- Jenni Davies
What is a Pelvic Health Physio?
What is a Pelvic Health Physio?
Pelvic Health Physiotherapy is a specialised area of work within the Physiotherapy profession as a whole. To become a Pelvic Health Physio requires additional training on top of our standard physiotherapy training. All of our Physiotherapists have become Pelvic Health Physios as a progression from working in more general sports and musculoskeletal physiotherapy in private practice and are very passionate about what they do.
Pelvic Health encompasses any issues to do with the internal aspects of the pelvis such as pelvic pain, bladder and bowel dysfunction (pain, leakage, altered sensation, urgency).
Why would I see a Pelvic Health Physio?
As a speciality, pelvic health has an incredibly broad spectrum of concerns that are treated including:
Urinary leakage (light bladder leakage, wetting yourself, full flooding of the bladder)
Urinary urgency/frequency due to fear of either leakage or pain (racing to the toilet, limiting your fluid for fear of needing the toilet, doing many ‘just in case’ trips to the loo to try to avoid the urgency occurring when there is no toilet near by
Pain associated with bowel motions (before, during or after)
Pain associated with the bladder (during filling, passing urine, or afterwards)
Pain with use of a tampon, or intercourse
Pain or symptoms occurring with menstrual cycle that is sufficient to keep you off work, school, sport, or normal social activities
Any other pain around the pelvis, internal or external
Bowel leakage (either of stool - however minor - or passing wind involuntary)
Incomplete emptying of either bladder or bowel
Altered bladder sensation (eg loss of sensation after giving birth)
Pelvic organ prolapse (sensations of heaviness, dragging, feeling like things are falling out of the vagina, feeling of having a dislodged tampon in)
In addition we deal with:
pre-/post-surgical management for gynaecological, urological, colorectal or prostate surgeries to optimise recovery and prevention of recurrence
Peri-natal concerns including pelvic girdle pain (pubic symphysis, sacroiliac joint, groin pain), mastitis, birth education, post-natal recovery (including abdominal separation, return to sport/exercise, pelvic floor and deep core retraining)
A final component of what we do is to investigate chronic hip/back/pelvic pain and dysfunctions that aren't responding to standard treatment. In these cases, there is often a missing component - usually internal - that can be treated. This is particularly common in women after childbirth (that may be 50yrs after childbirth!).
Can Pelvic Health Physio's diagnose?
Yes, we are primary practitioners and diagnose many dysfunctions around the pelvis. We also recognise when something does not have a musculoskeletal cause and refer on to Gp’s and Specialists for further investigations when needed.
Do I need a referral?
No, you can just call up to make an appointment.
You are more than welcome to come with a referral as well though. Many people attend with referrals from their Gynaecologist, Urologist, Gp, Sports Physician amongst others.
How do Pelvic Health Physio’s assess the above problems?
The initial part of your assessment is a discussion about your symptoms (both current and historic), general health, normal activities and goals for treatment. Following this, we will discuss how we will do the physical part of the assessment. This will vary depending on what your concerns are. It may be a purely external assessment of movement, muscle and nerve function etc or, if the problem is an internal one, we will usually need to assess your pelvic floor muscles, pelvic organ position and internal nerves.
For women, this usually requires a vaginal internal assessment. However, there are times when this may not be appropriate (teenagers, survivors of sexual abuse, intense pain, nervousness etc). In these cases we use the real-time ultrasound, either via a trans-abdominal view, or via a trans-peroneal (the area between the vagina and anus) view.
For men, if incontinence, prostate surgery or urinary urgency/frequency is the concern, we use the real-time ultrasound via a trans-peroneal (the area between the scrotum and anus) view. However for pain concerns we may assess via a digital rectal examination.
Which way we assess is always discussed with you prior to the examination. We will have explained what and where the pelvic floor muscles and organs are and how we assess, in detail. You will then be asked if you are ok with us doing a physical assessment, and will have the choice of how it is done. If you consent to an internal, please remember that it is a gentle assessment, no speculum is involved, and you are in control at all times - you can tell us to stop and go away at any time without issue.
For complex back, pelvic and hip issues that haven’t responded to standard Physio, Chiro, Osteo treatment, there may be a dual assessment of both internal and external aspects to identify the ‘missing link’ in the puzzle.
Once the physical assessment is complete, we will put together a management plan and a tailored treatment programme based around your specific goals. We will discuss this with you, including an expected timeline for recovery. If any further testing is required, we will refer you on as necessary.
How do Pelvic Health Physio’s actually treat the above problems?
Treatment is not just about Kegel’s (pelvic floor exercises).
We may use these as part of your treatment programme but it will be as part of a much more specific programme tailored to your needs that may include basic coordination, speed, endurance or functional coordination work. We also have a multitude of other techniques that we use such as manual release techniques for the joints, muscles and nerves, specific exercise programmes, breathwork, mindfulness, pilates and yoga, muscle and nerve stimulation and biofeedback units and therapeutic ultrasound (mainly for scars and mastitis) amongst others. Your treatment in the clinic ties in with a home programme to optimise your recovery.
Do you get good results from treatment?
Yes you do.
We would love to be able to say that 100% of the time we can guarantee that your problem will be resolved. Unfortunately we can’t. No-one can.
What is very clear and well documented in the research is that pelvic health problems are really common, not normal, and the vast majority will respond to treatment. Whether that is solely pelvic health physiotherapy, or a combination of our management together with management from your Specialist, Gp, Psychologist, Nutritionist, Massage Therapist, Trainer, Coach or a.n.other is decided on a case by case basis.
We can also guarantee that we’ll be 100% honest with you as to whether we can help you or not, and empower you to be part of the decision making process. We will give you an estimation of success rates, and alternate pathways for management if our treatment is not successful.
I’m not sure if I should come in or not?
If you are unsure if Pelvic Health Physiotherapy is the right approach for you, please email or call us. We are very happy to talk to you about your concerns and help you with that decision.
Please don’t feel embarrassed or ashamed to mention anything. There are no stupid questions in this area of work and there is nothing that we feel uncomfortable hearing. We have heard it all.
Pelvic health is one of the last bastions of medical science - it is one of the least researched areas of the body. Women (and men) are still having their symptoms dismissed or ignored because Practitioners either aren’t comfortable talking about it, or don’t know enough about it to know what to do with the information they’re being told. As Pelvic Health Physios we talk about it day in, day out and love what we do, and feel very passionately that this should be a non-taboo part of daily conversation, let alone healthcare. We want you to talk about it!
As stated above, if you have any questions or concerns, please don't hesitate to contact us at: email@example.com or call us on: 0435 150136 or 02 8964 5779