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Pelvic Floor Retraining / Continence

There are areas in Physiotherapy care that have been developed specifically to address needs in Womens Health. From care of musculoskeletal pains and exercise guidelines during pregnancy, post natal care, pelvic floor assessment and rehabilitation, and continence concerns, Physiotherapy can be a highly useful tool to assist you during your journey through pregnancy, recovery after delivery, and provide you with evidence based guidelines for your return to function and exercise.

We have Physiotherapists specifically trained in the treatment of Pregnancy Related Pelvic Girdle Pain (PRPGP), Pelvic Floor Assessment, and treatment of Continence and Pelvic Floor Rehabilitation. As always, our approach is hands on and education based, as well as exercise focused. We aim to enable each of you to manage your concerns in a confident, informed, and independent way. 

Pregnancy Related Pelvic Girdle Pain (PRPGP)

Our Physios are trained to specifically treat the common occurrence of PRPGP, along with the many other aches and pains common in pregnancy. We have an understanding of the ways in which pregnancy alters the body’s mechanics during the trimesters, and the treatment limitations or variations these may bring to the treatment of the pregnant woman. Our approach is based on diagnosis, treatment, and management, as well as ensuring that this condition is well understood and managed by both us, if needed, and yourself for the remaining weeks of your pregnancy. Our clients frequently find progression into our Clinical Pilates or Pre/Post Natal Pilates classes highly beneficial in their management.

Pelvic Floor Assessment and Retraining

Pelvic Floor Assessments are frequently used by Physios in Womens Health to assess pelvic floor strength and function. This can be required due to continence concerns, pelvic pain or symptoms, concerns regarding prolapse, and sometimes just to check pelvic floor exercises are being done correctly.

A clinical pelvic floor assessment will include discussion of your history, goals, and an objective examination. If incontinence is a concern, a bladder diary is usually sent to you to be completed prior to the consultation, and this is also assessed and discussed during your assessment.

A full pelvic floor assessment does involve an external and internal assessment to enable a proper judgement of pelvic floor strength and function. If pelvic floor dysfunction is indicated, the external and internal assessment gives us very valuable information to assist in the diagnosis and treatment of the dysfunction. This, however, is entirely up to you on the day of your assessment. If you chose not to receive a full external and internal assessment, we will do our best to assess, diagnose, and manage with what information you provide us and any assessment that can be achieved within the boundaries of your consent. The extent of the assessment is entirely up to you. Please be assured that all effort is taken to preserve your privacy and comfort, and the purpose of the assessment is to give you the most appropriate and effective tools to address your area of concern and provide you with the best possible management, or referral to the appropriate professional.

External and internal assessments are not compulsory for pelvic floor retraining, and other methods can be used, but it is the most effective way for us to directly assess the quality of the pelvic floor, as well as check for tears and/or prolapses.

POP (Pelvic Organ Prolapse) and Pessary Fitting

POP effects 1 in 2 women after a vaginal birth, and many that haven’t had a vaginal birth at all. It is not uncommon but its presentation varies greatly. Sometimes we find a Pelvic Organ Prolapse on assessment that the woman was not aware existed, and sometimes we confirm what a GP or Gynaecologist have found in the past and they have sent you to us for further assessment and management. 

Our Womens Health Physios can provide you with appropriate diagnosis, education, and management of POP, along with specialised fitting of pessary for POP or Stress Urinary Incontinence management if indicated.

Once again, external and internal assessments are not compulsory for pelvic floor retraining, however they are truly vital in the appropriate assessment, diagnosis and treatment of POP. However, we will certainly advise you to the best of our ability based on the information you are able to give us if you choose not to proceed with a full assessment.

DRAM Management

DRAM, or Diastases of the Rectus Abdominus Muscle, occurs when the Rectus Abdominus (the “6 pack”) splits longitudinally down the middle. Whether this occurs above or below the navel, it is a very common occurrence during pregnancy as the muscles are required to give way to your growing baby.

In the pre or ante natal setting, we can teach you how to manage your DRAM, aiming to keep separation to a minimum and prevent tearing. We can also look at your current training to make sure nothing you are doing is having an adverse effect on your DRAM or putting you at risk of tearing.

In the post natal setting we can aide in the assessment of the degree of diastases, as well as the functional implications (if any) that this may be presenting for you. We can also advise you on how to safely and effectively retrain the strength of your abdominals around your diastases, and discuss treatment options for DRAM.

Incontinence

To assess continence a bladder diary usually needs to be completed for 2 consecutive days. Clients will generally attend an appointment first, where the decision will be made as to whether a bladder diary is required for further treatment. This is usually indicated through your history and assessment combined. Once completed, your diary gives us information on the cause, type, and severity of your symptoms or problem.

During your initial clinical consultation a history will be taken, goals discussed, and an objective examination completed. If indicated, an external and internal assessment will be conducted at your consent. As with the pelvic floor assessment above, a full pelvic floor assessment does involve an external and internal assessment to enable a proper judgement of pelvic floor strength and function. If pelvic floor dysfunction is indicated, the external and internal assessment gives us very valuable information to assist in the diagnosis and treatment of the dysfunction. This, however, is entirely up to you on the day of your assessment. If you chose not to receive a full external and internal assessment, we will do our best to assess, diagnose, and manage with what information you provide us and any assessment that can be achieved within the boundaries of your consent. The extent of the assessment is entirely up to you. Please be assured that all effort is taken to preserve your privacy and comfort, and the purpose of the assessment is to give you the most appropriate and effective tools to address your area of concern and provide you with the best possible management, or referral to the appropriate professional.

External and internal assessments are not compulsory for pelvic floor retraining, and other methods can be used, but it is the most effective way for us to directly assess the quality of the pelvic floor, as well as check for tears and/or prolapses.

Mastitis

Our Womens Health physios can help with mastitis by application of therapeutic ultrasound, which helps to break down blockages, then gently (VERY gentle) massage to promote restoration of milk flow. They can also offer basic advise on feeding to prevent reoccurrence, though consultation with a lactation consultant is generally encouraged. This treatment can be used in conjunction with medical management (such as antibiotics).

Post Natal Information Sessions

We provide information sessions on a regular basis. These are information sessions where we sit down with a group to provide accurate and evidence based information on what to expect physically, discuss exercise guidelines, and educate on pelvic floor rehabilitation. We have found there is a lot of misinformation out there and wish to provide you with trustworthy guidelines so you can confidently return to, or begin, exercise regimes safely after pregnancy and delivery, whether conventional or C-section. These sessions are open to questions and discussion is encouraged.

Through these sessions we hope many of you can be reassured or educated into doing the right thing by your bodies, at the right pace, at the right time, using the best techniques. We also hope that the information and education may help some of you identify whether a concern you have had may benefit from further investigation, such as a Pelvic Floor Assessment, and through the education you receive the encouragement to follow up as appropriate with either a Gynaecologist, your GP, or a Pelvic Floor Assessment (see below).

We schedule these sessions to demand at times that suit you (frequently after work or on the weekends). Support persons are welcome to attend also. These are held either at the clinic or, with some organisation, we can come to you and your group.

If you would like an assessment of your pelvic floor function, but you are not comfortable with an external or internal examination, that is very acceptable and please discuss this with your therapist prior to performing the assessment.