Stress incontinence
Occurs when the pressure acting on the bladder is greater than your pelvic floor strength
May occur when you cough, sneeze, lift, run, or jump
Solution: Increase your pelvic floor strength
Urge Urinary incontinence
Occurs when your bladder contracts without you being on the toilet
May occur with these triggers: Coffee, fizzy drinks, alcohol, artificial sugars, running water, on route to the toilet or with key in the door
Solution: Bladder retraining and consultation with GP as you may need some medication to stop the bladder from contracting so strongly.
Book now to see one of our physiotherapists who can help
Bladder Dysfuntion
Stress incontinence
Occurs when the pressure acting on the bladder is greater than your pelvic floor strength
May occur when you cough, sneeze, lift, run, or jump
Solution: Increase your pelvic floor strength
Urge Urinary incontinence
Occurs when your bladder contracts without you being on the toilet
May occur with these triggers: Coffee, fizzy drinks, alcohol, artificial sugars, running water, on route to the toilet or with key in the door
Solution: Bladder retraining and consultation with GP as you may need some medication to stop the bladder from contracting so strongly.
Book now to see one of our physiotherapists who can help
Faecal Incontinence = Loss of Bowel Control
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.
What is a Prolapse?
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
What is Inner Pelvic Pain?
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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What is Sexual Pain (Dysparuenia)?
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.
Pelvic Girdle Pain
At Pelvic Health Melbourne we have some of the top clinical experts in Australia in pelvic girdle pain management.
Pelvic girdle pain can include sacroiliac pain, pubic symphysis pain, coccyx pain or a mix or any of these.
Sacroiliac Joint Pain
Can occur during pregnancy or beyond. It is commonly felt in a clear area over the sacroiliac joint and is often aggravated by walking, household chores and any single leg activity like dressing or stair climbing.
Causes of Sacroiliac joint pain
Muscle imbalance causing increased load to the ligaments around the joint.
Overload of the joint itself causing joint inflammation
Alterations in posture after pregnancy causing increased load to go through through the joint
Treatment for Sacroiliac joint pain
A tailored exercise program to address imbalances in muscle tightness and strength
Joint mobilizations to free up stiff joints
Bracing and life alterations to allow for ligament and bone healing
Pubic Symphysis Pain
Commonly associated with pregnancy or beyond, and usually caused by increased movement at the pubic symphysis joint. There are many contributing factors to developing this condition including; foot mechanics, hip mechanics, joint laxity, neuromuscular imbalance and occupational stresses. At Pelvic Health Melbourne, we have some of the top clinical experts in treating pelvic girdle pain, to help get you better faster.
Coccyx Pain
At Pelvic Health Melbourne we CAN help your coccyx pain.
Coccyx pain can be disabling, limiting your sitting tolerance and quality of life. Felt on tailbone mostly with sitting, it can often be caused by fall onto the tailbone or childbirth. We look at all the factors contributing to your tailbone pain and treat everything, reducing, if not completely relieving your pain.
Causes of coccyx pain
Muscles
Your pelvic floor muscles attach onto the coccyx bone, therefore any abnormal tension in these muscles can aggravate your pain. Additionally, if your lower buttock muscles are tight it can aggravate your pain.
Sitting Posture
You may have adjusted your sitting posture and are sitting more on your sacrum rather then your sit bones. This commonly happens to women after pregnancy as the pregnancy backward tilt is maintained after birth, causing the woman to sit on the sacrum – thus causing or aggravating their tailbone pain.
Treatment for coccyx pain
Our treatment involves releasing all the tight structures attaching to the coccyx, treating any pelvic floor tightness and adjusting your sitting posture to allow the coccyx to heal.
Wedge cushions and postural corrections are an easy fix for poor sitting posture.
Massage for the tight external muscles works brilliantly. Whilst we teach you how to normalize your pelvic floor muscle tension
Hip Pain
Pelvic Girdle pain may be caused or contributed to by hip dysfunction which can cause changes in forces going through either the pubic symphysis at the front or the sacroiliac joints.
You may require hip X-rays to adequately ascertain if you have hip dysplasia or some hip dysfunction which is altering the load through your pelvis.
After pregnancy your posture may be significantly changed contributing to alterations in load through the pelvis and causing hip or pelvic problems.
At Pelvic Health Melbourne we are experts at assessment, diagnosis and treatment of hip and pelvic pain.
WHERE are my pelvic floor muscles?
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
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HOW do I activate my pelvic floor muscles?
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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
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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
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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.
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Pelvic Floor dysfunction?
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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
Prenatal Physiotherapy
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
What is 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.
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.
What is a DRAM?
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
What is Menopause?
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
Bone Changes after Menopause
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.
Martin brings to the Pelvic health Melbourne Team years of experience as a physiotherapist and his most recent passion is helping men with pelvic health concerns and improving pelvic health outcomes for men. He works with men before and after prostate surgery, men experiencing pelvic pain, bladder and bowel dysfuntion and erectile health including peyronies disease.
Melissa had completed two postgraduate certificates in pelvic health and loves her pilates. She is interested in pelvic and bowel health and works at our Bundoora bowel clinic and our main Yarraville clinic. Come and see Melissa for better lifelong pelvic and bowel health.
