womens pelvic health

Women's Pelvic Health Conditions

Maree is experienced in assessing and treating issues relating to women’s pelvic health.  See below for a description of the types of issues Maree can help you with.

Maree will do a thorough assessment and make a management plan that suits your goals. In some cases Maree will arrange a referral to a specialist if this is required.

If you are not sure if your condition is something that Maree can help you with, please send an enquiry. Click here.

Pelvic Floor Muscle Exercises (Kegel Exercises)

Urinary incontinence: (there are two main types)

Stress Urinary Incontinence:
Symptoms: leaking urine with coughing, sneezing, laughing, exercise or any sudden movement.

Urge Incontinence:
Symptoms: a sudden strong urge to pass urine and leaking urine before you reach the toilet. This can be a symptom that follows on from urgency and frequency. Urgency and frequency without leakage or getting up at night to pass urine multiple times can be just as bothersome.

Difficulty passing urine:
Symptoms: urine flow may be hard to start or it is slow and a stop / start flow. Sometimes need to strain to empty. This is less common in women but can cause increasing anxiety and distress.

Painful bladder syndrome:
Symptoms: unable to hold on without feeling pain, discomfort in the location of the bladder, usually felt above the pubic bone. This triggers the need to frequently pass urine to ease the pain but often the sensation soon returns. This can be distressing and needs to be first assessed by a Urologist.

Faecal Incontinence:
Symptoms: Leakage of faeces or uncontrolled flatus (wind). Leakage may occur due to urgency to reach the toilet and not making it, or after passing a bowel motion. Wiping clean may also be difficult. Sometimes leakage may occur without warning or with physical activity.

Obstructed defaecation:
Symptoms: Difficulty passing a bowel motion. This may lead to straining to try and empty or a feeling of incomplete emptying. Sometimes applying pressure against your pelvic floor is needing to help empty.

Anorectal prolapse:
Symptoms: bulging of tissue through the anus which may occur with passing a bowel motion or with physical activity. This may be related to haemorrhoids or the lining of the rectum falling through the anus.

Vaginal Prolapse:
Symptoms: bulging or dragging sensation in the vagina. It may include lower abdominal or lower back ache. This is when any part of the vaginal wall can drop down towards the vaginal opening because a pelvic organ has moved. That is: the bladder, uterus, rectum or small bowel.

The causes of Pelvic Pain can be complex and require careful assessment in order to manage correctly.

Symptoms of pelvic pain in women may include:

  • Discomfort in the bladder
  • Pain passing urine
  • Dyspareunia (pain with sexual intercourse)
  • Pain in the pelvic floor when sitting
  • Pain passing a bowel motion
  • Pain in the rectum
  • Pain in the buttock area or pelvic joints
  • Pain in the lower abdomen

Common conditions of pelvic pain that Maree can assist in managing are:

  • Bladder Pain Syndrome (Painful Bladder Syndrome, Interstitial Cystitis)
  • Vulvodynia (pain in the vulvar)
  • Vaginismus (tight pelvic floor muscles)
  • Pudendal neuralgia. Nerve pain that may feel like a burning or irritation around the pelvic floor / genital region. It can include other nerves to the pelvic floor. There can be many causes for this in women.
  • Endometriosis
  • Myofascial Pain Syndrome. Increased tension in muscles of the pelvis including the pelvic floor, hips and abdomen causing pain.
  • Pelvic Joint Dysfunction (Sacroiliac Joints, Pubic Symphysis Joint)

Pre-operative:
Physiotherapy is recommended before any surgery that is to correct urinary or faecal incontinence or prolapse. Research shows that pelvic floor muscles that are strong and function correctly decrease the risk of reoccurring symptoms. It is recommended to trial physiotherapy before considering surgery as in many cases, surgery if not required.

Post-operative:
Physiotherapy following surgery is recommended to ensure a successful outcome through a rehabilitation plan that meets your needs and body.

Antenatal:
Pregnancy related issues can include back and pelvic pain, bladder and bowel issues. Maree may be able to see you during this time but as there can be a wait to see Maree, it may be best to see your local physiotherapist if you have back or pelvic pain issues. If you have any pelvic floor issues, Maree is happy to help you.

Postnatal:
Common post-partum issues include:

  • Back pain, upper or lower
  • Pelvic joint pain
  • Abdominal muscle separation (rectus diastasis)
  • Abdominal and pelvic floor muscle weakness
  • Perineal pain (pelvic floor pain)
  • Urinary incontinence
  • Faecal incontinence including uncontrollable flatus (wind)
  • Vaginal prolapse
  • Obstructed defaecation (difficulty passing a bowel motion)
  • Dyspareunia (painful intercourse)

Pelvic Floor Muscle Exercises

(Kegel Exercises)

The pelvic floor muscles lie at the base of the pelvis and are an integral part of support to the pelvic floor.

  • One does not usually think about the pelvic floor muscles unless you are pregnant, have had a baby or present with symptoms such as; urinary incontinence, faecal incontinence, vaginal prolapse or rectal prolapse.
  • Perhaps you have read or have been told by your health professional to ‘just do your pelvic floor muscle exercises’.
  • Perhaps you have tried to do pelvic floor muscle exercises after googling how to but you are not sure if you are doing them correctly or feel that they don’t work!

For some background, pelvic floor muscle exercises and kegel exercises are referring to the same thing.

Dr Arnold Kegel (1894-1972) was an American gynaecologist who invented a device for measuring the strength of a pelvic floor muscle contraction.

How do the pelvic floor muscles support the pelvic floor?

The pelvic floor muscles as well as the connective tissue and nerve supply to the muscles provide what is called:

  • Structural support at rest (what level the pelvic floor rests when not contracting / squeezing)
  • Active support (how strong they contract – squeeze and lift)
  • Structural support on straining or bearing down (what level the pelvic floor descends to)

When these three components of the pelvic floor are working well, this helps to:

  • Support the pelvic organs from underneath:
    • Rectum, vagina, bladder and uterus / rectum, prostate, bladder.
  • Aid continence – bladder and bowel.
  • Aid emptying – bladder and bowel.
  • Assist in sexual response.
  • Assist in pelvic stability. That is, they work with the deep abdominal and back muscles to support your pelvis, and spine.

What is the correct way to do pelvic floor muscle exercises?

To answer this question, it is helpful to understand that there are two main groups of pelvic floor muscles; the superficial or perineal muscles and the deep muscles sometimes called the levator muscles. The superficial muscles squeeze around the openings and the deep muscles lift up and forwards. The combination of squeeze and lift;

  • Tension the connective tissue between pelvic organs,
  • Compress the openings.
  • Net result: Pelvic organ support and continence

Depending on what description is used to contract or tighten the pelvic floor muscles, will depend on how effective the overall contraction is. For example, a common phrase to contract your pelvic floor muscles is to imagine you are stopping urine flow. However, this has the effect of contracting more the superficial muscles and not the deep pelvic floor muscles. This may have benefit in some cases but it is not optimising the whole function of the pelvic floor muscles and in most cases, all of the pelvic floor muscles need to be working well. In general, to contract your pelvic floor muscles, you need to think of squeezing around the openings and lifting from the back passage up towards the pubic bone in the front.

What affects good pelvic floor muscle function?

The ability to have good pelvic floor muscle function relies on:

  • Intact pelvic floor muscles. Sometimes the muscles are stretched or torn from childbirth or trauma.
  • Intact nerve supply. If nerves to the muscles have been stretched or torn from childbirth or trauma, the muscles cannot contract properly.
  • Correct breathing technique. Some people struggle to breathe in to their diaphragm / abdomen and instead breathe in to the upper chest or hold their breath. This can affect how well the pelvic floor muscles function.
  • Good coordination between the pelvic floor muscles and abdominal muscles. A common mistake with contracting the pelvic floor muscles, is to pull your navel in strongly or lift up under your ribs. The net result is minimal lift with the pelvic floor muscles or bearing down in to the pelvic floor.
  • Normal resting tone. This refers to what a muscle feels like. Sometimes a muscle is overactive or hypertonic meaning that if feels firm or is too tight. This affects how well a muscle can contract and relax. In these cases, the pelvic floor muscles need help to stretch and relax before they can function properly.

How do you know that pelvic floor muscle exercises are working for you?

If you have been doing pelvic floor muscle exercises from guidelines given from a health professional or from the internet, you should start to notice improvement in your symptoms over 6-12 weeks of regular exercising.

For example:

  • If you leaked with coughing or sneezing before, now you can control leakage by contracting your pelvic floor muscles first.
  • If you leaked faecal matter as you rushed to the toilet or after passing a bowel motion before, now you have control getting to the toilet and have no further faecal smearing afterwards.
  • If you had symptoms of vaginal bulging or dragging from a prolapse before, now it feels comfortable.

Perhaps you have made some improvement or no improvement at all. The reasons for this may be:

  • Incorrect technique when contracting your pelvic floor muscles,
  • You need a specific exercise programme to suit your physical needs,
  • There are other factors that are contributing to your symptoms.

If you are still struggling with symptoms or are not sure if you are working your pelvic floor muscles correctly, make an appointment to see Maree. Go to the Contact and Location page for more details.