Prolapse and Sphincteroplasty

My wife has been dealing with this as a result of a 4th degree episiotomy from our first son who was born 16 years ago. After years of no serious issues, her situation has become increasingly worse the last few years, specifically with regard to bowel continence. She has always been active, as in lifting, crossfitting, etc. Today she went to see a doctor, and a PA said “who told you it was okay to squat in your condition? You could literally blow your asshole out of your body! You need to not strain those muscles.” Not sure if this is an overly dramatic nocebo or if it’s actually within the realm of possibility. She has not had a surgery in a couple of years and has been training all along.

She was there to see an ortho (who was out by the way) about some tailbone pain she has been having for a very long time (the doctor had given her a shot about a month ago that didn’t bring any relief), but instead could only see the PA. Now she’s suddenly concerned that the training she has been doing may have contributed to her worsening symptoms the last few years. She has been seeing a specialist who works with pelvic floor issues and exercises to help with the continence. She also has an Interstim device to help stimulate the muscles in the pelvis to control her bowels better. It seems to be hit or miss. To say she’s not tried everything possible is an understatement.

So for the question, do you think the PA’s words have merit? My wife is wondering why no doctor ever told her to quit squatting like this, because she’s been very transparent about how she trains. Giving up her training would be another huge blow to her at this point. Living with the issue as she has if lifestyle-impacting enough as it is.

It is unfortunate that the PA you saw chose to use such unnecessarily graphic and dramatic language.

There is likely to be some amount of risk with respect to worsening pelvic organ prolapse in this situation, though no one can quantify it or accurately predict theta future clinical course.

However, this touches on one of the most frustrating things I hear about when people see healthcare professionals: we are specifically and repeatedly trained to weigh risks against benefits when performing tests and offering treatments. However, as soon as the context is any symptom versus exercise, there is no hesitation to tell patients to stop doing something, without actually bothering to weigh the benefits of the exercise against the risks of the disease/symptom in question – butt more importantly, against the risks of not exercising. Scaring people out of exercise (outside the context of a life threatening medical problem where exertion may actually be contraindicated) is malpractice.

Agree … I’ve delivered a few babies and repaired some injuries like that … while I wouldn’t comment on a particular person’s case, I’d say in general that that region of the body heals very well.

I mean … what was that person thinking … that weaker muscles would be better than stronger muscles? I’ve never commented here, but I agree with Austin … that’s malpractice to speak that way – even if hers is the rare case where something like that was true. I couldn’t hold back my comment.

In an ortho office … do they replace knees and then tell patients “But don’t use the damn thing … who knows?”

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