COMMON CONDITIONS WE TREAT
Stress urinary incontinence
Stress urinary incontinence (SUI) is the leaking of small amounts of urine during activities that increase pressure inside the abdomen and push down on the bladder. SUI is most common with activities such as coughing, sneezing, laughing, walking, lifting, or playing sport.
Urinary urgency and frequency (overactive bladder)
Urinary urgency is a sudden and strong need to pass urine. You may also hear it referred to as an unstable or overactive bladder, or detrusor instability. Often, if you experience urgency you will also have the need to frequently pass urine and may wake several times a night to do so (nocturia). You may also suffer from urinary incontinence (leaking on the way to the toilet associated with strong, sudden desire to pass urine).
Pelvic Organ Prolapse
“Prolapse” refers to a descending or drooping of the pelvic organs (the bladder, uterus or rectum). These organs are held in place by tissues called ‘fascia’ and ‘ligaments’ and the pelvic floor. If the fascia or ligaments are torn or stretched for any reason, and if your pelvic floor muscles are weak, then your pelvic organs might not be held in their right place and they may bulge or sag down into the vagina.
Signs and symptoms of prolapse may include:
- a heavy sensation or dragging in the vagina
- an awareness of something ‘coming down’ or a lump in the vagina
- sexual problems of pain or less sensation
- difficulty emptying your bladder or changes in your urine stream
- reoccurring urinary tract infections
- difficulty emptying your bowel
- symptoms worse at the end of the day and better after lying down.
Women’s Health Physiotherapy can provide bowel management strategies for constipation and straining, bowel urgency, decreased bowel and wind control or difficulty with evacuation or emptying the bowel.
Complex pelvic pain
Pelvic pain can have many causes. At Better Health with will endeavour to help you identify the cause of your pain.
We will complete a thorough pelvic assessment, provide an accurate diagnosis and explanation of your symptoms. As well as tailoring an individual management and treatment plan.
Vulvodynia is the term used to describe the condition experienced by women who have the sensation of vulval burning and soreness in the absence of any obvious skin condition or infection. The sensation of burning and soreness of the vulva can be continuous (unprovoked vulvodynia), or on light touch, e.g. from sexual intercourse or tampon use (provoked vulvodynia).
Physiotherapy treatment may include pelvic floor muscle training, vaginal dilators, exercise/ stretches, massage/ soft tissue release, acupuncture.
A multidisciplinary approach is often recommended. This may include physiotherapy, psychosexual therapy and medication.
Painful bladder syndrome (PBS)/ Interstitial Cystitis (IC)
Common symptoms include:
- Pain which gets worse as the bladder fills, and improves once the bladder empties
- Urinary frequency and urgency (needing to go to the toilet a lot or needing to rush to the toilet)
- Nocturia (needing to get up to the toilet at night)
- Pain with intercourse
- Many people with a painful bladder describe having ‘frequent urine infections’. Sometimes there is a bladder infection, but often it is a flare of their painful bladder that feels like a urine infection. If urine is sent to a laboratory during a flare, it may sometimes show blood but doesn’t show infection.
- Physiotherapy treatment may include pelvic floor re-education, internal and external trigger point management, soft tissue release for adhesions, stretching exercises, bladder retraining and TENS.
Endometriosis is a condition in which endometrium tissue (the tissue lining the inside of the uterus that builds up and is shed during menstruation) is found out-side the uterus.
Physiotherapy treatment may include:
Pelvic floor muscle re-education, internal and external trigger point management, soft tissue release for adhesions, stretching exercises, postural exercises to assist with elongation of the spine and de-creasing tension at the abdomen, spinal mobilizations and nerve glides
Rehabilitation following pelvic floor surgery/hysterectomy
Pelvic floor muscle re-education
- Abdominal exercises
- Post-operative advice
- General exercise/ safe exercise advice to help you regain your previous level of fitness following surgery
The term used to describe pain during sexual intercourse is ‘dyspareunia’. Pain felt at the entrance with attempt at of the vagina upon attempt at penetration is often cause by ‘vaginismus’. Sometimes the vagina can feel ‘tight’ or ‘blocked’. Vaginismus is an involuntary spasm of the vaginal muscles caused by a inability to relax these muscles in order to allow penetration. In almost all cases, the vulva and vagina are completely healthy. The severity of the problem can vary from one woman to the next. Some women are unable to insert anything into their vagina. Others can insert a tampon and are able to have a gynaecological exam, but sex is not possible. Some women with vaginismus are able to have sex, but find it very painful. Vaginismus is a common but treatable condition.
ASSESSMENT & TREATMENT PROTOCOLS
Initially, a thorough assessment will be completed to review your symptoms. This will include your obstetric and medical history and an evaluation of your bladder and bowel health. The physical examination may include an assessment of your pelvis, spine and abdomen. You will be offered a vaginal examination to assess your pelvic floor.
Postnatal Body Check
This will include:
- back/ pelvic/ postural assessment
- detailed abdominal muscle assessment
- pelvic floor assessment and re-education
- advice regarding specific postnatal exercises
- advice regarding safe return to exercise
A full assessment is one hour, however if you have a specific concern, a shorter, more concise (30min/45min) appointment can also be offered.
- Pelvic floor rehabilitation
Real-time ultrasound is a non-invasive, painless procedure. It is useful for evaluating muscle activity in the back, abdominal region and pelvic floor. It is useful for both diagnosis/assessment and rehabilitation.
This is used to promote patient confidence in performing pelvic floor exercises and can be used to facilitate strengthening or relaxation of the pelvic floor.
Soft tissue techniques such as massage target your muscles, tendons, ligaments or connective tissue, which may contribute to your symptoms.
Pelvic Floor Muscle Training
The most important part of pelvic floor muscle exercise is finding the pelvic floor and getting the technique right. We will provide coaching to help you identify the right muscles and teach you how to exercise the muscles correctly. We will then provide you with a specific tailored pelvic floor muscle exercise programme. Helping you achieve a healthy, strong pelvic floor.
- How the bladder works
- Good toilet habits
- Techniques to overcome your problem
- Advice regarding how much to drink and what to drink
- Establishing a bowel routine
- Advice regarding laxatives/stool softeners (if required)
- Teaching you how to empty your bowel correctly
- Dietary advice for bowel problems
Acupuncture and Dry Needling
Acupuncture can be used in combination with traditional physiotherapy to help in the management of pain, sleep, anxiety or musculoskeletal symptoms.
Transcutaneous electrical stimulation is a non-invasive, pain-free, safe treatment for urinary frequency and urgency. It is safe to use in adults and children.
Electrical stimulation can be used to assist in strengthening very weak pelvic floor muscles or when there is very little awareness of a pelvic floor muscle contraction. This is a non painful treatment and may be offered selectively to certain patients as a home treatment option.