Pelvic Health Physiotherapy can help empower you in understanding and managing through the various life stage transitions. Most pelvic health issues can be successfully treated and prevented from worsening, so you can maintain a physically active and healthy, creative lifestyle.
The hormonal changes with puberty and onset of menstruation, childbirth and later with the menopause transition, as well as ageing, can affect bladder, bowel, reproductive and bone health. Not to mention the emotional and mental health challenges that may arise in relation to all this.
Pregnancy and Postnatal
Pregnancy and childbirth is both a personal and community journey. Good health of mother and baby is paramount. From pregnancy, through childbirth and postnatally, a balance of relaxation and fitness are important for both mother and baby. How to exercise safely, how to get back into shape, knowing what exercises to do and at what stage, what to avoid and for how long – these are common concerns and questions. Each person and situation is unique. 
Common problems that may arise are aches and pains in the back or pelvic joints ( about 25% of all pregnant women will have some back pain) or the wrists and hands ( Carpal tunnel , DeQuervain’s), reduced bladder or bowel control, abdominal muscle separation and pelvic floor weakness. Some birthing experiences don’t always go to plan and can be traumatic. This can cause weakness, incontinence or pain problems and leave you feeling emotionally and mentally distressed.
All these difficulties can be helped. Most women will find they respond very well to physiotherapy treatment based on correct, individual assessment and understanding. Treatment may include self help strategies, posture correction, appropriate exercises, manual treatments or support devices. Referral for counselling may also be beneficial in coming to terms with traumatic events.
Menopause
Menopause is defined as the cessation of the menstrual cycle for a period of 12 months. Perimenopause is the transition period around menopause and can last several years for some women. Most women have minor symptoms only, sometimes ‘breezing’ through menopause – their periods wind down or just stop. However for others, the decrease in oestrogen level often does create noticeable physical symptoms. Changes associated with menopause vary considerably but some common ones affecting pelvic health are changes in bladder and bowel control, vaginal dryness and painful sex, prolapse, urinary tract infections, decreased bone strength, not to mention hot flushes, insomnia, and anxiety!
At the same time as this transition is occurring on the physical level, changes are happening in other areas of life. There can be changes in relationships – children becoming older and possibly leaving home, ageing parents, grandchildren being born, changes to our intimate relationship, older friends starting to have health issues more frequently. This may cause reflection on our role in life and shift perspective on our existence – who we are now, why are we here, what’s most important in life?
There are many very helpful strategies for addressing all these challenges, step by step.
Pelvic Health physiotherapy treatment strategies may include bladder and bowel training, correct pelvic floor training, appropriate general fitness exercise, relaxation methods, fitting of vaginal pessary for prolapse support, adopting healthy diet, use of vaginal moisturizers and recommendation for medical, counselling or complementary interventions as needed.
Prolapse
When the soft tissue of the pelvis and pelvic floor – ligaments, connective tissue, muscles – become overstretched and weakened, the pelvic organs may ‘drop down’ from their usual position. There are different types and degrees of prolapse. There can be prolapse of the bladder, bowel, uterus or vaginal vault, intestines or any combination. A minor prolapse may not be noticed at all. The more common first signs are heaviness/pressure/dragging down or pain sensation in the vagina, rectum or general pelvic floor region or even in the lower back. A vaginal or rectal bulge may appear. Bladder or bowel filling or emptying is sometimes affected.
It is important to have an examination and determine the type and degree of prolapse in order to have the best treatment outcome.
Pelvic floor strength training, sometimes in conjunction with fitting of a vaginal pessary support, can reduce early stage prolapse over time. Other useful strategies in managing prolapse are posture correction, learning relief positions, adopting pelvic floor safe general exercise, avoiding constipation and straining or heavy lifting.
Vulval and vaginal wellbeing, Overactive pelvic floor, Relaxation
Painful conditions involving the vulva and vagina can be greatly improved, if not cured. Pain can be experienced by women of all ages. Two conditions that are more common for women are vulvodynia and vaginismus.
Vulvodynia affects between 4-8% of women at any one time and between 10- 20% of all women at some stage through their life. It can be either generalised, affecting the whole perineum or localised, affecting a specific area, often the vaginal entrance. Inside the vagina may not be painful, just the opening area. It is usually described as burning, stinging, tearing or itchy. The pain can be constant, and will fluctuate in intensity with certain activities, such as sitting, tight clothes or penetration. Or it can be provoked, sometimes lasting minutes to hours or days, and at other times not present. Some women have never been able to use a tampon or have sex comfortably. Others never had any problems with tampons or sex before and the pain came on later. There may have been an obvious trigger, such as a trauma or period of significant stress, or gradual change with vaginal dryness of menopause causing repeated discomfort during sex, or history of recurrent bladder or vaginal infections.
Vaginismus is spasm of the vaginal muscles, commonly the outer ‘ring’ muscles but can include any of the pelvic floor muscle group. The muscles tighten, usually in response to pain or fear. Penetration is uncomfortable or painful and is usually described as feeling too tight and not enough vaginal space. This muscle tension causes restricted blood flow, and in turn this can create or worsen pain. Over time, the muscle tension can become an unconscious habit.
Any pain problems, including vulval and vaginal pain, or overactive and urgency issues of bladder or bowel, will benefit from relaxation awareness as part of desensitising and calming the nervous system. Downtraining the pelvic floor, sometimes using biofeedback, soft tissue release techniques or pelviwand device, is facilitated by relaxation awareness. Good perineal skin care and diet can also be important in better managing and improving vulval pain conditions.
Relaxation training is often neglected or diminished in importance but is actually an essential part of treatment. Just slowing down, taking time, noticing the breath and sensations, learning how to let go of body tension and mental tension, can bring great health benefits. The parasympathetic nervous system comes into operation with relaxation practise – pain can reduce, blood pressure can reduce, sleep can improve, better blood flow occurs, hormonal balance is achieved and full healing is facilitated.
Relaxation and desensitising practises vary. There can be very physical techniques, involving body movement, varieties of touch, ways of breathing, through to use of the imagination and visualisation. Relaxation can also be general for the whole body or specific for the pelvis and pelvic floor region (or any body part). Desensitisation is usually specific to the pelvic or pelvic floor area in restoring pelvic health.
Simply taking time to go to the toilet can make all the difference, in emptying the bladder and bowel more completely, without strain,and not have to go so frequently. This usually brings a sense of satisfaction and even pleasure.
Surgery
Surgery is sometimes necessary. When conservative approaches to treatment have not been successful in providing satisfactory improvement or cure, your doctor may refer you to a specialist doctor. Pelvic health physiotherapy can help you understand, prepare and recover.
The most common surgeries for women are hysterectomy, prolapse repair, laparoscopy for endometriosis, and for significant stress urinary incontinence. These conditions involve structural changes. Surgery aims to either remove abnormal tissue growth or improve the position of the internal organs. Surgery is not done for urinary urgency as this is not a structural condition. Rather it is an overactivity and/or habit of the bladder muscle and nervous system.
When surgery is necessary, preparation beforehand can make full recovery easier. Understanding test procedures like urodynamics, cystoscopies, ultrasound scans, anorectal measurements, the different types of surgery for prolapse repair or for stress urinary incontinence, is helpful in coming to terms with what’s required and making choices that are right for you.
Learning what to expect, correct pelvic floor exercises, good bladder and bowel habits, and how to safely return to usual life activities, sex, general exercise and sports, is reassuring and empowering.
