Our Women’s Health Physiotherapists utilise state of the art computerised biofeedback and real time ultrasound to help our clients understand their diagnosis and to assist in effective pelvic floor rehabilitation.
- Stress Urinary Incontinence (SUI)
- Urge Incontinence (UI)
- Mixed Incontinence
- Urgency/Frequency (urinary and faecal)
- Faecal Incontinence
Our pelvic health physiotherapists have extensive experience in the accurate assessment, diagnosis and treatment of pelvic organ prolapse.
Common treatments can include:
- Education regarding exacerbating factors and what to avoid
- Pelvic floor rehabilitation
- Prescription of pessary
What is a vaginal pessary?
A vaginal pessary is a device that supports the vagina. Pessaries have been proven to be as successful as surgery in relieving prolapse symptoms. We use silicone pessaries, which are inert and safe in your body.
How does a pessary work?
The pessary sits high in the vagina and supports the prolapse. When it’s in the correct position you should not be able to feel it, and it should make day to day activities more comfortable if you previously sensed the prolapse. You can have sex while wearing some pessaries (e.g. rings), and neither you nor your partner should be able to feel it. Others (e.g. cubes) need removal.
How long does it stay in there for?
You can use the pessary on a “needs” basis (e.g. for running, playing sport, gardening, daytime) or some can stay in for up to 6 months. Pessaries are safe, long term treatments for prolapse but they will need to be removed and washed regularly – that may be daily, weekly or 3-6 monthly. You can do this yourself or come back to your physio, your gynaecologist or some GPs.
How is a pessary inserted?
A pessary is inserted (and removed) through the vagina. Most women can learn to insert and remove it themselves and it quickly becomes easy. The wrong size might slip or even may fall out, but it cannot end up anywhere else in your body.
Benefits of trying a pessary
- Can reduce the symptoms of prolapse or incontinence
- May prevent/reduce prolapse worsening
- Is less invasive and complicated than surgery
- Doesn’t require activity restrictions or time off work
- Provides important guidance about the most suitable type of surgery should surgery eventually be required
Follow-up is essential
After initial fitting you must have the pessary checked within 1-2 weeks then again at 4 months. Thereafter an annual check is needed and the pessary should be replaced. If you are engaging in more challenging exercise, we recommend a check-up after 1 month of starting the exercise to ensure that the prolapse is not worsening.
Potential Problems with Pessaries
“I already tried a pessary elsewhere and it didn’t work”
We regularly see women who have tried one or multiple pessaries that weren’t right for them and either:
- Moved down too low
- Fell out
- Were uncomfortable or even painful
- Made incontinence more problematic
- Prevented normal bladder or bowel emptying
There is almost always a better solution that makes pessaries usable for women who are allowed to use them. Pessaries come in a number of shapes and sizes. We assess thoroughly, follow-up and teach you how to problem-solve common issues. This usually means that either a more suitable pessary can be found or other factors can be modified so the old pessary works. Some prolapse types are unable to be supported by pessaries. Luckily as physios we have the luxury of longer appointment times to problem solve and build your confidence and independence. We typically practice the solutions within the appointment to check whether they work or need adjustment. We also have relevant knowledge about pelvic floor, toileting and general exercise or movement patterns. These small factors can often make a very big difference.
Minor problems that are uncommon but can occur
- Smelly, coloured or blood-stained discharge
- Trouble passing urine or opening your bowel
- Increased incontinence/wetting
These side effects are minor and can be successfully managed by changing the type or size of your pessary, using vaginal oestrogen or removing the pessary for a while to give your body “a break”. A vaginal infection may need antibiotics, therefore smelly or coloured discharge needs to be checked by your GP. If incontinence is revealed when the organ support is improved by the pessary, nothing has been ‘broken’ by the pessary. Removing it would return things continence status to how it was.
Serious problems that are highly unlikely and avoidable with common sense
- Pressure sores inside the vagina
- Attachment to the vagina, making removal difficult or impossible
These serious problems are avoidable by:
- Ensuring you are a suitable candidate for a pessary, or is it too risky?
- Keeping follow-up appointments
- Taking action if symptoms arise
- We advise that your Dr and next of kin or emergency contact person are aware of the pessary’s existence and the need for follow-up. If you wish to keep the pessary completely confidential please let us know.
Is a pessary too risky for me?
- If follow-up by someone with pessary experience cannot be assured
- Undiagnosed vaginal bleeding
- Active vaginal infection
- Pelvic inflammatory disease
- In regard to dementia, pessaries are not impossible, but require the involvement of a gynaecologist. The pessary guidelines state:
“The Expert Working Party considers that pessaries should only be fitted as an emergency procedure by an appropriately trained health professional for a patient with dementia where informed consent has been obtained from the legal guardian/medical power of attorney. The procedure should trigger an immediate specialist review. Self-care is not appropriate in this group of patients.”
If it becomes painful or you notice any bleeding, please see your GP or gynaecologist. Sometimes, this indicates that it is not the ideal size or shape for you. Other times it has been neglected in there for too long. Attachment to the vaginal walls can only occur with neglected pessaries. If your memory is declining, or your sensation is reduced it is even more crucial to ensure that regular follow-up is maintained.
Because of these risks we never sell or fit pessaries without proper assessment
Our physiotherapists provide manual treatment techniques both internally and externally to release tight muscles, nerves and scar tissue making way for effective and longer lasting pain relief and muscular function. Tailored exercises are prescribed to improve the motion systems required in our clients’ activities of daily living, work and exercise goals.
- Pelvic Pain
- Pudendal Neuralgia
- Vulvodynia + Vulvar Vestibulitis
- Interstitial Cystitis
- Surgical Adhesion related pain
- Proctalgia Fugax
- Chronic Pelvic Pain
- Painful sex
- Hysterectomy (Removal of uterus)
- Bilateral Salpingo-oophorectomy (BSO) (removal of ovaries and fallopian tubes)
- Endometrial ablation
- Prolapse repair
- Pelvic floor reconstructive surgery
- Manual lymphatic drainage
- Exercise prescription
Post Operative Care
- Mastectomy +/- TRAM/lattisimus dorsi reconstruction
- Sentinel lymph node biopsy
- Axillary lymph node dissection
Physiotherapy during Chemotherapy/Radiation Therapy
- Exercise prescription
- Fatigue management
- Scarring/burns management
You will communicate with one of our sensitive and caring admin team members initially who will book you an appointment with the physiotherapist who will help you the most. Alchemy prioritises patient confidentiality and we understand that your concerns are very private in nature so we ensure that you will feel confident and reassured when discussing your condition with our admin team members.
Our pelvic health physiotherapists are highly experienced and trained and have a thorough understanding of the complex nature of pelvic health conditions including incontinence, prolapse and pelvic pain.
Initial Physiotherapy Consultation
All of your consultations will be carried out in a private room and all information will remain strictly confidential. Your physiotherapist will initially ask you specific questions related to your concerns and any other relevant details that will help to inform your diagnosis and treatment plan. Following this, your physiotherapist will ask your consent to a physical exam which may include a vaginal and/or rectal examination to determine pelvic floor function. If you do not feel comfortable with this, real time ultrasound may be used for a basic pelvic floor assessment. During this time, we make it a priority that you feel in control and comfortable. Please click here for more information regarding Pelvic Floor Assessments.
Diagnosis and Treatment
Your physiotherapist will explain the findings of the assessment and with you, will develop a tailored and effective treatment plan that will help you with your specific concerns. This typically involves a lot of education to ensure that you understand your condition and from there, are able to set meaningful goals for recovery.
How many sessions will I need?
Everyone is different, however pelvic floor physiotherapy has a strong emphasis on education and self management. Depending on your condition, you may need to attend clinic based treatment for a few weeks consecutively, to reviewing every 2 weeks, 4 weeks or 6 weeks. It is common to have at least 5-6 sessions spread out over a period of 3-6 months.
Our women’s health physiotherapists are: