Occurs when there is weakness in your pelvic floor muscles and changes in your stool consistency.

Bowel Urgency

Occurs when your rectum becomes hypersensitive and is often associated with looser bowel motions and weakness in your pelvic floor muscles.

May occurs with these triggers:
Coffee, fizzy drinks, alcohol, artificial sugars, running water, on route to the toilet or with key in the door.

Defecation Dyssynergia (Anismus)

Pelvic floor muscle dyssynergia is the condition where the external anal sphincter and the puborectalis muscle of the pelvic floor muscles contract rather than relax during an attempted bowel movement.

Common symptoms include: incomplete emptying of rectum after defecating, sensation of pushing against a blockage, fecal loading or impaction and soiling of liquid faeces.

A prolapse is a descent of one or more of the pelvic organs into the vagina. This includes; the bladder, bowels or uterus.

Symptoms of a Prolapse

Vaginal bulging, aching or heaviness
Incomplete emptying of bowels or bladder
Incontinence

What can help my Prolapse?

A supervised pelvic floor muscle training program
Suitable lifestyle advice and modifications
Exercise modifications
Vaginal Pessary

Internal Pelvic Pain

Internal pelvic pain is pain experienced on the inside of the pelvis, in the lower abdominal or perineal area and can be caused or contributed to, by pelvic floor muscle dysfunction.

The most common pelvic floor muscle dysfunction that causes abdominal pain is due to over activity or tension of these muscles.

Signs of Pelvic Floor Muscle over activity

Urinary 

• Incomplete emptying
• Slow flow

Bowel 

• Incomplete emptying
• Stools become thinner and cut short
• Difficulty releasing wind

Intimacy

• Painful on entry or deep penetration
• May have difficulty achieving an orgasm

This condition can be treated by Pelvic Health Physiotherapists

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Sexual pain is pain that is experienced in and around the vagina or pelvis during intercourse.
Sexual pain can be experienced at the vaginal entrance or can be a pain that occurs with deeper penetration.

Common Causes of Sexual Pain?

Overactive pelvic floor muscles
Vulvodynia or Vaginismus
Hormonal changes including menopause or breastfeeding
Vulval skin disorders
Emotions
Relationship problems
Medications that reduce sexual desire

Pelvic Floor Muscles and Sexual Pain

Overactive pelvic floor muscles occur when the pelvic floor muscles are constantly contracted, and they do not relax between each contraction.
When the pelvic floor muscles fail to relax, they can create muscle spasms and tension, and they can therefore become painful just like any other muscle in our body.

Your pelvic floor muscles lie inside the pelvic bones

WHAT do my pelvic floor muscles do?

•  Stop you from leaking urine or stool

  Helps with urine leakage by closing the wee tube (urethra)
  Stops stool leaking by helping the anal canal to maintain good closure pressures

•  Maintain normal sexual function

  Part of the clitoral organ lies within the pelvic floor musculature. Therefore, dysfunction of the pelvic floor can affect a woman’s ability to orgasm. Having optimal pelvic floor health can assist in improving intimacy for a woman.

• Help support your pelvic organs – bladder, uterus and bowel

  The pelvic floor acts like a hammock or trampoline sitting underneath your organs, providing support for your organs in times of high physical load and throughout life

HOW do I activate my pelvic floor muscles?

Below are a few cues to help you activate your pelvic floor muscles:

Back passage

Imagine you are holding wind in, or squeeze your anal sphincter and lift up and in

Middle passage

Imagine you’re lifting a scarf up through your vagina to your heart, or squeeze your labia closed and lift up and in

Front passage

Imagine you’re holding in the urge to go wee, or nodding your clitoris or retracting the clitoris inside you

HOW MANY should I be able to do?

3 sets of 10 repetitions of 10 second holds in standing

HOW OFTEN

Daily or bring them in when you lift –
In this way you are doing them functionally throughout every day.

Pelvic floor safe exercises?

Pelvic floor safe exercise are completely woman dependant

Pelvic health Melbourne recommends each woman has a pelvic health assessment to reliably define what are the safe and unsafe pelvic floor exercises for you.

Pelvic Floor dysfunction?

Weak pelvic floor muscles

Possible signs and symptoms of weak pelvic floor include:

Urine leakage when you cough / sneeze/ lift or jump
Vaginal wind
Difficulty holding a tampon in place
Difficulty holding in wind
Bowel urgency

Overactive pelvic floor muscles

Possible signs and symptoms of an overactive pelvic floor include:

Incomplete emptying of bladder and or bowel
Pain with intimacy either on entry or with deep penetration
Pain is often felt in the lower abdominal region

Exercise during Pregnancy

Benefits of regular exercise in Pregnancy:

• Reduce pregnancy related aches and pains
• Helps to maintain a heathy weight
• Helps to reduce your likelihood of developing gestational diabetes
• Help you to get a better nights sleep
• Helps improve your mood and self esteem

What type of exercise is safe during pregnancy and how often should I be exercising?

• Due to the hormonal and musculoskeletal changes that occur during pregnancy it is recommended that you participate in low impact cardiovascular exercise such as swimming, walking or cycling.
• It is important that you do not exercise continuously for more than 45 minutes as it can make your core body temperature too hot and this can potentially affect the baby.
• Exercise should be performed on most days of the week for around 30-45 minutes.

Signs and Symptoms to Stop Exercising

• Dizziness or feeling faint
• Shortness of breath
• Vaginal bleeding or fluid loss from your vagina
• Chest, leg or stomach pains
• Contractions

Childbirth Education

Physiotherapists have an important role in helping women prepare for childbirth. A Women’s Health Physiotherapist can provide advice on active birth positions to help with labor and also help to advise you on what positions to use and avoid with pregnancy related pelvic girdle pain.

Postnatal Physiotherapy

Mastitis

Mastitis is inflammation of the milk ducts. The inflammation is the result of milk flowing backwards through the ducts and into the breast tissue.
This is due to an increase in pressure in the milk ducts. Breast milk contains protein. When the milk enters the breast tissue, the protein is recognized as “foreign” and creates an inflammatory response in this tissue.

Exercise in the Post Natal period

What happens to the body during pregnancy and the post partum period?

During pregnancy and childbirth the body undergoes a significant amount of musculoskeletal and hormonal changes. These changes affect the body by weakening and stretching the abdominal, back and pelvic floor muscles. This results in an increased risk of joint and ligament injuries within the body. Breastfeeding also increases the size of their breast tissue as a result of hormonal changes and milk production.

Return to Sport and Exercise Guidelines

0-6 Weeks:

• Pelvic floor exercises
• Basic abdominal exercises
• Walking

6-8 Weeks:

• Recommended 6 week Post Natal Check with Pelvic Health Physiotherapist
• Increase the intensity, change position for pelvic floor exercises
• Abdominal exercises
• Walking
• Can start some light cardiovascular exercise provided you have no signs and symptoms of pelvic floor dysfunction

·   X-trainer, bike, rower
·   Low impact aerobics
·   Pilates
·   Yoga
·   Lightweights
·   Narrow squats, lunges, push-ups, and dips

12-16 Weeks:

• Further assessment of pelvic floor with Pelvic Health Physiotherapist, assessing to see if pelvic floor is ready to start higher impact exercise
• If your pelvic floor is ok, you can start to incorporate:

·  Jogging, skipping, running, return to sport specific drills

Mastitis is inflammation of the milk ducts.

The inflammation is the result of milk flowing backwards through the ducts and into the breast tissue. This is due to an increase in pressure in the milk ducts. Breast milk contains protein. When the milk enters the breast tissue, the protein is recognized as “foreign” and creates an inflammatory response in this tissue.

Signs and Symptoms of Mastitis?

• Pain
• Swelling
• Redness
• Fever
• Fatigue and generally feeling unwell
*These are all the signs of inflammation and infection

Treatment of Mastitis

1. Therapeutic Ultrasound from a qualified Lactation Physiotherapist.

2. Rest. Treat your condition like you have the flu. Rest in bed and only

look after you and your baby until the symptoms pass.

3. Ice. Use cold packs every 2hrs for 15-20 mins to help with pain and swelling.

4. Massage. Gently massage the breast towards the armpit. Use as much pressure as you would to stroke a cat or dog.

A DRAM is an abbreviation for a separation of your rectus abdominis muscle. Your rectus abdominis muscle is the muscle in the midline of your abdomen and it has a major role in providing stability to your lower back and trunk.

Why is important to have my DRAM assessed?

During the post natal period, your body undergoes healing for around 3-4 months. After 4 months your body is unlikely to be able to repair your DRAM any further without any specific abdominal exercises.
An assessment of your DRAM in the early post natal period will help identify if you have a significant DRAM which places you at increased risk of low back pain, pelvic floor dysfunction, abdominal hernias and other injury.
A DRAM which is greater than 2cm anywhere along your abdomen is considered to be clinically significant and requires specific abdominal exercises.

What should avoid if I have a DRAM?

If you have a DRAM you should avoid the following:

• Heavy lifting and carrying
• Sit ups, V ups, oblique twists
• Any abdominal exercises that cause the abdomen to bulge
• Any abdominal stretches

Menopause is the change of life where a woman no longer menstruates and their period stops permanently. A woman is considered to have gone through menopause when she has not had a period for 12 months.

After menopause our sex hormones, oestrogen, progesterone and testosterone slowly decline to a very low levels. These hormones are responsible for maintaining tissue elasticity including vaginal tissue and they cause our lining of the uterus to thicken during the menstrual cycle. These hormones also preserve bone and muscle mass, they maintain vaginal blood flow and lubrication and they contribute to libido.

What are some of the Common Symptoms Associated with Menopause?

• Hot flushes
• Night sweats
• Insomnia
• Vaginal dryness
• Bone loss (reduced bone density/osteoporosis)
• Fatigue
• Heavy or irregular bleeding
• Incontinence (bladder and/or bowel)
• Urinary urgency (the need to rush to the toilet to urinate)
• Urinary frequency

After menopause, changes to the female sex hormones affects the body’s natural bone remodelling process. The loss of the female sex hormone oestrogen accelerates bone loss (oestrogen helps to preserve calcium stores and prevent bone breakdown).

In the first 5 years after menopause most women will have lost around 10% of their bone mass. This loss of bone mass increases the woman’s likelihood of developing osteoporosis.

Guidelines for Exercises to Prevent Osteoporosis

• Exercises need to be moderate to high Osteogenic to continue to stimulate healthy bone growth.
• Exercise at least 3 x /week for 30 mins.
• Exercises should be progressed, e.g. increase weight used, increase the hill intensity, increase time, distance etc.
• Exercises should be challenging to stimulate bone growth.
• Exercises should be varied in their routines.

Balance Exercises to Prevent Falls

It is important to incorporate balance exercises as part of an exercise regime to help improve proprioception.
Reduced strength, balance, poor vision and tripping hazards around the home can cause falls. Women and men with low bone mass are at greater risk of fractures from falls.