Women’s Pelvic Health
Did you know that - 1 in 3 women and 1 in 10 men will experience urinary incontinence (UI). No matter how light, you should not accept this as normal. You don’t have to live with it or suffer in silence. In most cases, bladder problems can be cured or managed better.
What is normal bowel function?
Being ‘regular’ is a way of describing good bowel habits or normal bowel function. Being regular really means that soft yet well-formed bowel motions are easily passed and that this happens anywhere from 1-3 times a day to 3 times a week. These stools should take minimal effort to empty, you should feel empty and satisfied when you leave the toilet.
Pelvic Organ Prolapse
A prolapse means the “dropping down” of your pelvic organs - your bladder, bowel or uterus. It is NORMAL to have some movement of organs in the vagina, but symptoms associated with this should not be accepted as normal.
A prolapse sounds scary, but it is very common after childbirth and during menopause. In many cases, prolapse can be better managed, its symptoms reduced and its progression prevented.
Persistent Pelvic Pain
1 in 5 women experience pelvic or sexual pain.
Persistent pelvic pain is a condition where persistent or recurrent episodes of pain is experienced for more than 6 months. This pain can be experience in the abdomen, pelvic region, pelvic floor and/or pelvic organs.
Pelvic pain and sexual pain can have simple causes such as vaginal tissue dryness from breastfeeding or menopause
However, often persistent pelvic pain has complex causative mechanisms that involve not only muscles and pelvic structures, but sometimes also the peripheral nervous system and central nervous system (nerves and brain)
Signs and symptoms of persistent pelvic pain
Painful sex, penetration, feeling ‘too tight’ or a ‘blockage’
Pain when using tampons / having an internal examination
Pain with arousal
Twitching and/or spasm in your pelvic floor muscles
Pain or burning anywhere in the vulva, genitals, lower abdomen region
Common causes of persistent pelvic pain
Skin conditions of the vulva such as eczema, dermatitis and lichen sclerosus
Conditions such as vulvodynia, vaginismus, pudendal neuralgia, endometriosis, bladder pain syndrome or interstitial cystitis
Changes during menopause and childbirth
Ehlers-Danlos Syndrome (EDS) – 30-57% of women with EDS experience pain with sex
Recurrent UTIs and/or thrush
Psychological factors such as stress, anxiety, low mood and relationship problems
Things that have occurred in your past, such as a history of trauma and/or abuse
How can physiotherapy help?
Physiotherapy involves assessing all the potential contributing factors for your pain and can include:
A comprehensive assessment of the pain history, patterns and onset will be performed to help guide treatment
Retraining of the pelvic floor muscles and nerves
Lubricant and vaginal moisturisers
Relaxation strategies and down regulation of the central nervous system drivers
If indicated, manual techniques to desensitise the nerves and muscles of the pelvic floor which can include self massage, pelvic trainers and/or wands
A musculoskeletal assessment of your posture, breathing, thorax, abdomen and pelvis
Bladder and bowel retraining
If indicated, the use of a TENS machine to manage your pain
Advice on lifestyle factors including general exercise, sleep, diet and stress management
We work in conjunction with your specialist healthcare team which will normally include your GP, gynaecologist, pain specialist and psychologist. If you don't have a healthcare team already we work with some of the best pelvic pain caregivers in Melbourne and are happy to refer you for your overall care.
 Tinkle, B. T., Castori, M., Berglund, B., Cohen, H. S., Grahame, R., Kazkaz, H., & Levy, H. (2017). Hypermobile Ehlers-Danlos syndrome (a.k.a. Ehlers-Danlos syndrome Type III and Ehlers-Danlos syndrome hypermobility type): Clinical description and natural history. American Journal of Medical Genetics Part C: Seminars in Medical Genetics, 175(1), 48–69.
Endometriosis and Adenomyosis
What is endometriosis?
Endometriosis is a progressive and chronic condition that affects approximately 10% of women of reproductive age.
It specifically refers to when the endometrium (the tissue that normally lines the inside of the uterus) is found growing outside of the uterus.
Endometrial tissue has been found in many parts of the body including the bladder, bowels, vaginal wall and pelvic floor muscles.
Your body undergoes significant changes during pregnancy as your hormones change and baby grows.
There is significant research that supports the benefits of exercise and pelvic floor strengthening during pregnancy. At MPFP, we offer group physiotherapy exercise classes (similar to Pilates) and a pregnancy specific group exercise class.
Post Pregnancy Assessment
A postnatal assessment with a pelvic floor physiotherapist is quite different to a check with your obstetrician or GP – and they are both equally important.
Your body has just been through a huge transformation and you need to treat your body as though you are in recovery – you need to take time to heal and do what is right for your individual recovery.
Menopause is when you have your final period. Your periods stop because your ovaries don’t release eggs anymore.
Menopause can happen natural, at the expected age or early (average age 51). Your periods can also stop unexpectedly due to premature ovarian insufficiency, surgery or cancer treatment.
If you are preparing for gynaecological or vaginal surgery, such as removal of fibroids, hysterectomy, endometriosis surgery, pelvic organ prolapse repair, or are planning to have an incontinence surgical procedure, getting advice from a pelvic health physiotherapist beforehand can aid your recovery.
MPFP physiotherapists manage a range of conditions specifically affecting women during all stages of life from childhood, adolescence, childbearing years, post menopause and seniors. A women’s health physiotherapist pays particular attention to preventing or assisting problems with the female pelvic organs.
Pelvic floor muscle function is to support the pelvic organs and maintain continence. Having strong pelvic floor muscles gives us control over the bladder and bowel. Weakened pelvic floor muscles mean the internal organs are not fully supported and you may have difficulty controlling the release of urine, faeces or flatus.
Some of the common causes of a weakened pelvic floor include pregnancy, childbirth, menopause, surgery and straining from chronic constipation. Pelvic floor exercises are designed to improve muscle tone and prevent incontinence, symptoms of prolapse and prevent the need for corrective surgery.
How We Can Help
A full assessment will be done to determine your pelvic floor requirements, and a management plan will be provided to achieve your goals in agreed time frames.
How Healthy is Your Pelvic Floor?
- Do you experience urine leakage related to physical activity, coughing or sneezing?
- Do you experience any urine leakage related to the feeling of urgency?
- Do you experience frequent urination?
- Do you have difficulty emptying your bladder?
- Do you experience pain in the lower abdominal or genital area?
- Do you experience pelvic/vaginal discomfort after standing, lifting, carrying or physically exerting yourself?
- Do you experience night-time urination more than once?
- Is intercourse painful?
- Does your pelvic floor area “feel” like it did prior to childbirth?
- Do your pelvic floor muscles feel weak or loose?
- Are you unsure if you are actually contracting your pelvic floor muscles correctly or have been trying to and do not seem to be improving?
- Do you experience bowel problems such as poor wind control, soiling, urgency or difficulty evacuating your bowels?
If you answered YES to any of the questions then one of our friendly pelvic floor physiotherapists can help you.