PELVIC HEALTH

A pelvic floor physiotherapist can assess, diagnose and manage conditions or concerns within the pelvic cavity such as bladder or bowel incontinence, pelvic pain, pelvic organ prolapse, sexual dysfunction and pain, pre and postnatal rehabilitation or pre and post operative rehabilitation after procedures such as hysterectomy, prolapse repair, laparoscopy or prostatectomy. A pelvic floor physiotherapist provides extensive education, reassurance, support and encouragement in addition to prescription of individualised specific exercises and rehabilitation which restores optimal muscular function, strength, coordination and endurance. In addition to this, pelvic floor physiotherapists can prescribe devices to improve bladder, bowel, sexual or pelvic function such as electrical stimulation, dilators or vaginal pessaries. Pelvic floor physiotherapists work closely alongside specialists (such as obstetricians, gynaecologists, urologists, gastroenterologists, colorectal surgeons and pain specialists), GP’s and other allied health professionals who all assist patients to improve their wellbeing and function

A pelvic floor physiotherapy assessment does not always involve an internal examination nor is it always indicated. Depending on the specific concerns, we will discuss a range of assessment options which may involve, real time ultrasound, external palpation or viewing or internal palpation. You will always be involved and informed in the decision making process when it comes to what assessment will provide the best or clearest indication and explanation for the cause or contributing factors which may be leading to your concern or condition. There will never be any assessment carried out without your consent. Typically, in a consultation we sit down with you first and ask a range of specific questions related to your concern. From here, we will discuss what assessment options are available or indicated. If an internal assessment is recommended, your physiotherapist will explain how this will be carried out and they will always request for your consent. Your physiotherapist will leave the room to allow you to remove your clothing – typically this is only from the waist down. You will be provided with a towel or sheet to cover your pelvis so that you feel comfortable. Your physiotherapist will knock before reentering the room. From there, your physiotherapist will describe again what they will be assessing specifically in the consultation. The findings of the examination will be discussed with you during the consultation so that you feel informed and involved in the assessment process. Depending on the outcome of the assessment, your physiotherapist will then prescribe exercises, devices, education or support to manage your concern.

Yes, absolutely evidence demonstrates that pelvic floor physiotherapy can improve urinary incontinence in up to 80% of cases. Your pelvic floor physiotherapist will ask very specific questions related to your bladder function then based on what you are describing, they will prescribe exercises, bladder retraining programs, toileting advice and advice around hydration. In most cases, they will assess your pelvic floor function which may also indicate specific pelvic floor rehabilitation in order to support your bladder and improve or control your symptoms.

Evidence indicates that the ideal time frame to commence pelvic floor physiotherapy is 4-6 weeks prior to undergoing a prostatectomy. Preoperative physio is geared towards improving bladder function, managing incontinence and commencing pelvic floor exercises to improve strength, coordination, function and endurance. After having a prostatectomy, typically you will have an indwelling catheter which will be draining urine from your bladder. We recommend that in most cases (unless specified otherwise by your surgeon) that you commence postoperative pelvic floor physiotherapy 1 week after your catheter has been removed (which is typically 2 weeks post op). Post operative pelvic floor physiotherapy is aimed towards improving bladder function, managing incontinence, improving pelvic floor strength and function and improving erectile dysfunction.

Pelvic organ prolapse (POP) occurs typically when the soft tissues within the pelvis weaken or are damaged causing one or more pelvic organs to slip and descend into the vagina. Often, women experience a sensation of a bulge, fullness or dragging into the vagina or pelvis as a result which typically worsens with activity and by the end of the day. There are three primary types of prolapse – cystocele (bladder), rectocele (bowel) and uterine prolapse. A pelvic floor physiotherapist’s role in managing prolapse involves education around avoiding provocative factors such as heavy lifting, constipation management and specific types of exercise, improving pelvic floor function, strength, coordination and endurance in order to support the pelvic organs and when indicated, prescribing and fitting specific vaginal pessaries which act to support the vaginal walls and prevent the prolapse from dropping into the vagina.

As soon as you feel comfortable! Typically however, we recommend that you focus on bonding with your beautiful new baby and establishing good routines in the first 6 weeks. We recommend that you come in for your first postnatal check with your pelvic floor physiotherapist from 6 weeks post delivery.

Yes absolutely! Men have pelvic floor muscles, just like women and they can also experience incontinence especially after a prostatectomy which is a common surgical procedure to manage prostate cancer. There are primary supportive structures at the base of the bladder (near the prostate) that help to kink the urethra and stop urine from leaking involuntarily. In order to get clear margins and improve rates of remission, these supportive structures are usually removed along with the prostate as part of a prostatectomy. As a result, men can often experience incontinence after this procedure. Consequently, pelvic floor physiotherapy aims to improve strength, function, coordination and endurance of the pelvic floor so that it can support the bladder and manage incontinence.

Yes absolutely – we don’t need to do an internal examination on the initial consultation if that is your preference.