Women’s health

--What is prolapse?

Prolapse is a condition that will affect 1 in 3 women in their lifetime, with a similar statistic for incontinence. Women in the western world are now at a 20 per cent risk of needing surgery for incontinence or prolapse — and 1 in 10 women will have surgery for these problems. Many women are not aware of the role physiotherapy and appropriate exercise programs can have on the ability to improve symptoms of both incontinence and prolapse. Physiotherapy methods will usually include:

• biofeedback (using your mind to become aware of what's going on inside your body to gain more control over your health)
• pelvic floor exercises to improve coordination, strength and endurance
• postural and breathing exercises
• may include the fitting of a silicone pessary to provide support. Your physiotherapist will liaise with your GP or gynaecologist on this, however women’s health physiotherapists are experts in the fitting and management of support pessaries.

--What is incontinence?

Incontinence affects 21% of all Australians above the age of 15 years have urinary incontinence (UI), faecal incontinence (FI) or both.

UI is accidental leaking of urine from the bladder. The most common causes of UI are physical stress, like exercise or coughing—stress urinary incontinence (SUI); an urge to run to the toilet and not making it on time—urinary incontinence (UUI); or because you can’t empty the bladder properly and it becomes too full.

FI is accidental leaking of gas, leaking from the bowels (faeces) or staining in your underwear.

In men, urinary incontinence (UI) can be common after prostate surgery/radiation. In women, UI can be common after childbirth. There is also a high number of younger women who have UI, or FI, who are involved in high-level sports. So, it is not just an age-related problem. And ‘common’ doesn’t mean ‘normal’—you do not have to live with it.

For information, see bowel and bladder health. 

--What is sexual pain?

Sexual pain, or pain in the pelvic region that occurs during vaginal penetration, can occur in women of any age - 10 to 20% of women aged 20-50 years old experience some form of sexual pain. Some women have always had difficulty or discomfort with sexual activity and have never had an enjoyable sexual experience. For other women, sexual pain can start later in life after a period of relatively normal sexual function. This can be the result of childbirth, an injury to the pelvis or at the onset of menopause. Many women suffer sexual pain in silence and don’t seek help for what is often a very treatable condition.

Click here for more information on sexual health.

--What are other common conditions that can occur at different stages in women’s lives?

Menopause is another critical time for women with hormonal change, often uncovering problems with pelvic health that were only just being managed when their hormones were still adequate. During menopause, it’s common for incontinence or pelvic organ prolapse to become a problem for the first time, and is often related to pelvic floor changes that may have occurred when having babies. If you did not have access to a women’s health physiotherapist pre and post pregnancy, then you may not have had postnatal rehabilitation.

Some women modify or give up exercising because of incontinence or pelvic health issues. Exercise is important to avoid weight gain and to improve bone density, as 25 per cent of bone mass is lost in the 2 years either side of menopause. Often physiotherapists can assist women with the most appropriate exercise program to gain fitness and improve pelvic health.

Urinary frequency, urgency or excessive urination during the night (nocturia)

This is going to the toilet a lot (more than 5–7 times/day), feeling like you have a sudden or very strong sensation that you have to empty your bladder immediately, or waking more than once during the night to empty your bladder. Some people may have what is called an ‘overactive bladder’ where the bladder contracts too often, others may not be emptying their bladder fully.

Constipation

Difficulty with emptying your bowels/hard stool form. This may feel like you can’t go at all, you can’t empty it all out or you have to strain a lot to empty.

Pelvic pain

Pelvic pain affects many Australian men and women. This includes issues like pain with emptying bladder or bowels, pain with sex, severe pain with periods, any other pain in the pelvis area, and, sometimes, urinary tract infections.

For more information, see bowel and bladder health and sexual health.

--How do I know if my condition requires physiotherapy or other medical attention?

Physiotherapists with expertise in women’s health can tailor exercise programs for you to improve many things:

• bone health during or after menopause
• pregnancy and post natal exercises to optimise wellbeing
• pelvic floor down training
• relaxation and stretching exercises for muscle overactivity and pain
• and prescribe specific exercise programs if you are undergoing treatment for cancer.

Pelvic floor muscle overactivity and chronic pelvic pain are gaining increasing awareness among doctors and fitness coaches, and the role of women’s health physiotherapists has never been more important.

If you’ve had a history of endometriosis or painful periods, you may have difficulty inserting a tampon or experience pain with intercourse. Some people who have suffered a back injury are told they have weak core muscles and are encouraged to do a lot of ‘stability’ training. However, in some situations it may not be weak muscles causing your pain, but actually overactivity as a method of protection for those muscles. The signs of overactivity are difficulty fully emptying your bladder or bowel, pain with intercourse, and sometimes incontinence. 

Women’s health physiotherapists are highly skilled at taking a very complete history and thorough assessment. This may involve a vaginal examination, with your consent, to manually palpate (examine by touch) the pelvic floor muscles and locate the cause of the pain. Accurate diagnosis can then be made. Usually, your physiotherapist will work closely with your GP and may seek to include a psychologist, gynaecologist or a sexual health physician to best help you. 

--How can physiotherapy help women’s health conditions?

Physiotherapy treatment may include some of the following: pelvic floor muscle down training, relaxation and mindfulness training, stretching exercises, general exercise advice and a pelvic floor exercise program to restore normal coordination, endurance and strength to the muscles.

Pregnancy and the early years of motherhood is a time of enormous physical and emotional change. Women’s health physiotherapists assess, diagnose and treat many conditions that are commonly associated with pregnancy including musculoskeletal conditions such as pelvic girdle, low back or rib pain and carpal tunnel syndrome (de Quervain’s syndrome). They assist with optimal positioning for breast-feeding and baby holding, and can manage mastitis alongside medical doctors.

Incontinence and prolapse can be a problem for women soon after their babies are born, so a return to safe exercise that allows your pelvic floor muscles to return to optimal function is critical. Pelvic Floor First guidelines are a useful resource to help guide safe exercise after birth.

--How effective is physiotherapy for women’s health conditions?

Physiotherapy for management of incontinence and prolapse is now the first line recommendation by the International Consultation on Incontinence. This means it is important to access physiotherapy services before medication or surgery.  

Many patients will be referred from their GP or midwife for physiotherapy. However, it’s important to have a thorough screening from your gynaecologist or GP to exclude any other medical causes of your symptoms.

--What can I do at home to help my condition?

Pelvic floor exercises are an important part of treatment for many pelvic floor conditions such as incontinence and prolapse, but not all women have weakness. Over a third of people can’t contract their pelvic floor muscles correctly. An assessment is the one of the best ways to know if you are doing your exercises properly. If you ever experience any leakage, have feelings of dragging or heaviness down low in your pelvis, can feel a bulge in your vagina when you wipe, or if you are experiencing chronic pain in your pelvis, you should contact your women’s health physiotherapist.

If you do not have access to a women’s health physiotherapist, you can try to stop the flow of urine when you are on the toilet. Close your back passage, vagina and your front passage to stop the flow of urine. Try to achieve a complete stop. This is not a pelvic floor exercise but an awareness exercise to see if you can locate the correct muscles. Do not practice this every time you go to the toilet, just once every day or two. Once you can do it consistently, then you don’t need to keep practicing it. Stopping the flow of urine every time can cause the bladder to not fully empty.

It’s good to try to contract your pelvic floor muscles in different positions such as lying on your side, sitting or standing. It’s important that you can contract the internal pelvic floor muscles without clenching your buttocks, holding your breath or lifting your shoulders. You may feel your lower tummy draw in a little, but there should be no tension through the tummy muscles and you should be able to easily breathe.

Not every woman needs the same pelvic floor-training program. If you are having trouble, your women’s health physiotherapist can ensure you are practicing the exercises in a way that is suitable for you.

--How long until I feel normal again?

Pelvic floor muscle exercises should be a part of every day health, in the same way cleaning your teeth is. Start with shorter holds with the correct technique, and then slowly build up how long you can hold a contraction while maintaining your breathing. A typical goal is three sets of 10 contractions, aiming to build up to a 10 second hold, with 10 seconds rest between contractions. It’s important to feel the relaxation between each contraction.

Not all pelvic floor issues are caused by weakness so if you’re not improving following your own program, you should seek an accurate assessment and diagnosis with a women’s health physiotherapist.

Incontinence and prolapse are conditions that limit quality of life. Physiotherapists are ideally placed to help anyone suffering from these conditions to participate in all the activities they enjoy.  

--Factsheets

Get back to doing things you love, with your physio.

Download the factsheets about sexual health, incontinence or prolapse to see how physiotherapy can help you. 

--Videos

Get back to doing things you love, with your physio.

Watch the videos about incontinence, sexual health or prolapse to see how physiotherapy can help you. 

Incontience

Sexual health

Prolapse

--What next?

GO TO
Find a physio web page to find your nearest women's, men's and pelvic health physiotherapist.

CHOOSE
'Women's, Men's and Pelvic Health' option under special interest area in the 'refine your search' drop-down box.