Women’s Health Physiotherapy

Women’s Health Physiotherapy

The muscles and other structures of the pelvic floor are required to perform a wide variety of tasks over a woman’s life with pregnancy and childbirth and the ageing process contributing to potential problems of the pelvic floor.  This may include prolapse and urinary incontinence – distressing and common problems that may impact quality of life for a woman.  These issues require careful assessment and a range of treatment approaches are available, since not all issues need or respond to surgery.  Our dedicated women’s health physiotherapists are here to address these issues and improve your quality of life.

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Stress Urinary Incontinence

Stress urinary incontinence is a condition in which women suffer from leaking urine during ‘effort’ or activity.  Activities that commonly provoke leaking in women with this condition may include coughing, sneezing, lifting, running or jumping.  This type of incontinence can be multifactorial, and thorough assessment by an Alana Physiotherapist who is trained in pelvic floor dysfunction will correctly identify the leading cause.

Are there conservative (non surgical) treatments available for stress urinary incontinence?

Yes, there are several conservative options that can be effective in the management of this condition. However, the success rates of each option differ depending on the precise cause of your stress urinary incontinence. It is for this reason that a detailed pelvic floor assessment is required. Thorough diagnosis allows identification of all contributing factors, which will then aid in decisions regarding appropriate intervention.

Overactive Bladder Syndrome

“Overactive Bladder” (OAB) is a condition that will often cause distressing symptoms for women.  Symptoms may cause you to rush to the toilet many times during the day and/or night and this rush can sometimes also trigger you to leak some urine before you reach the toilet.

How does a normal bladder work?

The bladder is often referred to as similar to a balloon.  As urine is produced and fills the bladder up, the walls of the bladder will stretch to accommodate the fluid.  Urine is kept inside the bladder by the urethral system, which will keep the bladder from losing urine until there is an appropriate time and place to do so.  The muscles of the pelvic floor also assist the urethral system.

Normally, as the bladder fills with urine, you will start to be aware of the sensation that you need to go to the toilet, but are able to hold on or defer emptying until an appropriate time and place.

The bladder usually will need to be emptied approximately 4-7 times per day, and possibly once at night.

What are the symptoms of overactive bladder (OAB)?

The following collection of bladder symptoms may be indicative of overactive bladder syndrome:

  • Urgency – a sudden and intense need to pass urine that is difficult to defer. This may even happen when your bladder is not full. Sometimes you may have difficulty making it to the toilet in time and may suffer from urge incontinence (leaking urine on the way);
  • Frequency – a need to empty your bladder many times during the day that you consider to be bothersome (usually more than 7);
  • Nocturia – waking up more than once at night to go to the toilet.

What causes OAB?

The causes of OAB can be complex and multifactorial however essentially, the symptoms are due to the bladder muscle squeezing to empty urine either too often, sometimes without warning or when you do not want it to.

If you have had a previous surgery for stress urinary incontinence you may also be more likely to experience symptoms of OAB.

How is OAB diagnosed?

Often initial testing will involve screening your urine for any signs of infection, as it is first important that we rule out any organic cause, which could be contributing to your symptoms.  If there is no infection present then you may be asked to complete a bladder diary and often will be diagnosed based on these findings and your presenting symptoms.  You may also be asked questions about your bladder, fluid intake and general health.  If your case is more complex, you may also be required to complete Urodynamics testing.  This is a test that is able to examine the bladder muscle’s response independently as it is filled with fluid, and can identify if your bladder muscle is squeezing inappropriately (also known as ‘detrusor overactivity’).

Can OAB be treated conservatively (non-surgically)?

Fortunately, there are many treatments that can be effective in reducing the symptoms of OAB.  Often simple first line treatments such as lifestyle changes can significantly improve symptoms.  In addition your Alana Physiotherapist may suggest a bladder-retraining program, urge suppression techniques, pelvic floor strengthening, and/or the use of nerve stimulation to restore the normal messages being sent via the urinary system. These treatments can be non-invasive and are often very successful.

Pelvic Organ Prolapse

Your pelvic cavity houses three main sets of pelvic organs:

  1. Bladder and Urethra (urinary system);
  2. Uterus, Fallopian Tubes and Ovaries (reproductive system); and
  3. Rectum and Anal Canal (bowel).

There are two central support systems, which enable these organs to maintain their high position within the pelvic cavity. These systems include:

  1. Muscular System: “Pelvic Floor Muscles; and
  2. Connective Tissue System: “Endopelvic Fascia”.

If one or both of these systems become impaired, for example after childbirth, during pregnancy, or following high levels of abdominal straining, then a woman may develop pelvic organ prolapse.  Pelvic organ prolapse refers to the gradual or sometimes sudden descent of organs towards the vaginal opening.

What symptoms might I feel if I have developed Pelvic Organ Prolapse?

Pelvic organ prolapse is most often described as a sense of ‘heaviness’ or a vaginal bulge, however this may or may not be bothersome.  These symptoms may also seem more evident during certain activities such as high impact exercise or standing on your feet for long periods.  Symptoms may also present or worsen later in the day.

What should I do if I think I may have or be at risk of Pelvic Organ Prolapse?

If you suspect you may be suffering from, or are at risk of developing pelvic organ prolapse, then it is important to discuss your concerns with your Alana Gynaecologist or Physiotherapist.  Thorough assessment can assist you in making an informed decision regarding your treatment options.  There are several physiotherapy interventions available to assist in the management of pelvic organ prolapse, however the management option implemented will vary depending on each woman’s individual circumstance.

Pelvic Floor Exercises

Your pelvic floor muscles are a vital component in maintaining control of your bladder and bowel, as well as keeping your pelvic organs high within your pelvic cavity. Additionally, these muscles play a fundamental role in sexual function and lower back support.

How do I contract my Pelvic Floor Muscles?

It is not uncommon for women to experience difficulty in locating and contracting their pelvic floor muscles.  It is important that when you contract your pelvic floor muscles, you focus on the internal muscles and avoid overuse of accessory muscles such as the buttocks and stomach. When performing a contraction of the pelvic floor, it is normal to feel a squeeze and a lift component. It is also beneficial to be able to hold this contraction for a considerable period (e.g. 10 seconds), and turn these muscles on quickly for more intense activities such as sneezing or coughing.

Is there a way I can check my Pelvic Floor muscles are activating?

The Alana Physiotherapists have a special interest in pelvic floor muscle training and are here to help you.  We can perform an assessment of your muscles, provide you with information regarding strength, tissue extensibility (stretch) and quality of contraction.  Specific assessments can be performed that will not only give you an objective measure of your current pelvic floor function, but will provide an accurate means to monitor your progress.  The incorporation of an objective assessment tool also enables you to begin training your pelvic floor muscles correctly and at the appropriate stage for your individual circumstance.

Related Information:

Treatment for Chronic Pelvic Pain

Physiotherapy for Back and Pelvic Pain

Physiotherapy for Hand and Wrist Conditions