PELVIC FLOOR PHYSIOTHERAPY

Highly specialised treatments for pelvic floor conditions

FOR WOMEN
FOR MEN
FOR CHILDREN
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What is Pelvic Floor Physiotherapy?

Pelvic floor physiotherapy is a specialised field that is associated with the pelvic health of both women, men and children.

The pelvic floor and organs are complex structures that are part of the lower back and hip system. The pelvic floor is also a muscle that is very sensitive to our emotions and fears and every person is very unique so our consultations take all these complexities into consideration in order to tailor a treatment plan for your individual needs.

Observation: For the sake of simplification in this website, we have classified pelvic concerns under male, female, and paediatrics-children, however it is crucial to acknowledge that the LGBTQI+ concerns are often universal to all people and there are many anatomical variations, which do not define gender, sexual orientation, or identity. Therefore, wherever you read “women”, please read “female assigned at birth” and wherever you read “men” please read “male assigned at birth”. Our Pelvic floor Physiotherapist Aline is passionate about advocacy in pelvic health for all different types of anatomical variations including intersex and trans.

What to Expect 

Our clinic is a private, safe and comfortable space. We understand your first pelvic physiotherapy consultation can often be daunting and we aim to make your consultation as comfortable as possible. You are always in control and do not have to provide any information or undergo any assessments that you are not comfortable with.

Your physiotherapists will take a thorough history and ask you about your goals. Use this time to ask your physiotherapist all the questions you may have regarding protocol, expectations and goals, or ways to measure your progress.

An internal vaginal or rectal assessment may be advised as it will allow us to properly assess your pelvic muscles and structures that are not able to be checked externally. If you do not feel comfortable with this, please let us know.

After treatment, a letter outlining the findings and management plan will be sent to your GP or specialist unless requested otherwise.

  • First, your physio will ask you for a very detailed history. This will include details about your current concern, your medical, obstetric and gynaecological history, bladder and bowel habits, and exercise. We will also ask about your goals. This can take up to 30 minutes. Use this time to ask your physiotherapist all the questions you may have regarding protocol, expectations and goals, or ways to measure your progress.
  • Next, your physio may discuss pelvic floor, bladder and bowel function and anatomy, and what could be the possible causes of your symptoms.
  • After this, it may be recommended to have an external or internal pelvic assessment. This will allow us to check your pelvic floor muscles and structures, and to find out what exactly is the cause of your symptoms. Please let us know if you would prefer not to do this, and we can work around it. If you have your period it is still possible for us to do an internal assessment, if you are comfortable to do so.
  • Your physiotherapist will then explain the findings and come up with a management plan with you going forward. This will include time-frames, expectations, and what treatment will involve (this could be pelvic floor exercises, bladder and bowel habit changes, or other exercise).

Click here to make an appointment or call us on (02) 4759 1485

What Conditions May I Seek Treatment For?

Some of the common pelvic floor conditions we see and treatments include:

Urinary incontinence refers to a number of conditions:

  • Stress urinary incontinence (leaking of urine with laughing, coughing, sneezing, running, and change of position)

  • Urgency (the experience of a sudden, ‘difficult to defer’, desire to pass urine, not necessarily followed by urinary incontinence)

  • Urge urinary incontinence (incontinence associated with a sudden, ‘difficult to defer’, desire to pass urine)

  • Passive urinary incontinence (urinary incontinence not associated with a desire to pass urine or any particular activity)

Continence requires that the urethra (tube connecting the bladder to the outside world) remains closed, particularly during activities which increase the intra-abdominal pressure and pressure on the bladder. Urethral closure is maintained by (1) the tone in the urethra itself, (2) the fascial (connective tissue) support system around the bladder and urethra, and (3) the pelvic floor muscles. When one or more of these structures is impaired or damaged, incontinence can occur.

Stress urinary incontinence is the passive leakage of urine during activities including but not limited to:

  • coughing

  • sneezing
  • laughing
  • change of position
  • walking
  • running/high impact exercise
  • intercourse

Following assessment, your Physiotherapist will discuss with you your treatment options.

Treatment may include:

  • lifestyle modifications/education

  • pelvic floor exercise prescription
  • electrical stimulation
  • intra-vaginal continence devices/pessaries

Urgency is the complaint of a sudden compelling desire to pass urine which is difficult to defer. When this is accompanied by involuntary leakage, this is termed urge urinary incontinence. When urgency or urge urinary incontinence are accompanied by frequent bothersome voiding and frequent urination overnight, the International Continence Society term this ‘overactive bladder syndrome’. These conditions can severely impact quality of life.

Following assessment, your Physiotherapist will discuss your treatment options, which may include:

  • lifestyle modifications/ education

  • pelvic floor exercise prescription
  • electrical stimulation
  • pelvic floor manual therapy
  • treatment of bowel dysfunction

For further information on urgency/urge urinary incontinence, please see these resources:

Faecal/flatal incontinence refers to a number of conditions:

  • Faecal urgency (the experience of a sudden, ‘difficult to defer’, desire to pass a bowel motion, not necessarily followed by faecal incontinence)

  • Faecal urgency incontinence (faceal incontinence associated with the experience of a sudden, ‘difficult to defer’, desire to pass a bowel motion)
  • Passive faecal incontinence (faecal incontinence which is not associated with the desire to pass a bowel motion)
  • Post-defecation faecal incontinence (faecal incontinence or soiling, which occurs directly after passing a bowel motion)
  • Flatal incontinence (difficulty or inability to control wind)

Vaginal flatus refers to involuntary wind which is expelled vaginally. This condition can be embarrassing, and result in significantly reduced quality of life. Assessment by a pelvic floor physiotherapist will help to determine whether physiotherapy will be effective as a form of treatment.

Constipation has a number of causes and presentations:

  • Functional constipation (primary slow-transit constipation may be unresponsive to pelvic floor Physiotherapy; however, other forms of constipation may respond well to conservative management)

  • Obstructed defecation (when defecation is obstructed by an anatomical defect, such as pelvic organ prolapse)
  • Dysynergic defecation (when muscle incoordination impedes defecation)
  • Rectal hyposensitivity (when the nerves in the back passage no longer ‘fire’ appropriately)

Pelvic organ prolapse involves a descent of the bladder, uterus, rectum or small bowel into the vagina, and occurs when the pelvic organ supports have been damaged. This can occur following a vaginal delivery, and can also occur slowly over time with age-related changes of the support system.

Symptoms include:

  • Vaginal heaviness, dragging and pain

  • Low back pain
  • Awareness of a vaginal bulge
  • Difficulty emptying the bowel
  • Pain during intercourse

Treatment options may include:

  • Lifestyle modifications/education

  • Pelvic floor exercise prescription
  • Electrical stimulation
  • Pessary placement
  • Treatment of bowel dysfunction
  • Advice regarding the use of other assistive devices (i.e. femeze)

This group of conditions really refers to any pain, difficulty or obstruction experienced during intercourse, or attempted intercourse. It collapses terms such as dyspareunia (pain during intercourse), vaginismus (pelvic floor tightness), and vestibulodynia (burning and stinging near the entrance of the vagina). There are many possible causes of pain during intercourse. Some respond very very well to pelvic floor physiotherapy, so thorough assessment by a trained pelvic floor physiotherapist is essential.

Childbirth can be one of the most amazing and uplifting experiences in a woman’s life. It can also be deeply traumatic, physically and psychologically. If you would describe your birth as traumatic, please seek help and discuss this with your GP (although a GP referral is not required for you to attend physiotherapy). A pelvic floor physiotherapy assessment can be an important part of postnatal assessment. If necessary, your physiotherapist may encourage you to speak with your GP about referral to Nepean Clinical School (Professor Peter Dietz) for further assessment. Please feel free to access the following links for further information.

Pessaries are intra-vaginal devices fitted by a physiotherapist or Gynaecologist with the goal of reducing pelvic organ prolapse and related symptoms. Your physiotherapist will determine whether a pessary is appropriate for you, and will discuss with you the risks and potential benefits. If appropriate, your physiotherapist may suggest you review with your GP and/or Specialist, to ensure a collaborative approach to treatment.

For further information on Pessaries, please see the following resources:

For Women / Female Assigned at Birth

Acting as part of a multi-disciplinary team, our physiotherapists provide assessment and management for a number of conditions specific to women, including:

  • Urinary incontinence (loss of urine) and urgency (rushing to the bathroom or repeatedly feeling that need to go)
  • Pelvic organ prolapse (symptoms include vaginal heaviness and dragging, low back pain, awareness of a vaginal bulge, and need to digitate in order to pass a bowel motion)
  • Faecal/flatal incontinence (loss of poo or gas)
  • Constipation, straining or bowel emptying problems
  • Pain or inability of having intercourse (Genito-pelvic pain penetration disorder including vaginismus and vestibulodynia-provoked vestibulodynia)
  • Vaginal flatus (bothersome vaginal wind which occurs upon movement, strenuous exercise or intercourse)
  • Persistent pelvic pain (which may be linked to endometriosis or painful periods)
  • Persistent low back pain (including pubic symphysis dysfunction, sacroiliac dysfunction, anorectal pain/proctalgia fugax/chronic proctalgia, coccydynia)
  • Pelvic floor trauma after childbirth such as avulsion, OASIs, 2nd, 3rd and 4th degree tearing, recovery after episiotomy
  • Physiotherapy after and during gynecological cancer (PINC Cancer Certified)
  • Overactive and bladder pain syndrome (including interstitial cystitis)

  • Antenatal and postnatal pelvic floor assessment and education, with the view to optimizing recovery postnatally*
  • Assessment and treatment for women who have sustained obstetric tears (commonly referred to as OASIS – obstetric anal sphincter injuries; or 3rd and 4th degree tears sustained during labour)
  • Postnatal pelvic floor assessment for women wishing to return to exercise/high level sports*

*we do not offer pelvic floor examinations to women during the first trimester of pregnancy or during the first 6 weeks of the postnatal period

For Men/ Male Assigned at Birth

Acting as part of a multi-disciplinary team, our physiotherapists provides assessment and management for a number of conditions specific to men, including:

  • Post-prostatectomy incontinence
  • Post-prostatectomy erectile dysfunction
  • Penile and testicular pelvic floor conditions including pain during erection and ejaculation
  • Faecal/flatal incontinence
  • Constipation and bowel problems
  • Pelvic pain
  • Overactive and bladder pain syndrome (including interstitial cystitis)
  • Persistent low back pain (including pubic symphysis dysfunction, sacroiliac dysfunction, anorectal pain/ proctalgia fugax/ chronic proctalgia, coccydynia)
  • Pain or inability of having intercourse (due to Peyronie’s disease for example)

For Children

Although it may come to a surprise to many, children can also suffer from pelvic floor concerns. Bedwetting and incontinence (leaking urine or poo/ stools) and urgency (running to the bathroom frequently) can often be improved via pelvic floor physiotherapy. It is important to clarify that while working with children, pelvic floor physiotherapy is non invasive and, of course, non painful. The main goal is to help parents and children to tackle the problem and take control of their pelvic health.
  • Bedwetting or enuresis (losing control of urine during the night)
  • Encopresis (losing control of poo/ stools)
  • Urinary and fecal incontinence and urgency
  • Pelvic pain
  • Overactive bladder syndrome
  • Constipation
  • Bowel and anorectal dysfunction including straining during a bowel movement

MAKE AN APPOINTMENT

Call us on (02) 4759 1485 or fill out the contact form below with your details and we’ll be in touch.

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