What is a Women’s Health or a Pelvic Health Physiotherapist?

 

A women’s health or pelvic health physiotherapist is someone who has trained as a general physiotherapist, then at some point completed further training in the field of pelvic or women’s health. Some of these physios will still treat many conditions such as back pain or knee injuries, whereas others focus purely on their interest area and will refer to other physios for more general problems.

 

A women’s health physiotherapist is someone who works primarily in the field of care specifically for women and women’s issues – including pregnancy, the post-natal period and menopause. Their role will usually include pelvic floor assessment and treatment, which can be for female-only conditions such as prolapse, birth trauma or pain conditions such as vaginismus or endometriosis, and more general pelvic floor issues such as incontinence of bladder or bowel, and urinary urgency conditions which can affect anyone (but do affect females much more than they affect males).

 

A pelvic health physiotherapist may choose to use this title to indicate that they treat anyone with pelvic issues, regardless of gender or age. These physios treat women for the same issues mentioned above, but will also treat men’s issues such as incontinence, urinary urgency, post-prostatectomy weakness or pelvic pain. These physios will sometimes work with children and parents as well, on such issues like bedwetting, toileting routines, constipation or pelvic pain.

 

How does a physiotherapist end up working with people on issues like incontinence and sexual pain?

Within the pelvis there is a lot of muscular tissue and supportive fascia and ligamentous tissue. The functioning of this area we often take for granted – and when there is dysfunction here, it shows up in often distressing ways – leaking of urine, loss of control of bladder habits, faecal issues, or pain – which in the pelvis can mean difficulty with sitting, toileting or having sex. As there is a lot of muscle and soft tissue in this region, and physiotherapists have been working with muscle and soft tissue dysfunction for a long time, it makes for a good choice of health professional to help you manage these issues. Physiotherapists are able to assess, diagnose and treat many of the issues that can be experienced within the pelvis.

 

What will a consult with a women’s health or pelvic health physiotherapist involve?

Preferably an initial consult will be for 60 minutes, to allow for thorough history taking, education and assessment. This can be done via telehealth in particular circumstances, but we prefer to complete this in the clinic.

 

The assessment will be different for different presentations – it could include an assessment of your hips, back or abdominals, or involve an assessment of the pelvic floor, which can be done via ultrasound or with an external (vulval) or internal (vaginal) examination. Occasional an anal exam will be offered (but this is reasonably rare and will only be suggested if the issue is anal or rectal in nature).

 

Do I have to have an internal (vaginal or anal) assessment?

No, assessment and treatment are always guided by your comfort and consent. It will be offered if the physiotherapist believes it would be helpful for assessment and treatment for your presenting issue.

 

Do I require a doctor’s referral?

For ordinary appointments, a referral is not needed unless you have been given one by your GP or specialist. If you have relevant results or reports, please bring these with you.

 

A referral will be required if you are wanting to use a GP Medicare care plan – in which case, you will definitely need to have your referral with you on the day or have it sent to the clinic beforehand, otherwise the plan cannot be processed.

 

Can I claim with a private health fund?

Absolutely. We have HICAPS facilities so can process this in the clinic, or an invoice will be sent to you for processing online for any telehealth or online sessions.

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Urinary incontinence

 

Urinary incontinence describes the accidental or involuntary loss of bladder control, resulting in the leaking or loss of urine. It can range in severity from a small amount to a complete loss of control.

Urinary incontinence can significantly impact a person’s quality of life and day-to-day functioning. There are various ways of classifying urinary incontinence, including:

• stress incontinence (involuntary loss of urine on effort or physical exertion (e.g. sporting activities) or on sneezing or coughing

• urge incontinence (loss of urine associated with an urgency to empty your bladder – often experienced on the way to the toilet)

• mixed incontinence – both of the above

 

Urinary incontinence can affect people at any stage of life, and affects 1 in 3 women, 1 in 10 men and 1 in 5 children in Australia. There are various causes of urinary incontinence, and most cases can be treated and resolved. It is not a normal part of ageing and should never be accepted as so. It is common, but not normal, and help is available. It is also never too late to seek assistance, no matter how severe or how long-term the issue is.

 

Physiotherapy can address incontinence in several ways, including pelvic floor muscle training, assistance with tissue imbalances that might impair urinary functions or mobility, or bladder training and urgency suppression techniques. Pelvic floor physiotherapists are physiotherapists with further training in the various functions of the pelvis, including the urinary system. They work with you to create an individualised management approach to your particular issues and goals.

 

To discuss your concerns and begin better management of your urinary incontinence symptoms, contact us today to book an assessment with a pelvic floor physiotherapist.

 

Sources:

Continence Foundation of Australia (www.continence.org)

Haylen, B. T., De Ridder, D., Freeman, R. M., Swift, S. E., Berghmans, B., Lee, J., … & Schaer, G. N. (2010). An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Neurourology and Urodynamics: Official Journal of the International Continence Society, 29(1), 4-20.

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Urinary urgency and frequency

 

Urinary urgency is the experience of a sudden and severe urge to urinate. If you find yourself regularly running to the bathroom fearing you won’t make it, you might have urinary urgency.

 

Urinary frequency (otherwise known as polyuria) describes a higher than usual number of trips to the toilet through the day or night. If the first thing you do when you arrive somewhere is scout for the toilet, or you keep finding yourself back at the toilet and feel like you just left, you might be experiencing urinary frequency.

 

These symptoms are often accompanied by difficulty maintaining continence.

There are numerous reasons why these symptoms may be experienced and can be part of an issue known as overactive bladder.

 

A pelvic health physiotherapist is uniquely skilled in the rehabilitation of various functions of the pelvis, including the urinary system. They can assist with urinary urgency or frequency with bladder training, urgency suppression techniques, electrical stimulation, pelvic floor rehabilitation and more, depending on your circumstances and individual presentation.

 

 

 

Prolapse management (including pessary management)

 

A pelvic organ prolapse describes the descent of one or more of the pelvic organs (i.e. the bladder, uterus or bowel), often into the vagina.

A prolapse will generally feel like a heaviness or pressure in the pelvic or vaginal area and will sometimes appear as a bulge in the vagina. It is normal if a prolapse doesn’t feel or look the same all the time, as the severity of prolapse symptoms changes with certain activities, movements, or pressures in the body.

It is estimated that 1 in 3 women are affected by prolapse during their lifetime.

 

There are many terms that may be used to describe prolapse, including anterior vaginal wall prolapse, posterior vaginal wall prolapse, uterine prolapse, cystocele (bladder descent), rectocele (bowel descent), vault prolapse (vaginal movement following hysterectomy), enterocele (intestinal movement – quite rare). These terms help to classify the type of prolapse/s present - you can have more than one prolapse at a time – e.g. descent of both the bladder and the uterus. One may be more noticeable or symptomatic for you, or the whole lot could be troublesome.

 

A pelvic floor physiotherapist assesses for signs of prolapse during a pelvic floor exam and is able to grade the severity or extent of any prolapse present.

 

There are many ways to manage a prolapse, usually starting with conservative measures such as pelvic floor exercises, load management strategies (e.g. how to lift something or to exercise without aggravating your prolapse) and postural adjustments.

Physiotherapists collaborate with your doctor if further assistance such as oestrogen application is needed. A pessary is also another option.

 

Vaginal Pessaries for Prolapse Management

 

A pessary is a device made of medical grade silicone, designed to be worn inside the vagina to assist with prolapse and the various symptoms of prolapse.

The type of pessary used will depend on your symptoms, the type of prolapse/s you are presenting with, and your movement goals (e.g. there are different requirements of the body for walking vs a boxing class).

You may be fitted with a pessary that you manage yourself – i.e. you take it in and out as required and clean it yourself as often as needed; or you might be fitted with one that is managed by a health professional – i.e. it stays in all the time and is only removed then re-inserted when you come in for appointments. Both are reasonable options and it will depend on your lifestyle, symptoms and type of prolapse as to which option will be most suitable for you.

 

Pelvic Pain

 

Pelvic pain is often used as an umbrella term to describe pain in the perineal, vaginal, anal or general pelvic area.

Conditions or diagnoses that are often associated with pelvic pain include vulvodynia, vaginismus, vestibulodynia, endometriosis, adenomyosis, polycystic ovarian syndrome, painful bladder syndrome, pudendal neuralgia, and overactive pelvic floor. However, some people can experience pelvic pain without any associated condition or prior diagnosis – it can sometimes involve the tailbone or pelvic bones, or start from a one-off event, like sitting for a long drive or landing bottom-first on a hard surface.

A physiotherapist treating pelvic pain will often assess both external and internal muscles to discern contributors to pain and may treat with manual therapy, stretches, breathing exercises or relaxation exercises, depending on the issue. We can also prescribe and guide people using dilators, electrical stimulation, or biofeedback devices – whatever might be required for the condition each person is working on.

Physiotherapy is an under-utilised option for managing pelvic pain and for learning about ways to manage it – for some pelvic pain problems, physiotherapy intervention can cure the pain.

 

 

Faecal Incontinence and other bowel issues

 

Passing bowel motions at the wrong time or place, not making it to the toilet in time or frequent just making it in time, or having “accidents” involving faeces or wind are all considered types of faecal incontinence.

On the flip side, some people can be affected by acute or chronic constipation, pain emptying their bowels or other types of rectal pain or dysfunction such as proctalgia fugax (an anorectal pain associated with acute muscle spasm).

The mechanism in our body that helps us control our bowel motions and any wind movement in the rectum lives within our pelvis, and can be affected by pelvic muscles and connective tissue, including our pelvic floor network.

A pelvic health physiotherapist can assist with these issues by teaching suitable bowel emptying strategies, trouble-shooting any fluid balance issues and training your pelvic floor to respond appropriately for bowel emptying. These are often small changes that can make a big difference!

 

Postnatal assessment

 

We recommend that anyone who gives birth have a check-up with a women’s health physiotherapist six weeks postnatally. This is typically the time you will be advised to see your GP, as the tissues have had a month of healing as we can more properly assess their function at this stage.

 

The postnatal assessment is important for a number of reasons:

• a GP postnatal visit often won’t involve a pelvic floor check. Your physiotherapist will offer one routinely as part of your postnatal visit. This usually involves a check of sensation, any presence of pain, muscle function and strength, risk of prolapse – all this can guide how we progress your recovery. Any issues can be assessed early and treatment can begin immediately.

• abdominal muscles are also usually assessed as part of this consult, and an individualised rehabilitation is started to help abdominal muscles recover post pregnancy.

• we review your functional abilities and if you are struggling with any pain or stiffness, particularly when caring for your child or children.

• We can advise you regarding movements, postures and exercises to aid in your recovery. We align this with your personal goals and life as a busy mum.

 

Note that we recommend these visits for anyone who has given birth – not just those who had a vaginal delivery. Recovery from caesarean section can also be lengthy, and correct rehabilitation exercises can help optimise and speed up your recovery. The pelvic floor is also known to weaken during pregnancy, so no matter the delivery you had, it is recommended that the pelvic floor muscles have some form of rehabilitation following birth.

 

Can I come in sooner than 6 weeks if I feel I need it?

 

Yes, absolutely. We have had some women come in within a week of birthing before as they have been in pain, have an injury, had questions or just want reassurance that they are doing the right things for their recovery. We also offer phone consults which can be helpful if you want to discuss early rehabilitation, but don’t feel up to coming into the clinic.

 

 

Abdominal Separation

 

This condition is known by many names – Diastasis Rectus Abdominus Muscle (DRAM); Rectus Abdominis Diastasis (RAD), Rectus Abdominis Separation (RAS), abdominal separation, abdominal gapping – just some examples!

 

This is diagnosed when the first layer of abdominal muscles (the rectus abdominis muscles – otherwise known as the “six pack” muscles), becomes wider in the middle. This muscle group is made of two main bellies of muscle that are separated in the middle by a band of fascia (connective tissue). This is the case in everyone. However, pregnancy stretches the abdominals, and this band of connective tissue typically gets wider, and the muscles sit further apart. Following pregnancy, the muscles reduce back down to normal length, but sometimes the connective tissue and/or muscles do not move back into their original length or position. What can result is a wall of abdominal muscle that doesn’t work as well – this may cause pain, a bulge in the middle of the tummy, or difficulty completing movements with your abdominals such as sitting up in bed, lifting, carrying and exercise.

 

This issue can be addressed through adjustment of your movements or exercises, prescription of some individualised exercises and some pointers for caring for your belly muscles. Using these muscles well and getting them stronger and working more functionally can drastically change how strong your core is and how well your body can use these muscles for your daily tasks or exercise. A physiotherapist will assess your movements, posture and complete an abdominal check to develop a program for you specifically. This is a typical assessment we complete during a 6-week post-natal check-up.

 

 

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