she had been leaking urine for about the last year or so while she was gearing up for the next marathon. She was really embarrassed to bring it up, saying, Doesn't this just happen after you have a baby? I haven't had one and I have no idea why this is happening. So while I am glad that the information is getting out there that after you have a baby, leaking urine is pretty common. What I'm finding is exactly what this 24 year old was saying, which was. But I didn't have a baby. Why am I leaking? Right. And so, so glad that she came to us. So we had this opportunity to help her become the detective to her own body. Because she was gearing up for this big run that was happening in just a couple of weeks. She was getting really anxious and this is why she brought it up to her fitness trainer, fearing that maybe she wasn't going to be able to participate. Right. So she reported that she was leaking when she was running fast or moving directions very quickly. Otherwise, there was no leaking throughout her day. So this client pees frequently on days when she's training because she didn't want to leak. Right. Really, really common report that clients will say, I'm peeing every 30 minutes without an urge just because I don't want to be in a situation where I leak urine. Well, that's how it began a year ago. Right? And then over time, she started noticing that even on days when she wasn't training, she was also peeing frequently. And by the time she came and saw us at the functional pelvis, she was peeing at least 15 times a day. And she did report that it was worse when she had her sports drink. She said that she was burning when she was peeing and she was also going frequently in order to ease that sensation. So there are two reasons. Now, she goes as often as she does. So I want to stop for a second. And I wish I could I wish I could hear your thoughts. I wish you had the opportunity to interact with me because I would love to know what do you want to know more? So pretend we're sitting in the lunchroom together and you just got done hearing me explain about my new client. What do you want to know more about? What's your next question to me as your colleague? Personally, I wanted to know more about her fluid intake and I wanted to know more about her bowel habits. I personally think that in Pelvic health we start with the foundation the best do the basics better, and we start with the foundation. It gives us an opportunity to let this client know how she and her choices matter, how she has agency over her own body and the results of what happens when she makes those choices. If I were to just immediately put her on my table and start doing a hands on assessment, even though we're going to find some things that really will move the needle and that will give her an opportunity to have agency. I find starting with choices around our roles, habits and routines, move the needle the quickest and give that client an immediate sense of empowerment. Then we can move on to all the myriad of other skill sets that we have. It also leaves room for trauma. It's a trauma informed approach to start in this way that gives the client agency. Now, trauma informed care is something I'm extremely passionate about. I'm actually creating a trauma informed certification for pelvic health practitioners with the amazing Laura de Rozier. And in the shownotes you can find a list that you can hop on if you want to learn more about when this certification is coming out. I will tell you it's a six month long program that does culminate in a certification and there is an in-person component which I feel really passionate about. So this particular client has actually been constipated for years. And when I started asking her about her bowel habits, we learned so much. So she has around type one or type two stool on the Bristol stool scale. I'll link to that in the show notes. And she goes about 2 or 3 times a week. This client has hemorrhoids, has occasional bleeding, which she sees on the toilet paper. Again, she's had no children and penetrative intercourse is initially uncomfortable for her. All right. On to fluid intake. She told me that she drinks about 24oz a day because she really wants to stop leaking. So she just doesn't want to drink those fluids again. Very, very common and unfortunately counterproductive for our clients goals because when you drink less, your bladder is actually irritated more so you go more often. It's a little bit like a angry toddler throwing a ten temper tantrum. All right. My next question for her was what else is bothering her? Now, this is a very open ended question. This gives room for our clients to go into emotional health, to go into physical health. Talk about social aspects of their life. It's a very open ended question, leaving room for a lot of interpretation. I like asking these kind of questions. This particular client started talking about an achy back because she started a new commute. She got a new job and it was about 45 minutes from her house. So as a result, she's spending a lot of time in the car. And this is also a source of anxiety because she can't pee when she's in traffic. So then I asked her about her stress levels and they were very high. With this new job came a promotion. And so there was a certain amount of, quote unquote, showing up that she had to do in order to learn the new systems. Right. Kind of learn the new culture. And the job was going to involve traveling long distance traveling, international travel. So she was concerned about that as well. Now, that long car ride for her commute was intense. For her, it was often unpredictable. Minimum was 45 minutes. It could be 90 minutes. And this was also really stressful for her. She shared she had a new sexual partner, and the penetrative part of their intimacy was very uncomfortable in the beginning. Not so much with deep or thrusting. And this was stressing her out because she felt like her client, her partner, her new partner was starting to pull away from her. And of course, she was training Uber hard for that upcoming marathon. So lots going on there. She is in a very high sympathetic situation, not allowing a whole lot of time for any down regulation. She is a very hyper driven type, a very high achiever. So what did I do? What did I do? Well, you know, we're always screening for when it's appropriate to involve another practitioner. Right. And in this case, she was referred to the functional pelvis by a non-medical person. So I encouraged her to go back to her GP and check for a Utili. Right. I was wondering about that low back pain and I was curious about ruling out a kidney infection as well. Right. And her fluid intake was so low, especially for the level of activity she was participating in. So I did lots of education around fluid intake and how that can further aggravate the bladder make her symptoms worse. Right. I showed her the picture that I'm going to attach in the show notes that shows how the full the bladder it is when it's optimally receives the signals to empty. I find that a picture can can really truthfully say a thousand words and you know, not many of us have a sense of our bladder and what it looks like and how much it can fill. And, you know, it's such an esoteric part of our body, much like the pelvic floor is. But I find the organs are even more in this category. So this picture is just like beautiful, lovely picture that a former client of mine actually made for me that shows a water bottle and how full that water bottle is or how far the bladder is when we actually receive a signal to urinate. Now, we talked about how it could help constipation as well to drink more water. So now two of her symptoms. Right? Could could find a lot of relief with more fluid intake. We also talked about how backed up stool can cause urinary frequency and urinary urgency. Right. Talked about how connected the bowel system is to the bladder system. Now, this was a huge moment for her to realize these two can be connected. So again, lots of education around normal habits and functioning is so key to building that rapport, making the client feel comfortable and making the client feel they have agency over their body. I'm not doing something to her. I'm educating her, giving her the chance to adjust habits if she show if she so chooses to do so. Now, again, these topics are conversations we'd never have in our culture. And I love watching our clients moments as we have these conversations. It totally lights me up. So we put together a stepwise plan for increasing fluids, decreasing sport drinks, which will irritate the bladder in many cases. So we did move on to an exam. In this first session. We had time. The client felt really comfortable with the conversation we were having and she actually asked if we could move forward with it. So I discovered an overactive pelvic floor. Now, this doesn't surprise me, right? Given the painful intimacy she was having and the chronic constipation, This really surprised her, though, given her leaking symptoms, which was the main reason she was there. Right. She said, doesn't leaking happen after you have a baby and you're to, quote unquote, open down there? Right. She figured she had to work harder and get tighter. So many of our clients feel this way. It's the myth of the keyhole. It's the myth of a tighter, more, quote unquote, efficient pelvic floor. I explained to her how urine leaking doesn't necessarily mean, a, what she would consider a weak pelvic floor. Right. It means she has one that isn't working optimally to create pressure on her urethra to stop the passage of urine. Right. Her leaking happened with high impact, high velocity force activities. So this means that she needed to be able to become more buoyant in her coordination in order to accommodate the impact of the force activity that she was participating in. Now, the hemorrhoids. They also tell us a story of her overactivity and that she blithely resorts to straining often. In addition to this conversation around habits and routines with water and elimination, we were talking about optimal coordination with the pelvic floor, right? We dove into activation that could help balance her nervous system. She this took a little bit of buy in from her, but she did agree that she's always been a very high driven, highly achieving person. And quite frankly, she didn't enjoy downtime. Right. So we spent a large portion of the rest of our time together really talking about why and how she could see herself. Participating in down regulation. Right. Which would help her achieve the goals that she came into our session with. She thought for a long time and she didn't come up with any activities in the course of our session together. That sounded good to her. But I followed up with her via email, like I do with all my clients, usually same day. And I asked her, you know, had she thought of anything? And she wrote back right away saying, I still haven't thought of anything. So I asked her if I could send her a few ideas and if she could kind of pick the ones that maybe sounded doable, maybe weren't exciting, because obviously she she wasn't able to generate ideas herself. Nothing really sounded fantastic to her. So she's like, Yeah, absolutely. I'd love to hear some ideas. So the one she chose were 15 minutes of yoga. Specifically, she wrote back saying 15 minutes because anything longer seemed like pure agony to her swimming, making time for weekly visits to the nail salon where she would listen to a podcast that she had been missing and hadn't had time to listen to. The next time she came in to the office, we spent some time with a calendar literally slotting in when we could do these activities or scuse me, when she could do these activities over the next two weeks. I really recommend that you don't take for granted that a client knows when and where they're going to do the work. Now, this doesn't have to be slotting in a podcast or nervous system down regulating work. This could be the client making time for any home exercise program that you gave them. Physical, emotional, mental. Otherwise, why? Why is this important? Again the best do the basics better. And a very O.T. approach to this whole thing is allowing room for habit stacking, which I find is how nervous system work is effective the most. When, when and where do you have space for this? Now, this client, who was a type-A person who had no trouble filling, filling every moment of her day with work, especially needed a few moments to pause and reflect on when and where she could fit these activities in. But I encourage you to think about this for each and every single one of your clients, even clients who don't match the profile of this 24 year old client who could really use this, because I find that this simple activity enables them to actually see in their day. And it encourages the follow through just on the mere fact that they could actually visualize the space that it took up in their day temporally and any other way. Now, we agreed that we would reassess how it was going in two weeks. And I also talked about some daily things that she could do to stimulate the vagus nerve. Now, the vagus nerve is something I talk about often over in the OTs for Pelvic health Facebook group. I've also had have had quite a few podcast episodes on this in particular. Check out the episode called Poly Vagal Theory and Pelvic health. You can also check out trauma informed pelvic floor therapy centering through interception, which came out last July. So some activities that we discussed to stimulate the vagus nerve were chewing gum humming on the way to work, gargling anything repetitive and rhythmic really, really speaks to that vagus nerve. And the cool thing about it is little bits of this sprinkled throughout our day does wonders. We also talked about how to identify when her pelvic floor was lifted and clenching, and she herself was thrilled when she noticed a relationship between when her abs were gripping and when her pelvic floor was lifting. And this was an awesome start. We were really starting to build in her own into reception and her own sense of agency and being able to just monitor what her body needed because she was in her head so much except for when she was running. And I wanted her to be in her body in a somatic place in small doses throughout her day, says that she wasn't playing catch up with her stress. So I hope that this case study provided a little bit of food for thought for you. And I would love to hear from you. I would love to hear if you have questions about this, if you have different approaches that you would have taken with this client. Send me an email. It's Lindseyvestal@functionalpelvis.com. It's also in the show notes. Let's keep this conversation going and I can't wait to see you at our next episode. Thanks for listening to another episode of OTs and Pelvic health. If you haven't already, hop onto 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.