Mid North Coast Women’s Health, Pregnancy & Postnatal Physiotherapy



What is a Women’s Health Physiotherapist?

Our Women’s Health Physiotherapist Bec, has a specific interest in the management and treatment of Women’s health conditions. Our Women’s Health Physiotherapist has undertaken extensive specialised training through the Women’s Health Training Association, tailored specifically to help all sorts of conditions experienced by women of all ages.

Why do we need Women’s Health Physiotherapists?

Well, mainly because Women’s health issues are extremely common issues. In addition to that:

What to Expect from an Initial Women’s Health Physiotherapy Appointment

1. Your Story & History

We start by listening to your story to make sure you are heard. Depending on your problem we get detailed history on things such as your pelvic floor symptoms, toileting habits, and previous pregnancies. We also want to find out what your goals are and what you would like to get back to doing.

2. Assessment

We will be performing a thorough assessment of your pelvic floor, breathing, bladder and musculoskeletal system. We will also do an internal exam and a real time ultrasound (click below for more info.)

An internal vaginal exam (at the consent of the person) provides us with extensive information on:

  • Pelvic floor strength and tone
  • If you are performing pelvic floor contractions correctly
  • What level we need to set your pelvic floor rehab program at
  • If prolapse is present, what type of prolapse and what grade of prolapse
  • If there is any pelvic pain and potential sources of the pain

This is exam allows us to get started on the most accurate and beneficial treatment for your condition

We use transabdominal real time ultrasound (ultrasound probe on the abdomen) to look at your pelvic floor function.

We localise your bladder on the ultrasound screen and get you to perform a pelvic floor contraction. What we are looking for is correct movement of the bladder to indicate that pelvic floor contractions are being performed correctly.

The ultrasound machine provides great feedback for you and allows you to see when you are performing the contraction correctly

3. Education and Empowerment

We will give you a likely diagnosis and explain to you exactly what is going on. It is so important that you understand what the problem is and how we are going to work together to resolve the issue.

We show you diagrams to help you understand the anatomy (where the issue is) and how it is happening and we will put a plan in place so you are clear on where you are and where you are heading.

4. Treatment

Depending on your diagnosis and assessment findings your treatment may include:

  • A very specific approach to building up your pelvic floor
  • Developing your exercise program
  • Any manual therapy and hands on treatment (if needed) to release
    muscles and manage pain
  • Lifestyle modifications to help improve your condition
  • Prescription of equipment if needed

All of these treatments are aimed at helping you achieve your end goal!

5. Follow Up

Pelvic floor conditions are complex and if we can work together to ensure the correct treatment is being done you are more likely to achieve your goals. Before leaving your appointment we will set a treatment plan – this will highlight when we need to see you next to continue treatment and what needs to be done in the meantime to achieve your goals.

Extended information on Women’s Health conditions we treat at Phyx You Physiotherapy:

Urinary incontinence includes:

  • Stress Urinary Incontinence (SUI) – occurs when activities that increase intra abdominal pressure (such as coughing, sneezing, laughing, jumping, running) cause urinary leakage
  • Urge Urinary Incontinence (UUI) – occurs when one has an extremely strong urge to pass urine and it is associated with leakage. It can also be associated with needing to pass urine very frequently
  • Mixed Urinary Incontinence – occurs when someone has a mixture of the above 2 conditions
  • A condition in which the bladder muscle (the detrusor) contracts/spasms causing an extreme urge to urinate (even when bladder volume is low). It can lead to leakage and urinary incontinence.
  • It is important that your Women’s Health Physio determine if you have Over Active Bladder as the treatment will differ from Urge Urinary Incontinence

Pelvic organ prolapse occurs when any of the pelvic organs (bladder, uterus, rectum) creating a bulge into the vagina
Symptoms include:

  • A bulging feeling into the vagina
  • A dragging sensation in the lower abdomen
  • Back pain
  • Trouble emptying your bladder
  • Sensation of bowel motions becoming stuck
  • Dribbling after urinating
  • Needing to go back to pass urine quite quickly after you recently passed urine
  • Pain or discomfort with intercourse

Musculoskeletal pain is common during pregnancy, however proper treatment can help reduce and manage your pain. Conditions include:

  • Low back pain
  • Pelvic pain
  • Hip pain
  • Wrist and hand pain (commonly related to lifting the baby and breastfeeding position)
  • Leg pain
  • Diastasis Recti is the separation of the two rectus abdominis muscles along the linea alba (the “six pack” muscles)
  • Commonly occurs during and after pregnancy as your muscles stretch to accomodate for the baby
  • We can measure the size of your Diastasis Recti and get you started on treatment
  • Proper treatment and correct exercises can help significantly reduce your Diastis Recti
  • A proper assessment and information session with our Women’s health Physiotherapist can help guide you on what you should and shouldn’t be doing in terms of exercise during your pregnancy
  • We can help guide you on this, especially if you have any complications or conditions that require specialist knowledge. For example exercising with Gestational Diabetes.

We recommend an assessment and education session prior to giving birth. This is to get your started on your pelvic floor program and provide education on how to manage in your first few weeks after giving birth. We provide education on:

  • Caesarian sections: what you can/can’t lift, how to reduce strain on your scar, pain management, when you can return to certain activities
  • Peroneal trauma and tear: how to manage your pain, healing process, what to avoid
  • Pelvic floor rehab: when to start your pelvic floor exercises after birth

Postnatal assessment

We recommend a Women’s Health assessment when you are 4-6 weeks post birth
This assessment includes:

  • Assessing your pelvic floor strength
  • Assessing and grading any prolapse
  • Treatment of any incontinence that may have developed since birth
  • Assessment and treatment of Diastasis Recti (abdominal separation)
  • Assessment of when it is appropriate to return to your choice of exercise
  • Clinical Exercise Assessment for our Clinical Exercises classes which are run by a Physiotherapist and incorporate Reformer Pilates for postnatal rehabilitation
  • Pelvic pain
  • Vaginismus (A condition involving muscle spasms of the pelvic floor muscles. It can make it painful, difficult, or impossible to have sexual intercourse, to undergo a gynecological exam, and to insert a tampon)
  • Dyspareunia (Pain before, during or after vaginal intercourse)
  • Women’s health Physiotherapy can also assist in treating bowel issues (not just urinary issues)
  • The pelvic floor muscles play a role in controlling not only your bladder but also your bowel
  • Bowel incontinence affects 4% of women who have given birth
  • Bowel incontinence can occur when the pelvic floor muscles are not strong enough to maintain closure of the anal sphincter
  • Pelvic floor assessment and rehab may be a necessity for treating your bowel incontinence and constipation

Breastfeeding comes with many benefits to both mum and bub. In fact exclusive breastfeeding is encouraged for at least the first 6 months of the infant’s life. It is estimated that 12-44% of infants experience suboptimal breastfeeding. This can be contributed to by things such as mastitis and blocked ducts. It is estimated that 2/3rds of breastfeeding women experience blocked ducts.

How can Physiotherapy and Ultrasound help with mastitis and blocked ducts?
Therapeutic ultrasound can help address the symptoms of, and treat mastitis and blocked ducts. While the exact mechanism are unknown it is proposed that the therapeutic ultrasound:

  • May reduce swelling by improving blood flow and lymphatic drainage
  • May reduce pain by having an effect on the sensory nerves in the area
  • May change permeability of breast tissues
  • Ultrasound can increase the effectiveness of antibiotic treatment by increasing cell wall permeability

What does Therapeutic ultrasound and Physiotherapy treatment for mastitis and blocked ducts involve?

  • Assessment to determine affected areas + areas requiring treatment
  • Obtaining a detailed history on breastfeeding and factors that may have contributed to the blocked duct or mastitis
  • Ultrasound applied to the affected breast tissues by our Women’s Health Physio (Usually requiring 2-3 sessions every 1-2 days). The ultrasound probe is moved around the affected breast tissues, it is not painful, some gentle warmth may be felt.
  • Breastfeeding advice and treatment plan regarding positioning, what to do before breastfeeding and how to maximise milk flow and reduce duct compression
  • Demonstrations on how to properly self-massage to promote lymphatic drainage rather than compressing the ducts

What is a pessary?

A pessary is a soft silicon device that is inserted into the vagina to provide support for the pelvic organs and the vaginal walls. Pessaries can be a life changing device for many women, and can be a great conservative option prior to considering surgery.

How does a pessary help?

During pelvic organ prolapse the ligaments and fascia can become damaged or stretch allowing the pelvic organs to descend. Often pelvic floor muscle training alone is not enough to help support the prolapse. A pessary inserted into the vagina assists the connective tissue (ligaments and fascia) and helps support the pelvic organs.

The use of pessaries can:

  • Reduce or stop urinary incontinence and leakage
  • Reduce pelvic organ prolapse (it is proposed that use of a pessary can give time for the connective tissue to heal)
  • Prevent pelvic organ prolapse
  • Reduce or eliminate the symptoms of prolapse (including a vaginal bulge, pelvic pain, urinary incontinence, back pain)
  • Allow women to return to hobbies and exercise they love
  • Delay or prevent surgery for prolapse and incontinence

How do I know which pessary is right for me?

Your Physiotherapist trained in pelvic organ prolapse and pessary fitting will do an assessment to determine the best type and size of pessary for you. Factors that will impact on if you are a candidate for a pessary and what type include:

  • Type and severity of prolapse
  • Skin quality
  • Your ability to manage your pessary

Pessaries come in many shapes and sizes to meet the needs of each individual woman. Some pessaries can stay in for longer periods of time, while others can be easily removed and reinserted on a daily basis. This means women can wear the pessary as recommended by their Physiotherapist but can remove the pessary for intercourse.

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