Notes from a Pelvic Health Physiotherapist

When arriving to do my ‘Women’s Health’ elective placement in 2000, I thought I’d observe Pregnancy classes, talk to ladies about bladder care, teach exercises to do after a Hysterectomy, and teach Pelvic Floor exercises.  To my horror, I met my clinical educator for the next 6 weeks… coming out of fracture clinic with a BROKEN right arm!  So I became her right hand, LITERALLY!  That afternoon, she guided me through a vaginal examination of a new mum with weak pelvic floor muscles and leakage after having her baby; rectal Biofeedback on a 25 year old gentlemen who had been in a diving accident which left his anal sphincter weak and we examined a lady with a vaginal prolapse and taught her how to manage it. From then on I was hooked and most of my training since has centred around Pelvic Floor/Continence.

 

‘Women’s Health’ is now more often called ‘Pelvic Health’, in many hospitals/clinics not only because it is a more accurate description, but in sympathy with the poor men having to hide at the back of the waiting room of the ‘Women’s Health’ clinic!

Who needs Pelvic Health Physiotherapy?

 

People who come to see me usually have one or more of the following symptoms; Leakage from the bladder or bowel; difficulty passing a stool; urgency to urinate or going to the loo more frequently; recurrent bladder infections; pain in the pelvic area, including bladder pain; pain or lack of enjoyment during sexual intercourse; erectile problems; a bulge in the vagina/back passage or a feeling of ‘something coming down’ between the legs (prolapse).

 

Symptoms usually creep up on people slowly, they may have had surgery in the pelvic area, (e.g. Hysterectomy or Prostatectomy) a change in lifestyle, stress, taken up a new sport and of course for women – being pregnant and having a baby can cause quite a stir in the downstairs region, especially if the baby was big, the labour was very long, or there was an injury to the skin or muscles. Chronic coughs, constipation, smoking, and being overweight make you more likely to get Pelvic Health issues.  A huge culprit is the MENOPAUSE, (it’s not diamonds ladies, but OESTROGEN that is a girl’s best friend, well, a vaginas at least!)

 

The important ‘BITS’…The Pelvic Floor

 

 

 

 

33% of women and 13% of men will suffer with incontinence due to pelvic health issues!

 

A healthy pelvic floor keeps our openings closed to prevent leakage and also helps stabilise the pelvis with other spinal and abdominal muscles and contributes to the ‘core’.   In men, it contributes to getting and maintaining erections, not to mention ORGASMIC function for both sexes!! It has to contract well and relax to be efficient.  Short/tight muscles don’t work well and can give pelvic pain.

 

 

Treatments…

 

Most people need pelvic floor strengthening and relaxation. ‘Release work’ can help the muscles co-ordinate better and reduce pain.  In women this is done vaginally, for men, this is done through the back passage (sorry!).  If your spine, hips or pelvis don’t move well, treatment and exercises will be given to help.    Many need advice on fluids, bladder training and will be advised to avoid caffeine.  For some, if sex is painful, and fear is present (muscle tension), treatments can involve counselling to help put coping strategies into place.

 

When pelvic floor muscles are very weak, Biofeedback is used where an electrode is inserted (vaginally or anally) to monitor the muscle strength on a visual graph to help strengthen.  Electrical stimulation can also be delivered to ‘wake’ the muscles up.  So it’s not as simple as just ‘doing your pelvic floor exercises’!! 

 

The main aim of physiotherapy is to AVOID SURGERY.  For some however, the support structures  for the bladder and the bowel require supportive surgery and Physiotherapy can help to ‘pre-hab’ those waiting for surgery.  Arming people with the right ‘tools for recovery’ is hugely beneficial here.

 

Top Tips…..

 

  • Avoid ‘just in case’ wees, they shrink the bladder.
  • Avoid caffeine.
  • Drink 1.5 litres of fluid per day
  • Tackle constipation
  • See your GP if you have pelvic pain or bleeding
  • Fast walking/swimming are good for ‘core activation’
  • Stretch and move your spine regularly
  • Relax more – the body can’t function well if the mind is in knots!

 

If you think you need help with a pelvic health problem, why not ring Physio & Therapies on 01706 819464 for a confidential chat with me?

 

Katy Winters

Specialist in Pelvic Health

 

 

 

 

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