Women’s, Men’s and Pelvic Health Physiotherapy

STRESS URINARY INCONTINENCE

Signs and Symptoms

• Leakage of urine with downward pressure (ie  stress) on the pelvic floor such as cough, sneeze, laugh, run or jump.

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.

URINARY URGENCY AND URGE URINARY INCONTINENCE (OVERACTIVE BLADDER)

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:

• The bladder is “oversensitive” and sends signals of fullness to the brain when it is not really full.
• The brain “hears” the messages for the bladder too loudly
• The bladder is inherently not very “stretchy” and reaches fullness sooner than expected
• Factors such as a history of urinary tract infections (UTI), anxiety or neurological disorders can also contribute to urgency
• Leakage will occur when the urge to empty is too strong for the muscles to counteract. This will be more likely if the muscles are weak or the urethra more mobile (as in SUI).

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.

PELVIC ORGAN PROLAPSE

Signs and Symptoms 

• Feeling of a lump/bulge or heaviness/dragging feeling in the vagina
• Difficulty retaining a tampon
• Incomplete emptying of the bladder or bowel
• Symptoms may be worse at the end of the day, following exercise or heavy lifting or straining to empty the bowels

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.

CHRONIC PELVIC PAIN

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.

• Dyspareunia – pain with intercourse
• Vulvodynia – pain in the vulval area associated with intercourse, tampon use, contact with clothing
• Pudendal neuralgia – pain in the area supplied by the pudendal nerve – lower buttocks, perineum, anus and rectum, genitals.

People with pain may also have symptoms of urinary, sexual, bowel, pelvic floor or gynaecological problems such as:

• Urinary – frequency, hesitancy, altered flow, urge incontinence
• Bowel – constipation, diarhoea, bloatedness,
• Gynaecological – menstrual pain, menopausal symptoms
• Pelvic floor muscles – spasm or overactivity
• Sexual – pain, avoidance, lack of satisfaction

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.

BOWEL PROBLEMS

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? 

• Advice regarding optimising stool consistency and correct technique for emptying the bowels
• Pelvic floor muscle exercises
• Electrical stimulation and biofeedback

CONSTIPATION 

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? 

• Advice regarding optimising stool consistency and correct technique for emptying the bowels
• Pelvic floor muscle relaxation exercises