Lecture at Robert Wood Johnson University Hospital

I recently had the opportunity to present a lecture on bowel dysfunction to the GI fellows at Robert Wood Johnson University Hospital.  This incredible opportunity afforded me the ability to educate budding new professionals at the beginning of their career on the benefits of pelvic floor physical therapy in relation to gastroenterology disorders.

The lecture focused on fecal incontinence and constipation as paradigms of underactive and overactive pelvic floor dysfunction, respectively.  It addressed the various components of a pelvic floor physical therapy initial evaluation, including food and fluid intake, toileting habits, and tests and measures.  It also explained the differences between treatment approaches for underactive versus overactive pelvic floor dysfunction.  The final section of the lecture focused on the benefits of biofeedback and how it can be utilized to educate patients on how to properly activate or release tension within the pelvic floor muscles, depending on the patient’s individual needs.

My personal favorite moment was at the end of the lecture, during the Q and A portion.  One of the fellows turned to me and remarked, “This information is so important!  Why don’t they teach us this in medical school?”  I responded, “I, know, RIGHT?!  But don’t worry.  If it makes you feel any better, they don’t teach this to us in physical therapy graduate school either.  My pelvic floor knowledge derives from continuing education courses and on-the-job training.”  And that is why I have made it my mission to share the wealth with as many physicians and laymen as possible.  The more informed we are in general about pelvic floor dysfunction, the more likely that those who need it will be properly diagnosed and referred for treatment in a timely manner.

For those of you who wish you could have been there to learn all about this fascinating topic, fear not and FOMO no more!  I have included the lecture in today’s blog post for your listening pleasure.  I hope you enjoy the lecture, and I encourage you to continue sharing the wealth with others.

Scary Scars

Disney knew what they were doing when they made Scar the dangerous villain in the movie, The Lion King.  That is because as a pelvic floor physical therapist, I can attest to the fact that scars are the enemy which can contribute to pelvic floor dysfunction and pain.

In general, scars are one of the most overlooked clinical findings that I encounter during treatment.  Time after time, I will notice a post-surgical scar in an area seemingly unrelated to the pelvic floor (ex. mastectomy, hip replacement, hysterectomy) and inquire regarding what suggestions were made to the individual about proper scar care.  An overwhelming majority of women inform me that they have not been educated at all on scar care or mobilization.  In fact, some are even afraid to touch the scar “lest it open.” Scars may take the form of episiotomies, healed perineal tears (for vaginal deliveries), and C-section scars.  All three of these scars may contribute to pain during intercourse, and a C-section scar can interfere with lumbar mobility, especially trunk extension.

In our bodies, movement equals health.  Every muscle, joint, tendon, ligament, nerve, and connective tissue structure, including fascia, has some degree of mobility and movement.  Scars are the enemy when it comes to mobility.  Almost every wound or injury (including surgery) results in some amount of scarring.  Scars are composed of a protein called collagen, and this is the same protein in healthy skin.  However, the protein fiber composition in scars is different and less functional than the collagen that exists in normal tissue.  In other words, the body may do “too good” of a job healing itself; stiff and excessive bundles of collagen growth accumulate near the scar.  This interferes with the mobility of the local structures.  So while scar formation is a necessary and a natural part of the healing process, the accompanying issue of decreased structural mobility must be addressed.

This is best accomplished by performing scar massage, a technique that can be performed by a physical therapist or on one’s own body.  The general goal is to mobilize the tight tissue and release myofascial adhesions or restrictions caused by the scar.  Many women find the following direct mobilization techniques helpful for abdominal C-section scars:

  • Using two to three fingers, apply force in a horizontal direction along the entire length of the scar (side to side, or right to left)
  • Using two to three fingers, apply force in a vertical direction along the entire length of the scar (up and down, or above to below)
  • Using two to three fingers, apply force in a circular or rotational direction along the entire length of the scar. Create circles in both a clockwise and a counterclockwise direction
  • Pinch, twist, and roll the skin along the entire length of the scar
  • Lift the overlying skin along the entire length of the scar.

These techniques help break adhesions and free up the underlying tissue in all directions.  The amount of suggested force for all of these techniques is until the point prior to pain.  Meaning, it should not hurt!  If it does, try applying slightly less force.  Furthermore, scar massage should not be performed until the skin has healed, which generally takes six weeks to occur.  Please consult with your pelvic floor physical therapist or physician prior to initiating any scar mobilization program.