Pelvic Organ prolapse affects approximately 50% of women who have experienced a vaginal delivery and refers to the descent of one or more of our pelvic organs. This could involve the bladder, bowel, or uterus. Often the symptoms of prolapse become more noticeable at the oneset of perimenopause or menopause. Symptoms of prolapse include:

• a heaviness or dragging sensation in the vagina, usually worse at the end of the day

• a noticeable lump at the entrance to the vagina

• difficulty inserting tampons or getting them to stay in

• lower back pain

• changes to our bowel or bladder function, including increased frequency of urination, bladder urgency, or incomplete emptying of the bowel or bladder

• pain with sexual intercourse

Physiotherapy management of pelvic organ prolapse includes a tailored pelvic floor muscle program to support the pelvic organs. Fitting of a support pessary is also a common and successful treatment option, especially for those who would prefer not to have surgery. The type of pessary chosen is dependent on a number of factors, which your physiotherapist will discuss with you after an examination.

Urinary Incontinence refers to the involuntary loss of urine. This can happen when we exert pressure through our abdomen, for example when we cough or sneeze our lift something heavy. Another example is leaking with running or skipping in the gym, when our pelvic floor muscles are fatigued. Approximately 1 in 3 women will experience leakage at some point in their life, and this risk increases with each vaginal birth. Another type of incontinence we commonly see is urge incontinence, where leakage occurs once our brain senses the signal to urinate and we cant make it to the toilet in time. Once a thorough assessment has been taken on your history, fluid intake and bladder habits, a physical assessment will be performed, and often a bladder diary will be completed to give us a clear picture of your bladder habits.

Physiotherapy for incontinence focuses on addressing the underlying cause, some of which can include:

• pelvic floor muscle weakness/poor muscle tone

• pelvic floor muscle overactivity

• poor coordination of muscle activity

• bowel issues such as constipation can result in increased urgency and leakage.

• menopausal changes to tissue health

• reducing bladder stimulants and monitoring fluid intakes to reduce overactive bladder muscle contractions.

Pelvic health physiotherapist treat more than just the pelvic floor. We are trained to treat dysfunction of the bowel and bladder, and because these organs share a space in the pelvis, along with a shared supply of nerves, we often find dysfunction in one organ results in disruption to the other. For example it is very common to find that people with chronic constipation or issues emptying their bowels will also experience bladder frequency and urgency issues. Constipation is a common finding in the general population, and as well as encouraging a healthy diet and adequate fluid intake we can also teach you the correct way to sit on the toilet to encourage relaxation of the pelvic floor muscles.

In addition to treating issues with bowel emptying, we also treat Faecal Incontinence. This includes the inability to hold onto flatus. Although this is a topic people try to hide away from, there is help available so please reach out.

A major focus area for me is aiding those suffering with endometriosis in managing the often very variable bowel habits ranging from constipation and pain with opening bowels, to diarrhoea. Thankfully we now have a much greater awareness of ways to help manage these symptoms using a varied and holistic approach. Pain with bowel opening in this case is often due to pelvic floor muscle spasms, which we can treat with a variety of methods.

This is an area I am very passionate about. As someone who has struggled with the chronic effects of endometriosis and adenomyosis myself, I am able to emphathise with patients on this journey. Although we have come along way in the detection and treatment of these conditions, more still needs to be done. To be able to help those experiencing chronic pelvic pain to either become pain free, or to learn to manage their condition and have quality of life is something I strive for. Pelvic pain can be due to a number of reasons and include a range of conditions such as:

• Endometriosis or Adenomyosis

• Vaginissmus

• Vulvodynia

• Genito-pelvic pain penetration disorder

• pain with intercourse post-episiotomy

• pain with intercourse due to vaginal dryness during peri menopause and menopause

• pain with intercourse post-radiation therapy

  Treatment for pelvic pain and pain with sexual intercourse is different for each individual. Some methods include:

• Pelvic floor muscle relaxation/downtraining

• Belly breathing/breathing awareness

• Pelvic stretches

• Myofascial release of the pelvic floor muscles

• Gentle exercise

• Vaginal dilator therapy

• Use of additional therapies such as remedial massage, reflexology and counselling. This is particularly important if the pain is linked with past trauma

Pelvic health physiotherapists are well trained in helping new mums recover from both vaginal and caesarean sections. In the pre-natal period, it is important to remain as active as possible. This has been shown to assist in post-natal recovery. Including pelvic floor and abdominal exercises in a modified and safe way has been shown to reduce the degree of diastasis post-birth. In addition to this, we encourage women to continue exercising for as long as they can during pregnancy. Using a well trained exercise professional is advisable. For those living in the Byford region, Jacqui Sommerville from Mum and mini Fitness is a wonderful option.

In the post-natal period, advice on gentle exercise for both the pelvic floor and abdominals, maintaining good bowel and bladder habits and general exercise advice generally form part of our assessment. This may or may not include a vaginal examination depending on patient preference. This is especially recommended if you had a long or difficult labour or birth.

Perimenopause and menopause both come with different changes and challenges to the female body. This can manifest as changes in our bowel and bladder habits, changes in our libido and mood, vaginal dryness, brain fog, loss of skeletal muscle mass and poor sleep. The role of a pelvic health physiotherapist during these life phases may include:

• general exercise advice to maintain muscle mass and cardiovascular fitness

• advice on the use of vaginal oestrogen therapy (prescribed by your GP)

• Referral to a specialist GP who has further training in the hormonal management of women in perimenopause and menopause.

• pelvic floor exercises to maintain muscle strength and endurance

• healthy bowel and bladder advice

• referral to a sex therapist

Pelvic health physiotherapists are expertly trained to manage all of the above issues and provide you with advice and management based on your complaint. A combination of exercise, lifestyle modifications and hormonal therapy provides most patients with relief from their symptoms. Finding a specialised GP who has further training in hormonal medicine is strongly advised

Common issues treated include:

• urinary urgency and increased frequency (sometimes referred to as Overactive Bladder)

• urinary leakage

• bowel dysfunction/constipation

• pelvic or perineal pain

• post-prostatectomy rehabilitation

• erectile dysfunction related to pelvic floor dysfunction

  Treatment is individualised and evidence-based, combining assessment of pelvic floor muscle function, targeted exercises, breath and core retraining, biofeedback and lifestyle advice. Goals are to reduce pain, improve continence and sexual function, restore normal bladder and bowel habits, and enhance quality of life. Appointments are private and respectful, with clear education and home programs to support progress.