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Women’s & Men’s Pelvic Health

PHYSIOTHERAPY SERVICES > Women’s & Men’s Pelvic Health
Table of Contents
Pelvic Floor Assessment (Pre/post natal)

There are two ways to assess the pelvic floor muscles, either via real time ultrasound (RTUS) or internal vaginal examination. 

Real time ultrasound is an external way to assess how the pelvic floor muscles are working. Generally, a probe is placed on your lower abdominal and we can see the pelvic flood muscles contract and relax. With this we can also see how long you can hold your pelvic floor muscles for. However, with real time ultrasound, we cannot determine how strong your muscles are or if there is any pain associated with these muscles. 

The other option to assess the pelvic floor muscles is via internal vaginal examination. This is generally performed with a gloved single finger examination. With this method the ability to activate and relax the pelvic floor muscles can be assessed. As well as the strengthen, endurance, pain, overactivity and if there is any pelvic organ prolapse. 

Either way can be performed in the pre and postnatal period to help get a better understanding of what is going on with your pelvic floor muscles and how to make exercise during this phase of your life pelvic floor safe. 

Abdominal Seperation

What is abdominal separation (DRAM)? 

Abdominal separation is a completely normal process of pregnancy. Over the course of your pregnancy, your abdominal muscles will stretch to accommodate your growing baby. The linear alba, which is the fascia that joins the rectus abdominus muscles together, will stretch allowing space for the baby to grow. After you have delivered, the abdominal muscles have stretched and will be weak. It is important to re-strengthen these muscles in a safe way to prevent further injury. 

-Preventing abdominal separation in pregnancy: 

-Strengthening your deep abdominal muscles before pregnancy or in the early stages of pregnancy 

-Avoid use of your superficial abdominal muscles while exercising during pregnancy

-Make sure all exercises during pregnancy are pelvic floor safe  

-Use of support garment during daily activities or while exercising, such as tubi grip, compression shorts  

 

Potential treatment of DRAM postnatally: 

-Individual assessment is required for treatment of abdominal separation. 

-First 6 weeks postpartum

-Compression garment, tubi grip or compression shorts 

-Light pelvic floor activation 

-After the first 6 weeks postpartum

-Postnatal assessment is recommended, which will include a DRAM check

-Individualised and tailored evidenced-based home exercise program for rehabilitation to decrease separation 

-Compression garment may be recommended 

Lower Back & Pelvic Girdle Pain

What is pelvic girdle pain? 

Pelvic girdle pain is a common problem in pregnancy and postnatally due to the hormonal effects on the ligaments, as well as the increased weight gain and postural changes putting extra pressure on the joints. Approximately 2 out of 3 women will experience a degree of pelvic girdle pain during their pregnancy or postnatally. 

How a physiotherapist can help? 

A physiotherapist can assess the pelvis and prescribe the correct treatment for you. This may include modifications of daily activities and/ or exercise, exercises to help decrease pain and increase strength of the muscles around the pelvis, and even prescribing SIJ support belts. 

Wrist Pain

Varying wrist pain may occur during pregnancy and postnatally. Two of the most common concerns include “new mum’s wrist” (De Quervain’s tendinopathy) and pregnancy induced Carpal Tunnel Syndrome. 

“New mum’s wrist” or De Quervain’s tendinopathy is an inflammation of the sheath around the tendons of the thumb and wrist. The sheath is there to protect from excessive friction. However, when there is overuse of lifting, wrist movements etc the sheath becomes inflamed. 

Pregnancy induced Carpal tunnel syndrome is due to extra fluid that generally occurs in the third trimester of pregnancy at the wrist and hands that causes compression on the median nerve. This can lead to pins and needles, numbness and/or loss of strength in your hand. 

Your physiotherapist will assess the presenting condition and may use varying treatments to help minimise pain and discomfort. 

Safe Exercise during Pregnancy & Postnatally

Prenatal exercise:

Exercise is important during pregnancy. It can help you maintain your fitness, strength and prepare you for labour. As your body changes, there are some important considerations to take into account before starting exercise. Our prenatal exercise guidelines have been developed from the most recent guidelines of safe exercise during pregnancy developed by the American College of Obstetricians and Gynaecologists. 

 

Postnatal exercise:

One of the most common questions we get in the postnatal period is “when can I return back to exercise?” Everyone’s pregnancy and postnatal recovery is different. 

 

After an assessment with a specialised women’s health physiotherapist, most clients can get back into low impact exercise. However, it usually takes a little longer to get back into high impact exercise such as running or jumping exercises. Our assessment includes assessment of abdominal separation, pelvic floor, pelvic control and strength. 

Mastitis/Engorgement

Mastitis is swelling in the breast tissue. Milk leaks from porous milk ducts into the surrounding breast tissue. It occurs at times of oversupply (when the baby is born, going through a growth spurt and when weaning). Breastfeeding and expressing milk will relieve the inflammation and discomfort. Any excess fluid left in the breast can be removed via lymph and venous drainage. 

Symptoms? 

Engorgement is suspected with increasing firmness or hardness, redness and discomfort which may progress into flu like symptoms. The flu like symptoms can include fever, aching body, headaches. 

How a specialised women’s health physiotherapist can help? 

A specialised women’s health physiotherapist can assess the affected breast(s), educate on helpful at home management strategies, as well as treat with therapeutic ultrasound treatment to help clear the inflammation. 

Caesarean Scan Management

During a caesarean, your baby was delivered through a surgical incision in your lower abdomen and uterus. There are many strategies a physiotherapist can help you with pain management and healing. 

Pain management:

-Medication prescribed by your doctor 

-Heat pack 

-Use of TENs machine 

 

Healing management

-Shower once daily and try keep the wound dry 

-No lifting over the weight of your baby 

-Hold a pillow or hands over the wound when cough, sneeze or laughing 

-Scar mobility and massage started from 6 weeks postnatally as prescribed by your physiotherapist 

 

Watch for infection 

-Fever of 38C or higher 

-Watch the incision site for infection like redness 

-Bleeding that requires a new sanitary pad every hour

-Severe abdomen pain 

-Swelling, redness, pain in leg 

-No bowel movement 1 week after the birth of your baby 

Bladder Continence

Continence is the ability to control your bladder. Research shows that ¼ people are incontinent. Although incontinence is very common, it is not normal and can be treated. There are many types of incontinence, however these are the most common types: 

-Urge incontinence: the involuntary loss of urine associated with a sudden need to urinate 

-Stress urinary incontinence: the involuntary loss of urine with activity such as cough, sneeze, laugh, exercise and lifting

-Urinary retention: the inability to completely empty your bladder, which may result in leakage of urine

-Nocturia: when you need to wake during the night to go to the toilet and pass urine. 

-Post micturition incontinence: commonly known as after dribble, which is when there is leakage of urine after emptying the bladder:


-Risk factors for bladder incontinence 

-Pregnancy 

-Childbirth 

-Menopause 

-Age 

-Constipation 

-Pelvic surgeries 

-Chronic illness and disease 

Our specialised physiotherapists will take a detailed history by discussing factors that may be affecting your condition and help establish goals for your treatment. Following this, a detailed pelvic floor assessment will be performed, either via real time ultrasound or via a vaginal or rectal examination. This will allow our physiotherapist to gain a better understanding of your condition and assess your ability to correctly activate your pelvic floor muscles. Everything will then be discussed, and a treatment plan will be put together to help you.