physiotherapist - Grow Health

Pelvic Floor Stress – The Unspoken Symptom of COVID

Posted on 15/08/202215/08/2022 by Juanita McDonald

Covid, alongside its friend’s influenza, the common cold, RSV etc., have shown an increase in the number of women presenting to the clinic with symptoms of both:

SUI (Stress Urinary Incontinence): ‘the complaint of any involuntary loss of urine on effort or physical exertion (e.g sporting activities) or on sneezing or coughing’ (International Continence Society). I.e leaking when the bladder is under a high pressure
Prolapse: ‘the descent of one or more of the anterior or posterior vaginal wall or uterus/apex of the vagina’ (International Continence Society) which is also associated with feeling or seeing a bulge inside or outside of the vagina. This could also present as a feeling of heaviness or dragging within the vagina or lower back.

To understand why this occurs, we need to zoom out for a moment and look at the torso as a cylinder. The diaphragm (base of the lungs) is the roof of the cylinder, the sides are created by your abdominal muscles and spine, and the base of the cylinder is the pelvic floor. For a cough, sneeze or nose blow to occur, we need to create a lot more pressure inside the cylinder. If either the pelvic ligaments and fascia are weak, or the pelvic floor muscles are weak or not functioning optimally, we see an excessive stress placed on the base of the cylinder from this.

What can you do to help manage this at home?

Do “the knack”. We have an Instagram post on this, but essentially what it involves is a voluntary squeeze and lift of the pelvic floor muscles prior to a sneeze/cough. This is to help reinforce the support at the base of the cylinder.
Ensure you keep drinking enough and eating enough “bowel friendly foods”. Constipation puts extra strain on the pelvic floor, and can occur when you’re sick. Try to be on the front foot with looking after your bowels when you’re unwell, and if you’re worried, telehealth your GP for assistance with managing this further.

What we can do to help with your pelvic floor care before or after you are unwell:

Assess you for prolapse. If we know you have one, or if you develop symptoms as a result of being unwell, we can give you specific strategies to help you manage your prolapse during periods of sickness in the future.
Assess your pelvic floor muscle coordination. How strong is it? How fast can you contract it? How well can you keep it on through movement? Do you bear down effectively? All things that are important for helping you keep the happiest pelvic floor possible during times of illness.
Constipation management strategies.

Pelvic floor strain not only occurs in women with acute conditions such as a Covid, it also occurs in women with chronic respiratory conditions such as:

Cystic fibrosis
Bronchiectasis
Asthma
Hayfever and Allergies

In these populations, pelvic floor symptoms are common, but not well known. We treat women of all ages, with a variety of pelvic floor conditions that occur for numerous reasons. If you are worried, please reach out, we would love to help you make periods of illness, just a little less stressful.

A Physiotherapist’s role in Endometriosis.

Posted on 28/03/202205/07/2022 by Juanita McDonald

A (very) brief rundown of the basics:

Endometriosis affects 1 in 9 women* (and those who identify as gender diverse or non-binary). It is a condition where tissue similar to the uterus lining (endometrium) is found in other areas of the body, most commonly the pelvic organs (uterus, bladder or bowel). There are a wide variety of symptoms, and each woman’s experience with endometriosis will differ. Some, all, or none of the following may be experienced:

Pain in your pelvis, lower back or abdominal region
Irregular, heavy and/or painful periods
Fatigue
Ovulation pain
Painful sex
Changes, pain or difficulty with bladder and bowel function
Infertility
Pelvic floor dysfunction

Endometriosis is diagnosed through laparoscopy surgery, where a biopsy on a tissue sample is taken. It may be diagnosed as mild, moderate or severe (or stages 1-4). However, the severity of diagnosis does not necessarily correlate to the severity of symptoms.

There is no cure for endometriosis, and there is much to be done in terms of research to improve the knowledge and treatment options health care providers can offer.

The role of pelvic floor physiotherapy in endometriosis

Where we come in. While we can’t cure endometriosis, we do have treatment techniques that can help you to manage your symptoms better. Often endometriosis is present in the pelvic organs (bladder, bowel, uterus), and therefore can affect the function of these organs, and the function of the pelvic floor muscles. It is common (not always) for those with endometriosis to have pelvic floor muscles that are tense and painful. As your pelvic floor muscles play a vital role in sexual, bladder and bowel function, it is possible that these muscles are partially responsible for some of your symptoms and pelvic floor dysfunction, including:

Internal pelvic pain, such as pain with intercourse or penetration
Bladder dysfunction, such as urgency/frequency, difficulty with emptying, pain, leakage
Bowel dysfunction, such as constipation, urgency, pain, difficulty emptying
External pelvic pain/lower back pain/abdominal pain
Persistent pain

A pelvic floor physiotherapy assessment is likely to include extensive questioning of your pelvic floor health, as well as a physical assessment which may involve an internal vaginal assessment.

Physiotherapy treatment options will vary depending on the individual’s symptoms and goals. Management and treatment options we may suggest include:

Pelvic floor relaxation training
Manual release work to the pelvic floor and surrounding muscles (internal and external muscles)
Bladder training
Bowel training
Breathing techniques
Stretching and appropriate strengthening exercises
Pain education and management strategies

Physiotherapy can help to reduce pain, improve bladder and bowel function and improve your pelvic floor muscle function. The goal of physiotherapy is to help provide you with strategies to manage your symptoms.

Other Management of Endometriosis

Those with endometriosis will often require a multidisciplinary team to help treat the condition and manage symptoms. A good GP and gynaecologist who has specialised in endometriosis is vital to optimising outcomes. Management options may include:

Laparoscopic surgery to remove the affected tissue
Medications (including pain medications, hormone therapy etc)
Psychology
Pain management
Physiotherapy
Physical/exercise therapy
Dietician
Sexual therapist/sexologist
Natural therapies/lifestyle management

Interesting Facts:

It takes an average of 6.5 years to receive a diagnosis (often longer).
Period pain is NOT normal.
Although endometriosis is normally found in the pelvic organs, it has been found in muscles, joints, and the brain.
Getting pregnant or having a hysterectomy will NOT cure endometriosis.

If you are suffering from endometriosis and have not tried pelvic floor physiotherapy, look into it – it can not cure endometriosis, but it may assist with symptoms and reduce pain and dysfunction. See below for some national groups that have further information and links to support groups you may find useful.

https://www.endometriosisaustralia.org/

https://www.jeanhailes.org.au/health-a-z/endometriosis

Let’s Talk About Sex

Posted on 06/01/202205/07/2022 by Juanita McDonald

For many women, sex is far from enjoyable or pleasurable. In fact, sex can be painful for many women. So painful for some, that it is not at all possible. Dyspareunia is the term we use for painful sex. Pain may be experienced before, during or following sexual intercourse. Dyspareunia may be deep (felt deep inside the vagina), or superficial (felt at the introitus or entry to the vagina). It can affect women of all ages. The important point is, sex should not be painful, and there are treatment options out there (that don’t include “just have a glass of wine and try to relax”).

Often there are multiple factors that are contributing to why a woman experiences pain with sexual intercourse (or any form of arousal, touch, or penetration). These may include various physical and psychological factors such as; lubrication, infection (UTI, thrush), surgery, endometriosis, physical or emotional trauma, stress, anxiety, relationships, personal beliefs and more. Some of these factors may affect the function of the pelvic floor muscles and nerves which may be one of the reasons why a woman is experiencing dyspareunia.

Pelvic floor muscles lay in the base of the pelvis and surround the vaginal and anal openings. They play a huge role in sexual function. Sometimes, these muscles, and the nerves in the area, are not functioning optimally. This may result in pain sensations being experienced in anticipation of, during, or following sexual activity. One of the reasons this occurs is due to involuntary contraction or persistent spasm of the pelvic floor muscles when they should be relatively relaxed during sexual activity. We call this spasm/involuntary contraction of the pelvic floor muscles, vaginismus.

Pelvic floor physiotherapy can often assist women experiencing pain with sex (dyspareunia), particularly those experiencing vaginismus. It will vary depending on each individual, but frequently we work on techniques that help to relax the pelvic floor muscles. Some techniques we use are rather passive (breathing exercises, stretches), and some techniques are more physical or involve manual therapy to the pelvic floor muscles, devices such as dilators and biofeedback tools. We also work with you on your overall pelvic health including bladder and bowel function and pain education and management.

Treatment for dyspareunia is never the same for any two women, and often input from multiple health professionals is required to achieve holistic care and optimal outcomes. Other health professionals that can assist include psychologists, sexologists, GPs and other specialists.

If you experience pain with sexual intercourse, and you haven’t had a pelvic floor physiotherapy assessment, we recommend you do. Further information can be found at the links below, or give us a call.

https://www.pelvicpain.org.au/

https://www.endometriosisaustralia.org/

https://www.jeanhailes.org.au/

This is intended as general information only. It is not to be interpreted as professional advice. Please consult a health professional before attempting any form of treatment. We use the terms women/woman/her/she, however, we treat anyone who identifies as a woman or has female genitalia and is supportive of all LGBTQ and non-binary people. If you are male and in need of assistance, we know of some wonderful physios around town and can point you in the right direction.

Exercise in Pregnancy

Posted on 02/12/202118/11/2022 by Juanita McDonald

Exercise during pregnancy can seem daunting and confusing. There is a great deal of (often conflicting) advice out there which makes choosing how to stay active during this life stage challenging. What we do know, is much like all other stages in life, exercise is hugely beneficial during uncomplicated pregnancies. Unless it is medically indicated you cease exercise (which can be required in some rare instances), staying active will have immediate and long-term benefits on maternal and child health.

As women’s health physio we are very passionate about keeping women active during pregnancy, however, we understand the implications the physiological changes can have on your body and what adaptations are necessary to manage these changes. There is no one size fits all approach for women during pregnancy. There are some general guidelines we follow, however, specific recommendations can differ for each individual.

What we do know:

It is recommended women stay active throughout pregnancy (unless medically contraindicated).
In a healthy pregnancy, exercise is safe for both the mother and baby
Women should be cleared to exercise by their treating team prior to commencing an exercise program

Things we know need to be considered:

The physiological changes throughout pregnancy should be considered when determining appropriate forms of exercise. Things such as ligament laxity, muscle function, increase in weight, and changes in heart rate and blood pressure, will all influence what forms of exercise or activity are appropriate for each individual.

Frequency, duration and intensity of exercise should be adjusted to suit each woman at each stage of pregnancy. These things will be impacted by factors such as previous activity and fitness levels.

Exertion levels and temperature need to be managed to avoid overexertion or overheating

How these considerations are applied to each individual woman can differ greatly. For example, if a woman had a high baseline level of fitness and activity prior to falling pregnant, it may be appropriate for her to continue those previous forms of exercise which may include running or high-intensity gym-based training early in her pregnancy, provided the above-mentioned factors were considered. As the pregnancy progressed, and further physiological changes took effect, it would be likely that this exercise would need to be modified to lower impact options more suitable for the late stages of pregnancy. In other instances, where a woman was relatively inactive prior to pregnancy, easing into a low-moderate intensity exercise regime that could include things such as brisk walking and bodyweight training would be appropriate and recommended.

In most instances, exercise is safe and recommended to commence or maintain throughout pregnancy. Avoiding postures (such as lying on your back) and activities (such as high-impact movements or high-risk activities) that stress the body unnecessarily should be avoided as pregnancy progresses. If women have a change in symptoms throughout their pregnancy or develop symptoms during exercise, they should seek advice from their treating team.

If you don’t know where to start with your exercise, or you are eager to continue what you love but are unsure if it’s safe, get in touch with a women’s health physio who can help guide you!

Bladder Leakage – Common but not Normal

Posted on 21/11/202105/07/2022 by

Yes, mild bladder leakage is common. Very common. In fact, up to 1 in 3 women in Australia experience bladder leakage (also known as urinary incontinence). However, common does not mean normal. And lucky for you, most leakage can be treated very effectively with pelvic floor physiotherapy and, in many cases, cured!

There are two main types of urinary incontinence. Stress urinary incontinence (SUI) or urge urinary incontinence (UUI). Some women may experience both (mixed incontinence).

Stress urinary incontinence occurs when the body (and bladder in particular), is placed under an increased load such as; coughing, sneezing, lifting, jumping or running. Activities such as these, cause an increase in abdominal pressure, and this increase in pressure is also placed on the bladder. In order for your bladder to keep the urine in, there are a few muscles and structures that need to be strong and function well enough to help counteract this increase in pressure. Your pelvic floor muscles play a big role here! Which is one of the many reasons you need to become familiar with your pelvic floor muscles and learn how to work them optimally.

If you experience SUI when you are exercising, it is a sign that the level of exercise or activity you are doing when you leak, is (at this point in time), too much for your body. It does not necessarily mean that you can not do the activity, but it is wise to reduce or modify and see a pelvic floor physiotherapist to help you recover. Pelvic floor physiotherapy can greatly improve, and in many cases, cure SUI. So if you want to be able to continue performing your favourite high-level activity with improved strength, function and confidence you can wear the coloured tights! Get in touch

Grow Women’s Health

Category: physiotherapist

Pelvic Floor Stress – The Unspoken Symptom of COVID

A Physiotherapist’s role in Endometriosis.

Let’s Talk About Sex

Exercise in Pregnancy

Bladder Leakage – Common but not Normal

GROW WOMEN’S HEALTH

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