What is Pelvic Floor and Womens Health physiotherapy and how can it help me?
Women's Health Physiotherapy is a specialist branch of physiotherapy where the physiotherapist has undergone specialist training and achieved advanced competencies in pelvic and gynechalogical anatomy, pathology, diagnosis and treatment. They are trained to assess and treat women suffering from pelvic floor weakness, problems with the bowel and bladder, pain in the pelvis and those women who have had a baby or who are pregnant and having problems. At Core Body Clinic our physiotherapists are dual trained in musculoskeletal physiotherapy and Women's Health Physiotherapy. They have a detailed understanding of pelvic anatomy and pelvic floor function and they are skilled in many techniques to treat pain and rehabilitate function.
Seeing a Women's Health Physiotherapist can be a life changing moment and help with a number of problems. One in three women are affected by pelvic pain or pelvic girdle dysfunction. It can take an average of 3 years for a woman to consult with their GP or to see a women's health physiotherapist. Women's health physiotherapy is essential after giving birth and can prevent future problems with pelvic floor weakness, stress incontinence and regaining confidence with sport and sexual function.
It has been recommended by the department of health that women should see a physiotherapist for a post birth check 6 weeks after having a baby. The check aims to identify problems affecting the pelvic floor before they become a burden on life.
Many conditions can be split into two categories: Pain and/or Weakness.
Pain conditions can be caused becasue of a number of reasons, some of which are listed below. Weakness relates to incontinence that is caused by the birth of a child and the trauma caused as the baby exists the birth canal. Many women we see have waited years before seeking help, often making the assumption that wearing pads or coughing or sneezing and experiencing a leak is the natural course of life. Many women stop exercising or leak when they run, again thinking this is normal and they cant do anything about it. We know this is wrong and we have helped 1000's of women since opening our doors in 2014.
Below is a list of the common things we treat:
Difficulty opening bowels or incontinent of bowels
Endometriosis and pain associated with this conditon
Pain and abdominal cramps during periods
Pelvic floor weakness
Pregnancy related Pelvic Girdle Pain
Chronic Pelvic Pain
Post surgery rehabilitation
Can I see a physio if I’m pregnant?
Yes. The question should be "when should I see a physio?". Pregnancy is hard on the body so some gentle attention can be really helpful for the spine, mother and baby.
Techniques are very gentle and can help alleviate pain, enhance muscle control, improve posture and function.
It is also recommended for pregnant mothers to have a session with our physiotherapist because it can help reduce problems post-natal (after giving birth). We strongly recommend having a check after your give birth to ensure your pelvic muscles are firing.
The educational and one-to-one sessions are brilliant to help you understand the journey the pregnant mother makes and how to best manage your body.
We can also help with pain and discomfort during and after pregnancy. When you are pregnant Physiotherapy can really help, keep you moving, keep you reassured that you are doing the right things and can help with any problems or pains you may have/develop.
We regularly treat pelvic girdle pain both before and after pregnancy (SPD or symphysis pubis dysfunction now called pelvic girdle pain). Pelvic girdle pain can also occur without pregnancy and can be treated with physioherapy. Careful adjustments can be made to the pelvis and specific exercises to maintain pelvic floor strength can be taught to our patients.
Seeing a physio can help you reduce the gap in the tummy after having a baby (rectus diastasis) by reducing a weak core and strengthening abdominal muscles.
Prolapses are a troubling conditon often requiring surgery. However, our service allows us to assess and in a lot of cases successfully treat the problem with physiotherapy.
Nerve pain like Pudendal Neuralgia can occur in the pelvis and requires delicate assessment. It can affect both men and women.
What to expect on assessment?
The assessment of pelvic pain uses a comprehensive subjective examination where we will encourage dialogue from the patient to discuss their problem in as much detail as possible. We will use differential questioning to hone in on the possible causes of your problem. The history of any condition as told by the patient reveals much more (in many cases) than any test or examination. Therefore, this phase may take a little time to ensure we get all the important information down on paper. Some questions may be of a sensitive nature considering the nature of the pelvic problem. We will always explain why we need to ask such questions and will use our knowledge of pelvic anatomy and skeletal models/diagrams to help with our explanation.
We may also use a questionnaire which helps to diagnose your problem and also to identify an objective marker so that we can accurately identify progress.
Examination may include the lumbar spine, pelvis, hips and pelvic muscles. If you are pregnant the physiotherapist will know exactly how to handle the patient so not to cause worry to the mother and certainly not to bring any harm to the baby. Women’s health and pregnancy physiotherapists are experts in the handling of pregnant women.
Most of the examination will be external and will include palpation of the abdomen. It may include direct palpation of the perineum or instruction to the patient to palpate their own perineum (saddle region between the anus and scrotum). We may also palpate on the inside of the pelvis. Gaining access requires palpation through the vagina or the anus. This is by no means an absolute necessity but remains the gold standard for assessment of the pelvic floor. Total understanding and a complete explanation, and only after consent in a written format are any form of internal examinations conducted. Dynamic ultrasound may also be used to achieve this. Internal examination, while useful, is not tolerated by all patients and is never forced upon a patient.
Once we have completed both phases of the examination we will then formulate an action plan with the patient and begin treatment.
The examination will last at least an hour. In some cases 1hr 30 minutes is necessary.
Muscles can be rehabilitated and retrained and at the Reading Pelvic Health Clinic we are specifically trained to identify pelvic floor dysfunction and apply a bespoke regime of motor control exercises to remedy such dysfunction. Specialised manual therapy techniques for the pelvic floor can be incorporated to reduce muscle sensitivity and facilitate appropriate muscle activation.
Treatment (might include):
· Hands on manual therapy treatment to your low back and pelvis, getting the joints moving correctly
· Trigger point therapy: Getting the muscles working properly and rid of the overactive parts in both the low back muscles, hip muscles and pelvic floor muscles. You will also be taught how to do this yourself.
· Pelvic floor exercises to release your pelvic floor
· Specific hip, spine and pelvis exercises to get you and your pelvic floor moving better, think yoga poses and squatting
· Specialised Breathing and relaxation work
· Re-education of the pelvic floor, hip and abdominal musculature
· General exercise
· Pain management education (essential to understanding WHY the pelvis hurts).
· Advice re sexual and toileting practices
Back pain and Pelvic pain:
Sometimes, people can present with back pain. They may have consulted a regular physiotherapist, osteopath or chiropractor with no success. We have seen people who have even gone down the route of spinal injections only to see a specialist women's health physio and find out that the pain is actually related to a problem inside the pelvis!
Careful and expert assessment is essential and a comprehensive knowledge of anatomy makes for a more complete physical assessment.
Women's health physiotherapy is a good choice if you have back pain and you also suffer from issues of weakness in the pelvic floor, pain during menstruation, pain during toileting or during sexual intercourse. These can be sometimes very sensitive issues. Therefore, having Arbana in our team at Core Body Clinic helps us to reach out to these patients who are in pain but do not know where to turn.