F/U Pelvic Health (Issues List)

"Notes transcribed via Heidi Health - patient consented verbally prior to commencing session" Patient Information: - Sarah Jenkins, Age: 45 years and 3 months, Female - Occupation: Marketing Manager - Physical Activity: Walks 30 minutes daily, attends yoga twice a week, occasional swimming on weekends. - Present: John Jenkins (Husband) - Upcoming Appointments: Gynaecologist follow-up on 15 November 2024 --- Subjective: - Reason for visit: Follow-up regarding ongoing pelvic floor dysfunction, specifically urinary urgency and mild prolapse symptoms. Patient also requested guidance on returning to running. - Progress since last appointment: Reports slight improvement in urinary urgency, now experiencing 4-5 urgent episodes daily compared to 7-8. Prolapse symptoms (vaginal heaviness) are stable, still present in the late afternoon. Has been diligent with home exercises. - Adherence to home exercises: Adherent to all prescribed home exercises, performing them twice daily as instructed. Finds the Kegel exercises easier now. - Bladder Symptoms: Urinary urgency 4-5 times daily, with occasional urge incontinence (1-2 times per week, requiring a thin pad). Nocturia 1-2 times per night. Reports improved control with urge suppression techniques. Voiding function is generally good, no straining. - Bowel Symptoms: Bowel frequency 4-5 times per week, stool type 3-4 on Bristol Stool Chart. No urgency or incontinence. Reports occasional mild straining. Has increased fluid and fibre intake as advised. - Prolapse Symptoms: Reports a feeling of vaginal heaviness/bulge, particularly after prolonged standing or at the end of the day. No impact on voiding or defecation. Feels it is a stage 1 bulge. - Sexual Symptoms: Reports mild dyspareunia with deep penetration, stable since last visit. No other sexual symptoms. - Completed Investigations with Results: None reported since last visit. Patient Goals: - Short-term goals: Reduce urinary urgency to 2-3 episodes daily within 4 weeks. Improve pelvic floor muscle strength to allow for comfortable return to light jogging within 6 weeks. - Long-term goals: Fully resolve urge incontinence and dyspareunia within 6 months. Maintain active lifestyle without pelvic floor symptoms. - Progress towards goals: Good progress towards short-term goals. Urinary urgency has decreased, and PFM strength has improved, indicating she is on track for a return to light jogging. --- Objective: PFM assessment: - PFM examination findings: Internal vaginal examination performed with verbal consent in supine hook-lying position. Good tone, no noticeable prolapse on straining (GH+PB -/0), strength 3/5 (previously 2/5), endurance 5 seconds (previously 3 seconds), good relaxation. No tenderness on palpation. MSK assessment: - MSK examination findings: General observation: good posture, no obvious gait abnormalities. Lumbar spine ROM full and pain-free. Hip flexion 110 degrees bilaterally, abduction 40 degrees bilaterally, both pain-free. No tenderness in lower abdominal or hip musculature. --- Action Taken: 1. Urinary Urgency and Incontinence - Interventions: Reviewed urge suppression strategies and provided biofeedback for optimal pelvic floor muscle contraction. // Patient response: Patient demonstrated improved understanding and technique. Reported feeling more confident in managing urges. - Education: Discussed bladder retraining principles and fluid intake modifications. 2. Mild Pelvic Organ Prolapse - Interventions: Progressed pelvic floor muscle exercises to include functional bracing techniques during lifting and coughing. Reviewed pessary options for potential future consideration. // Patient response: Patient understood the bracing techniques and found them helpful. Expressed interest in learning more about pessaries. - Education: Re-emphasised the importance of avoiding constipation and heavy lifting. 3. Return to Running - Interventions: Provided a graded return-to-running programme, starting with short intervals of walking and light jogging. Emphasised core engagement and landing mechanics. // Patient response: Patient was enthusiastic and understood the gradual progression required. - Education: Discussed appropriate footwear and the importance of listening to her body. --- Evaluation: Good progress towards short-term treatment goals, particularly with urinary urgency and PFM strength. Patient is motivated and adherent to the home program. Home Program: Continued twice-daily pelvic floor muscle exercises (incorporating new functional bracing). Bladder retraining log to continue. Initiated graded return-to-running program (walk 3 mins/jog 1 min x 5 repetitions, 3 times per week). Handouts/Leaflets: "Managing Urge Incontinence" leaflet emailed. Printed copy of graded return-to-running program provided. --- Plan: - Review: Next appointment in 3 weeks, 1 November 2024. - Letter: Letter to be sent to GP outlining progress and ongoing plan. - Ongoing plan: - Urinary Urgency and Incontinence: Continue bladder retraining and PFM exercises. Monitor pad usage. - Mild Pelvic Organ Prolapse: Continue functional bracing techniques. Discuss pessary fitting if symptoms do not continue to improve. - Return to Running: Progress running program as tolerated. Address any discomfort or symptoms as they arise.