Women's Health - Your Questions Answered

19th November 2018

What is a WH specialist and how are they different from a ‘normal’ physiotherapist?

A women’s health specialist is a chartered therapist that has specialised training in pelvic health. A ‘normal’ physio will treat movement issues related to all your joints and muscles, a women’s health specialist assesses and treats problems related to your pelvis (pubic symphysis or sacro-iliac joints), abdominal wall, vulva, vagina, uterus, bladder and bowel as well. This might be particularly important when you are pregnant or have had a baby or presenting with symptoms related to the menopause. All women, also women that haven’t had babies may experience problems with bowel or bladder control, prolapse, painful sex, recurrent pelvic pain or bladder infections, or separation of the abdominal wall.

We are lucky that our team of women’s health physios is also supported by an osteopath fully trained in women’s health. Pelvic health symptoms can be more complex than general conditions physios deal with due to the close relationship of the bladder, bowel and sexual organs. We also work closely with other disciplines including gynaecologists.

What Can I expect at my first appointment?

We will first ask you what your expectations are and ask you questions about your general & gynecological health, bowel, bladder & sexual history or symptoms. We will talk about current activity levels and work on an exercise plan that works for you. We have close relationships with excellent fitness professionals, which we can introduce you to. During the first assessment we perform a full pelvic and movement assessment, including the abdominal wall, core and internal assessment.

Do I have to have an internal examination?

Most women’s health assessments involve an internal examination however, we will make sure that you are fully comfortable with this before we do. We use medical gloves and lubrication to assess your pelvic floor muscle function as well as the position of your bladder, rectum and uterus at rest and during movement. We understand that these issues are often difficult to discuss and have assessed. We provide a non-judgemental and safe environment. There is no such thing as a ‘normal’ vagnina, you can talk to us about anything that concerns you, it is all totally fine.

Which parts will you examine?

The external pelvis & vulva, internal vaginal walls and abdominal wall and anything else that is relevant to any issues you may have. If you present with bowel issues, occasionally a rectal exam maybe helpful, again we will discuss this with your first, the most important thing is that you are comfortable.

Will it hurt?

A women’s health specialist internal assessment does not usually hurt (but please let us know if you have a history of pain with sex or with previous internal examinations), we will work together with you to make sure it is as comfortable as possible.

I think I’m going to be really uncomfortable with this but I know there’s an issue I need help with – what else can you do?

We will talk to you and listen to your concerns, and make sure we only assess if you are fully comfortable.

Do I need to look?

You don’t need to look. We do generally encourage women to look with a mirror and become familiar with their anatomy. This will help you to check yourself for any changes, similar to a breast self-examination.

What type of things do you treat?

Bladder leakage, bladder urgency, pelvic floor muscle weakness or over activity, pelvic pain, tummy separation (diastatis), painful sex, constipation, bowel urgency, bowel incontinence and prolapses.  Preparation and rehab following gynaecological or abdominal surgery. Preperation and child birth recovery. Post natal & Menopause MOT.

What will you teach me?

Depending on what we find during the assessment, we might work on the breath, teach you how to do a pelvic floor muscle activation, we will make sure you can go home confident you are doing the right thing. We may give you pelvic floor muscle strengthening or release work, teach you strategies on how to best activate your core, bladder retraining; a whole range of things depending on your expectations and our findings.

How many sessions will I need?

It all depends on what we find, we will discuss and agree on a plan with you, sometimes one session is enough, possibly 4-6 sessions are needed, few people need to come for a longer period of time. We always work towards helping you to be as comfortable with self-managing your condition as possible. Sometimes this does need some ongoing support.

What type of things will you get me to do at home?

Almost certainly pelvic floor muscle exercises and or release connected to your breath. Depending on our findings, it might range from bladder retraining, abdominal work to knowing how to do a perfect poo!

How much does treatment cost?

The first 1-hour assessment is £95, a follow up is £65

What happens if I’m on my period?

We are generally fine to assess you, as long as you are comfortable. If we are also carrying out an external vaginal ultrasound scan, it is more comfortable for you to re-arrange.

Should I go to the loo before I see you?

The most important thing is that you are comfortable, if you need to go, go, if you don’t need to, it is fine.

Why are you so passionate about this part of a women’s body?

Having control over our bowel and bladder function and having pleasurable, pain free sex significantly impacts our overall quality of life. Around 50% of women do have symptoms, only few seek help. This breaks our heart as so often these symptoms can be helped. Talk to your fit-pro, health care professionals and friends, if we all support each other in asking for help, women’s health will get on the map! We are not men with boobs & tubes, we have different physiologies and health needs, which too often aren’t met!

Are you going to tell me to stop doing what I love (dancing, running)?

We nearly always help women back to the activity they love doing, be it cross fit, walking the dog or running. Our role as physiotherapists is to keep women as active as possible.

How bad do my symptoms need to be to make a session worthwhile?

We believe all women would benefit from a post natal MOT following childbirth, independent of the type of delivery (6 weeks onwards, earlier if you have a specific concern, years later if you didn’t have one after your delivery, It is still very worthwhile). We also encourage women to have a menopause MOT, preferably ‘bank it early’ during your perimenopause or any time post menopausal. Hormonal changes have a significant impact on the vaginal tissues and pelvic floor muscles. It will also be an opportunity to provide you with frank and honest advice on how best to manage the many changes your mind & body go through during the menopause

Can you tell me what you wish all women would know about your job?

Women are so good at putting up with things, we would like all women to ask for help & support, women’s health specialists are in a great position to meet specific women’s health needs. We work closely with medics and other health care professionals, and we will make sure you end up with the best team for you. Prevention is key to a lot of women’s health issues.

Does women’s health physio work?

The National Institute of Clinical Excellence (NICE) recommends women’s health physio as a first line of treatment for bladder, bowel and prolapse symptoms. There is a rigorous body of evidence that women’s health physio works.

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