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Women's Health Physiotherapy can help you to overcome some of the things that make life difficult. If you experience any of the following, we can help.

Women's Health and Wellbeing

Urinary Incontinence There are two main types of incontinence. Stress incontinence is related to the leakage of urine when there is an increase in abdominal pressure e.g., when running, lifting, jumping, coughing or laughing. Urge Incontinence occurs when there is an overwhelming urge to go to the toilet, but you are unable to make it there in time. These types of incontinence will often exist together. Overactive bladder presents as a higher than usual frequency of needing to urinate. This will often occur with urgency and low volumes. These symptoms can be caused by hormonal changes or post-infection/surgery. Treatment may include: - Pelvic floor muscle assessment - Bladder habit assessment and retraining - Fluid analysis and education - Diet and lifestyle advice - PTNS - posterior tibial nerve stimulation - Acupuncture - Visceral release/massage

Pelvic Organ Prolapse Vaginal prolapse occurs when pelvic organs (bladder, bowel or uterus) start to descend towards the vaginal opening. This is due to increased stretch of the tissues that support these organs. This can occur as a result of trauma e.g., vaginal delivery, or can occur as a result of repetitive heavy lifting e.g., gym/occupation. Vaginal prolapse can also occur as part of the menopausal changes that women will experience around the age of 45-55. Treatment may include: - Pelvic floor muscle assessment - Assessment and measurement of the prolapse - Ultrasound scanning of lower abdomen/perinium - Pelvic floor strengthening exercises - Fitting of a vaginal support pessary - Exercise prescription - Lifestyle management - Bladder and bowel health, including management of constipation

Pelvic Pain/Sexual Dysfunction Pelvic pain is described as pain felt deep within the pelvic region, often with vaginal or rectal symptoms. Pain will often be present during sexual intercourse which is often deeply distressing and can cause subsequent problems. Pain may also occur with speculum examinations or inserting a tampon. Menstrual type pain that may occur with a menstrual period is also considered pelvic pain. Treatment will often be in conjunction your GP or sexual health nurse. Treatment may include: - Pelvic floor and abdominal assessment - Pelvic floor muscle re-education - Relaxation techniques/ breathwork - Visceral release and mobilisation of pelvic organs - Sexual health advice - Lubrication advice - Medication management - Acupuncture/dry needling - Bladder and bowel health management - Use of vaginal dilators where required

Bowel Health/Constipation Optimal bowel health is required for good pelvic health and often is the causative factor behind several pelvic conditions. There are a range of issues that cause constipation, bowel incontinence or poor bowel health that are not simply dietary. Such issues can stem from pregnancy, the postnatal period and most frequently menopause. Treatment may include: - Pelvic floor assessment - Pelvic floor exercises/strengthening - Continence product advice - PTNS (posterior tibial nerve stimulation) - Visceral mobilisation - Bowel retraining - Diet and lifestyle advice - Referral to a naturopath if required

Breast Cancer Management Physiotherapy is an integral part of breast cancer management, particularly in the post-operative phase. It is required for the restoration of arm and shoulder movement, as well as assisting in the management of cording and scarring. Treatment may include: - Lymphoedema management - Compression prescription - Scar/cording release work - Exercise prescription - Advice for return to exercise

Menopause Menopause can be a challenging time of life for many. It is common to experience symptoms such as vaginal dryness, pelvic pain, joint pain and bladder symptoms. Many of these can be managed with specific physiotherapy treatment. These symptoms are primarily occurring because of the significant hormonal decline, however these symptoms can be effectively managed alongside your GP. Treatment may include: - Pelvic floor assessment and treatment - Bladder and bowel management - Referral for medical management including vaginal oestrogen prescription - Sexual health management - Lubrication advice - Prolapse management - Osteoporosis management and exercise prescription

Gender Affirming Surgery Pelvic health physiotherapy plays an important role in those individuals undergoing gender affirming surgery or making the transition to their desired gender. Physiotherapy may be required for those having genital reconfiguration surgery, hysterectomy, or breast augmentation. Physiotherapy is designed to help manage any issues as a result of surgery and work towards normal function where possible. Treatment may include: - Pelvic floor rehabilitation - Vaginal dilator therapy where appropriate - Pain and scar management - Exercise therapy - Sexual health management

Pregnancy and Post-natal Conditions

Pelvic Girdle Pain Pelvic pain is very common during pregnancy. This can occur due to changes in hormone levels, along with the normal weight gain, in and around the pelvis. This increased weight puts additional stress on either the front of the pelvis near the pubic joint, or at the back of the pelvis at the sacrum. The pain caused by either of these can be disruptive to walking, exercising and sleeping. Pain can occur at any time in the pregnancy and requires optimum management to ensure mobility is maintained. This decreases the impact on labour and the ability to care for your baby after delivery. Treatment may include: - Advice and education - Exercise prescription - Garment/support wear prescription - Manual therapy - Acupuncture/dry needling - Preparation for labour and birth

Back Pain General back pain can occur both with pregnancy and postnatal changes. The growing weight of the pregnant belly puts pressure on the lumbar spine causing joint stiffness and surrounding muscle tension. After delivery, demands on the back change, with large amounts of repetitive bending and lifting of your growing baby. Static postures, such as those while comforting and feeding your baby, will also increase load on the spine and potentially lead to pain. Treatment may include: - Posture advice and management - Advice for feeding, sleeping and exercising - Manual therapy for muscle tightness - Garment/support wear prescription - Exercise prescription - Acupuncture/dry needling

Abdominal Muscle Separation (Diastasis Recti) As the pregnant belly grows the abdominal muscles are designed to stretch and make room for your bump. All pregnant bellies have a "separation" of the rectus muscle after 34 weeks of pregnancy. In some cases, this resolves itself with time in the postnatal period. In many cases however, it will require specific rehabilitation. It is always advised to follow a few basic abdominal exercises to aid recovery of this separation, while also being mindful of how you lift your baby and when you return to exercise. Ultimately, the function of the abdominal wall is the most important thing, and this is something that physiotherapy will help with. Treatment may include: - Assessment and measurement of the separation - Use of ultrasound scanning to assess and educate - Taping to help recovery and healing - Prescription of support wear - Exercise prescription - Pelvic floor assessment and exercises - Posture re-education - Reintroduction to exercise of your choice - Visceral mobilisation to aid organ repositioning post pregnancy

Pregnant Woman in Brown
Mother and Baby

Scar Management Caesarean section scarring needs to be managed post operatively. Abdominal surgery is extensive and involves cutting through and stitching of multiple layers. As a result, there is often an effect on underlying tissues and organs, and particularly the pelvic organs. The scar tissue that forms as the wound heals can be effectively managed with physiotherapy treatment. We also assist with scar management post hysterectomy and laparoscopic surgery. Treatment may include: - Scar release work - Visceral release/mobilisation - Acupuncture/dry needling - Advice on topical agents to use - Teaching of self-management techniques

Mastitis Mastitis occurs when there is a blocked milk duct or inflammation surrounding the milk ducts in the breast tissue. This causes reduced of a reduction in the flow of milk and can be very painful when feeding your baby or expressing milk. You can also see and feel a painful red lump developing in the breast. This can occur at any time in the breastfeeding journey but is more likely to be experienced in the first 6-8 weeks post birth while the supply of milk is being established. Treatment may include: - Ultrasound therapy to help reduce the inflammation and 'unblock' the duct - Massage and drainage techniques - Feeding positions - Hot/cold therapy - Taping techniques - Referral to a lactation consultant if needed

Hand/Wrist Conditions It is very common for hand and wrist injuries to develop in the pregnancy and postnatal periods. These will occur due to the hormonal changes that increase fluid retention, combined with repetitive activities such as lifting and holding a growing baby. The most common conditions seen are carpal tunnel syndrome and De Quervain’s tenosynovitis. Treatment may include: - Splinting for wrist support - Exercises and stretches - Advice on lifting and holding techniques - Acupuncture/dry needling - Soft tissue release

Post-natal Physiotherapy Check up

It is recommended that all women post pregnancy have a 6- week postnatal check with a Women's Health Physiotherapist. In this appointment, the pelvic floor and abdominal muscles will be assessed. In addition to this, we will also look at your general posture and help to address any concerns you may have following child birth. One of the biggest and most important reasons women will seek help with, is returning to exercise. We will provide advice to you on this based on your current situation and tailor an exercise program to suit your individual needs.

FitRight Assessments can also be completed along with referral to any of the FitRight classes.

Pregnancy Loss One of the most difficult aspects of pregnancy is the potential for pregnancy loss to occur. This can happen at any time in the pregnancy and is an extremely distressing and sad time. In some cases, if pregnancy loss has resulted in the delivery and loss of a baby or surgical input in labour, there may be requirement for postnatal physiotherapy. This may be needed to address any pelvic floor concerns, scarring or mastitis. Physiotherapy is always delivered with care, compassion and understanding during this difficult time.

Pilates Clinical Pilates is a useful tool in pelvic health physiotherapy, it is an ideal way to help rehabilitate during and after pregnancy, as well as post-surgery. This can be done in a small group setting or one-on-one to ensure an exercise program is tailored specifically for your needs.

Mother Holding Baby
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