Bladder
Stress incontinence.
This is the very common problem of leakage of urine when there is pressure over the bladder for example when coughing, laughing, sneezing, bending, jumping, turning suddenly….all sorts of things can lead to stress urinary incontinence. 1 in 3 women who have ever had a baby will have this problem at some stage in life. It usually relates to inability to keep the bladder exit closed due to pelvic floor muscle weakness. But anyone can have this problem for all sorts of reasons that do not relate to giving birth.
Overactive Bladder
This is the problem whereby the bladder doesn’t want to hold on easily. You might experience frequency so need to go to the toilet often. You may well feel that the bladder is so full you won’t be able to hold, and yet there is only a small amount of urine present when you get to the toilet. Very annoying! Frequency and urgency are common but you can have an overactive bladder that lets you down without feelings of urgency.
Many people will come in telling us they have a “weak bladder”, when actually, the muscular wall of the bladder is simply not happy to relax and fill until you are ready to empty.
As for Nocturia below, we will usually suggest that you fill out a bladder diary to see exactly where the bladder is going wrong. From this we work through steps towards bladder control called “bladder training”. Don’t worry if a diary is too difficult to do, we will explain everything and there are always options.
Bladder pain syndrome/interstitial cystitis.
Interstitial cystitis is a very specific problem diagnosed by a Urologist who will have looked inside the bladder and found red areas on the wall of the bladder. These are called Hunner’s Ulcers and they bleed and are painful when the bladder wall stretches as the bladder fills. Urologists have treatments that they can offer. We can’t offer these treatments but we can help with strategies to manage symptoms if required.
Bladder pain syndrome (BPS) is the name given to the problem of pain when the bladder fills. The pain is relieved by emptying the bladder just like those with Interstitial Cystitis. However there are no signs of Hunner’s Ulcers in this condition. BPS may be linked to painful tender points in the pelvic floor muscles. We can certainly look for these and offer help to settle these muscle problems,.
Nocturia (Passing urine at night)
It is not normal to have to routinely get up to pass urine at night. If you are bothered by getting up at night, come in and find out why. There are multiple subtle issues that lead to this problem. We will usually ask you to fill out a bladder diary once you understand a little more about the problem. From the diary will be able to work through solutions.
There are certain medical issues that cause some people to make more urine at night than normal. We can pick this up on a bladder diary and let your doctor know so that medical solutions can be offered in those particular cases. A simple urine dipstick test rules out any other issues that need medical attention.
Bowel
Constipation and difficulties emptying
Some people have gut disorders that cause constipation such as Irritable Bowel Syndrome (constipation type). Others might have always been prone to constipation in life and may have been told they have “slow transit constipation” or “lazy bowel”. Some people develop constipation secondary to other health problems later in life. Whatever the circumstances, there is a lot we can do to help you understand why the problem occurs and how the system works so that you can help yourself towards a regular bowel that empties without strain.
Obstructed defecation (levator ani syndrome).
This is often diagnosed by Gastroenterologists or Colorectal Surgeons. It is the term given to the problem of difficulty emptying the bowel due to the muscles of the pelvic floor and anal sphincter being too tight. The tight muscle obstruct the easy passing of stool.
Levator ani is the official latin name for “pelvic floor”. So levator ani syndrome is a term from many years ago, referring to the syndrome of the pelvic floor muscles being too tight to allow the passing of stool. In effect, levator ani syndrome is similar to obstructed defecation.
Dyssynergic defecation.
Again, this is a term that your doctor might use to describe the constipation problem whereby the muscles of the pelvic floor do not coordinate with the emptying muscles of the rectum. (Don’t worry, we can explain the anatomy!) The result is that the stool will not pass easily.
When you come to see us, we will assess how your muscles are working and make the necessary changes so that you can empty the bowel with ease.
Problems with bowel control
Faecal Incontinence associated with urgency
Many people have trouble controlling either wind or formed stool. Loose stool is difficult for many people to control and most of us have experienced the problem of urgency with diarrhoea when the tummy is upset. But it is not normal for the stool to leak out before we get to the toilet.
Faecal incontinence associated with urgency needs to be addressed and may be a sign of weak muscles or poor sensation in the rectum.
Faecal Incontinence with no sense of urgency
This presents as the problem of small soiling after emptying.
This is a problem that can occur when there has been damage or trauma to the anal sphincters so they do not close fully after emptying.
Or it can occur more generally as we age, as a result of poor bowel emptying and ironically, secondary to constipation.
Painful bowel movements
It should not be painful to open the bowel. Most people with this issue will have been to a G.P who may or may not refer to a specialist. It is reasonable to know that there is no serious problem causing pain. However a lot of bowel pain problems are linked to painful tender points in the pelvic floor secondary to pelvic floor muscle spasm. Physios can work on releasing the muscles for you and even teach you how to do this yourself if needs b
Prolapse
Pelvic organ prolapse after childbirth.
It is quite common for there to be loss of support for the pelvic organs after a vaginal delivery. Pelvic floor exercise and rehab is usually recommended. It is vital tha you know how to exercise correctly and effectively. Most prolapse does resolve with exercise and time. It is however distressing and quite upsetting for many people.
An assessment helps to put your mind at rest and allow you to feel confident that you are on the path to recovery.
Prolapse later in life.
Prolapse is more common in women who have given birth via vaginal delivery but can also occur in those who have lifted heavy things over long time periods and it is also linked to carrying excess body weight. After menopause, the pelvic floor weakens quickly if we don’t exercise well. Many women have not had good exercise patterns in life so all in all, prolapse symptoms commonly creep up on women as they age. Every woman deserves to know what to do to prevent and manage symptoms. So if you have any worries or symptoms, don’t hesitate to come in before surgery becomes a necessity! Pessaries, as mentioned above, are an option for management.
Ring pessary for prolapse after delivery of your baby
Luckily this option has become more available again and can help women who have recently given birth gain comfort and support. A ring pessary can enable you to lift toddlers, exercise in the gym and generally be active without symptoms of heaviness. You can feel comfortable whilst you do your pelvic floor rehab over weeks and months.
Ring pessaries later in life
Pessaries are also an option later in life if you do not wish to have surgery, or you want to ease symptoms whilst you do a rehab program. You must check with your Doctor that there is no sinister cause of prolapse symptoms before we can fit a pessary. In other words we want to be sure that there are no tumours or large fibroids before we fit a pessary. It is also a requirement that post menopausal women use vaginal oestrogen for us to be able to fit a pessary.
Rectal prolapse.
This is when the inner lining of the rectum (ie the vessel where the stool temporarily holds stool whilst you make your way to the toilet to empty), slips out as you empty the bowel. With mild cases, your Doctor will often recommend that you learn pelvic floor exercises whilst making sure you know how to empty without straining.
Sexual pain.
Sex can become painful for many reasons. Below are some of the causes of sexual pain. Note that those who are not sexually active may also have the issues outlined below.
Vaginismus
This is the term commonly used by Doctors to refer to tightness in the pelvic floor muscles. Symptoms of muscle tightness might be pain with vaginal penetration, whether sexual, tampons, speculum, internal ultrasound. Treatment involves learning to relax the pelvic floor and often, the whole body.
Vulvodynia/vestibulodynia.
This is the pain syndrome that is most commonly provoked by touch to the area around the vaginal entrance (vulva) and inside the entrance to the vagina (vestibule). The pain is often burning or scratching in nature, and can be excruciating. We know that in these cases, the nerves at this part of the body have become highly sensitive so that those sensations that would not usually be painful, have now become painful. It goes hand in hand with tight pelvic floor (but not always). Management is very specific to each individual and may involve pelvic floor relaxation, desensitisation of the sensitive tissue, use of dilators/trainers, whole body techniques and exercise to calm down the nervous system.
Increased tone/tight pelvic floor
This is really the same as “vaginismus” ie the muscle of the pelvic floor have become tight. People who have tight pelvic floor muscles often note that life stresses seem to go straight to muscle tension all over the body. Anxiety disorders are linked to muscle tension as are hypermobility syndromes (see specific tab below). Tight pelvic floor muscles are often weak since the muscles become quite depleted over time holding excess tension.
Menopause related pelvic floor issues.
Do not be surprised if pelvic floor problems develop after menopause. Any of the issues described here can start or become worse once hormones change. You certainly don’t have to put up with issues just because menopause occurs to all women. Seek help and ask questions
Musculoskeletal
Coccyx pain
Coccyx pain is often present after a fall onto the coccyx and a Doctor will usually send you for an x-ray if there has been trauma. But coccyx pain can be present long after any trauma has healed. The pain might start after prolonged sitting that you are not used to. Sometimes the pain is very much joint related and sometimes it is pelvic floor muscle tension around the coccyx causing pain. We can assess this for you.
Sacroiliac joint pain. (SIJ pain)
Most Physios will assess these joints for you. Our area of interest enables us to give very detailed assessment of the pelvic floor which applies force to the SIJ joints from the inside, working with and responding to the muscles working on the outside. Most of the people we see have had pain for a long time and are not progressing well with other treatment approaches. Often other treatment approaches seem only to give temporary relief. Our aim is to look at the bigger picture and help you onto a better self management path.
Chronic hip and pelvic pain
As with SIJ pain above, the problems we see are usually chronic in nature and have not been fixed elsewhere. You need to understand that bigger picture and be able to help yourself rather than be reliant on therapies that only give temporary relief.
Hypermobility
I have put this as a heading on its own. It is not traditionally an area of pelvic health physio. But over the years I have seen SO many women who have pelvic floor dysfunction linked to hypermobility. Why? The pelvic floor will have been working harder over years to support the pelvis leading to problems of increased tone pelvic floor. Often it is very subtle but can explain a multitude of insidious symptoms : these might be a sense of heaviness and yet there is no prolapse present, some discomfort with initial sexual penetration, difficulty strengthening the pelvic floor which is actually tense so can’t work effectively for you.
