After reading a Medscape article about compassion fatigue and cancer care, it seemed appropriate to bring up the topic for pelvic rehab therapists and providers. In the article, burnout is described with phrases such as overwhelming exhaustion, detachment from job, and a sense of ineffectiveness. Compassion fatigue, while being associated with burnout, is related more directly to being in a role of helper to those in distress, thereby creating tension and distress for the one giving care. Health care workers are believed to be a vulnerable group for this compassion fatigue.
Many of the pelvic rehab therapists I have met over the last decade describe the challenges of working with this rewarding, yet challenging population. Patients with chronic pelvic pain are particularly in need of a listening ear and also require a significant amount of case management, hands-on rehabilitation, and encouragement. All of these factors can lead to increased work task burden for the therapist as well as psychological burden from carrying the weight of the patient's suffering. It then becomes important to "heal the healer" as described in this family practice article.
There are some resources in place at various work sites, such as employee assistance programs that provide a few visits to a counselor, and these should be used readily as the visits are usually free to an employee. The life skill of self-care does become the responsibility of the care provider, however, and in order to take care of ourselves the basic (but difficult to achieve) balance can be maintained by good nutrition, breaks from work (not documenting through lunch), having our own social support, and getting sleep and exercise.
You can take a Compassion Fatigue self- test, or the Professional Quality of Life (ProQOL) testhere.There are resources to combat burnout, one of the latest that I've seen is a book by Joan Borysenko, PhD. Check out her book Fried: Why You Burn Out and How To Revive.Another book that is clear in practical suggestions is The Art of Extreme Self-Care by Cheryl Richardson. You may also find support within the pelvic rehab community, as the therapists who have similar jobs truly understand some of the challenges as well as the rewards of our meaningful work. It is the hope of the Pelvic Rehab Institute that therapists continue to look towards the Institute to provide such support and a sense of community.
In a study that was originally published in Alimentary Pharmacology and Therapeutics, researchers correlated self-reported irritable bowel syndrome (IBS) with symptoms of urinary incontinence, pelvic organ prolapse (POP), sexual function, and quality of life (QOL.)
In a population of more than 2100 female patients, the reported incidence of IBS was nearly 10%. Within these women, an increased risk of bother from prolapse and sexual dysfunction was reported as well as a decrease in quality of life scores. The authors point out the hypothesis that frequent bouts of constipation may lead to weak pelvic floor muscles, and therefore increased pelvic prolapse, but this remains to be proven in the literature.
This study is meaningful not only because it evaluates information about a large group of women, but also because the population is a diverse group between the ages of 40 and 69. As IBS according to the ROME III can be further divided into constipation-dominant, diarrhea-dominant, or both, it makes sense that pelvic floor dysfunction is correlated to the diagnosis. Many patients who experience loose stool with IBS may unknowingly tighten the pelvic floor chronically to avoid leakage, and this in itself could lead to pelvic muscle tension and dysco-ordination as we see in many of our patients. Those patients who experience constipation and straining may also interfere with healthy muscle activity and create prolonged stress on the supporting tissues in the pelvis and pelvic floor.
The relationships pointed out in this study remind rehabilitation experts that it is important to ask detailed questions about all aspects of a patient's pelvic health, from sexual function to bladder or bowel function. This study is now available in PubMed Central, where you can find free, full-access articles.
Abdominal adhesions following surgeries can lead to pain with bowel function or general movement. This study aimed to assess whether or not a specific manual therapy approach could reduce the prevalence of such painful adhesions.
Researchers using an experimental animal model did in fact report benefits from applying post-operative visceral mobilization (VM). 3 groups of 10 rats were examined post-mortem at 7 days following an adhesion-producing surgery. The rats in the Lysis group were treated (unsedated) on day 7 only, while the Preventive group animals were treated daily beginning the day after surgery.
The severity and the number of adhesions were significantly lower in the Preventive group. Clear signs of disrupted adhesions were noted in both the Preventive and Lysis groups. The authors in this study conclude that pending further studies, “…visceral mobilization could readily be implemented into post-surgical care and patient education.” They propose that VM could aid in preventing and/or treating abdominal adhesions.
This is a very well cited study that describes the available literature in reference to abdominal surgery and adhesions. Although an animal model was utilized, the authors believe that the assessment and treatment to the animals creates an environment that encourages tissue mobility and discourages fibroblast invasion of the peritoneal tissues in the same manner as human tissues would react.
You can check out coursework that the Institute offers that focuses on visceral mobilization for patients with pelvic issues.