Bladder and Bowel Health

1 in 3 women have concerns with incontinence after pregnancy and birth.

40-45% of elite athletes have daily episodes of incontinence.

20% of Australian men have concerns with bowel control. Continence Foundation of Australia

Physiotherapy is internationally regarded as the first-line treatment for all types of bladder incontinence. Studies consistently show that the rate of success from supervised and targeted training is over 70%. There are many contributing factors and types of bladder and bowel conditions so a detailed assessment is important to achieve best outcomes.

As well as improving the function of the pelvic floor muscles, physiotherapy also includes lifestyle changes, strategies to improve toileting habits and address risk factors such as weight, constipation and other modifiable dietary factors.

Pre- and Post-Pregnancy

Pelvic Floor training in pregnancy can reduce your chance of developing incontinence by 62%. Cochrane Database of Systematic Reviews 2017

It is estimated that during pregnancy, 50% of women will develop symptoms of back or pelvic pain. A review by a physiotherapist and a tailored exercise program can make a significant difference to your ongoing ability to manage back or pelvic pain throughout your pregnancy and after birth.

Recently, research is being focused on reducing birthing trauma and improving recovery. It is recommended to see a physiotherapist as part of your scheduled care team. It is beneficial to attend an appointment early in your second trimester (week 12 to 20), at around 34 weeks as part of birth preparation, and again at six weeks post-delivery.

Common pregnancy-related conditions and advice that a physiotherapist can help you with include:

• Back and neck pain

• Wrist and hand pain, and carpal tunnel syndrome

• Pelvic floor muscle functional training

• Muscle cramps and lower limb swelling

• Abdominal wall instability and muscle separation (diastasis rectus abdominal muscle or DRAM)

• Guidance for appropriate exercise and return to sport

• Birth preparation

• Positioning for breastfeeding and support with mastitis

• Returning to intimacy after birth

Gynaecology

1 in 10 women may need intervention for pelvic organ prolapse. Australian commission on the safety and quality in health care.

Prolapse is most often associated with heaviness or bulging sensations in the vagina. It is not just common in older women but may be noticeable soon after childbirth. Prolapse can effect bladder and bowel function and interfere with quality of life and activity. Several risk factors have been identified such as genetic/family history, obesity, chronic cough, prolonged high impact activity and childbirth.

Physiotherapy can assess the causes of prolapse, improve the support structures in the body with a combination of muscle training and support devices, and help to modify your activity so you can remain healthy and active without symptoms.

Physiotherapists are also a very useful person to have in your care team if you are considering surgery. Pelvic floor training and guided recovery are important to improve the long-term success following surgery.

Pelvic Pain

1 in 10 women can suffer from pain and Endometriosis.

1 in 5 women can have painful intercourse.

Up to 15% of men can also have persistent pelvic pain. Pelvic Pain Foundation of Australia.

My passion is to work with patients to understand the drivers of their pain and improve their symptoms. People who suffer from pelvic pain often have to contend with a myriad of other symptoms including painful intercourse, muscle spasm, bladder and bowel dysfunction (or pain), anxiety, psychological effects, and social and relationship issues.

Pain may have local triggers such as overactive pelvic floor muscles, changes to the sensitivity and stimuli around the nerves and skin, and conditions that escalate pain like prostatitis, urinary tract infections, recurrent thrush infections or autoimmune contributors including Endometriosis. The nervous system also contributes to the way information from the tissues is processed and identifies pain.

Pain physiotherapy includes many management options that can improve your pain, including:

• Modern pain science education

• Muscle retraining, stretching and tension release

• Guided imagery and progressive desensitisation

• Relaxation techniques

• Good bladder and bowel habits and training

• Appropriate graded exercise and lifestyle modifications

• Sexual health advice

• Surgery preparation and recovery support