PELVIC FLOOR PHYSIOTHERAPY

Highly specialised treatments for pelvic floor conditions

FOR WOMEN
FOR MEN
CONDITIONS WE TREAT
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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 and men.

The pelvic floor and organs are complex structures. Our consultations take all these complexities into consideration in order to tailor a treatment plan for your individual needs.

What can I Expect at My First Appointment?

At your first appointment we will take your medical history, perform a thorough assessment and consult with you regarding a treatment plan that addresses your needs.

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

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
  • 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
  • Constipation
  • Genito-pelvic pain penetration disorder (pain during intercourse or inability of have intercourse due to pain)
  • Vaginal flatus (bothersome vaginal wind which occurs upon movement, strenuous exercise or intercourse)
  • Persistent pelvic pain/low back pain (including pubic symphysis dysfunction, sacroiliac dysfunction, anorectal pain/proctalgia fugax/chronic proctalgia, coccydynia)
  • Avulsion and pelvic floor trauma in childbirth

What services are available to women during pregnancy and the postnatal period?

  • 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

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
  • Faecal/flatal incontinence
  • Constipation
  • Persistant pelvic pain/anorectal pain/proctaglia fugax/chronic proctalgia (including referred genital pain where no other abnormalities have been detected upon investigation)

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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