Pelvic Health
Pelvic Health used to be known as “women’s health physiotherapy”. It was then extended to include “continence” then further to include men. So our area of practice was known as: “Continence, Women’s and Men’s Health”. In recognition that simply referring to the binary of “women” and “men” was limiting, our group became known as “Pelvic Health”. It is to be recognised that the nature of our work dictates that we deal with sexual organs and that we must be mindful of the complexities of this area of the body. Aim is that anyone can feel able to express issues, regardless of gender assigned at birth, and regardless of sexual orientation, and feel that solutions can be found in an understanding and respectful environment.
Bladder
Overactive bladder
This is the problem of needing to empty the bladder urgently for fear of leakage. Those with weak pelvic floor muscles for whatever reason, may go on to develop leakage associated with urgency. Stress and anxiety can make this problem worse.
Stress urinary incontinence
This is the problem of drops of leakage when there is pressure above the bladder. It might happen typically with coughing, sneezing, laughing, exercising, lifting. It is usually due to weak pelvic floor muscles. Pelvic floor muscles weaken in pregnancy and after delivery. They weaken if you strain chronically to empty the bowel. They weaken over time if you are overweight (and just losing weight isn’t always that easy). They can weaken if you do a lot of heavy lifting in life or say at gym workouts. Also, we notice that people who have none of those factors can have stress incontinence if the pelvic floor is too tight. A tight pelvic floor is strongly linked to stress and anxiety and prevents the muscles from working effectively.
Nocturia
(going to the toilet frequently at night.)
You shouldn’t have to go to the toilet at night if you stop drinking roughly 2 hours before bed; this is because the bladder has an ability to hold good volumes or urine and the body naturally slows down urine production when we go to sleep.
If you get up to go to the toilet and it is a problem for you, that is reason enough to get help. There are multiple causes of the frequency which might be just poor sleep, other health issues, a small capacity bladder, the problem of making too much urine at night relative to the day…….this can all be worked out for you on a path to finding solutions.
Difficulty emptying
Many issues can lead to a sense of incomplete bladder emptying. Some people have this sensation, but they are in fact emptying properly. We have an ultrasound available for all consultations and this shows clearly whether there is urine left in the bladder after emptying or not. If there is urine left in the bladder, we will find out if tight pelvic floor muscles are not relaxing to enable emptying or something else that needs a medical opinion. Anxiety around toilet environment can cause hesitancy and difficulty emptying.
Bowel
Constipation/obstructed defecation.
There are many reasons for constipation. Many of us will experience it now and then when diet changes or daily routines change but the bowel quickly recovers. If poor emptying becomes persistent and chronic, it is time to do something about it.
It is important not to strain to empty the bowel over time, since this causes other issues such as hemorrhoids or even rectal prolapse (the inner lining of the rectum slides out after emptying).
If constipation is an issue, the therapist will help work out what the problems are and in particular, try and find out if your pelvic floor muscles are relaxing to empty or not relaxing when they should (obstructed defecation). Usually, management is a combination of understanding how it should work, at what part of the whole body system things have gone awry and then you can get yourself onto a path back to regularity.
Faecal Incontinence/bowel leakage
This is a problem that can be caused, ironically enough, by chronic constipation. Or, it might be loss associated with loose, urgent stool. Sometimes it is a problem of seepage /soiling of underwear after emptying suggesting that emptying is not as effective as it should be. These problems do tend to get worse with aging: everyone’s muscles weaken more rapidly as we age so pelvic floor exercise becomes all the more important as we get older.
Pelvic Pain
Pelvic pain refers to pain anywhere in the pelvic region: coccyx, hips, sexual organs, bowel, rectum, anus, bladder etc. It sometimes goes together with back pain or other chronic pain conditions. We will look to see if pelvic floor muscle tension or other factors are contributing to enable you to find relief.
Sexual Pain
This is pain related specifically to any sexual function. You should be given the opportunity to describe exactly what causes the pain. Please let the therapist know what terminology and vocabulary you prefer to use. You may want to let the therapist know your sexual orientation or you may feel this is unnecessary. It is up to you and good communication is vital for good outcomes.
Prolapse
This refers to either rectal prolapse, whereby the inner lining of the bowel comes out of the anus after opening the bowel, or, in those with a vagina, descent of pelvic organs towards the exit of the vagina. It is strongly correlated with giving birth but can be present due to straining over time for the bowel, being overweight over many years and prolonged heavy lifting in life.
Pelvic floor exercise rehab is the recommended first option for management.
Issues specific to Transgender people undergoing surgery or hormone treatment
Therapists are becoming more aware of the need for Pelvic Health services around gender-affirming surgery. We are now attending professional development and receiving education at workshops and conferences in an effort to understand the needs in this area. If this is your concern, I would encourage you to make contact and talk through needs to see if we can help.
