(646) 355-8777

Herman & Wallace Blog

Adapting Pelvic Muscle Exam for Patients with Obesity

A few weeks ago, a pelvic course participant shared some sensitive and intimate thoughts about being at a course and being "the biggest girl in class." This week, we will address specific strategies for communicating with your patients and for adapting your exam techniques when appropriate. The following quote is from an educational book for Nurse Practitioners, and echoes a very healthy and realistic sentiment about our role when working with patients in pelvic rehabilitation.

"If the exam is limited by obesity, the patient should be told in a clear, non-judgmental manner. Patients have a right and responsibility to understand the findings of the health care visit."

Unfortunately, according to the authors, women who are obese are less likely to receive routine gynecologic care due to bias and fear of judgement, or even practical issues like exam tables, gowns, and equipment not being adequate. Another issue is that of mobility: is the exam table too narrow for safety and comfortable positioning? In my own clinical practice, I have had patients ask me: "Is that massage table going to hold me?" In order to answer that question, you need to know what the safe weight limits are for your chairs, walkers, exam tables, and any other equipment your patients may use. You might imagine that if a patient is concerned about falling off of a table, completing an appropriate exam could be difficult due to muscle guarding. Other techniques recommended include the following:

- ask an assistant to gently hold back skin folds if vagina or vulva is obscured
- ask the patient to flex her hips upward if able
- ask patient to help hold back excess skin in lower abdomen if helpful
- ultrasound may be used rather than palpation as needed (this is in reference to a medical gynecologic exam, but how might rehab US contribute to our toolkit?)
- document any difficulty with the examination - placing a small towel or pillow under the patient's hips may also help in viewing the cervix

This "Bias Tool Kit" offers further suggestions to avoid causing harm when evaluating a woman who is obese:

- if you would like to weigh the patient, ask for consent first, using sensitive language, i.e. "would you like to be weighed today?" and maintain privacy
- in addition to considering equipment like tables, think about having a stepstool with a handle, properly sized blood pressure cuffs, sturdy, armless chairs, and a long exam speculum
- use words that patients find more acceptable, such as excess weight or BMI

Advice to the nurse practitioners include the following to counter the fact that obese women are often discriminated against:

"If the exam is limited by obesity, the patient should be told in a clear, non-judgmental manner. Patients have a right and responsibility to understand the findings of the health care visit." For example, for a medical exam: "Due to the shape and size of your body, I wasn't able to feel your uterus and ovaries." Any similarly needed communications can be shared in a professional and warm tone.

While sensitive topics can require patience, practice, and an abundance of professionalism, everyone wins when difficult subjects are approached with honesty. Thanks again to Erin B. for shining her light on this sensitive and valuable topic.

Visceral Mobilization as a Component of Manual The...
Do Male Therapists Belong in Pelvic Rehab: Part II

Upcoming Continuing Education Courses

Pelvic Floor Level 1 - Chicago, IL (Rescheduled)

Apr 3, 2020 - Apr 5, 2020
Location: Cancer Treatment Centers of America - Chicago, IL

Male Pelvic Floor - St. Paul, MN (Rescheduled)

Apr 3, 2020 - Apr 5, 2020
Location: Regions Hospital

Pelvic Floor Level 1 - Boston, MA (Rescheduled)

Apr 3, 2020 - Apr 5, 2020
Location: Marathon Physical Therapy

Chronic Pelvic Pain - Kansas City, MO (Rescheduled)

Apr 3, 2020 - Apr 5, 2020
Location: Saint Luke\'s Health System

Pudendal Neuralgia and Nerve Entrapment - Philadelphia, PA (Rescheduled)

Apr 4, 2020 - Apr 5, 2020
Location: Core 3 Physical Therapy

Pelvic Floor Level 2B - Freehold, NJ (Rescheduled)

Apr 4, 2020 - Apr 6, 2020
Location: CentraState Medical Center

Sexual Interviewing for Pelvic Health Therapists - Seattle, WA (Rescheduled)

Apr 4, 2020 - Apr 5, 2020
Location: Evergreen Hospital Medical Center

Pelvic Floor Level 2A - Grand Rapids, MI (Rescheduled)

Apr 17, 2020 - Apr 19, 2020
Location: Mary Free Bed Rehabilitation Hospital

Pelvic Floor Level 1- Kansas City, MO (Rescheduled)

Apr 17, 2020 - Apr 19, 2020
Location: Centerpoint Medical Center

Oncology of the Pelvic Floor Level 1 - Grand Junction, CO (Rescheduled)

Apr 17, 2020 - Apr 19, 2020
Location: Urological Associates of Western Colorado

Mobilization of Visceral Fascia: The Gastrointestinal System - Arlington, VA (Rescheduled)

Apr 17, 2020 - Apr 19, 2020
Location: Virginia Hospital Center

Pelvic Floor Level 2B - East Greenwich, RI (Rescheduled)

Apr 17, 2020 - Apr 19, 2020
Location: New England Institute of Technology

Pilates for the Pelvic Floor - Livingston, NJ (Rescheduled)

Apr 18, 2020 - Apr 19, 2020
Location: Ambulatory Care Center- RWJ Barnabas Health

Genital Lymphedema

Apr 24, 2020

Pelvic Floor Level 1- Canton, OH (Rescheduled)

Apr 24, 2020 - Apr 26, 2020
Location: Aultman Hospital

Pelvic Floor Level 1 - Rochester, NY (Rescheduled)

Apr 24, 2020 - Apr 26, 2020
Location: Unity Health System

Pediatric Functional Gastrointestinal Disorders - Ann Arbor, MI (Rescheduled)

Apr 24, 2020 - Apr 26, 2020
Location: Michigan Medicine

Lumbar Nerve Manual Assessment and Treatment - Madison, WI (Rescheduled)

Apr 24, 2020 - Apr 26, 2020
Location: University of Wisconsin Hospital

Pelvic Floor Level 2A - Winfield, IL (Rescheduled)

Apr 24, 2020 - Apr 26, 2020
Location: Northwestern Medicine

Low Pressure Fitness for Pelvic Floor Care - Trenton, NJ (Rescheduled)

Apr 24, 2020 - Apr 26, 2020
Location: Robert Wood Johnson Medical Associates

Athletes & Pelvic Rehabilitation - Minneapolis, MN (Rescheduled)

Apr 25, 2020 - Apr 26, 2020
Location: Viverant

Sacral Nerve Manual Assessment and Treatment - Fairlawn, NJ

May 1, 2020 - May 3, 2020
Location: Bella Physical Therapy

Pelvic Floor Level 1 - Fayetteville, AR

May 1, 2020 - May 3, 2020
Location: Washington Regional Medical Center

Pelvic Floor Level 1 - Boise, ID

May 1, 2020 - May 3, 2020
Location: St Luke's Rehab Hospital

Pediatric Incontinence - Duluth, MN

May 1, 2020 - May 3, 2020
Location: Polinsky Medical Rehabilitation Center

Yoga for Pelvic Pain - Online Course

May 2, 2020 - May 3, 2020