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Women’s & Men’s Pelvic Health

What we do > Women’s & Men’s Pelvic Health

What is Pelvic Pain?

Pelvic pain for women is a term that relates to a pain problem in the structures related to the pelvis such as lower abdomen (below the belly button), bladder, bowel, inside or outside the vagina, the perineum (region between the vagina and anus) and clitoris.

Common examples of pelvic pain conditions in women are pudendal neuralgia, bladder or urethral pain syndromeirritable bowel, vulval pain or vulvodynia, dyspareunia or pain with intercourse, and coccydynia or tailbone pain. Pelvic pain can vary throughout the menstrual cycle and may be associated with endometriosis (link).

Pelvic pain for men is a term that relates to a pain problem in structures related to the pelvis including lower abdomen, bladder, bowel, penis or testicles, coccyx or tailbone. Pain may start as a result of an injury or come on gradually. Symptoms may vary but many men describe pain when sitting. Pelvic pain is often described as a throbbing or pressure pain in the rectal areapenis or testicles. This pain may be associated with bladder and bowel problems and sexual pain during intercourse or orgasm. It is sometimes termed chronic prostatitis but, if infection has been ruled out, it is often not due to the prostate.

Both women and men with pelvic pain may experience more than one pelvic pain condition. Urinary symptoms such as urgency to get to the toilet and going to the toilet more often commonly coexist. Pain may be associated with the bladder filling or pain with urinating. Similarly, pain may be aggravated with a full bowel or opening the bowels and can be aggravated by either irritable bowel syndrome or constipation.

Persistent pain can be very distressing, exhausting, and disrupt many important aspects of a person’s life.

How common is it?

Approximately 25% of women and 5% of men experience pelvic pain and for some individuals this is severe and significantly affects their quality of life.

Pelvic floor muscle tension and difficulty relaxing the pelvic floor muscles is found in up to 80% of individuals with persistent pelvic pain.

The pelvic floor muscles tighten to control the bladder or bowel and they relax when you urinate or defaecate (open your bowels).

Pelvic pain often makes the pelvic floor muscles tense up sub-consciously.  Most people do not realise that it’s happening. Muscles that are constantly clenched, become tight and shortened – then they start hurting.

If you have pelvic pain, you need to learn to relax your pelvic floor. These exercises are sometimes called pelvic floor muscle down-training or ‘Reverse Kegels’. Your physiotherapist can teach you how to perform pelvic floor exercises correctly.

Exercises that tighten the pelvic floor are often called ‘Kegel Exercises’. You should avoid these exercises.

Research shows that physiotherapy management strategies to restore normal function of the muscles around the abdomen, hips and the pelvic floor muscles can help to reduce pain.

Myths

– Pelvic pain is something you have to just live with

– Pain in the bladder and bowel cannot be helped

– Pelvic pain means you cannot go back to having pleasurable sex

– Pelvic pain means you can’t exercise

– Pelvic pain means you should just lay down and rest

– Pelvic pain can only be helped by surgery or injections

Facts

– Pelvic pain is complex linked to sensitivity of the pelvic organs and muscles in the pelvis

– Pelvic pain often worsens when things get out of balance in our lives

– Pelvic pain is linked to many things like increased stress, low mood, poor sleep, fatigue, poor exercise habits and in some cases a history of trauma

– Pelvic pain is often linked to too much pelvic floor muscle tension

– Pelvic pain is often linked to reversible muscle changes and may not need surgery

Risk factors for developing pelvic pain

In many cases pelvic pain and pelvic floor muscle problems may emerge at a time of increased stress, emotional distress, poor sleep and fatigue causing sensitisation of the muscles and organs of the pelvis.

A person’s response to pain such as fear of pain, depressed mood, activity and movement avoidance, can set up a vicious cycle of distress and ongoing sensitisation.

Management of pelvic pain and bladder, bowel and sexual dysfunction:

It’s important to understand that pelvic pain is complex and often multiple factors need to be considered.

At West Coast Health our Marika our Pelvic Health physiotherapist have completed postgraduate advanced training in the treatment of pelvic pain, bladder, bowel and sexual problems.

To understand each individual, it is important to understand all the factors that are involved in your presentation and the impact that your symptoms are having on your life. Our physiotherapists will take a thorough history, screen for factors that could be influencing your problem and establish your goals for treatment.

Following this we will conduct a comprehensive assessment of your condition including assessment of all the muscles around the lower abdomen, hips, pelvis and pelvic floor muscles.

Assessment of the pelvic floor muscles can be done fully clothed using real-time ultrasound. For a more comprehensive assessment of pelvic floor muscles a direct assessment can be performed via a vaginal or rectal assessment. This method is recommended for an accurate assessment of the pelvic floor muscles if you have pain and sexual dysfunction. The method of assessing your pelvic floor muscles is always your choice and will be thoroughly explained and based on your consent.

Following the assessment, we will explain to you in simple terms the factors that may be impacting on your problem and design a collaborative treatment plan to help you achieve your goals.

Physiotherapy management includes bladder or bowel habit retraining, pelvic floor and abdominal muscle retraining. Most individuals with pelvic pain and pelvic floor muscle dysfunction need to learn to relax their pelvic floor muscles fully. Any management program includes identifying the key factors linked to your symptoms, coaching you in body relaxation, breathing techniques, relaxed fearless movement, graded activity and sleep rehabilitation.

A long-term plan is the key to managing your pain and it may take up to 3-6 months to make this plan work. We also work with your doctor and or a clinical psychologist if additional care is needed.

Incontinence Care
What is Incontinence?

Incontinence is a term that describes any accidental loss of urine from the bladder (urinary incontinence) or bowel (faecal or bowel incontinence).

Common types of incontinence are:

– Stress urinary incontinence, which is bladder leakage with coughing, sneezing or during exercise and sport.

– Urge urinary incontinence is bladder leakage associated with a strong urge to empty the bladder “when you have to go, you have got to go!”

– Post prostatectomy incontinence which is bladder leakage following prostate

– Anal incontinence is difficulty controlling wind or stool and may be associated with a sudden urge to empty to the bowel or may occur without the person being aware until the next time they go to the toilet.


How Common Is It?

Bladder leakage affects 30% of women and 10% men, and although it is very common it is not normal. The symptoms of urinary incontinence may start with an occasional leakage of urine with coughing, sneezing or whilst trying to get to the toilet on time. If left untreated, leakage that initially occurs only occasionally may start happening every day.

Bowel leakage occurs in 3-10% of men and women but is often not talked about.  Some people feel that they do not empty their bowels completely or may have soiling after using their bowels. This can occur with a looser bowel motion or may be associated with constipation.

Although incontinence is not a life-threatening condition it can affect a person’s quality of life and incontinence is often cited as one of the major reasons for older persons requiring nursing home care. It is, therefore, better to seek treatment for incontinence even when the symptoms may seem mild.

Bladder and bowel leakage can be a sign that the pelvic floor muscles are not functioning properly.

The Myths

– Incontinence is just a sign of old age

– You just have to live with incontinence

– I am too old to do anything about it

– Pelvic floor exercises won’t work for someone like me

– Light bladder leakage is normal

– Wearing a pad is the best solution

– Drinking less fluid will improve incontinence

– Surgery is the only successful treatment for incontinence

The facts

– Incontinence occurs in people of all ages, and affects     men women and children

– Age is no barrier to improvement

– The sooner you seek help the better

– Mild incontinence symptoms are an early warning sign to get help

– Incontinence can be greatly reduced or eliminated by seeing a pelvic health physiotherapist

– Pelvic floor exercises are recommended by the International Continence Society as first line treatment for incontinence before surgery

– An Australian study showed 83% of women with stress incontinence (leakage with cough, sneeze and exercise) significantly improved in 1-5 treatments with a continence physiotherapist


Risk Factors For Incontinence

Pregnancy, childbirth, menopause,older age, constipation, chronic coughing, being overweight, recurrent bladder infections, heavy lifting or high impact exercise, and pelvic surgery such as prostate and gynaecological surgery may increase the risk.


Assessment Of Incontinence

At West Coast Health – Marika our Pelvic Health physiotherapist has completed advanced training in the treatment of incontinence.

Firstly, it is important to understand the factors that cause your incontinence symptoms and the impact that this has on your life. Our physiotherapists will take a thorough history, screen for factors that could be influencing your problem and establish your goals for treatment.

Following this we will conduct a comprehensive assessment of your condition including assessment of your ability to perform correct pelvic floor muscle contractions. Assessment of the pelvic floor muscles can be done fully clothed using real-time ultrasound. For a more comprehensive assessment of pelvic floor muscles a direct assessment can be performed via a vaginal or rectal assessment. This method is recommended for an accurate assessment of the strength of the pelvic floor muscles and the urinary and anal sphincters. The method of assessing your pelvic floor muscles is always your choice and will be thoroughly explained and based on your consent.

Following the assessment, we will explain to you in simple terms the factors that may be impacting on your problem and design a collaborative treatment plan to help you achieve your goals.


Treatment Of Incontinence

There is strong evidence that physiotherapy management should be first line therapy for incontinence before surgery is considered. Physiotherapy management includes pelvic floor and abdominal muscle training, bladder or bowel habit retraining. We can work with you  to personalise a program that addresses lifestyle factors such as regular physical activity, sleep, diet and stress management.

Pelvic floor muscle training is an important part of any management program for the management of incontinence. Research has shown that pelvic floor exercises are difficult to perform correctly with up to one third of people performing exercises incorrectly and could be worsening incontinence symptoms.

We first teach you how to contract your pelvic floor correctly. Following this  we will guide you in a progressive specific pelvic floor and abdominal exercise program. We will then integrate this into a generalised graduated exercise program based on your preference, starting with low impact exercise and building up as is necessary and aligned to your goals.

Incorporating your pelvic floor exercises into functional daily tasks is an essential as part of a self-management plan and is the key to controlling your symptoms in the long term. Research has shown that improvements can occur with 1-5 physiotherapy sessions.

Your physiotherapist is skilled in non-surgical management of incontinence and will identify additional factors that may need to be modified to optimise improvements and ensure they are maintained. We also work with your doctor if additional care is needed.


Children And Adolescents – Bladder And Bowel Problems

The journey through childhood and adolescence is a time of incredible learning, growth and development for both the mind and body.  Problems with bladder and bowel control can greatly impact the life of a child and their caregivers, causing significant stress, anxiety, embarrassment and frustration.

Wee accidents or wetting in the daytime (daytime urinary incontinence), difficulties emptying the bladder, feeling of urgency or ‘busting’ a lot of the time, repeated urinary tract infections, and routinely delaying going to the toilet are common concerns raised by families. Bedwetting (enuresis) is also a problem for many children, and while often improving over time, in some cases this continues through primary school years and even in to adolescence.

Constipation is the most common bowel complaint, affecting approximately 10% of children.  In the majority of cases, the constipation is functional, which means there is no underlying organic cause. Soiling issues (encopresis, or faecal incontinence) are often secondary to the constipation itself.

Children often present with both bladder and bowel concerns, which is rarely the result of poor behaviour or laziness.  Our Pelvic Health Physiotherapist at West Coast Health ha expertise in helping your child or adolescent with a thorough assessment to understand the underlying causes and issues that contribute to their toileting problems.

Age-appropriate education and practical advice for the child and parent form the basis of individualised management programs.  Guidance on an appropriate toileting program, assessment and biofeedback using real time ultrasound, uroflowmetry, TENS and bedwetting programs are strategies that may be incorporated with consideration to your child’s needs.  We also strive to collaborate with caregivers and other health providers to ensure your child is best supported in overcoming these challenges.

To learn more about  incontinence and it can be treated, or for any other condition, get in contact with us today.