kim_vopni (00:01.916)
hi terry welcome thanks so much for joining me on this week's episode
terri_robertson_elder (00:07.46)
i'm so happy to be here thanks for thanks for speaking with me i looking forward to it for a while and i've been following you for years so i'm super excited to be able to speak with you
kim_vopni (00:11.376)
yeah
kim_vopni (00:18.036)
awesome yeah i'm really glad you reached out to share in and the first thing that jumped out to me was the crouch crusader i think that's one of the best lines i've heard in a while so can you tell us how you became a crotch crusader
terri_robertson_elder (00:32.8)
sure like where the actual name came from or like my journey to crusade
kim_vopni (00:36.576)
yeah kind of your journey and and then how the name came along will be part of that story so how you came to be where you are now
terri_robertson_elder (00:42.38)
sure so you know i'm a physical therapist i've been practicing for eight years i was a massage therapist yoga teacher palais teacher before that and i always had an interest in pelvic health although i didn't know that i was necessarily going to go this route but i was actually in an oncology specialty center and doing oncology care an out patient and got really interested in pelvic health and so i've been practicing pelvic health for five years
now um and when i found the specialty it just it was like oh this is it this is this is my jam and the name crash crusader actually i think i heard it in a susigronski podcast i think she came up with it um so i will credit her you know
kim_vopni (01:34.756)
awesome yeah it's i love it i think it's great so i know the hash tag pelvic mafia was used for quite a while on social media sort of back in the i say the early days of when social media pelvic health was starting to be talked about i don't see it used quite as much but i think crotchcrucator could also have another good hash tag week and start another following
terri_robertson_elder (01:56.54)
tagging it you're right i have it in my instagram bio i should i'll start hash tagging it thank you the nudge
kim_vopni (02:00.856)
yes yeah yeah totally cool so i want to start with a big part of your practice which is prolapse and i would argue most public health physical therapist will have obviously a lot to do with with prolapse that's one of the more common public for conditions but can you talk about what prolapse is and what are the most common types that you see in your practice or maybe even what is the research say or the more common types
terri_robertson_elder (02:31.12)
oh that's a big hat a big one that's okay ll break it down but so i definitely got interested in early on in public health was kind of passion for me specifically because of my own experience if i might share with being newly post part newly in the specialty and being diagnosed with my own prolapse i was only seven or eight weeks post part of them i was very
kim_vopni (02:33.176)
question to start with
terri_robertson_elder (03:01.26)
new i came into the clinic um just for i didn't have any symptoms just for regular post natal rehab and she gave me a hand out with all the things i was never supposed to do again run jump lift squat with my hips below my knees and i was devastated and i thought it was a death sentence to not to men
words really and it really put me on a path to want to know everything that i could about it and it's been quite a journey to get to where i am now reading every piece of literature i could find taking every course that i could find um and i absolutely love helping people because it is so common and you asked me what it is to begin with i didn't even define it yet but essentially it is
kim_vopni (03:56.356)
yeah
terri_robertson_elder (04:00.8)
the pelvic organs for pelvic organ prolapse specifically the pelvic organs pressing into and sometimes coming out of the vagina so there is rectal prolapse which is a different things but for pelvic organ prolapse pop which is usually shortened to prolapse specifically usually refers to a vaginal prolapse so the there's an anatomic definition and there's a clinical
definition and there really is a difference that i like to share with people because there are there essentially four different stages and stage one and two are considered more mild stage one now which is basically just a slight bit of um organ descent and if i can show on my little model here so i have a little crochet model so it can be coming
from the top down the bladder pro lapsing it can be the recto vaginal wall the wall between the rectum and the vagina that's kind of pushing in and it can be coming from the top down either the apex of the vagina or if the universe is present then then you can also have a uterine prolapse but it's essentially considered an epical prolapse or or something coming down from the ceiling
i call you can think of to the milder stage one prolapse now is considered normal it has been re kind of classified and the new definition that's actually just recently come out last year the new clinical definition of prolapse um the descent needs to be at least to the vaginal opening or beyond to be considered clinical definition of pro lap so someone might ha
an anatomic descent they might have stage one or so stage to his one centimeter the prolapse coming to within one centimeter of the opening or one centimeter beyond so stage two can be either within or outside um and so some people do break that down into like two a and two b but not to get to m you know
terri_robertson_elder (06:30.8)
lost in the weeds essentially you know the reason why that definition has changed is because over the years we've gathered so much research and found that a great majority of women even young women even women who are niliporous who have never had a baby fifty percent have at least stage one prolapse and so the euroginacological community fine
has kind of shifted things after many years of kind of grappling with this definition and has kind of re define that mild prolapse is normal or at least acceptable amount of support and having that mild prolapse does not necessarily mean that it will progress it doesn't mean that you are at any more risk of having a worse prolapse than someone who has no
prolapse at all i know that
kim_vopni (07:33.396)
okay so yeah well and and before we go into because i had also asked about common types but before we go there i want to expand that a little because this is is new for me as well so i've always at least in north america we as you said there's four stages early stage was sort of just you know as you say just a partial bulge sometimes often very often a symptomatic stage two i used to be that it was two centimeters away
from the opening stage three with at the opening stage four without the opening so that's kind of what it used to be at least from the people that i've been taught by and led by so that now has changed if i understand correctly stage one is kind of considered just most many people have it stage two one centimeter above or below so you could technically have a bulge slightly out
side the entrance in a stage two is that right interesting
terri_robertson_elder (08:35.56)
yes yes and that's per and there are different staging criteria there's the bain marker scale but for the pop q m scale it is that's what the criteria is and then
kim_vopni (08:51.496)
and then what would stage three and four be then
terri_robertson_elder (08:53.88)
so stage three is from one centimeter beyond the opening two within so you have to check the total virginal length and then basically it's anything from within two centimeters of what that total version would be and then stage four is complete version
kim_vopni (09:10.216)
okay
kim_vopni (09:13.936)
got it okay and you mentioned how i guess i just asked the question how is it graded so how when you go in what sort of do you have a is there a tool that is used is it manual palpation are we referring to you mentioned a scale
terri_robertson_elder (09:32.82)
so sorry a scale just meaning a system of measurement not necessarily a tool but its measured with observation and with the person who is being examined bearing down fully for six to eight seconds you can either use a half speculum but there's a way that you know we kind of screen it in pelvic physio quite often just with a gloved finger and we press
kim_vopni (10:01.916)
for those of you who are listening if you head over to you tube you'll be able to see the video where there is some some demonstration
terri_robertson_elder (10:09.38)
so you press up and you have the individual bear down as much as they can and then if you see things descend either you know however much they descend and then you can also press the tissues down this way and then you can palpate deeply and feel either the services or if it's not present the apex of the vagina and then you can measure how much it descends there are sticks that you can get they're called potcuesticks that have little centimeter measurements on them
um and that's how you measure the maximum descent of yeah
kim_vopni (10:43.716)
right and the pop q is essentially as you meant sort of the grading scale that is used to evaluate is that correct
terri_robertson_elder (10:51.04)
so it's not as much of a grading scale it there is the stages that they use they use the staging words for the pot q m and that is really when they came up with that in ninety believe it was in nineteen ninety six um they used expert opinion because they didn't have any data to kind of come up with that and you know for deciding what was stage one what was stage two
kim_vopni (11:01.076)
okay
terri_robertson_elder (11:20.84)
and really it's it's um you measure and it goes on a grid and it's how you know surgeons will do pray up and post up to basically describe what the anatomy is and how much it descends with bearing down
kim_vopni (11:36.956)
okay and just for those that were listening if you if you can't see the video the first one you were talking about you were putting your finger on you as the clinic and putting the finger in and pressing against sort of the interior the front wall of the vagina to see the uterus and to see the back wall and then and then you also pressed on the back wall and would look in and see what's happening on the front wall with the uterus and with the uterus is that correct right yep
terri_robertson_elder (11:51.86)
m
terri_robertson_elder (12:02.6)
wait ye how it tends to be done in public physio and quite often now more so half speculum is being used you can also use like a tongue depressor that's wrapped in a glove and kind of use that to compress the tissues up and down as you see what's going on to give you a better view
kim_vopni (12:26.416)
okay so with this information then with this kind of new classification something that i recommend is that people see a public for physical therapist once a year as a checking and part of that purpose i i think there's value in knowing if there is something we need to kind of monitor or manage or what have you so and this is mainly the reason if there's early stage prolapse i personally would want to know
terri_robertson_elder (12:39.12)
yeah
kim_vopni (12:56.316)
that because i would want to be able to come in and do whatever intervention strategies i need to to prevent that from getting worse i've also heard on the flip side more so for people who've been working maybe with a medical provider who haven't been told because a lot of people also don't want to provide that information because they think it might alarm the patient or create issue so i can see the logic on both sides where do you sit in that that field
terri_robertson_elder (13:21.8)
hm
kim_vopni (13:26.256)
what would you recommend
terri_robertson_elder (13:27.22)
a really good question so for one i do think that it's important to ask people when they come in what sorts of evaluations they want whether or not they want to be screened for organ descent what it might mean if we find something because we know symptoms and anatomy don't always match up right so you know most i think most people want as much information that's why they're coming in but i think there is
really powerful how information is presented and so i think that's a big part of why there has been the shift in the clinical diagnosis of prolapse because those with stage one per the pop q stage one organ descent m it's not known to be progressive and so essentially it is really re defining as normal that doesn't mean that if someone comes in and they have
stage one prolapse and their symptomatic that we're going to say no you're normal you don't need to do anything shoot them out the door and completely disregard them absolutely not we still look at their symptoms we look at other drivers for what's going on and certainly help them and screen them for things that are meaningful in my opinion so i don't think that finding stage one prolapse that's a symptomatic on evaluation is um
terri_robertson_elder (14:57.8)
necessarily something that needs to be um alarm the patient about i would definitely tell them i'm seeing you know this amount of movement this is considered to be within normal the normal realm but there are some other tests and measures that i do that i think are more impactful um that do show the risk of potentially having some issues in the future how pressure is being managed
um some other measurements that we take called g h plus p b which is a part of the pope measurement system um and those measurements do actually give us a lot of information for one whether or not someone might be more symptomatic or whether or not they have a higher risk for developing our worsening prolapse in the future so i tell people what i find i try to offer it in a non pathologizing way um i definte
don't give that hand out i created actually a hand out that i'm happy to share with you and anyone that that might want it that has more evidence based information
kim_vopni (16:00.576)
yeah
kim_vopni (16:09.676)
i want to come back to your story but i'm gonna ask one more thing before we go there and you mentioned g h plus p b can you talk about what that measurement is because it does get referred to a lot especially with prolapse and and increased risks depending on what your score is that the right word to use there would be on that
terri_robertson_elder (16:17.52)
hm
terri_robertson_elder (16:26.34)
awful
yeah what the measurement is so i have all this stuff here and i didn't t can i grab one very quickly okay
kim_vopni (16:36.756)
yes yes please
terri_robertson_elder (16:43.28)
okay so here are the little pop que sticks u g h refers to genital hiatus and what that means is the opening of the most superficial muscles p b is parennial body the measurement of gh plus p b together is basically the levatorhiatis or the opening in the deeper pelvic floor muscles so both measurements are
portant for different things and the way that we measure is very simply we hold up the popcustic we measure from the urethra opening to the base of the vaginal opening and from the base of that's for the g h the superficial pelvic floor muscles basically and then parenial body is from the base of the vaginal opening to the anus basically the center of the anus we measure at rest
kim_vopni (17:28.355)
hm
terri_robertson_elder (17:42.96)
we have the patient bear down maximaly um and then looking at those measurements there are there's all kinds of research on what numbers are considered to be higher risk for both symptoms and risk of developing relapse in the future
kim_vopni (18:04.896)
right thanks for explaining that so coming back to your story you went you went in just because you were told or you believed that you should have an assessment post part and you didn't have any symptoms and then you were given a brocer that had all of these limitations that you should never be able to do i'm assuming because they found a prolapse correct yeah and that then sort of set off
terri_robertson_elder (18:10.38)
hm
terri_robertson_elder (18:30.68)
correct because raid one it was great one to two she kind of you know gave me she wasn't sure and i did go for i think seven months later to a yeuroginacologist to get a pestoryfit um and she's like you have there's no lapse there's nothing so it is
terri_robertson_elder (19:00.66)
you know there is no doubt i would love to have more research on that early post natal period and how much because there's so much more tissue extensibility i mean i had a vaginal delivery um there's a lot going on and the fact that stage one we know is um you know now considered to be a normal or at least um uh that whole amount of of organ support than you know really have we been pathologizingwomen
kim_vopni (19:22.296)
acceptable range
terri_robertson_elder (19:30.78)
mile prolapse for so long restricting them telling them don't lift weights don't go you know do all these things that you need to do but guess what we need to actually do these things we need to lift strollers we need to lift i mean i was thinking like i have this you know ten pound baby now in a twenty five pound car seat and he's going to only get bigger so what does what does that mean but anyway just you know these limitations and restrictions are really well intentioned they're meant to help
kim_vopni (19:48.996)
hm
terri_robertson_elder (20:00.78)
save people from this thing um but keeping people restricting people from activity i think just makes us weaker and makes our tissues more susceptible to damage and so um you know the irony is is so painful because you know people go out they don't exercise the don't do all these things and then they have to go you know m move something one day and then they feel you know then they have a symptomatic organ descent after
kim_vopni (20:02.296)
hm
terri_robertson_elder (20:31.8)
and you know it can become kind of a self fulfilling prophecy yeah
kim_vopni (20:35.856)
right yeah and it's interesting to because as i i'm myself personally impost menopause and work with a lot of people in that sort of pery menopause post menopause transition and becoming more aware of the the vaso motor piece the bone health piece the muscle lost piece post menopause and i just think of all the people who have been either told to restrict not
if not do impact not this or who have kind of self prescribed them those restrictions because self prescribe to themselves because they were afraid of leaking or because they were afraid of making their prolapse worse or didn't like the symptoms or whatever reason it just it further compounds the already increased risk we have especially moving into that phase of our life
terri_robertson_elder (21:30.3)
right absolutely i mean we know the benefits of exercise are well established the like you said the bone health the heart health the mental health and you know you have to weigh all the risks and benefits and that's certainly what i talk to people about depending on you know what they want to do um you know it's most of the people that come in just want to be able to kind of like go about their lives but i do have people who are higher level who want to be
kim_vopni (21:36.216)
right
terri_robertson_elder (22:00.28)
you know lift heavier weights on who want to be able to run and things like that and you know we don't have a lot of really good longitudinal longitudinal data or we don't have good long term studies on um the impacts to running per se but what we do have is a lot of good research on introdominal pressure and basically what a lot of these studies show is that there are no completely safe
unsafe activities um and the way that someone does something even between you know even the same person doing the same movement it can be different you know depending on how they do it so that is really what's important not necessarily these blanket recommendations
kim_vopni (22:49.096)
yeah i reflect back to when i was first starting out and at the time there was really not a lot of fitness professionals in this field and i was working kind of collaborating with public health physios and we didn't have a ton of research at the time and in the the general consensus at the time was there was a good and a bad list of exercises and you know no twist no planks no crunches no this no heavy lifting no jumping and so when i think back to when i was
first getting this word out there very it was very much like the er you had very restrictive and then forming a second business with two other women one was a pelvichealphysio one was a trainer like myself and the three of us would have very healthy debates about crunches or not and rolling to your side and not and and i always seem to be the one who was saying but it just doesn't make sense that we should just because we've given birth just because we're doing this or just because we're older that we should not be able to
do a forward flexion movement in our life anymore that doesn't so why are we not kind of training for the resilience in that movement and so anyway it was always that dance and then antony low was a really big catalyst for shifting that that conversation which i'm forever grateful for and still is and so that was i think kind of a turning point within the last like five to seven years of opening up that conversation of we absolutely
and we absolutely should be doing all of these quote unquote unsafe exercises that we were told along the way right
terri_robertson_elder (24:26.52)
yeah absolutely so i mean we definitely i think you know a lot of that early advice was again came from a really good placement to be protective but it was restricted and i think it has had negative unintended consequences and you know we don't necessarily go completely the other direction although there are some people who definitely you know want to say no you can do whatever you want and really it's up to the individual to do
kim_vopni (24:34.576)
hm
kim_vopni (24:49.176)
yeah
terri_robertson_elder (24:56.36)
side risk versus benefit but i think with progressive loading you can get to very safely lift weights that can strengthen your muscles strengthen your bones have all that the and even some impact activity with the right you know support especially with the right training with being progressive um you know can be incredible tool for people
kim_vopni (25:25.216)
yeah yeah i wholeheartedly agree so i had asked earlier and it's not it's not that relevant but it kind of is just out of curiosity what are the most common types of prolats that you see in your practice
terri_robertson_elder (25:38.78)
in my practice i've tend to see a lot of anterior vaginal wall descent some people call it systerseal which is the bladder descending and i'm not sure if i've just had a lot of those lately but it seems to be the most common although certainly certainly i think that as far as you know rates in the general population i haven't seen one being necessarily more than
kim_vopni (25:55.456)
hm
terri_robertson_elder (26:08.52)
other i think they they happen equally and quite commonly there may be decent in all three compartments um quite commonly especially when there's descent of either the uterus or the top of the vagina when the uterus isn't present it kind of pulls things with it so yeah these are coma
kim_vopni (26:09.136)
yeah yeah
kim_vopni (26:30.356)
yeah and yeah so in terms of the treatment i really want to go like nobody intended heavier into the lifting and the impact but before we do when we when you have somebody who is symptomatic who is potentially looking and wants to do the higher impact activity wants to eliminate symptoms what sort of treatment so we talked about petries that's one thing that i want to explore where do you start is pessary the first thing or are there other things that you explore first
terri_robertson_elder (26:59.26)
certainly i mean the first thing is just educating people on general you know generally what they can do for symptom management how to you know to elevated hips post legs up the wall really start with the basics help them learn how to navigate their own symptoms so it could be that they're more symptomatic at the end of the day taking breaks throughout the day so so a lot of kind of life
style advice and education certainly constipation management is a huge one to prevent the bearing down just to keep everything moving talking to people about how they are going to the bathroom is a big one and then you know checking out you know what's going on with their pelvic floor muscles as far as strength coordination are they do they have an automatic contraction with it
of m and if not kind of trying to re train that so they can learn how to support better support their organs um but pesteries are big part of the treatment um but we certainly also look at hormonal health we may recommend that they seek care to get some topical estrogen or other topicals that may help um and that certainly can be a big driver of symptoms when there is a very mild prolapse
so the health of the cosa is really really important especially if you're going to bring on any kind of device like a pastry definitely needs of good tissue health so and then working we gradually will work towards you know looking at what's happening and standing look at what's happening with exercise umhelviclor muscle training definitely whether or not that has
as much of an impact as all the other things put together yeah
kim_vopni (29:03.696)
yeah okay and so let's talk then about pessaries and there's there's many different sizes and shapes and you as a physio fit pessaries which is not yet globally accepted a lot of times it may be a euroganachologist or nurse continence advisor who is fitting the pesseries what i like about the fact that if i think i absolutely believe that all physios should be able to fit because i think it will eliminate a lot of the
weight and a lot of the frustration that is currently associated with finding that right size and shape so how do you where do you start with the pastor conversation
terri_robertson_elder (29:45.36)
sure so so a history is an internal device the way that i describe it to people to clients is it is a kind of like a orthotic that you would put in your shoe but it's worn vaginally i also like to say sports for your pelvic organs is a nice one and they are medical grade silicone devices there are lots of different shapes and sizes so i will
recommend them basically anyone can get a pastor who stage one to stage four um there are definitely certain factors that can contribute to a more successful pastry fit and a less successful fit and i can talk about that more in a moment but i'd love to show you some different have a bunch right here if you'd like to see different um different types so this is the ring this is the most common type
kim_vopni (30:38.496)
m
terri_robertson_elder (30:45.16)
um and the ring can really be used for all compartments but it tends to be more so for a mild um milder stage one stage to it tends to work a little bit better for anterior vaginal wall just because of the way the um the way the organs sit um and so if i can show i'm going to pull off my superficial so we would fold it in half
kim_vopni (31:14.776)
it's sort of like a it's like a skinny doughnut that you would fold in half like a taco basically
terri_robertson_elder (31:17.9)
m right fold it like a taco little bit of loop insert
and it sits up on top of the pelvic floor muscles and so if someone does have like a muscle injury a wider levator hiatus and so that's where that g h plus p v measurement comes in that corresponds to a wider measurement someone may not be as good of a fit for the ring but typically it is the first one that's tried
kim_vopni (31:33.476)
hm
terri_robertson_elder (31:56.04)
i think around seventy percent or something um do are able to be fit successfully with a ring so it's the softest one it's the easiest one on the mucosa and it can stay in for like four months um some people may even leave it in longer depending but this one does not have to be self managed so this is really better one of someone like doesn't want to have to deal with anything it can
stay in you technically could even have intercourse with it in
terri_robertson_elder (32:33.5)
many people choose not to so i do like to teach people to take theirs out if they can the next yeah the next most common probably is the cube and so the cube has suction on six sides and this can be used for basically any stage or any grade but it has to be self managed it cannot be left in during intercourse
um most remove most recommend to remove nightly um although hopefully we can get more data but sometimes some you know one of the big educators um for pessary fittings she thinks that it's the in and out every night that can be a little a brace ov to tissues and so there in some are recommendations just to take it out a few times a week we really need better data
for those types of recommendations but some people wear these even just for exercise they'll put it in for exercise remove it but you do have to take care with removing them because you have to break the the suction on all sides you can't just pull straight down from the string
kim_vopni (33:50.696)
and are you talking are you referring to gain or morgan
terri_robertson_elder (33:54.36)
uh gainer recommends she is she i have taken her course she's not who i'm speaking about she recomensnightly that's what the manufacturers recommend
kim_vopni (33:59.896)
okay
kim_vopni (34:03.156)
yeah yeah gainer i interviewed on the podcast as well too so i'll link to that yeah i love gainer so there'll be links to hers as well so you can it goes a little bit more depth into into pessaries but yeah cool carry on yeah yeah awesome
terri_robertson_elder (34:07.26)
she is lovely isn't she yeah
terri_robertson_elder (34:17.92)
i've heard right here that she invents actually yeah she's fantastic and then also have the gal horn and this one is and it's packaging but this one has section on the the top um and it sits in this one is you can use it for different types but it's really great for um uterine prolapse and then there are also certain types of pastries that are
really more for our arian continents can i show you a few of those as well they don't work they're not quite as effective
kim_vopni (34:53.256)
please
terri_robertson_elder (35:01.4)
just because i'll show you this little knob which you place it there's my help is you place it insert it and you have to kind of get rotated around so that the knob is there you go so that the knob is hitting the urethra and so when it rotates and the knob slips off of the urethra
and there can be kind of leaking again but there are some over the counter at least in the states i don't know if you guys have these in canada but we have the the impress and revive which are over the counter the this is the impress at single use it goes in expands pushes on the sides of the vaginal walls pushes on the urethra which helps support the urethra
kim_vopni (35:43.696)
hm
terri_robertson_elder (36:01.28)
the revive if you'd like me to show that as well and this one is a multi use has a little applicator as well as the the impress it has an applicator and you press it it expands vagunally it's quite a different
terri_robertson_elder (36:21.5)
different shape than the impress a and this is what supports the urethra and then it just can be pulled out the string placed back in the applicator washed of course placed back in the applicator and this is just used as needed so i quite often will suggest to people to try over the counter ones just to see how they feel about having something there to get a little bit of confidence with manipulating
vaginal tool um and especially if someone has associated eurnarian continents um but most people i feel are much more open to the pestories now than there used to be i think because people are realizing that surgeries are not are wonderful for some not everyone wants one and certainly it's good to even try a pastry
before you do surgery um there's one really really important reason that i've seen sometimes post operatively people come in following a pro lap surgery and they are leaking like they never had before because it uncovers this cult stress nearing continent that they did know they had because the urethrowss being kinked by the prolapse coming down organs are put back into place and then they're leaking and um once you've had surgery depending on the type of
or you may it may not be good idea to use a peter if there's mess there
kim_vopni (37:57.436)
yeah that's such an important point i love that and and the pois you can get in canada they revive i've had a few people who have been able to order it through amazon into canada as well to so exactly as you said i do recommend that people at least give that a try it's a it's an inexpensive way see and and there's also a lot of cool innovation that's happening in the pessary world so three d printing and you know
terri_robertson_elder (38:04.86)
okay
kim_vopni (38:28.276)
imaging that will be specific to your anatomy i think there's some some interesting things coming along the along the way
terri_robertson_elder (38:34.72)
yeah and there are there's a couple of over the counter products that are coming out as well that are meant for organ support not just for urineering continents yeah there's some there's some great things coming out and you know if i say nothing else about pastries i do want people to know that they're not just for symptom management they can help remodel the architecture over with con
sistent use um they can the g h or the genital hits can really come in because it lifts the pelvic organs off of the pelvic floor pelvic floor can function more effectively you can work on your strengthen all of that but tissues ligaments fascia can shorten can remodel and many people need either a smaller or a different type of pastry when they come back and people often after many years may not even need a pester
kim_vopni (39:35.816)
i'm so glad you said that because i hear from so many people that their concern with using a pessary is that it's a crutch and that they're going to become reliant or dependent on it and exactly as you said it it really can actually improve the function and benefit it helps improve some of your symptoms as well but i love the way that you explain that is so important
terri_robertson_elder (39:59.42)
creatyeah and people are concerned about that and you know one of the other metaphors that i really like to use is um when people have issues with eyesight you know we have different choices you can wear glasses which is like an external support like there's shorts that we that are made for helping kind of support things or you can wear contacts which is like the pastry or you can get the lase surgery you know often you might want to try that
kim_vopni (40:27.876)
hm
terri_robertson_elder (40:29.22)
glasses in the context before you go to the lasicuh and so you have the lasic and then you still need to wear the glasses right yeah
kim_vopni (40:31.956)
totally such a good analogy so
yes yes so with when when you're fitting then you start out typically with a ring and as you mentioned that's the one that is fairly likely to be successful if that wasn't could you know that within that first session so when like when you go to euroganicollege ist oftentimes people don't have as much time when they say pubicclorphysical therapist they typically have longer treatment sessions or longer appointment times so could you theoretically
terri_robertson_elder (41:02.6)
m hm
kim_vopni (41:07.716)
if needed put one in and know fairly quickly if that was going to be the right one or not and then potentially try another one
terri_robertson_elder (41:14.34)
sure yes absolutely so i have you know multiple sizes of each pastry have you know i only keep the top you know three that i would use that that well for that really will fit like ninety five percent of individuals and if i need a specialty when i'll order it but for the most part yes we have a lot more time were to see people more frequently too so if someone is coming in and they've got you know a couple of weeks scheduled we can tweak things
kim_vopni (41:30.576)
hm
terri_robertson_elder (41:44.38)
um but the way that i kind of we check to make sure we do fit and there's different ways to fit for different pessaries depending on what's going on and we have an idea of what size will put that size pessary in and then we'll have the persons stand up do a bunch of jumps i have a bunch of heavy weights they'll lift some heavy weights they'll go avoid their bladder and make sure that they can void see if they can feel it i'll also have them
now reach and feel often they can feel kind of where you know where the pastor is coming down and i'll have them just you know especially in the first couple of weeks they want to go and kind of just push things up even if they feel it coming down and then after a few weeks typically um even just a few weeks things can kind of support start supporting a little bit better so um certainly if it's continuing to be expelled then we would want to try something probably with suck
like the ring or the gilt horn but i'm sorry the cube or the gilt horn have the section but i just find the ring is so much easier for people to put in to take out there are sometimes though if someone does have a very wide levator hiatus or they have a very short total virginal length if they've had a historic to me that where the service was not spared or they've had a previous
urjury then there probably not going to be a good candidate for the ring so there are some things that we would look at and think about where we might not try a ring to begin with but it is so great that you know people are coming in more often we have more time with them and i do think that that's why one of the reasons why you know physios are really well suited to to offer this in clinic
kim_vopni (43:37.656)
thousand percent so i want to shift over and sort of end our conversation on the weight lifting and impact activity you and i are on the same page let's build the tolerance the progressive loading it's a very that's one of the principles of fitness even is progressive loading so you've got weights in your office and pesseris we can do it sometimes with or without pester so how do you help people get that compt
so people may be coming to you who have been told that they can't do this can't do this can't do this or maybe they don't have that knowledge but they do want to be able to run or lift or you know do not be limited in their activity so how do you get them there
terri_robertson_elder (44:23.54)
so good question it depends on the person where they are where they want to get to and then of course what we find in the evaluation really give them the information to help them way the risk and benefit but building people progressive programs um you know for instance i had a woman who came in recently with a new prolapse she's she's mentapausil she hiked like two thousand miles last year
she hiked like the p c t i mean this woman is very very fit um and you know her prolapse happened while she was on a hike so can we say that her prolapse happened because she was hiking all those miles we can't she built progressively up to that there are other things you know that were happening for her and she is i just fit her last week with the pastor but even before she had her pastry she was already back up
kim_vopni (45:07.536)
hiking
terri_robertson_elder (45:23.28)
to walking i think she was hiked maybe did a twelve mile hike and she was managing her symptoms with when she would feel the bulge now hers was um grade or stage three but it didn't always sit out she she was mostly mostly you know fairly reasonable as far as her symptoms went but she was able to really manage her symptoms without the pastry but she
wanted to go ahead and get the pastry so she could have that support because she's about to hit the appelation trail and be out for weeks and weeks at a time and she knows that she'll have her ring in and she won't have to worry about it taking it in and out every night so that was you know another thing for her why i you know why we chose that one so the q might not have been as good for her taking in and out which she's like in the woods as far as exercise you know i
kim_vopni (46:18.116)
yeah yeah
terri_robertson_elder (46:24.02)
you know helped to guide her back to twelve mile hikes because she was already doing twenty miles hikes but someone else i might you know give them a program that was you know went out a little bit further and was really gradual and then you know with weight lifting i often well assess and standing um see what's happening with you know pressure management see what's happening with public flo
strength coordination and then gradually build from there and you know offering to people that they are lifting ten fifteen twenty pants kind of in their day to day um and that you know we need to make people's training harder than every day life um so finding ways to build the program m and give people confidence and managing their own symptoms and knowing you know
how their body is moving um is so powerful i do often recommend like the pop up lifting program if people you know don't want to sign up for a whole series of um you know because it's expensive to come to clinic and there takes a lot of time so there are some at home programs that are really really good but for the most part it's yeah like you said progressive loading over time building that confidence and learn
how to manage symptoms and then knowing that you have that organ support with a device can be you know so empowering as well
kim_vopni (48:02.096)
when you talk about pressure management just for people that may not be familiar with that term so we're talking about intra abdominal pressure can you explain explain what is what is pressure management
terri_robertson_elder (48:14.6)
sure so basically intra abdominal pressure is the pressure from if you imagine that the abdomen core muscles around the front the muscles in the back your diafram on top and then your pelvitfloor muscles on bottom those those muscles all coordinate to manage pressure so when we cough
are diafhram descends fast and the public floor also has to contract to support the public organs so basically when we talk about pressure management how we're really looking at um we're looking at a lot of things but one of the big things is is the public floor coming on when it needs to be how well is it able to support and manage those forces
um and then we do also look at you know what's going on up above if someone is doing especially if like say there weight lifting you know are they taking a big breath and bearing down when they you know lift the weight so um there are a lot of different strategies for breathing for you know your position what is happening at the velvet floor that helps you coordinate all those pieces together basically to offer your organs the support that they need
to be able to do those do those movements
kim_vopni (49:47.836)
is there a breath strategy that you prefer i mean a lot of the sort of re training philosophy even if you go back to julie webs piston it's about an exhale blow before you go exhale just before exertion sort of as a starting point then exhaling with exertion but then there's the opposite especially in the heavy lifting where there's often a big huge breath where there's an the sons with weight belt there breathing into the belt to create more pressure which arguable is
rating more stability right so there's that that's the kind of the part that's tough to hear is like well i can't i can't increase pressure because it's bad for my process but i i could potentially be creating more stability if i increase pressure right so it's a bit of a dichotomy there
terri_robertson_elder (50:30.6)
right
kim_vopni (52:53.356)
and how do you make it safer to use a belt
kim_vopni (53:16.336)
um in terms of no kind of wrapping up here but in terms of of the research that i've laurie fawner has done some research with regards to heavy lifting there's also been that the heavy lifting is bad but running is fine and you know and then comparing the two and is that really true and it's not and and it comes down to as you were mentioning before that it's not the exercise is that person's execution of that exercise on that given day at that point in their life
with all of the other factors that we have to consider right so i don't think we can blanket statement say you know we don't have the laungetudial data but heavy lifting or and what is heavy lifting like eighty percent of one rep max but not not many people know what their one repmaxis and what's heavy to one person is not heavy to another person right so there's all these factors that we do need to consider but is there a recommendation of you know we have some evidence that shows heavy lifting from a occupation so somebody working care
heavy loads every day for hours five days a week that's an increased risk so would we want to taylor our programs to be i mean obviously nobody is going to be training for that many hours but what would you say there
kim_vopni (54:54.436)
m hm
kim_vopni (55:07.996)
hm
kim_vopni (55:28.256)
yeah yeah bottom line is we all especially fitness professionals fitness professionals love the protocol tell me how many sets tell me how many ramps and how frequently you know the fit principle right frequency intensity time and and even just general fitness we just it's not that easy any more there's it's it can be easy and i think a lot of times we we complicate it by adding in so many other things to think about and social media is like
every day you probably walk away from social median line oh my gosh i might have health problems i might have bone health challenges i might have any kind of becomes overwhelming but and that that's what i mean by kind of clouding giving us all this extra layer to consider which is important to know but um but really just move move your body move in varied ways change something like antony loses do something different but change your breast strategy and and see how you respond really
kim_vopni (57:03.976)
yes
kim_vopni (57:19.916)
so with with like no there's the fit principle and there's no real recipe or exact protocol that somebody is going to follow
kim_vopni (58:00.276)
i'll send him this episode
kim_vopni (58:06.836)
no amazing
kim_vopni (58:38.516)
i love it thank you so much for sharing your wisdom and for the amazing work that you do
