When you have a painful back, neck, or knee, you most likely seek a physiotherapist’s help. However, have you ever considered seeing one if you have pelvic floor symptoms? These symptoms can include leaking with cough, sneezing or exercise, heaviness vaginally, bowel symptoms, or pain with intercourse. Such symptoms are less talked about – they can even be taboo – and yet, they commonly occur throughout a woman’s lifetime. Pelvic health physiotherapists are experts in the treatment of these pelvic floor symptoms. They undergo extensive post-graduate training to help manage these personal, often complex, and emotional issues.
What Led Me Down the Road of Pelvic Health?
During my physiotherapy degree and after, when I began working, I knew very little about pelvic floor issues. It wasn’t until the birth of my first baby 10 years ago that I delved into the world of pelvic health physiotherapy. After a difficult birth and a slow recovery, I started to feel symptoms of heaviness vaginally, and that something was just not quite right down there. Scared and unsure, I went to see a pelvic floor physiotherapist who diagnosed me with vaginal prolapse.
If I’m honest, I didn’t even know what a prolapse was until that point! This diagnosis and my subsequent recovery journey catapulted me into the world of pelvic health. I felt a need to educate myself and women about these taboo and stigmatised issues – to spread the word that there is help and support out there. Pelvic health is now my passion! I travelled to Melbourne University to complete my post-graduate education in this area in 2015 and I haven’t looked back since. All my work and education is now in this area.
What Is a Vaginal Prolapse or Pelvic Organ Prolapse (POP)?
POP is when one or more of the pelvic organs (bladder, bowel, uterus) descend into the vagina. The pelvic organs are supported by connective tissue and the pelvic floor muscles. This support system can be affected by many lifestyle factors. Pregnancy and childbirth injuries (as in my case) are probably the more well-known. Other factors such as chronic constipation, genetics, menopause, being overweight, and chronic cough can also contribute to it. It’s quite prevalent, with about 50% of women (over 50) having some degree of prolapse, but only 3-6% of women are symptomatic. Despite this, very few women know what a prolapse is unless they experience symptoms.
What Are the Symptoms?
Vaginal dragging or heaviness, and visually seeing or feeling a bulge vaginally is the most common symptom. Others – bladder or bowel symptoms, difficulty inserting a tampon, pain with intercourse, and pain in the back or abdomen – may also be present. These symptoms can vary in intensity and be influenced by many factors, including fatigue, menstrual cycle, stress, menopause, and pregnancy. The good news is it’s not all doom and gloom! Physiotherapy can help manage symptoms and get you back to doing what you love.
What Should You Do If You Suspect POP?
I highly recommend seeing your OBGYN and a pelvic health physiotherapist – and the research agrees! The guidelines recommend pelvic floor muscle training for at least 16 weeks, supervised by a professional as first-line treatment of women with mild to moderate POP. One large study found that individualised pelvic floor muscle training is effective at improving prolapse symptoms.
My Journey to Recovery
When I first developed symptoms, I will admit I was devastated. I felt a vast spectrum of emotions from sadness to fear, grief, and rage. Exercising was a massive part of my self-care, and I felt my symptoms every time I tried to work out and even when lifting my baby. I felt like my body was failing me, and it took me time (and a lot of tears!) to accept my prolapse and come out of this mindset.
My pelvic health physiotherapist supported and empowered me, and with treatment and a progressive exercise programme, I was back doing the things I love. Yes, it took time, effort, and commitment, but seeing the results inspired me to continue. My recovery was much more than kegels/pelvic floor exercises – but they played a large part! It included whole-body conditioning, education, manual release of scar tissue internally, progressive loading of the pelvic floor and surrounding muscles, maintaining good bowel habits, and managing stress and sleep. Plus, a great friend, family, and professional support network was key. It’s not just the physical part that needs to heal, but also the emotional. This experience opened my eyes and was the main driver for me to educate myself and others on pelvic health issues.
What Happens When You See a Pelvic Health Physiotherapist?
I know it can be daunting initially and, rest assured, we are here to put you at ease. Being informed is vital, and all aspects of the session are explained in detail so you can make an informed, autonomous decision in your care. Firstly, we have a chat discussing your main concerns, what you want to achieve, and your goals.
Next is the physical assessment based on your goals and issues. For example, assessing movements that you find difficult or symptomatic and finding ways to make these more manageable for you. We may also look at certain muscle groups or specific joint and nerve tests. Then, we move to the internal vaginal assessment where we assess pelvic floor muscle strength, endurance, coordination, and relaxation, as well as the position of your pelvic organs and scarring if present. This assessment is performed privately and at your pace.
We check how it is by lying first and potentially in standing or during functional movements, such as squatting. After the physical evaluation, you are provided with education and an individualised programme. The session might also include a manual, hands-on treatment of the pelvic floor or other areas of the body and, of course, time to answer any questions you may have. Let’s break the taboo and begin talking about these issues candidly and openly!
Neasa Barry is a pelvic health physiotherapist at Heal Hub Rehabilitation Center in Dubai. Visit @herphysio for more information.