If you're a Kegel8 follower, you'll know that we are dedicated to bringing you the very latest and best pelvic floor tips, knowledge and advice, so that's why we are bringing a series of top pelvic floor tips via our blog, Facebook and Twitter over the coming weeks. Today's top tip comes from leading Australian physiotherapist Sue Croft.
Sue Croft, Leading Physiotherapist's Tip for Prolapse Prevention
"P stands for Prolapse. Now if all patients with minor vaginal wall laxity were alerted early to their slight prolapse then perhaps the conservative interventions would have a far greater chance of holding things at bay! Avoiding straining at stool by using the correct position and dynamics for defaecation, softening the bowel motion with soluble fibres or other products, always engaging in pelvic floor safe exercising (that is, no sit ups, curl ups, crunches, double leg lifts or full planks), regular pelvic floor muscle training and bracing (tightening your low tummy and pelvic floor muscles prior to increases in intra-abdominal pressure) – these are simple strategies to prevent worsening prolapse.
I stands for Incontinence. By questioning the patient as to whether they leak with cough or sneeze or with the urge to go will identify stress or urge incontinence. Stress incontinence has been shown in studies to be significantly improved and cured in 60-80% of patients. (Neumann P et al 2005 Physiotherapy for female stress urinary incontinence: a multicentre observational study, Australia and New Zealand Journal of Obstetrics and Gynaecology 45:226-232). Urgency and urge incontinence responds well to bladder retraining and modification of caffeine intake. These are simple conservative measures taught by a Continence and Women’s Health physiotherapist in one session.
P stands for PAIN. Chronic pelvic pain is seen in many patients attending a GP’s surgery. With a normal consultation where there is only 15 minutes to see the patient, it must be daunting to even think about delving into the question of “Do you have any pelvic/vaginal/bladder/ bowel pain. If the patient doesn’t come in specifically with that condition, then why the heck would you go fishing for it? Because chronic pelvic pain will get worse as the patient’s nervous system gets well practised at producing pain, (central sensitization) and with some time taken to ExplainPain, the patient can start to gain control over their condition and not feel so helpless. But it takes time and this is where the physios can help. Teaching the concept that the brain decides whether there is going to be pain or not really has changed our direction of treating the end organ and the peripheries to more the central sensitization nature of chronic pain.
E stands for exercise. Now exercise can mean pelvic floor exercises- the bread and butter of a pelvic floor physiotherapist- but as you can see we do far more than teach Kegels these days! But exercise is far more than that. There was an interesting article recently highlighting, that the UK’s Royal College of Physicians has just approved a report” Exercise for life: Physical activity in health and disease”. The report states: “There is evidence for the benefits of exercise in many forms of disease. It is effective, inexpensive, with a low side-effect profile and can have a positive environmental impact. Despite this, there remains a reluctance within the medical profession to use exercise as a treatment.” (Royal College of Physicians Exercise for life: Physical activity in health and disease. London RCP,2012). So, physiotherapists have a critical role in assisting GPs in this invaluable and essential treatment modality, as do exercise physiologists. S stands for sex. I’ve learnt over the years never to assume anything about sex. I have patients in their 30’s who can take it, but mostly leave it, and patients in their 80s who are still having a satisfying sexual relationship. And therefore you should always ask the question and never assume someone is too old to be worried about pain or dryness with intercourse or a lack of libido. There is much to be offered to these patients by a Continence and Women’s Health Physiotherapist, even if it’s just reassurance that having intercourse is still possible and even beneficial if you have prolapse."
Biography: Sue Croft is an Australian Physiotherapist and author of ’Pelvic Floor Recovery - A Physiotherapy Guide for Gynaecological Repair Surgery’ and ‘Pelvic Floor Recovery Essentials’ (both available from our friends at www.stressnomore.co.uk). She is a specialist in pelvic floor conditions, urinary incontinence, bowel conditions, prolapse and pelvic pain and a member of the Australian Physiotherapy Association, the National Continence and Women’s Health Special Interest Group, the International Continence Society and a Committee member of the Queensland Branch of the Continence Foundation of Australia.