On International Women’s Day we should take a moment and reflect on the rights and needs of all women for health and wellness. This includes access to good healthcare, access to unbiased education regarding her body, and ultimate control over what treatment and care she receives.
No women should accept pain, incontinence, or discomfort as part and parcel of their life, or as an accepted outcome of being a woman or having children. There is much we can do to help and Physiotherapy plays an important role.
An important issue affecting women is pelvic health. Pelvic health includes pelvic floor dysfunction, pelvic organ prolapse, sexual health, and cervical and ovarian cancer.
So how does Physiotherapy fit into this?
Women’s Health Physiotherapists are specifically trained to assess and treat pelvic floor related problems. The pelvic floor is a sling of muscles that sits underneath the pelvis, quite literally, creating a muscular floor.
The pelvic floor has four main roles, these are:
supporting the pelvic organs, that is the bladder, uterus and bowel
keeping us continent
allowing satisfying sex, and
providing stability to our back and pelvis, by being an integral part of the “core” muscles.
When the pelvic floor fails to work well, we can experience incontinence, pelvic pain, back pain, and/or heaviness or aching in our lower back or pelvis. While a weak pelvic floor is often the cause of these problems, a pelvic floor that is too strong or tight could also cause many of these symptoms.
A thorough assessment by a women’s health physio will be able to determine the cause, teach you about what is causing your specific concerns and about what steps can be taken to effectively treat and manage your specific concerns.
Physiotherapy has been shown to be an effective first line treatment for incontinence, urgency, early pelvic organ prolapse, and pelvic pain.
We are also finding that early intervention, that is seeking treatment and looking after our pelvic floor before there is a problem is so much more effective. By doing this we can even prevent the need for more significant complications and invasive intervention. This means having a women’s health physio assessment as part of your 6 week post natal check, and working out how to protect your pelvic floor as you get back into life and exercise.
In summary, Physiotherapy is effective early management and can teach you
about your symptoms,
what steps you can take to protect your body,
how to safely strengthen your pelvic floor,
how to safely exercise, and
conservative management that will help support your pelvic organs, and help prevent the need for surgery.
So take this moment to help the women in our lives look after themselves, not accept pain and incontinence as a given and allow for a healthier future.
Rebecca Reicher, at Bondi Junction Physiotherapy, is a Women’s Health Physiotherapist with 15 years of experience working with women helping them to be strong, healthy, and the best they can be.
In honour of International Women’s Day Bondi Junction Physiotherapy is donating $100 to Jean Hailes for Women’s Health.
When we talk about men’s pelvic floor problems we often think of bladder problems due to prostate enlargement and/or prostate cancer and associated surgeries. Unfortunately men can also experience problems relating to over-active bladder, pelvic pain including testicular and penile pain, and erectile dysfunction. Therefore when looking at the cause of pelvic floor dysfunction it is important to consider the whole system including bladder compliance, health of the urinary tract system, previous or upcoming surgery, pelvic floor function, bowel health, the stabilising muscles of the lumbo-pelvic complex, and general health.
Many men comment that they have suffered in silence for months to years before they seek help. And it takes a lot of courage to talk about bladder problems and/or sexual problems with a doctor, specialist or physiotherapist. However it is really important that they do. As we can make a very significant impact on their quality of life.
When you consider the combined impact that pain, loss of continence and sexual function can have, you wonder why we are not doing more. The social and emotional implications are broad and can affect work, sporting activities, social engagements, and relationships with friends and significant others.
The pelvic floor muscle sling is important for providing stabilisation of the pelvis, support of pelvic organs, allowing us to have normal bladder and bowel function, and healthy and satisfying sexual function. For this it not only needs to have appropriate strength, but also correct control. Problems can occur if the pelvic floor is either too weak or too tight and strong; if the pelvic floor doesn’t turn on at the correct time, or if it works all the time. As a pelvic floor physiotherapist we can assess all of these components and therefore target treatment specifically to each persons needs.
Providing accurate education and access to thorough, and clinically relevant pelvic floor physiotherapy care for men is essential.
Chronic Pelvic Pain
Chronic Pelvic Pain is commonly very difficult to diagnose, and standard tests can be negative. Possible diagnosis can include:
over-active bladder syndrome
levator ani syndrome
What all of these conditions can commonly do is refer pain to the genitals, anus, coccyx, pelvic and abdominal region.
When there has been a period of chronic pain, we often see changes in the musculoskeletal system, and peripheral and central nervous system. While these may not be the cause of the initial symptoms, they can definitely cause perpetuation of pain long after the trigger has passed.
Prostate Cancer accounted for 30% of all newly diagnosed cancers in 2010 (Australian Cancer Incidence and Mortality Book, March 2014). Surgery can unfortunately leave a very large percentage of men with urinary incontinence. It can take up to 2 years for men to regain continence, and even then they may need the use of continence pad. Another devastating statistic is that 68-99% of men can experience erectile dysfunction, with only 30% recovering fully.
A pelvic floor physiotherapist can teach men how to:
Correctly contract the pelvic floor muscles,
Maintain a balance of muscle strength and control,
Coordinate pelvic floor muscles with the abdominal muscles and breathing
Assist in management of constipation, and optimise bowel health
Educate regarding aides to assist in erections and help maintain penile health.
Address dysfunctions of the lumbo-pelvic complex.
Pelvic Floor Physiotherapy pre-prostate surgery has been shown to significantly decrease both the severity and duration of incontinence (Yao et al 2012). By strengthening the pelvic floor prior to surgery we improve post-operative outcomes, in much the same way as knee rehabilitation prior to ACL surgery or total knee replacement improves outcomes.
At Bondi Junction Physiotherapy we use Real-Time Ultrasound to assess and educate men on performing a correct pelvic floor contraction. The visual feedback can be invaluable and allows men see the muscles move, in a non-invasive manner (Dorey et al 2005).
Rebecca Reicher at Bondi Junction Physiotherapy has over 10 years of experience in treating lumbo-pelvic and pelvic floor conditions in men and women. Individualised, comprehensive, and compassionate physiotherapy care is guaranteed.
Breastfeeding does not come easily or “naturally” to many mother’s, and is not something that we instinctively know how to do. Unfortunately, some women can experience set-backs during breastfeeding including chapped nipples, pain during latching and feeds, strain to the neck and shoulders, breast tissue engorgement, blocked ducts, and mastitis. Recurrent blocked ducts and mastitis is one of the more common reasons for premature weaning, but hopefully with good support, education and care women should be able to feed for as long as they wish to.
So why breastfeed? There are many reasons why we should support women to breastfeed. Breastfeeding has been shown to benefit and enhance the mother’s bond with her baby, assist in weight loss, and decreases the life-time risk for ovarian and breast cancer if a mother feeds for 12 months or more1. Babies who are breastfeed are less likely to have SIDs1, they have a decreased infection risk1, it helps in prevention of obesity in childhood and adulthood2, decreases the risk of developing Type 2 diabetes in adulthood, as well as decreasing the risk of developing hypertension in adulthood 3.
How can a Physio Help?
One of the first things a Physio can help with is in education of good posture when feeding, and this is important whether a mum is breast or bottle feeding. You should be able to sit comfortably and relaxed for the full feed. It is important to sit with good posture, so that the strain to the body, neck and shoulders is less. When you consider that the mother of a newborn can spend up to 40 hours or more a week feeding her baby, you realise how import this is. Pillows can be used to help support the baby up to chest height, with the baby’s weight supported on pillows rather then held up by the arms. This also will stop mums from slumping forward during a feed.
Good posture will help the baby latch well. A good latch can help minimise the amount of damage and irritation to the nipples4. It will also help ensure that the breast drains well during feeds, and therefore decrease risk of developing blocked ducts and mastitis.
Here at Bondi Junction Physiotherapy we are also skilled at managing engorgement, blocked, ducts, and mastitis.
Breast engorgement is a normal biological process that commonly occurs when milk first comes in, often between Day 2-4. However the breast can become engorged at any stage especially if a feed is missed. Women will experience a swollen, hard and throbbing breast. The swelling will compress ducts making it hard for milk to flow. The swollen breast also can make it harder for a newborn to latch. Physiotherapy can help with ultrasound to reduce inflammation and swelling, and instruction in gentle lymphatic massage to help reduce swelling. Use of cold compressed between feeds can help settle both the pain and swelling, and heat can be helpful to warm the breast just before a feed.
Blocked ducts can occur whenever there is excess compression on a duct that stops the duct from draining fully, and the milk becomes stuck or “set” in the duct. The technical term for this is milk stasis. Causes of blocked ducts include, poor latching, a missed feed, a rushed feed, an over-supply of milk, or wearing a compressive or poorly fitting bra. Physiotherapy is an extremely effective first line of treatment. Treatment may include gentle massage to help settle inflammation and clear the duct; ultrasound to settle the inflammatory process, as well as cause dilation of ductal tissue, both which will help the blockage to clear; and use of warm and cold packs continue to be very helpful.
If the blocked duct fails to clear, a mother is at risk of developing mastitis. This is an inflammatory condition that can be accompanied by an infection4. If the set milk fails to clear, new milk will form behind the blockage and cause pressure on the duct and surrounding tissue, causing an inflammatory reaction. Mastitis is often diagnosed by the symptoms of fever, flu-like symptoms, chills, a red, hot and tender breast, that often has a localised hard lump or wedge shaped area. It is always ok to continue breastfeeding with both a blocked duct and mastitis, and in fact this can often help clear the duct and settle symptoms. Again ultrasound is extremely effective at helping to resolve both the inflammation and assist in clearing the “set” milk from the ducts.
Up to 1/3 of all breastfeeding women can experience mastitis. And inexperience isn’t a risk factor! Rather a previous history of mastitis will increase risk of developing blocked ducts or mastitis again. Many women have said that fatigue and tiredness, stress, poor diet, a change in feed patterns or a missed feed, infection, breast trauma as factors related to the onset of a blocked duct or mastitis5. Unfortunately mastitis causes many women to worry, have days in bed due to illness, experience pain, and can lead to early weaning. For this reason we should given women every bit of support possible to make this breastfeeding journey as smooth as possible.
At Bondi Junction Physiotherapy every effort will be made to see mother’s with blocked ducts or mastitis as soon as possible, as our clinical experience shows that mother’s that are seen early on generally recover much faster. We also promise to support women no matter what their breastfeeding goals are.
1. Leung A.K.C., Sauve R.S. Breast is best for babies.J Natl Med Assoc 2005;97: 1010-1019
2. Owen C.G., Martin R.M., Whincup P.H. Effect of infant feeding on the risk of obesity across the life course: a quantitative review of published evidence. Pediatrics. 2005;115:1367–1377.
3. Owen C.G., Martin R.M., Whincup P.H. Does breast feeding influence the risk of type 2 diabetes in later life? A quantitative analysis of the published evidence. Am J Clin Nutr. 2006;84:1043–1054.
4. Mastitis: Cause and Management. Department of Child and Adolescent Health and Development, World Health Organisation, Geneva 2000
5. Riordan J.M., Nichols F.H. A descriptive study of lactation mastitis in long-term breastfeeding women. J Hum Lact 1990;6: 53-58