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Physio for your… Behind?! Anorectal Disorders Explained!

Pelvic floor physiotherapists are physios who have had additional training to perform external and internal pelvic exams in order to treat a variety of pelvic floor disorders. Among those disorders include some that pertain to the dysfunction of the bowel – your behind. These anorectal disorders may include

  • Leaking of stool from the rectum (fecal incontinence)
  • Inability to control flatulence (being unable to hold back a fart)
  • Chronic constipation
  • OASIS (obstetric anal sphincter injuries) which include 3rd or 4th degree perineal tears sustained during labour and delivery, rectocele, rectal prolapse, and pain disorders of the anus
There is something we can do to help!

Fecal incontinence refers to the uncontrolled passage of fecal material (aka poop) in individuals who are 4 years old or older. There can be various reasons why fecal incontinence may be present. There may be damage to the internal or external anal sphincters during OASIS. Radiation therapy for certain pelvic cancers may have reduced the ability of the rectum to stretch contributing to incontinence, stool consistency may be too liquid making it difficult for the sphincters to stop the feces from exiting the anus (possibly due to partial bowel resection surgery due to various medical conditions. Food intolerances/poor diet may also cause stool consistency to be too loose. There may be some weakness in the external anal sphincter muscle or the puborectalis portion of the levator ani muscle (the main pelvic floor muscle group) contributing to leakage of stool.

Some leakage can be due to nerve disorders (example multiple sclerosis). Sometimes even chronic constipation can be a source of loose stools leading to fecal incontinence!

 

What does it mean to have a 3rd or 4th degree tear during labour and delivery?

A 3rd degree tear is a tear into the external anal sphincter and a 4th degree tear includes tearing into the internal anal sphincter. These two sphincters are what control the exit of the stool and gas out at the anus from the rectum. When there is a tear in the sphincters, the scar tissue that forms from the injury may cause problems. Common issues to these injuries include having pain during bowel movements and it can contribute to constipation. There can also be low tone of the IAS or EAS (internal or external sphincters) or weakness of the external anal sphincter that may cause fecal incontinence or difficulty with controlling an unwanted fart. Fecal urgency can also be a symptom following 3rd or 4th degree vaginal tears.

Even if there is no bowel dysfunction in the post partum period following labour and delivery with a 3rd or 4th degree tear, having a pelvic floor physiotherapist examine the pelvic floor and provide an individualized home exercise program to optimize the scar tissue mobility, pelvic floor mobility and strength, and provide education on optimization of defecation strategies. This can be very helpful as sometimes occult injuries (meaning those without obvious injury to the anal sphincters) are present. They could result in symptoms like fecal urgency and loss of control of farting or fecal incontinence later in life (post menopausal).

Proactive treatment can be beneficial in these cases!

Chronic constipation is often characterized by:

  • having a bowel movement less than 3 days/week
  • and/or a stool consistency on the Bristol Stool Chart of Type 1 or Type 2
  • history of very large bowel movements (plugging the toilet for instance)

A pelvic floor physiotherapist can be helpful in providing various strategies to assist with the evacuation of the bowels. Some basic recommendations may include:

  • general advice on fibre and fluid intake recommendations for optimal stool consistency
  • activity recommendations
  • manual therapy techniques to assist with motility of the stool through the rectum
  • education on various physical evacuation strategies
  • breathing techniques to assist with optimal bowel evacuation
  • minimization/elimination of straining

 

 

 

For those suffering from prolapse, a physiotherapist can help by teaching optimal defecation techniques to reduce strain to the area, thereby reducing strain to the tissues. There may also be too much tension in the pelvic floor muscles or there may be scar tissue present from obstetrical or other surgical injuries which can lead to pain in the pelvic floor or anus with or without having a poop.

Struggling? Book online with a physiotherapist today in Warman at Warman Physiotherapy & Wellness or Saskatoon, at Warman Physio Saskatoon. Don’t see a spot that works? Add yourself to the waitlist! You can even select if you have a therapist, location, and day/time preferences!

 

 

This post was created by Maja Stroh MPT and pelvic health physiotherapist at Warman Physiotherapy & Wellness

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Why Should I Sit to Pee?

Half the population doesn’t give it much thought. The other half have various opinions. For people that have the option to stand to pee, here are some reasons to sit!

 

Potty Learning

When young children are first learning to use the toilet, it can be easier to teach them to stand to pee. Maybe they already stand to pee in their diaper. Maybe they don’t have the patience to wait to sit to pee. Whatever the case may be, sitting to pee has many benefits through the potty training phases.

Sitting to pee (at all ages) will decrease the amount of mess in the bathroom. Huge motivating factor if you ask me! This mess is reduced even if you are able to continuously hit the bullseye. Having the ability to sit to pee will also help young bodies learning the new skill to relax fully. Being able to relax all the pelvic floor muscles when you sit, gives kiddo the opportunity to have a poop too. Remember from a previous article – being constipated actually makes potty training harder!

 

Adults

Many adults struggle with functional constipation as well. We may still be pooping every day – but not completely emptying. This can lead to issues such as tightness, pain, or perineal discomfort that is tricky to pin down a cause to.

Sitting to pee often seems to take significantly more time, even for adults

Public Bathrooms

The most common question I get is – but what about public bathrooms? We all know the state those washrooms can be in… ick. So of course, in the event of a less than stellar bathroom situation, or being out in the wilderness, standing to pee is a great option! By all means use it!

Just remember – sitting to pee as a general default can often save you headaches later!

 

 

Haylie has been practicing pelvic health and focused in prenatal and post-partum care since graduating from the U of S MPT program in 2011. Officially adding to her practice pediatric pelvic floor therapy in 2017. She has been advocating for treatment for women, ensuring appropriate and effective care throughout pregnancy and post-partum, and helping all expecting and post-partum moms ultimately brought her to open her family-friendly clinic. She now primarily focuses on pediatric pelvic health, perinatal care, and persistent pain in her practice in Warman and Saskatoon locations.

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Easing into the New Year

It is another New Year. A time of change and reflection. Last year we wrote our New Year blog with the knowledge that the year was going to be VERY different. Forced changes were happening even as the holidays were gearing up. What we didn’t know is how much of a collective experience having control snatched away would be!

This year it feels that instead of jumping into new resolutions and generalizations of what the year has in store, we are all keeping a close eye on 2021. The new puppy that you aren’t sure won’t wreck those shoes or pee on the carpet. Whatever 2021 had had in store for you, we truly wish that 2021 brings the growth and expansion of happiness and health to all our clients and communities.

Eloquence and gushing are not something that many people find comfortable, including us, however this reflection begs some serious accolades. This past year has shown us that our team is rock solid. We have phenomenal staff. Not only were they able to pick up the slack for Haylie stepping back for her own treatment, but they were able to do this AND navigate a pandemic! Our team had nothing but the health and well-being of our clients and community at the forefront throughout the entire process.

It is for these reasons that we are grateful to 2020. It showed us:
  • We can do hard things (very VERY hard things)
  • Everyone has each others back
  • Continuing as a team and supporting our clients remained a top priority
  • Striking a work/life balance made a big difference in our ability to show up for our clients
  • The adaptability and mental flexibility to move from in-person to virtual services was phenomenal
  • Our values and mission has held strong and true through this whole endeavor

Changes are inevitable. Such massive changes as a collective society is less common. Beyond a shadow of a doubt that we are proud of our clients and community to make this pivot in our social and professional interactions. We have also discovered that some massive changes will not waiver the core values.

Warman Physio will continue to provide:
  1. Exceptional comprehensive and compassionate care
  2. A family friendly and welcoming environment where you are heard
  3. Services across a wide span of providers to best suit your needs

So even though we are all watching our backs waiting to see what 2021 has in store for us, we still plan on going out and exploring the ways we will grow this year.

 

P.S. Did you know we have some new services? Check them out and see how to book:

Virtual Services: Physiotherapy, Dietitian, Counselling

In-person: Fitness, Physiotherapy, Massage, Occupational Therapy, Dietitian, Counselling

Return of Haylie to Practice: Virtual exclusive

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Are We Ever Ready?

Thank YOU!

In a blink we are nearly into June 2020. Halfway through the year. Nearly half of that time spent in a pandemic. Feels weird to some days be “ok” while others feeling like you can barely hold it together long enough to get through that next task.

It has felt like from the moment we announced the clinic closure to in-person care March 18 we have been consistently adjusting, moving, re-planning. Through it all we have been forever grateful to the community and our clients for your understanding and grace you have given us during this time. I don’t think we can ever over-state how deeply we appreciate your support during these many transitions!

In-Person Care

Although things are still seeming to be ever changing, we have settled on some specifics for those that are appropriate for our in-person appointments we are providing for Physiotherapy & Massage services at this time.

  1. Ensure you have completed your online COVID screening questionnaire and re-book if you are feeling at all unwell
  2. When you arrive please stay in your vehicle! Our team will call you when they have your personal waiting room ready
  3. We are required to have everyone who enters the building to wear a mask (please bring one with you to your appointment)
  4. There will be hand sanitizer available for you to use once you enter the building
  5. The bathrooms at this time are closed to public use
  6. Contact-less payment is preferred whenever possible

*Please note that depending on the type of appointment you are scheduled for, your therapist may have differing levels of PPE on

 

PPE (Personal Protective Equipment)

At the clinic the therapists and staff have access to approved PPE for all levels of available services. This means various levels of equipment will be used for different treatment types, in addition to personal protective measures that each therapist feels necessary to take for their own/family safety.

You will always see your therapists and staff in a mask if they are unable to remain physically distanced (this includes Laura until our fancy new sneeze guard comes!) – which of course will be the case for any in-person/hands on appointments. You may also see: protective eye wear, a gown/specific lab jacket (we have special ordered some), and/or gloves.

It must be noted that at this time we are not completing any assessment or treatment intraorally. This means that until further notice appointments for TMJ will not be able to evaluate the muscles within the mouth. We can however, still provide assessment and treatment of any additional factors that would be related to the neck and external to the mouth!

 

Why are we so diligent?

We are so fortunate to have such understanding clientele at the clinic, and haven’t had any issues with our new protocols and procedures. It is important that we ensure that our clients understand why it is important that we follow the guidelines, are honest in our COVID screening questionnaires for a couple main reasons.

1) There are hefty fines for not following the proper protocols

Businesses that do not comply with the government or association guidelines are at risk of fines up to $250,000. We have been so grateful to persevere through this pandemic to date. Fines during this time not only for our business, but any business, could prove catastrophic for any business.

2) We need to protect those that are at risk that are coming in to provide care

There are some individuals at the clinic that are at-risk themselves or have family members that are at greater risk for COVID.

Although I am a generally private person, I have felt that now is the time to let our clients and community know that I have been diagnosed and started treatment for cancer. COVID has thrown a real wrench in the entire process and brings a new element to have to navigate during an already challenging time. As many people know, my dad has leukemia and has for years so I am very familiar with the increased protective measures required for a compromised immune system during a typical flu season. I am confident in our team’s ability to navigate these uncertain times and continue to provide the high level of care that we have become accustomed to.

~Haylie Lashta

Our top priority is the health and safety of our staff, the clients, and the community. We appreciate that we are all working together through these processes.

Thank you for choosing us to help you, help yourself!

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Re-open Sask at Warman Physio

The Saskatchewan Government announced the plan to re-open Saskatchewan on April 24 at 11am. We are so grateful to have been included in Phase 1 and Phase 2 with the services provided at the clinic. Many of our clients and community members reached out and flooded us with calls, emails, and messages asking what the plan was. We are happy to have an initial first announcement of our re-opening plans available.

Waiting patiently for the regulations from our licensing bodies after the announcement was difficult but necessary to ensure that we are able to meet the required protocol changes at the clinic in order to re-open. We will continue to monitor the requirements, as they are continually changing as well!

We will note that at this time we are still awaiting guidelines for the Massage Services. Once we have this information we will evaluate the ability to provide services and what the time line looks like. At this time all counselling and nutrition services will remain virtual services only as well.

Slow and Steady

We have been working diligently since the announcement to procure personal protective equipment (PPE) and creating policies and procedures to ensure that we meet, and exceed, the standards set. The health and safety of our clients, community, and staff are of the utmost importance. We are taking this re-opening seriously, ensuring that we are moving slowly, making significant adjustments, and allowing for as much physical distancing as we can allow.

This being said, physiotherapy and massage are a hands-on in-person appointment. If you are coming into the clinic we will be unable to maintain physical distancing. Having appropriate PPE and sanitization protocols between each client is how we will be mitigating the risk of the inability to maintain social distancing. We have been providing telehealth appointments to our current client base for over a month, and we are confident in the quality of the service that can be provided remotely to our clients. With the indication that physical distancing options are still considered the best options we will continue to have a primary focus on telehealth options. Telehealth services will remain a permanent offering at the clinic and will be utilized extensively during this time of re-opening in combination with in-person appointments as needed.

Just because we are permitted to re-open doesn’t mean it will be back to business as usual for us. There are going to be some significant changes moving forward, and some of these changes may remain well into the future.

What to Expect

Prior to booking an appointment you will be asked to complete a screening tool to determine the best-fit assessment/treatment option. This will help us to determine who is going to be seen in-person and who is ideal to be seen remotely. Having strict guidelines will ensure that everyone will receive the most appropriate and safest option for booking at this time. Once you have been deemed appropriate for in-clinic care you can expect to see the following measures in place:

  • Everyone will receive a COVID screening questionnaire via email prior to their appointment
  • Clients will be asked to wait in their vehicle and not come into the building until after your therapist calls you; they will ask you the screening questions again prior to entering the building
    • Should a client not pass the screening questionnaire they will not be permitted in the building
    • It is paramount for the health and safety of our staff and community that everyone answer the questions truthfully
  • Prior to entering the building please put on your face mask
  • Upon entering the building the client will sanitize hands appropriately
  • Your therapist will have all appropriate PPE in place and has been trained and tested on their ability to don and doff PPE
  • The therapist will guide you as to what PPE is required of you prior to your appointment
  • At the end of the appointment you will be able to pay online, or utilize the tap function on the machine at the clinic
  • Please do not attend an appointment if you are feeling sick or unwell
  • At this time the clinic will not be providing public washroom use
  • We are encouraging anyone who has the option to come alone to please do so, however, we understand that there are some limitations to this
    • If the client must come with additional individuals, the COVID questionnaire needs to be filled out for each person attending the facility

How we are protecting you

In addition to our usually stringent cleaning protocols, personal hygiene, and overall cleanliness, we at Warman Physio want you to know some of the additional measures we will be taking:

  • The door will be locked between clients to reduce the amount of foot traffic in the clinic
    • Contact us via phone (306-373-9355) or email (info@warmanphysio.com) to discuss booking an appointment
  • Clinicians will be completing the COVID questionnaire prior to coming into the clinic and will be unable to work if they are unsuccessful at completing it
  • Proper PPE has been procured and will be utilized appropriately throughout the appointment
    • All staff and therapists will be trained and tested in their ability to don and doff PPE properly and can instruct their clients in appropriate usage as well
  • The therapists are spreading out appointments to allow for physical distancing; there will be no overlap in clients in the clinic to allow for a complete sanitization of the common spaces
    • This may lead to some delays despite planning in advance and providing additional time between appointments, please be patient as we figure out the best practices!
  • All unnecessary items will be removed from the counter surfaces
  • We are only allowing scheduling of therapists at specific times and in specific combinations to allow for physical distancing
    • This may mean that until further notice that you may not be able to schedule appointments with different providers back to back as we are typically accustomed
  • At this time there is a significant increase in required PPE to provide appointments for TMJ and pelvic health. As such these appointments  will not be appropriate for in-clinic care at this time

Cautiously Optimistic

We cannot express enough how much providing care to our community and returning to in-person services means to us. We have been missing the connection and interaction that comes with in-clinic care. Of course we hope that the re-opening of Saskatchewan goes smoothly and we are able to maintain a controlled spread; and we understand the role that we play in making this dream a reality. Should there be indication or recommendation that we must again eliminate in-clinic care we of course will follow any and all recommendations. Knowing that our community supports us in our slow re-opening has been a huge weight lifted off our shoulders and for this we will be forever grateful.

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