Signs and Symptoms
What is happening with the body?
Essentially the downward pressure on the bladder with the provocative activity is greater than the closing pressure. Closing pressure is created by the position of the urethra behind the pubic bone and the action of the pelvic floor muscles. Some women will have urethra which is naturally more mobile or become so due to the effects of pregnancy and childbirth. Similarly, pelvic floor muscles can lose strength as the result of childbirth and ageing. For some women, the reduction in oestrogen post menopause can affect urethral closing pressure.
How can physiotherapy help?
A physiotherapist with expertise in Continence and Women’s Health can identify the contributing factors in your situation and devise a plan to help. The evidence demonstrates that an individualised program of pelvic floor exercises supervised by your physiotherapist results in up to 70% cure or significant improvement. Our Women’s health physiotherapists will take a thorough history, assess the pelvic floor muscle function via real time ultrasound or a vaginal assessment according to your preference and formulate a specific exercise plan.
Signs and Symptoms
Urgency is the strong, sudden urge to urinate which is difficult to defer. This can be triggered by factors such the cold, running water, “key in the door”. Sometimes leakage of urine will then occur on the way to the bathroom.
What is happening with the body?
The urgency can arise for one or more reasons:
How can physiotherapy help?
If you have symptoms of urgency, it is wise to consult your GP to rule out a UTI – an infection can be present even if there is no stinging or burning with emptying. Our C and WH physiotherapists will take a thorough history to understand the puzzle of your particular problem. Often you will be asked to complete a bladder diary to show fluid intake, frequency and amount of voiding (bladder emptying). The pelvic floor muscle function can be assessed via real time ultrasound or a vaginal assessment according to your preference. In the same way that there can be many contributing factors causing the problem, management will be multifactorial. This can include modifying fluid intake and type of fluids, techniques to calm the bladder and pelvic floor exercises.
Signs and Symptoms
What is happening with the body?
Prolapse is the descent of one or more of the pelvic organs (bladder, uterus or bowel) which creates a bulge into the vaginal space. It occurs due to stretching or tearing of the fascia and ligaments that hold the organs in place. Factors that can contribute to the problem are pregnancy, vaginal deliveries (particularly with forceps), advancing age, obesity and potentially chronic constipation and heavy occupations. There may be a genetic predisposition.
How can physiotherapy help?
Pelvic floor exercises have been shown to improve symptoms – the best results occur when the exercises have been prescribed by a therapist with expertise in the area. Your physio will advise on how to modify factors that may be exacerbating the prolapse. A pessary to provide support for the prolapse will be helpful for some women – Rebecca and Louise are able to fit simple pessaries.
Signs and Symptoms
Chronic pelvic pain is an umbrella term to describe chronic or persistent pain perceived in structures related to the pelvis of either men or women. There is often an overlap of the various symptoms. Pain in a particular area or linked with certain activities may have a separate name eg.
People with pain may also have symptoms of urinary, sexual, bowel, pelvic floor or gynaecological problems such as:
What is happening with the body?
Pelvic pain is often described as a puzzle with many pieces. It may have begun with a problem in one area of the pelvis eg. The bladder (bladder pain syndrome), the bowel (eg. Irritable bowel syndrome), the uterus in women (eg. Painful periods) or vagina (eg. Thrush infection). The pudendal nerve can also be a source of pain (eg.pudendal neuralgia). The initial problem may have “re-set” the signals going from the organ to the brain – essentially so the brain will pay more attention to the organ – even if the initial problem has passed. Rather like a car alarm that has become too sensitive and sounds when lightly touched rather than when someone is trying to break in. The pelvic floor muscles will often then go into protection mode and become overactive, painful and go into spasm.
How can physiotherapy help?
As pelvic pain can have many contributing pieces, a team approach is the best solution. Your first stop should be your GP to rule out any infections, inflammatory conditions, cysts, fibroids or tumours. A C and WH physio can help you understand your problem, teach relaxation techniques (general and specific to the pelvic floor), advise on pelvic floor and general exercise, and manage concurrent bladder or bowel symptoms. A psychologist can also help with strategies for pain and stress management.
Faecal urgency and anal incontinence
Signs and symptoms
Faecal urgency describes a strong urge to empty the bowels which cannot be delayed due to a fear of losing control. Anal incontinence is the accidental leakage of solid/liquid stool or wind.
What is happening with the body?
These symptoms are often related to third or fourth degree tears sustained during childbirth although symptoms may not occur until later in life. Age related changes to the support structures or pelvic floor and anal sphincter muscles can also contribute.
How can physiotherapy help?
Signs and symptoms
Can include emptying the bowel twice per week or less often, firm or pebbly stools, needing to strain to empty, feeling of incomplete emptying. Chronic constipation can result in abdominal pain or bloating, anal fissures or haemorrhoids, and may worsen prolapse symptoms.
What is happening with the body?
Constipation can have many causes such as slow transit of the bowel, inflammatory disorders or irritable bowel. Consulting your GP should be the first port of call to diagnose such conditions. For some people there will be no specific diagnosis and it will be found that constipation relates to the effect of diet on stool consistency, poor position and technique for emptying the bowels and pelvic floor muscles that do not relax as needed.
How can physiotherapy help?
Symptoms
Removal of the prostate can impact the function of the pelvic floor muscles and their ability to control the bladder resulting in leakage of urine.
The degree to which each man experiences this problem varies greatly from just a few weeks of minimal leakage to feeling a complete loss of control in the first few weeks and many months to becoming dry. There might be a small leak each time you stand from a chair, cough or sneeze or a feeling of limited sensation of when you need to wee, or a feeling that you just “can’t turn off the tap”.
What is happening to the body?
Removal of the prostate means there is less of a buffer between the bladder and the pelvic floor muscles. The muscles can take a while to cope with a different feeling of the weight of the bladder. Also, the removal of a small part of the urethra that travels through the prostate means that a small part of the muscle around the urethra is removed so that the remaining muscle needs to work harder.
How can physiotherapy help?
A specially trained Men’s Pelvic Health physiotherapist can teach you how to use the pelvic floor muscles correctly and how to strengthen them. The muscles that men use to prevent leakage are a little different to the ones that women use. We can use the real time ultrasound to visualise the three key muscles and teach you how to activate them correctly.
Men who are able to start their pelvic floor exercises before surgery are shown to have a better outcome following surgery so if you have the opportunity, please come to see us beforehand. After surgery we can see you once the catheter is removed.
Pelvic floor exercises are also an important part of return to sexual function.
A. The pelvic floor muscles that are important to leakage are the striated urethral sphincter, the bulbocavernosous and the puborectalis. They work together to create a “kink in the hose” of the urethera.
B. Using the ultrasound can provide an image of the muscles so that you can learn to use them correctly.
Image from Stafford et al, Journal of Urology 2012
Signs and symptoms
Women who are breastfeeding may experience some, all or just one of the following:
• Tenderness to touch on the breast
• Feeling lumps in the breast
• Feeling like the breast is hot
• Seeing a redness on the breast
• Feeling very unwell, like the start of a cold/virus/flu
• Feeling achy and hot/cold all over
What is happening with the body?
Mastitis is a condition which affects the lactating breast. Other conditions are engorgement and blocked ducts and women’s health physiotherapy can help with all of these.
The breast is made up of very fine tissue and milk ducts within it. Sometimes, a cracked nipple or graze may change the conditions within the breast tissue, sometimes your body is making too much milk, or your baby skips a feed at night(hurray!) and the breast is not adequately drained. Some women experience blocked ducts, and others engorgement. All these conditions can be very uncomfortable.
How can physiotherapy help?
Should you have symptoms of a fever, you should first consult your GP in case antibiotics are required.
The main physiotherapy treatment is therapeutic ultrasound applied to the area of discomfort. It alters the size of the lump, the tension and redness on the breast.
This usually takes 10- 20 minutes. 2 sessions in 48 hours are recommended for maximum symptom reduction, and many women need a 3rd session with 2-3 days.
A women’s health physiotherapist can also teach you some techniques to manage your symptoms at home, such as massage, stretches and when to use heat and cold. Breast tissue is not like muscle and if we are too firm in massaging, we can increase the bruising and/or inflammation in the area. Sometimes, a Tubigrip support bandage can help.
Consulting a lactation consultant is also important to help find the best breastfeeding technique for you and your baby.
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