WH follow-up

Subjective: - Bladder: Patient reports a decrease in urinary frequency from every 2 hours to every 3-4 hours since starting pelvic floor exercises. No leakage reported. - Bowel: Patient reports regular bowel movements, no constipation or straining. - Sexual Function: Patient reports improved sensation and comfort during intercourse. - Prolapse Symptoms: Patient denies any feelings of heaviness or bulging. - Pain: Patient reports no pelvic pain. - Past Medical History: Patient had a vaginal delivery 2 years ago. No previous surgeries. - Medications: Patient is not taking any medications or herbal supplements. - Social History: Patient is a stay-at-home mother, lives with her partner and child. She is a non-smoker and drinks alcohol socially. - Compliance with Home Exercise Program: Patient reports consistent adherence to the home exercise program, performing exercises daily. Objective: - Physical Examination: - Observation: No visible prolapse. - Palpation: Pelvic floor muscles demonstrate good tone and strength. - Strength Testing: Pelvic floor muscle strength assessed at 4/5 on the Oxford scale. - Imaging Results: No imaging performed. Impression Patient demonstrates significant improvement in pelvic floor function and symptoms since the initial assessment. Continued progress is expected with ongoing adherence to the home exercise program. Treatment 1. Education: - Reviewed proper pelvic floor muscle contraction technique. - Discussed bladder diary and fluid intake. - Provided education on constipation management. 2. Manual therapy: - Internal pelvic floor muscle release performed. Home exercise program: - Pelvic floor muscle contractions: 10 repetitions, 3 times per day. - Abdominal bracing: 10 repetitions, 3 times per day. - Diaphragmatic breathing: 10 repetitions, 3 times per day. Plan Review patient in 4 weeks. Continue with home exercise program. Discuss progression of exercises at next visit. Dr. Sarah Jones, Chartered Physiotherapist