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Posts tagged ‘pelvic floor’

AARP recognizes family caregivers across US, presents Portrait of Care to Mukwonago woman

Mukwonago, Wisconsin – November marks National Family Caregivers Month, a time to recognize the 40 million Americans – including an estimated 578,000 from Wisconsin – who help older parents, spouses, and other loved ones live independently at home, where they want to be.

The unpaid care they provide, such as managing medications, cooking meals, driving to appointments, performing complex medical tasks and more, is valued at about $7 billion in Wisconsin alone.

Sherrie Palm of Mukwonago is one of these unsung heroes.

Sherrie is in the “sandwich generation,” providing support throughout much of her life for both parents and children, including step-children. Sherrie is the founder and Executive Director for the healthcare nonprofit Association for Pelvic Organ Prolapse Support. Her caregiving work has been an add-on.

“I learned as I went. You make mistakes, but you only make them once. I’m an all-cards-on-the-table kind of person, so I learn by asking questions. We all want to keep the wheels turning. We all feel guilty – like we should do more. I am able to find balance by laughing and focusing on the funny,” she said.

AARP Wisconsin is recognizing Sherrie with a “Portrait of Care,” which is an artist’s painting of her with a loved one.

Selected through AARP’s storytelling initiative called “I Heart Caregivers”, Sherrie is among 53 family caregivers chosen nationwide, including one each from each state, Washington D.C., Puerto Rico and the U.S. Virgin Islands to receive a hand-painted portrait.

Thousands of caregivers have shared their stories on the website www.aarp.org/iheartcaregivers

“We want to celebrate family caregivers, spotlight their experiences of hope, love, dedication and perseverance, and elevate their stories – especially during National Family Caregivers Month,” said Sam Wilson of AARP Wisconsin, which serves about 820,000 Wisconsinites age 50 and older. “This is especially important as we work to support family caregivers through public policy, education, outreach and more.

“Family caregivers are the backbone of our care system, serving a crucial role in helping older Wisconsinites and other loved ones remain in their own homes and communities as long as possible,” Wilson said. “That’s why AARP is fighting for commonsense solutions to help make their big responsibilities a little bit easier.”

For nearly 15 years Sherrie has provided guidance for her parents and son, Erik – now age 27 – who has aggressive Lyme and additional underlying health concerns. Her father has degenerative spine issues while her mother suffers from genetic endocrine disorders and severe arthritis. “The backdrop of everything I do is to help out on either side as best I can,” she said.

Sherrie stays in daily contact with her son and visits her parents every chance she gets. She cooks dinner, shares funny stories, stays overnight and helps manage medical consultations and quality of life needs.

“I’ve come to recognize that on days when I feel like the mayo on all three layers of a triple-decker sandwich, nothing feeds my soul and recharges my battery like humor,” she says.

“Being a sandwich boomer is all day every day. At times do I feel like my life is absurd sideways? You bet. Would I trade a single aspect of it? Not on your life. If I can get the people I care about to laugh out loud, it fires my engines and I’m good to go.”

Earlier this year, AARP conducted a statewide survey of registered voters age 45 and older in Wisconsin to learn about their experiences, challenges and needs as family caregivers, and attitudes toward public policy that would support family caregivers.

The survey found that family caregivers in Wisconsin provide 538 million hours of care per year to their parents, spouses, partners, and other adult loved ones. They help with daily activities such as bathing or dressing, preparing meals, administering medications, driving to doctor visits, and paying bills.

“This report demonstrates that we need to do more to assist the hundreds of thousands of caregivers in our state,” said Wilson said. “Some of the things that will help family caregivers include improved workplace flexibility, respite care, tax credits and home care services.”

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AARP is a nonprofit, nonpartisan organization, with a membership of more than 37 million, that helps people turn their goals and dreams into real possibilities, strengthens communities and fights for the issues that matter most to families such as healthcare, employment security and retirement planning. We advocate for consumers in the marketplace by selecting products and services of high quality and value to carry the AARP name as well as help our members obtain discounts on a wide range of products, travel, and services.  A trusted source for lifestyle tips, news and educational information, AARP produces AARP The Magazine, the world’s largest circulation magazine; AARP Bulletin; www. aarp.org; AARP TV & Radio; AARP Books; and AARP VIVA, a bilingual news source.  AARP does not endorse candidates for public office or make contributions to political campaigns or candidates.  The AARP Foundation is an affiliated charity that provides security, protection, and empowerment to older persons in need with support from thousands of volunteers, donors, and sponsors. AARP has staffed offices in all 50 states, the District of Columbia, Puerto Rico, and the U.S. Virgin Islands. Learn more at www.aarp.org. 

AARP recognizes family caregivers across US, presents Portrait of Care to Mukwonago woman

Mukwonago, Wisconsin – November marks National Family Caregivers Month, a time to recognize the 40 million Americans – including an estimated 578,000 from Wisconsin – who help older parents, spouses, and other loved ones live independently at home, where they want to be.

The unpaid care they provide, such as managing medications, cooking meals, driving to appointments, performing complex medical tasks and more, is valued at about $7 billion in Wisconsin alone.

Sherrie Palm of Mukwonago is one of these unsung heroes.

Sherrie is in the “sandwich generation,” providing support throughout much of her life for both parents and children, including step-children. Sherrie is the founder and Executive Director for the healthcare nonprofit Association for Pelvic Organ Prolapse Support. Her caregiving work has been an add-on.

“I learned as I went. You make mistakes, but you only make them once. I’m an all-cards-on-the-table kind of person, so I learn by asking questions. We all want to keep the wheels turning. We all feel guilty – like we should do more. I am able to find balance by laughing and focusing on the funny,” she said.

AARP Wisconsin is recognizing Sherrie with a “Portrait of Care,” which is an artist’s painting of her with a loved one.

Selected through AARP’s storytelling initiative called “I Heart Caregivers”, Sherrie is among 53 family caregivers chosen nationwide, including one each from each state, Washington D.C., Puerto Rico and the U.S. Virgin Islands to receive a hand-painted portrait.

Thousands of caregivers have shared their stories on the website www.aarp.org/iheartcaregivers

“We want to celebrate family caregivers, spotlight their experiences of hope, love, dedication and perseverance, and elevate their stories – especially during National Family Caregivers Month,” said Sam Wilson of AARP Wisconsin, which serves about 820,000 Wisconsinites age 50 and older. “This is especially important as we work to support family caregivers through public policy, education, outreach and more.

“Family caregivers are the backbone of our care system, serving a crucial role in helping older Wisconsinites and other loved ones remain in their own homes and communities as long as possible,” Wilson said. “That’s why AARP is fighting for commonsense solutions to help make their big responsibilities a little bit easier.”

For nearly 15 years Sherrie has provided guidance for her parents and son, Erik – now age 27 – who has aggressive Lyme and additional underlying health concerns. Her father has degenerative spine issues while her mother suffers from genetic endocrine disorders and severe arthritis. “The backdrop of everything I do is to help out on either side as best I can,” she said.

Sherrie stays in daily contact with her son and visits her parents every chance she gets. She cooks dinner, shares funny stories, stays overnight and helps manage medical consultations and quality of life needs.

“I’ve come to recognize that on days when I feel like the mayo on all three layers of a triple-decker sandwich, nothing feeds my soul and recharges my battery like humor,” she says.

“Being a sandwich boomer is all day every day. At times do I feel like my life is absurd sideways? You bet. Would I trade a single aspect of it? Not on your life. If I can get the people I care about to laugh out loud, it fires my engines and I’m good to go.”

Earlier this year, AARP conducted a statewide survey of registered voters age 45 and older in Wisconsin to learn about their experiences, challenges and needs as family caregivers, and attitudes toward public policy that would support family caregivers.

The survey found that family caregivers in Wisconsin provide 538 million hours of care per year to their parents, spouses, partners, and other adult loved ones. They help with daily activities such as bathing or dressing, preparing meals, administering medications, driving to doctor visits, and paying bills.

“This report demonstrates that we need to do more to assist the hundreds of thousands of caregivers in our state,” said Wilson said. “Some of the things that will help family caregivers include improved workplace flexibility, respite care, tax credits and home care services.”

Sherrie Palm

Sherrie Palm

###

AARP is a nonprofit, nonpartisan organization, with a membership of more than 37 million, that helps people turn their goals and dreams into real possibilities, strengthens communities and fights for the issues that matter most to families such as healthcare, employment security and retirement planning. We advocate for consumers in the marketplace by selecting products and services of high quality and value to carry the AARP name as well as help our members obtain discounts on a wide range of products, travel, and services.  A trusted source for lifestyle tips, news and educational information, AARP produces AARP The Magazine, the world’s largest circulation magazine; AARP Bulletin; www. aarp.org; AARP TV & Radio; AARP Books; and AARP VIVA, a bilingual news source.  AARP does not endorse candidates for public office or make contributions to political campaigns or candidates.  The AARP Foundation is an affiliated charity that provides security, protection, and empowerment to older persons in need with support from thousands of volunteers, donors, and sponsors. AARP has staffed offices in all 50 states, the District of Columbia, Puerto Rico, and the U.S. Virgin Islands. Learn more at www.aarp.org. 

Pessaries and pelvic organ prolapse – The history

Pessaries and pelvic organ prolapse – The history

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PES.SA.RY (/ˈpesərē/)

The word pessary comes from the Greek word pesos and the Latin word pessarium meaning oval stone.

Pessaries have been around hundreds of years to treat symptoms as a treatment for menstrual problems, dysmenorrhea, incompetent cervix, infertility, uterovaginal prolapse and displacement of the uterus and treatment of women who showed symptoms of a pelvic organ prolapse has been around for thousands of years.

The earliest text found to be on obstetrics and gynaecology is that of Soranus of Ephesus a Greek physician (A.D. 98-138), which can be found in the ‘Bibliothèque Royale’ in Paris. Soranus had observed and reviewed a number of techniques used for management of uterovaginal prolapse during the Hippocratic era.

Soranus challenged and criticized treatments involving suspending the patient upside down by her feet from a moving frame which moved rapidly up and down for a few minutes, which was said to reduce the prolapse. The woman was then left to hang upside down for up to a day.

He also criticized the practise of his peers when they used ox meat inserted into the vagina and also those who used the method of a ‘hairy bag to the uterus, so that the sharp pains to the uterus caused from the hair caused the uterus to contract.

Pleasant aromas where used for patients to smell so as to disguise the unpleasant pungent odour of the ‘fumigation procedure to the uterus’ surgeons carried out. Their reasoning behind this method was that they believed the uterus would revoke the bad odours and move up in the direction towards the pleasant ones. Soranus condemned these treatments as harmful, painful and mostly ineffective.

Soranus had his own ideas about the treatment of a uterine prolapse, a method which was less painful and later on the pessary for pelvic organ prolapse and lubricant was to be innovated from this method.

He made the patient bathe the uterus in luke warm olive oil then corresponding to the shape and the diameter he would make a woollen tampon wrapped in very thin linen. He then dipped the tampon in diluted vinegar or the juice of acacia mixed with wine and applied this to the uterus whilst moving the uterus very gently upwards towards its natural anatomical state. To ensure the uterus stayed in position he wadded the whole vaginal cavity with wool. After this the woman’s legs were bandaged together where she remained on rest for 3 days. After 3 days the ‘pessary of wool and linen were removed.

Today’s methods have evolved still using pessaries as a non – surgical support mechanism for various types of pelvic organ prolapse conditions. There are many pessary shapes and sizes available, the most common used today are the ring and Gellhorn pessaries.

Pessaries are made from either PVC or silicone. Silicone being the favoured choice as it is flexible yet strong enough to support the prolapse and silicone is an inert material which reduces the chance of infection drastically.

There are various surgical procedures to correct pelvic organ prolapse conditions and the DaVinci Robot is one of the least invasive procedures for surgery to date.

Who knows, that maybe in another 100 years from now we will find the use of today’s pessaries and surgical procedures barbaric and unthinkable, but until we find the perfect solution to help women who suffer pelvic organ prolapse we just have to keep educating and raising the awareness that there are solutions out there for pelvic organ prolapses.

Written by Gaynor Morgan

 

For more information about types of pessaries and procedures visit www.incostress.com

Recommended reading available from all bookstores:

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Pelvic Organ Prolapse by Sherrie Palm

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Hold It Sister by Mary O’Dwyer

Hold It Mama by Mary O’Dwyer

Pelvic floor dysfunction in women before their first pregnancy

Credit: Lead women’s health physiotherapist Mary O’Dwyer newsletter

A high rate of pelvic floor dysfunction (PFD) in nulliparous women with clinically significant symptoms and associated bother has been reported in a cross sectional study (part of the SCOPE study) in Ireland.

A total of 1484 women completed the validated Australian Pelvic Floor Questionnaire at 15 weeks gestation. Urinary dysfunction was present in 61%, faecal dysfunction in 41%, prolapse in 5% and sexual dysfunction in 41%. The dysfunction was perceived as bothersome by 37%.

In the urinary section, 61% of participants reported at least one primary symptom and 35% showed clinically significant symptoms. In those who reported urinary incontinence (UI), stress urinary incontinence was present in 50%, urge urinary incontinence alone in 20% and mixed urinary incontinence in 30%. The overall prevalence of UI in this study was 24%.

In the faecal dysfunction (FD) section, 41% of all women were symptomatic for primary symptoms. Within this affected group, 5.3% reported faecal incontinence, 36.8% reported flatal incontinence and 5.5% reported obstructed defecation. The authors explain the high rates of FD could be partially explained by 11% of women having a medical history of irritable bowel syndrome, celiac disease or inflammatory bowel disease.

Pelvic organ prolapse symptoms were reported by 4.8% of all women and 26% of symptomatic women commonly reported symptoms of vaginal pressure or heaviness. The authors state these results should be interpreted with caution as some bowel or bladder related symptoms might resemble prolapse.

Sexual dysfunction symptoms were reported by 41% of all women. Within this group 31% reported dyspareunia (painful intercourse), 25% reported vaginal tightness/vaginismus, 4.8% reported vaginal laxity and coital incontinence was reported by 1.2%. Regarding dyspareunia, the authors believe it is due to endometriosis, which is more prevalent in nulliparous women.

The study demonstrates that in the majority of nulliparous women with PFD, the disorder affects more than one pelvic floor compartment simultaneously. The authors stated the ‘high prevalence of PFD and multi-compartment involvement in nulliparous women could possibly suggest that congenital factors play an important role in PFD development. In order to understand the real role of childbearing in pelvic floor morbidity it is important to know the natural history of PFD by studying women before and after their first delivery.’

The authors believe the strength of this study is the large number of nulliparous women with extensive, detailed demographic characteristics and medical history of the participants. The study can be considered representative of an entire population from a statistical point of view. The main limitation of this study is that the women were not clinically examined to verify the questionnaires findings. As women completed the questionnaire in early pregnancy, they cannot rule out the potential for confusion or recall bias, as questions related only to pre-pregnancy status.

Due to the high prevalence of PDF in pregnant nulliparous women, the authors say that a comprehensive approach to investigating this group is needed to determine their history of PFD. Postpartum follow up will detect the role of pre-pregnancy PFD in the structure of postpartum pathology and determine the women who could be at a higher risk of severe postpartum PFD.

Reference:

Durnea CM, Khashan AS, Kenny LC, Tabirca SS, O’Reilly BA. An insight in pelvic floor status in nulliparous women. Int Urogyn Journal. Vol 25: 3, 337-345. March 2014.

ImageMary O’Dwyer has written many wonderful books in a language every lay person can relate to. Her books ‘speak to you’ Hold it sister and hold it mama are available at all bookstores and on line at www.incostress.com

Medical professionals contact info@incostress.com for reduced prices on books.

 

Pelvic floor stimulators

Urinary incontinence and pelvic organ prolapse can have a significant physical, social and psychological for many women. There are a number of solutions in the management of these problems.

The process of urination and its control depend on an intact neuromuscular system. The bladder is made up of smooth muscle – the detrusor muscle, while the urethra has smooth muscles with a band of striated muscle. Both the somatic and autonomic nervous systems provide innervation to these muscles. The bladder muscle must contract while the urethral sphincter relaxes during urination. It works best when the two are coordinated. The pelvic floor musculature consists of striated muscle fibres innervated by the pudendal nerve. By supporting the bladder and helping to lengthen the urethra, the pelvic floor muscles assist the passage of urine and its control.

Electrical stimulation is a modality that physiotherapists use to treat a variety of conditions. Electrical stimulation is used to restore normal physiological reflex mechanisms in abnormal nervous systems and muscles, as well as to strengthen striated muscles. Using Electro therapy, we try to stimulate the fibres of the pelvic (S2-S4), hypogastric (T10-L2), and pudendal nerves. It is believed that electrical stimulation can inhibit detrusor activity by activating inhibitory nerve fibres in the sympathetic hypogastric nerve, and inhibiting parasympathetic excitatory nerves in the pelvic nerve. It is also used to stimulate and strengthen the striated muscles of the pelvic floor via the pudendal nerve.

Routinely used machines are the interferential electrical stimulation machine and intra-vaginal stimulation machines. The Empi Intravaginal Stimulation Unit is a unit providing neuromuscular stimulation that can be used at home by the patient. The unit consists of a compact battery operated stimulator has two independent channels. One channel operates at 125 Hz to promote bladder inhibition; the other operates at 50 Hz to stimulate muscle contraction. Both channels can be used separately, or together. The electrode is a soft, silicone rubber cylinder about the size of a tampon. The electrode can be easily inserted and the patient learns how to take proper care of it. The therapist adjusts the settings on the stimulator and then the patient is taught how to control the intensity. The intensity should be high enough to cause a muscle contraction but within the patient’s comfort limits.

Many of the patients with incontinence have weakened musculature contributing to their urinary incontinence. Their symptoms often improve when they follow their prescribed exercise program and have adequate strength. Electrical stimulation is indicated when they have strength less than ‘fair’ as measured during a manual muscle test. It may also be indicated to provide sensory stimulation for patients with urge incontinence.

It is always advisable to seek medical help and undoubtedly a good session with your women’s health physiotherapist is the best way for you to learn correct techniques.

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What is Estim?

Estim is known under a few descriptions, Erotic Stimulation, Erotic Electro Stimulation and Electric Stimulation.

Depending what your needs are there are plenty of devices to chose from and it is always best to discuss the types of devices with your medical advisor prior to investing.

Estim is also known as EMS Electrical muscle stimulation or neuromuscular electrical stimulation (NMES)

What ever you chose to call it or which ever product you decide to use all of them come down to one thing, which is forcing the of muscles to contract through electric impulses.

Women with weak pelvic floor muscles may see this as an easy option for pelvic floor exercising, but  with every good idea there is always a down side, which is why it is so important to discuss any alternative pelvic floor therapy with your medical advisor and physiotherapist. Over use of an electrical stimulation on muscles and cause over tightening of the muscles which can lead to fatigue.

Using Estim with a physiotherapist.

The physiotherapist may place electrodes on the skin in various locations or insert a probe into the vagina to be able to stimulate a single or group of muslces.

These controled contractions via electrical stimulation helps strengthen the affected muscles. The physiotherapist can chnage the settings to allow for a strong or gentle muscle contraction. Along with increasing muscle strength, the contraction of the muscle also promotes blood supply to the area that assists in healing.

EMS machines can be beneficial as a strengthening training device towards healthy muscles and ligaments. It can also be used effectively as a rehabilitation method in patients that have little or no sensation of the muscles.

The machines used in physiotherapy practises are more powerful and tend to reach deeper into the muscle mass than the home devices.

There are several types of EMS devices and are used in different ways but all end up with the same purpose: to contract and stimulate muscles through the delivery of electrical impulses.

EMS can be particularly helpful for stroke patients.

For more information about EMS, Estim and other muscle rehabilitation products please see the specialists www.win-health.com

Dribbly women don’t dance – incontinence and exercise.

Dribbly women don’t dance – incontinence and exercise by Elaine Miller physiotherapist

 If you are reading this you are not my audience.  Sorry.  The fact that you are reading something to do with incontinence suggests that you already have an understanding about the condition, are comfortable getting information about it, and are keen to learn more. So, you either are, or, will be, alright.

The people I fret about are the millions of women who are living with their leaking and not yet seeking help.  They just put up with having poor bladder control, pad up, and feel a bit disappointed.

Well, I say “feel a bit disappointed”.  In fact is that a third of them go on to develop clinical depression.  Of course, exercise is commonly recommended for managing mood disorders – but, if you leak when you run, well, you’re not going to go for a run, are you?

And, therein lies the huge public health rub.

Diseases of inactivity, like coronary heart disease, kill women.  One in eight UK women die from heart disease.  Exercise isn’t just about being able to keep up with the kids, or beating the blue, it’ll keep us alive.

But, speaking as someone who peed herself during zumba…it is very difficult to be physically active and avoid impact on your pelvic floor.

When I rule the world, some pieces of gym equipment will carry “pelvic floor warning” signs.  Rowing machines, reclining bikes, a loaded leg press – yep, wouldn’t want anyone with a prolapse on those things.  Oh, or trampolines, those things can have a label on them.  And, the plank, star jumps, tennis, lunges, I could go on.

In fact, I’d force incontinence pad manufacturers to print pelvic health advice on their packaging.  And, while we’re at it, they can fix that awful glue which comes unstuck and allows the pad to attach itself to your labia instead of your gusset…ouch.

So, we’ve got a classic Catch 22.  In order to reduce your risk of pelvic organ prolapse and your symptoms of stress incontinence you need to keep your weight under control.  But, you wet yourself at zumba, so aren’t keen…

Pelvic floor friendly exercises have reduced impact forces – like swimming, cycling, pilates (when it’s well taught and you are absolutely sure your technique is good), speed/power/Nordic pole/hill walking, aqua-aerobics and low-intensity cross trainers.

However, runners?  They wanna run, not walk, they want to run. That’s when internal support can be helpful, Sherrie Palm (she knows everything there is to know about pelvic floors) says that pessaries like incostress should be used when a woman is participating in acvities with impact.

Now, that does not mean that you can shove in a grade 4 prolapse with an incostress and get back to athletics training…but, it does mean that if you have a mild prolapse, or mild stress incontinence symptoms, and you are complying with a pelvic floor strengthening regime which your physiotherapist has given you, AND you use internal support – well, you just might manage to get back to zumba.

Ask me how I know.

Credited to  Elaine Miller Gussie Grippers

Elaine Miller on of the UKs leading physiotherapists who has a post-grad in sports medicine. She focuses her energy on helping women overcome pelvic floor disorders and incontinence and breaks down the taboo through her humour and pelvic floor parties where she has a one hour solo show entitled ‘Gusset Grippers’. Look out for Gusset Grippers at Edinburgh Fringe Festival this August. An amazing lady who fears no pelvic floor!

Find out more about Gusset Grippers on the Gusset Grippers website 

Elaine’s blog and more information on where to see Elaine at the Edinburgh Festival

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