Women’s health Physiotherapy

What is women’s health rehabilitation?
This is the area of specialization in physiotherapy that deals with the unique problems experienced by women, including incontinence treatment and pelvic floor strengthening. It also treats conditions and problems experienced pre and post birth such as back pain, swollen legs, mastitis and safe exercise.

  • Incontinence
  • Pelvic Floor
  • Pre and Post Natal Related Conditions
  • Lymph Edema (Swelling)

Incontinence
Incontinence occurs when the muscles controlling the bladder or bowel function (the pelvic floor muscles) stop working properly, losing strength or endurance, which results in uncontrolled “leaks.” The cause of muscle weakness can vary, but is usually due to multiple pregnancies, organ prolapse or nerve dysfunction and ageing. There are three major types of incontinence:

  • Stress incontinence – Occurs when the pressure in the abdomen increases (for example during coughing, laughing, sneezing, exercising or heavy lifting) and the pelvic floor muscles are not strong enough to prevent leaking.
  • Urge incontinence – Occurs when patients cannot exert urinary control once they feel the urge to urinate, even if their bladder is not full. The ability to hold the muscle contraction is lost and results in leaking.
  • Mixed type incontinence – Occurs in women who might suffer from both, stress and urge incontinence, at the same time.

Treatment is suited depending on the type and cause of incontinence but will almost always involve Pelvic Floor Rehabilitation which is explained below.

Pelvic floor
The pelvic floor is a hammock of muscles that supports all the lower organs including the bladder, uterus, and rectum. It attaches to the pubic bone in the front, the tail bone at the back and from the base of the pelvis. The muscles give you control over your bladder and are involved in urinating. They prevent leaking of urine and incontinence, especially when coughing, sneezing, lifting something heavy or exercising, uncontrolled wind and stool. The muscle tone of the pelvic floor also helps vaginal tightness and prevents possible prolapse which happens when organs it supports such as the uterus fall down or slip out of place. The pelvic floor also contributes to the stability of connecting joints around it including the hip, sacroiliac joint and lumbar spine. Therefore, weakness in these muscles can cause hip or lower back pain. Unfortunately, there is a general lack of awareness about these facts.

WHAT IS PELVIC FLOOR REHABILITATION?
The Pelvic Floor (PF), like any other muscle group, can loose strength, go into spasm or stress and dysfunction. This is especially common following pregnancy and delivery, episiotomy, and any strain or sprain in the area, all of which can result in pain and different types of incontinence. PF rehabilitation, carried out under the guidance of a qualified physiotherapist, can help the PF regain its strength. Rehabilitation involves:
Education: teaching the patient to locate and correctly contract the pelvic floor, understand the role of the pelvic floor in the movements of everyday life, giving instruction of bladder/bowel health, teaching bladder re-training exercises and habits.

Exercise and manual therapy: stretching, soft tissue massage and joint mobilization, developing the qualities of the pelvic floor including flexibility, muscle tone, and endurance, relaxation exercises
Pelvic Floor Electrical Stimulation is a non-invasive treatment which activates natural nerve and muscle mechanisms to strengthen and tone the sphincter and pelvic floor muscles in case of weakness as well as calming involuntary bladder muscle contractions on other cases as urge incontinence
Biofeedback: is a non-painful treatment to help patients to learn to strengthen and relax their pelvic floor muscles by using special electrical sensors on the skin inside the vagina to measure the electrical activity of the muscles at rest and when they contract. The reading is shown on a screen so the patients become more aware of their rehabilitation progress.

Who can benefit from pelvic floor rehabilitation?
PF rehabilitation is proposed according to the pathology of the person and is generally offered to women during the period that follows childbirth (postpartum), but is also prescribed in the following cases:

  • Women in the pre and post-natal periods
  • Women suffering from stress urge or mixed incontinence, Overactive/Under active Bladder.
  • Women in Preoperative or postoperative treatment of pelvic organ prolapse.
  • Women In post-surgical cases such as hysterectomy, C-section, bladder suspension.
  • Women suffering from pelvic or genital pain as: Painful Episiotomy, Urethral or Anorectal Pain, Vulvar Pain Syndrome.
  • Women experiencing musculoskeletal dysfunction as: Sacroiliac and Lumbo-sacral Pain, Coccygodynia (tailbone) Pain, Hip or Low Back Pain, Diastasis.

How long does it take to recover function of the PF?
The tone of the pelvic floor is only achieved over time. The number of required sessions to recover elasticity and increase muscle tone varies from 10 to 20 depending on the patient’s condition. Your therapist will discuss this with your after your initial assessment and regularly review and adapt the program based on your needs.
For PF to be effective and produce desired results, it is important that sessions are attended regularly. Your therapist will give you a home exercise program. Following this program can speed up the recovery process and is imperative to sustain your results.

About the sessions:
The sessions are prescribed 2 to 3 times per week. During your first session, your therapist will talk to you, ask questions related to your condition and examine you. This meeting will provide an opportunity to explain the causes of your symptoms and discuss the treatment plan including duration, frequency, and expected outcomes. The following sessions will involve a combination of education, electrical stimulation, manual and exercise therapy for muscle training.

Successful rehabilitation requires the presence of a skilled therapist at your side to guide you through the sessions by giving constant feedback and helping you achieve the correct muscle contractions. However, your engagement in the rehabilitation program remains one of the most important success factors to recovery.
Pre and Post Natal Related Conditions
During pregnancy, as well as the period that follows it, a woman’s body will go through a lot of changes. Our physiotherapists help to prevent and alleviate physical and emotional stresses by assessing and identifying any musculoskeletal or neuromuscular problems ,which can include :

  • Ante-natal
  • Low and mid back pain
  • Sacro-Iliac Joint pain
  • Sciatica
  • Piriformis muscle spasm
  • Difficulty/pain with movement
  • Bladder control problems or constipation
  • Carpal tunnel symptoms
  • Swelling of ankles, hands & face

Post-natal

  • Pelvic Floor Trauma post Vaginal Delivery (see below )
  • Pelvic Girdle Pain
  • Painful episiotomy or c-section scar
  • Diastasi
  • Painful sexual intercourse
  • Low Back Pain
  • Rib Pain / Thoracic Spine Pain
  • Neck and upper shoulder pain and stiffness
  • Carpal Tunnel Syndrome
  • Tendinitis

Our sessions include a combination of the following and more:

  • Advising on back care and lifting
  • Leg exercises to prevent varicose veins.
  • Pelvic tilting and postural correction.
  • Pelvic floor rehabilitation.
  • Abdominal reeducation.
  • Relaxation techniques.
  • Breathing exercises.
  • Manual lymphatic drainage.

Exercise is very important during this time and there are many exercises that can be done safely, even late into pregnancy. This helps keep the mother and child healthy, maintains a healthy pregnancy weight and decreases problems such as low back pain.

Lymph Edema
Edema is a collection of excess fluid occurring in tissue and usually affects the legs and arms. The buildup of fluid can be due to a number of causes, but is most commonly associated with:

  • Pregnancy
  • Problems with Lymph Nodes, especially after mastectomy
  • Excessive standing or walking
  • Post surgical including post liposuction
  • Sunburn
  • Heat Failure
  • Kidney disease
  • Liver Problems from Cirrhosis
  • Some Medicines
  • Eating too much salt

The aim of treatment is to return this excess fluid back into the circulation system and thereby decreasing the swelling in the area. This is done by gentle massage techniques, referred to as Manual Lymphatic Drainage, that bring about changes in pressure and can be assisted by electrotherapy treatment and specialized bandaging. The treatment should be comfortable and relaxing and depending on the severity of the swelling will require 6-12 sessions.
The benefits of MLD include:

  • Body detoxification
  • Decreases fluid retention
  • Provides relief from heavy legs sensation
  • Decrease symptoms of subacute and chronic inflammation
  • _ Support the body s immune system.

MLD is a safe and gentle technic of cleansing the body’s tissues, which promotes health and speeds up recovery from certain illness, as well as blocking pain receptors and giving real relaxation.

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