There are some conditions that are specific to women and can present at any stage of life. They are often associated with changes that occur during pregnancy, childbirth and menopause.
What is the pelvic floor?
The pelvic floor consists of a number of muscles, ligaments and fascia which support the pelvic organs (bladder, bowel and uterus). The pelvic floor muscles include two layers of muscle that sit at the base of the pelvis and also play a role in controlling bladder function, bowel function and sexual intercourse. Damage or weakness to any of the pelvic floor muscles, ligaments or fascia can lead to problems with bladder control, bowel control, sexual dysfunction, or pelvic organ prolapse. Often these conditions can be resolved with pelvic floor physiotherapy and rehabilitation.
Assessment
An initial Women’s Health assessment will involve extensive questioning about your main concerns. Usually this requires asking detailed information about your previous medical history, bladder and bowel function, sexual function and obstetric history. Some objective testing may involve observation of your movement patterns, real-time ultrasound or an internal vaginal assessment. Internal vaginal assessments are performed to check the function of the pelvic floor muscles and the position of pelvic organs. Assessments will only be conducted after a clear explanation and only with the patient’s informed consent.
Treatment
Following a thorough assessment and diagnosis, a detailed treatment plan will be developed to best suit the patient’s function and goals. Treatment options will vary depending on the individual and their diagnosis. We provide the following:
- Pelvic floor muscle rehabilitation for treatment of incontinence, prolapse, post-surgical and/or postnatal
- Pelvic floor muscle rehabilitation for treatment of pain and sexual dysfunction
- Bladder retraining for urgency, overactive bladder, night-time frequency and incontinence
- Bowel retraining for constipation and/or incontinence
- Pain management for pelvic and/or sexual pain and dysfunction
- Musculoskeletal manual therapy for pregnancy or postnatal related conditions
- Clinical Pilates and exercise rehabilitation for prenatal and postnatal women
- Mastitis treatment
Some of the most common conditions we treat include:
Incontinence
Incontinence refers to any form of involuntary loss of urine from the bladder or faeces from the bowel. It can result from various factors including;
- changes that occur to pelvic floor tissues during pregnancy
- childbirth or menopause
- excessive or repetitive stresses that are placed on the pelvic floor region including frequent constipation
- chronic coughing
- high BMI; or other conditions
Many women suffer in silence and believe it is a normal part of aging. They do not realise that it can be effectively treated with physiotherapy.
There are various forms of incontinence such as:
- Stress urinary incontinence – small leaks of urine from the bladder with activities that cause an increase in abdominal pressure. For example, coughing, sneezing, laughing, jumping, lifting, or high impact exercise
- Urge urinary incontinence – leakage of urine from the bladder with a sudden onset of a strong urge that can not be delayed
- Faecal Incontinence – involuntary leakage of faeces from the bowel. May be associated with a sudden urge
Incontinence can often be treated very effectively with bladder and bowel training and pelvic floor muscle rehabilitation.
Prolapse
A prolapse refers to the descent of one of the pelvic organs (bladder, bowel or uterus) into the vaginal wall. It often presents as a feeling of dragging or heaviness within the vagina or pelvic region, and/or a lump or bulge can be felt or seen. Prolapse may also result in difficulty emptying bladder or bowel, pain or discomfort with sexual intercouse. Normally the pelvic organs are held in position by fascia and ligaments, and supported underneath by pelvic floor muscles. Significant stress on these support structures and pelvic floor muscle weakness can lead to prolapse. Some risk factors include: pregnancy, childbirth, high BMI, high impact exercise/heavy lifting, constipation, chronic coughing.
Often lifestyle modification, pelvic floor muscle rehabilitation and healthy bladder and bowel habits can improve the symptoms and severity of a prolapse. A physiotherapist trained in pelvic floor rehabilitation is able to assess your prolapse and develop a treatment plan in line with your lifestyle and goals. Pelvic floor muscle rehabilitation and pelvic floor safe exercises are important in your recovery and ongoing management.
Pelvic Pain and/or Sexual Dysfunction
Many women suffer from various types of pelvic pain or sexual pain conditions such as vaginismus, vulvodynia, and endometriosis. These conditions can significantly impact on a woman’s overall physical and social health and wellbeing. Often there are a number of contributing factors causing the pain or dysfunction and therefore treatment may involve multiple strategies and members of other allied health teams.
Post-natal Rehabilitation
Common conditions that present during pregnancy include:
Lower Back Pain
An ache in the lower back often presents in the later stages of pregnancy as your baby grows, you gain weight, and your abdominal muscles stretch and weaken. This can place increased load on the muscles and joints of your lower back. Physiotherapy can provide manual therapy to help ease the pain and guide you through pregnancy friendly stretches and strengthening exercises that can assist with managing your pain.
Pelvic Girdle Pain
Many women will encounter pelvic girdle pain in the later stages of pregnancy. This can be due to increased weight from the baby, softening of ligaments and reduced strength around the core and hips. Often the pain will be felt with activities that are asymmetrical, for example, walking, stairs, turning in bed. Pain can be felt around the sacrum, bottom or pubic bone.
Resting from aggravating activities and learning how to alter your movement patterns can help alleviate the pain. Manual therapy, supportive belts and specific exercises can also assist in relieving symptoms.
Other Musculoskeletal Conditions
Rib pain, carpal tunnel, and abdominal pain may present during pregnancy. Physiotherapy can provide manual therapy, posture and movement strategies and appropriate exercises to help alleviate symptoms.
Post-natal Rehabilitation
Pregnancy and childbirth is an incredible stage of a woman’s life. There are significant changes that occur to the body as the baby grows and during labour. In particular, abdominal muscles and pelvic floor muscles are placed under stress and strain and require rehabilitation in the postnatal period.
Diastasis of Rectus Abdominus Muscle (DRAM)
Your rectus abdominis is the outermost abdominal muscle of your trunk (the six pack muscle). During pregnancy, as your baby, uterus and belly grow, this muscle can be stretched. Following childbirth, there is often a small separation of this muscle that can make simple tasks like sitting up out of bed and lifting rather difficult due to reduced core strength.
Over time, as your body recovers from pregnancy and birth, this will improve. However, there are ways you can assist the speed, and optimise the recovery, of these muscles. Too much too soon can hinder your recovery. Your physiotherapist can assess you and guide you through the appropriate exercises for you and your activity levels and goals.
Pelvic Floor Rehabilitation
The pelvic floor is placed under high loads during pregnancy and further so during labour. Many women will sustain a perineal tear during childbirth and may strain pelvic fascia and ligaments. While many recover well over time, some women will encounter pelvic floor issues such as prolapse or incontinence. This may be shortly after childbirth or several years later. Often these conditions can be prevented with correct advice and pelvic floor rehabilitation in the postnatal period. Your physiotherapist can assess you and guide you through the appropriate exercises for you and your activity levels and goals.
Mastitis
Mastitis, or inflammation of the breast tissue, can affect many new mothers. Often it is caused by a blocked milk duct. Pain, heat, redness and fever type symptoms may be present. Some women will require medical treatment so it is recommended you consult your GP if you think you have mastitis. Physiotherapy can provide ultrasound therapy which can help to clear a blocked duct and reduce pain and symptoms.
Musculoskeletal Conditions
Other musculoskeletal conditions which are common in new mothers include; upper back, neck or wrist pain. Physiotherapy can provide manual therapy, posture and movement strategies and appropriate exercises to help alleviate these symptoms
