Pelvic Health Physiotherapy for women is becoming a more talked about subject, but still one that is far less common and known about than so many other area of Physiotherapy. Many people can feel alone and unable to ask for help. So here is a bit more information that might help you today….

Pelvic health Physiotherapy can help with many problems that are commonly experienced in pregnancy; post-birth (both a vaginal delivery and a caesarean section), as well as during the menopause (where hormone changes can impact on pelvic floor function and strength of other muscles too).

Common pelvic problems include:

Stress incontinence (leaking with coughing, sneezing, impact and lifting);

Difficulty fully emptying the bladder and urgency (the need to go more frequent than usual or necessary).

Bowel incontinence and constipation

Pain and problems during intercourse.

Recurrent Urinary Tract Infections.

Pelvic girdle pain (pain around the groin and pelvis, front or back, and is often linked to the sensitisation of tissue in the area).

  

Today, lets focus on the symptoms of a prolapse:

Last month was national prolapse awareness month. Prolapses are common, with 1 in 2 women having a prolapse after child birth (Hagen & Stark, 2011), some with symptoms and some without, with 1 in 10 women by the age of 80 requiring surgical intervention due to their symptoms (Hagen & Stark, 2011). NICE guidelines state over 50% of all women will be affected by a prolapse in their lifetime.  You can have a bladder, uterus or bowel prolapse and can give differing symptoms.

Symptoms of a prolapse include:

Heaviness and dragging feelings around the entrance to the vagina, or a bulging/lump.

Pain or numbness with intercourse

Problems with emptying the bladder or bowel, and leaking.

Some it will be picked up on an internal check, without having any symptoms.

The pelvis is interlinked with the core muscles, back muscles, pelvic floor muscles, leg muscles as well as many organs including the bladder and bowel, and can therefore be complex. Historically, it was thought that a prolapse was everything ‘falling out’ with gravity, and therefore lots of pelvic floor exercises to strengthen around the pelvis was encouraged and prescribed to stop it from happening. However, more recent evidence suggests this is not the case and is more closely related to a build up of tension, often after the trauma or childbirth or with scarring, pulling things out of alignment, creating more tension and pull in particularly directions (called biotensegrity, Anna crawle). This can take years after childbirth to build up more and more tension, and can be linked with back and pelvic pain which is highly linked with having prolapse symptoms.

Biotensegrity Model (ref) INSERT IMAGE BELOW

Physiotherapy can help with these problems, using thorough assessment looking at:

Posture, movement, strength, scar healing and sensitivity and pelvic floor strength and function- to provide advice, exercise and hands on therapy including scar release. Advice on the use of aids such as pessaries to help symptoms can also be helpful. Exercises may include pelvic floor strengthening and pelvic floor relaxing exercises, strengthening around the hips and core, as well breathing re-education and spinal mobility which all play a part in how different parts of the body work to function.