In her first article about PREhab, pelvic health physical therapist Dr. Sarah Ecker explained the benefits of working with a PT to prepare for surgery. This second article addresses PREhab benefits specifically for top surgery and bottom surgery patients.
It makes sense that physically preparing your body for surgery can help to reduce pain, speed recovery and improve outcomes. Now, let’s get more specific in these gender surgery clinical case studies.
Top surgery candidate: Jordy, a 27-year-old trans man who was assigned female at birth
Jordy loves working on cars and shooting hoops in the driveway with his younger brother. He reports hating his chest since his breast tissue started showing up at age 12. He started binding right away, although he didn’t even know what “binding” actually was yet and would use tape, ACE bandages and the tightest sports bras known to Dick’s Sporting Goods.
Jordy reports that he knows he has bad posture, but it’s because he’s so self-conscious of his chest. He also reports frequent headaches and gets winded easily when playing basketball or doing other strenuous activities. He is scheduled for top surgery in a few months and can’t wait.
How will PREhab help Jordy?
First, let’s look at some potential problems that could affect Jordy’s post-operative recovery:
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- Poor posture
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- Frequent headaches
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- Shortness of breath with strenuous activity
You might be thinking, “Okay, a lot of people have these issues. Why does it matter for my top surgery recovery?”
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- Poor posture can alter the length of your chest, neck, and shoulder muscles, as well as decrease the mobility of your spine (stiffness). Improved posture and muscle function will allow you to optimize recovery from your top surgery – and more importantly, help you develop that confident posture you’ve been waiting for!
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- Tight muscles happen for many reasons: posture, over use, inefficient use, stress, trauma, and mechanics (how you move your body … or not). Unfortunately, chronic muscle tightness – especially in and around the chest, neck, and shoulders – can cause tension headaches. Your body is going to need these muscles to be healthy and relaxed so that you don’t continue to have headaches or soreness in these areas as you recover from your surgery. Also, strong, relaxed muscles mean better blood flow! Better blood flow means faster healing! Speaking of blood flow …
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- Sit back, relax, and take the biggest breath you possibly can, filling up your belly, your rib cage, and finally your chest. Take a few of these breaths. Now imagine you have a SUPER tight binder around your chest. Would you be able to achieve the same full breath? Probably not. Breathing is obviously important. We don’t have to think about it. We just do it. But when we have spent years (sometimes decades) with restricted breathing, our chest wall and rib cage become stiff. We may even feel anxious because we take shortened breaths or feel like we’re out of breath all the time. Our ability to take full breaths allows our lungs to become more efficient at providing oxygen to our bloodstream, which is EVERYTHING! Better blood flow and oxygen to the tissues in your body not only assists in healing but reduces pain, stress, and anxiety.
Bottom surgery candidate: Cam, a 25-year-old trans woman who was assigned male at birth
Cam has had a few feminizing procedures during the past few years, including breast implants and facial/neck feminization. She is currently (anxiously) awaiting her orchiectomy and vaginoplasty surgery (hoping for full depth), scheduled for next year.
Cam works full time as a veterinarian assistant, loves to read and cook, and loves taking her dogs for walks in the evening with her boyfriend of three years. Cam reports tucking on and off for as long as she can remember and reports that when she starts having urinary issues, she takes a break from her gaff. She has also struggled with anxiety and depression and knows that this has contributed to her irritable bowel syndrome. She is feeling nervous about dilating after her bottom surgery because she has read online that it can be a “nightmare.”
How will PREhab help Cam?
Let’s look at some potential problems that could affect Cam’s post-operative recovery:
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- History of tucking, sometimes causing pain or urinary issues
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- Irritable bowel syndrome (mostly constipation)
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- Anxiety with anticipation of dilating protocol following vaginoplasty
Why would these factors affect Cam’s recovery, and how can PT help?
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- Using a gaff or tucking long-term can sometimes cause pelvic floor muscle problems and even tightening of the lower abdominals and hip muscles. The health of these muscles prior to bottom surgery is SO IMPORTANT for post-op bottom surgery recovery. During prehab, your physical therapist will work with you to “down-train” or “relax” these muscles. Making sure that these muscles are not only relaxed but also coordinated and strong will optimize your recovery and make dilating so much easier!
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- Ok, back to the pelvic floor. When we talk about the pelvic floor muscles, these are the muscles primarily responsible for allowing us to have bowel movements, empty our bladder, and have sex (arguably the MOST important muscles of the body!). When we have issues with peeing, pooping or sex, it’s often because these muscles are tight/shortened, weak, or uncoordinated. Cam has been suffering with IBS for years and reports straining to have bowel movements. Just like the urinary issues caused by tucking, straining or chronic constipation can cause the pelvic floor muscles to be tense, weak, or uncoordinated. It is imperative that these issues are worked out prior to surgery for optimal recovery.
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- Any time the human body is anticipating pain or danger or fear, our brains are ready for fight or flight! This means our incredible brains pump up our muscles with blood (tighten them), increase our breathing rate, dump stress hormones into our bloodstream, and essentially shut down all other bodily processes so that we can either: 1) run from the bear, or 2) fight the bear. Perhaps dilating after vaginoplasty doesn’t seem the same as running from or fighting a bear, but it is for Cam’s brain. She is anticipating pain, difficulty and anxiety around it. And that is very real. Science shows us that simply anticipating pain can cause this same flight or fight process to occur in our bodies. So what we can do about it? SO MUCH! Prior to surgery, we can work with Cam to educate her about her muscles, how to use the dilators, relaxing her pelvic floor and other muscles in her abdomen and hips, using breathwork to calm the nervous system, and even imagery exercises that help train the brain in advance to not perceive dilating as a threat. This works so well!
“This all makes sense. So, how do I find a pelvic health PT who specializes in this stuff and is also sensitive to my unique needs as a trans person undergoing reconstructive surgery?”
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- Speak to your surgeon! They are a great resource for your overall needs.
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- Visit Pelvic Global Directory https://pelvicglobal.com/directory/
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- Visit OutCare Health https://www.outcarehealth.org/
