Pelvic Health Physiotherapy

Urinary frequency: going too little or too frequently to the toilet can be bothersome and problematic.  Clinically reasoning through history taking and bladder diary analysis can help to identify contributing factors and treatment options.

Voiding symptoms include hesitancy, slow stream, straining to pass urine, pain to pass urine, sense of incomplete emptying, dribbling urine after already dressed and double voiding.  Presence of these symptoms can often indicate that something else is going on, such as prolapse or overactive pelvic floor muscles.

Storage symptoms include absent, reduced, increased or urgent bladder sensation of filling.  An ultrasound and bladder diary is often required to determine appropriate conservative treatment options, or whether referral on to a Urologist and/or Gynaecologist is indicated.

UUI: Urge urinary incontinence (UUI) is urinary incontinence preceded by a sudden and strong need to urinate (definition provided by Australian Commission on Safety & Quality in Health Care).  There are often clues in a good history taking, as well as a completed bladder diary that helps us decide contributing factors and tailor treatment choices

SUI: Stress Urinary Incontinence (SUI) is the leaking of urine during activities that increase pressure inside the abdomen and push down on the bladder, such as coughing, sneezing, running, or heavy lifting (definition provided by Australian Commission on Safety & Quality in Health Care).  There can be many contributing factors to this condition, such as weak pelvic floor muscles and tissue changes during menopause.  Pelvic health Physiotherapists aim to identify all the contributing factors to facilitate targeted treatments.

Bedwetting (Nocturnal enuresis): a common childhood condition, management options from 7years old

Coital incontinence; can be due to an overactive bladder or stress urinary incontinence.  Adequate assessment and treatment can resolve this issue

The pelvic organs include your bladder, womb (if assigned female at birth) and rectum. Pelvic organ prolapse occurs when one or more of these organs bulges against, or sags down into the vagina and the muscles and ligaments in the pelvic floor become stretched, or too weak to hold the organs in the correct place (definition provided by Australian Commission on Safety & Quality in Health Care).

Symptoms you might experience:

• Pressure or bulging in your vagina, often made worse with physical activities
• Painful intercourse, or less sensation with intercourse
• Less control with your bladder or bowels
• Urinary problems such as retention (unable to urinate when your bladder is full), incontinence, and urinary tract infection

Pelvic health physios can determine the contributing factors and provide treatment options relevant to your type/s of prolapse.  These may include pelvic floor muscle training and a pessary.

Persistent pelvic pain is complex and often multi-factorial in nature.  Endometriosis is a common condition where persistent pelvic pain is often prevalent.  However, not all people with persistent pelvic pain have Endometriosis.  Bladder Pain Syndrome / Interstitial Cystitis and Coccyx Pain Syndrome are other conditions that are included under the umbrella term of Persistent Pelvic Pain.  Some persistent pelvic pain conditions have no known cause.  Physiotherapists are often part of an inter-disciplinary team assisting people with persistent pelvic pain to reduce symptoms and improve function.  This may include pelvic floor muscle down-training, breathing and relaxation exercises or vaginal dilators/trainers.

Pain with intercourse is not normal.  Determining the driving factors is important to resolve symptoms.  Pelvic health physios are uniquely qualified to assess and treat this cohort of people.  We can also link in with appropriate Psychologists and/or Counsellors when needed.

Prostatectomy: prepping the pelvic floor muscles correctly before surgery can drastically reduce time to regaining continence after prostate surgery

Bowel surgeries: rehabilitation to promote long term healthy bowel habits and control

Urogynaecological surgeries: pre-surgical advice and education to optimise your recovery; rehabilitation to optimise surgical results and promote long term healthy bladder habits and control.

Breast cancer surgery: regaining normal shoulder and upper limb function, safe exercise guidance and prescription, screening for lymphoedema and cording.

Physiotherapy education throughout the pregnancy regarding posture, normal bodily changes, and the role of the abdominal and pelvic floor muscles including appropriate exercise prescription.  We also help the mother prepare for birth and can treat common pregnancy-related low back pain and pelvic girdle pain.  We recommend routine follow-up after delivery (regardless of mode of delivery) to ensure optimal return to function, exercise and sport.  The use of real-time ultrasound can help measure any abdominal muscle separation (rectus abdominis diastasis), track its improvement and allow feedback from the core muscles to ensure they are working effectively.