Pelvic Floor Physiotherapy at Taylor’s
A huge part of what we offer at Taylor Physiotherapy is Male & Female Health Physiotherapy.
Taylor Physiotherapy is one of the few clinics in central Scotland to offer specialised treatment in all areas on Women and Men’s Health Physiotherapy.
Bill Taylor, Elaine Walpole and Yvonne Brannigan have extensive post graduate experience and training in both Male/Female Health Physiotherapy.
As well as treating patients Bill Taylor lectures both nationally and internationally in treatment of CPPS, Men’s/Women’s Health and Pelvic Gridle Pain. We have patients who travel nationally and internationally to have treatment at Taylor Physiotherapy. In addition Bill teaches on undergraduate and post graduate Physiotherapy and Midwifery University Programmes. He is also on The Mummy MOT teaching faculty where he teaches on the subject of Pelvic Girdle Pain.
So what do our Specialist Women’s Health Physiotherapists treat?
Conditions treated –
Urinary Incontinence (UI)
Urinary Incontinence (UI) or accidental leakage of urine is a common pelvic health issue for women of all ages. Most women believe that it’s normal after childbirth or part of the ageing process.
BUT IT’S NOT NORMAL…………. THERE IS HELP!!!
There are 2 main types or Urinary Incontinence and they can occur together:
STRESS INCONTINENCE is leakage of urine during activities that stress the bladder such as lifting, jumping, sneezing, coughing and laughing
URGE INCONTINENCE is a sudden urge to urinate with an inability to control the bladder, patients often don’t make it to the bathroom in time.
Pelvic Organ Prolapse (POP)
Pelvic organ prolapse is bulging of one or more of the pelvic organs into the Vagina – these conditions are often called Cystocele and Rectocele.
Prolapse is very common affecting 1 in 3 women who have had children.
Symptoms include discomfort or a feeling of heaviness, bladder or bowel problems and sexual activity may also be affected.
At Taylor Physiotherapy we have a Women’s Health Specialist trained to fit vaginal pessaries for pelvic organ prolapse as part of the treatment.
Pelvic Pain often presents as a group of varied symptoms in the pelvic area (vaginal, anorectal, vulva, abdomen and clitoris)
Pelvic pain patients have often seen a number of other medical specialists and despite many examinations and tests feel their problem is not understood or being treated effectively.
Overactive Pelvic Floor
What is an overactive/hypertonic pelvic floor?
A hypertonic pelvic floor occurs when the muscles in the pelvic floor become to tense and are unable to relax. Many people with tense and non-relaxing pelvic floor experience pelvic health concerns such as constipation, painful sex, urgency and pelvic pain. A hypertonic pelvic floor may also be accompanied by tension is surrounding hip and pelvic muscles such as the piriformis, obturator internus, coccygeus and hamstrings.
What causes a hypertonic pelvic floor?
There is no one cause of a hypertonic pelvic floor, however many activities can lead to the muscles tightening up – For example many people who spend a lot of time working out and squeezing their core muscles can develop tension in their pelvic floor because they keep these muscles switched “on” without giving the muscles time to relax and let go. People who have a history of holding on to their bladder and/or bowels can also develop tension in their pelvic floor muscles. Some people feel uncomfortable using public toilets an may hold on for hours until they return home from school, work or social activities. Also high levels of stress, fear and anxiety can cause muscles to tighten up. One way of thinking about this is to consider how a dog behaves when it’s stressed, it tucks its tail between its legs. We have primitive response during stressful times where we respond by fight or flight and we tuck what we have left of our tail – the tailbone – under. As the pelvic floor muscles are attached to the tailbone this causes the muscles to shorten – hypertonic pelvic floor.
Many Pelvic and Abdominal health conditions can also result in hypertonicity of the pelvic floor. Endometriosis can cause tense pelvic floor muscles due to the chronic pain and inflammation. Irritable bowl syndrome which can cause abdominal pain and cramping can result in pelvic floor muscles cramping and pain, other conditions linked to hypertonic pelvic floor include – interstitial cystitis, pudendal neuralgia and vulvodynia.
Birth trauma and scar tissue is another cause of tightness in the pelvic floor muscles. Women who experience Perineal or vaginal tearing may be at a higher risk, as the pain and scarring can cause the pelvic floor muscles to tighten protectively. It is essential to determine the cause of the hypertonicity in each individual.
A Pelvic Health physiotherapist is best equipped to do this.
What are the signs and symptoms of a hypertonic pelvic floor –
There are several typical signs of a hypertonic or non-relaxing pelvic floor muscle –
● incomplete emptying of the bowels
● straining when emptying the bowels
● pelvic pain
● low back pain
● hip pain
● coccyx pain
● painful sex
● urinary incontinence
● incomplete emptying of the bladder
● slow flow of urine
● hesitancy or delayed start of urine stream
● urinary urgency
● urinary frequency
● painful urination (thanks to the continence association of Australia for much of the information above)
Pudendal Neuralgia (In Men and Women)
Pudendal neuralgia in chronic pain related to the pudendal nerve. Your pudendal nerve runs from your lower back, along your pelvic floor muscles, out to your perineum (the skin between your pubic bone and your tailbone). It supplies the skin between the anus and clitoris (or in a man – the penis) as well as the muscles of the urethra and the anus. Generally nerves throughout our bodies are usually supple and mobile. They glide and slide smoothly when we are active – think how far the nerves in your arms stretch when you reach above your head? Nerves are robust and resilient – we can gently squish then for a while before they let us know, like the ‘dead arm’ feeling or pins and needles. They usually recover quickly too. When nerves go through a large trauma (like a big fall onto a hard surface or difficult labour) or lots of repetitive small trauma (like years of straining with constipation or repetitive heavy physical exercise) they become irritated. Your nervous system can then become sensitised so that pain is triggered at a lower level, and the response is greater. It’s as though the volume is turned up for pain.
Pudendal neuralgia can come about when your pudendal nerve is exposed to traumas, the nerve is irritated or compressed by bulky pelvic floor muscles or tight ligaments.
Symptoms of pudendal neuralgia
The main symptom is pain – this can be highly variable.
You might feel burning, electric shock, shooting, aching, itch and a raw feeling in your clitoris, labia, vagina (penis in men), urethra, perineum, anus or rectum. One of the most common symptoms is pain when sitting. You may also experience bladder and bowel irritation. Sometimes you can feel this irritation without feeling much pain. Urgency and frequency of voiding can also be an annoying an annoying symptom. Occasionally there is a full sensation is the vagina or rectum. Sometimes pain can be felt into the buttocks, legs and feet – this is because the skin there is supplied by the same level of your spinal cord and your brain ‘perceives’ the pain in the skin of your buttocks, legs and feet. You may also have associated bladder, bowel or sexual problems.
What causes Pudendal Neuralgia?
There is no one cause of pudendal neuralgia but can be related to: –
● Gynaecological or colo-rectal surgery
● Excessive physical exercise
● Past pelvic or perineal trauma
● Childbirth trauma
● Musculoskeletal issues
Often it is a combination of a few of these factors. Sometimes there is no obvious link to any specific factor, but there are always options for treatment.
We’ll conduct examinations and tests to work out whether you have pudendal neuralgia. None of these tests on it’s own is a diagnosis, but combined they can.
Physical examination – when you first come in you’ll have an initial examination with one of our specialist physios, we’ll look at the neurological and musculoskeletal functions of your legs.
Pudendal neuralgia – like any pain condition its managed through adapting your everyday life. We’ll suggest adjustments to your work and home life. The crucial element in the process is that you are the driver of your management plan. Your physical work, home an social goals are the main focus. We will help you work towards them and with tailored management we will help you regain that as much as possible.
Conservative Management –
Depending on the factors involved in your pudendal neuralgia, your management plan might involve several different specialists, as well as your own self-management. The aim is to reduce the irritability of your pudendal nerve. As with any nerve irritability in the body, the nerve needs time to settle, even after you’ve made changes in you lifestyle. Many people find that understanding what triggers their nerve pain and knowing how to modify their life around it makes it much easier to manage. With the right knowledge and tools, you can reduce your pain significantly and live an full and functional life.
Common lifestyle changes include:
● Sitting modification: Avoid pressure on your perineum (the area inside your ‘sit bones’) helps to prevent the nerve compressing. You can buy special coccyx cut-out memory foam cushions and modify them to remove the section under your perineum, so that when you sit you won’t take any weight there. Decreasing your sitting can also help – try standing at your desk for part of the day using a laptop on a box or a portable desk raiser.
● Bowel and Bladder management strategies: Try not to strain when emptying your bowels or passing urine, as this stretches the nerve. Avoid stimulant laxatives. Physiotherapy can help you develop a plan for good bladder and bowel habits that suit you
● Modify physical activities that irritate the nerve – this might be specific to you
● Some people find bike riding/horse riding exacerbating
● Initially minimise excessive ‘core muscle’ exercises
● Physiotherapy can help you identify movements specific to you that may need to be minimised for a period of time.
● Adapting your sex life – some people find sex can flare their pain. There are many options to keep your sex life going while avoiding pain. Your physio can help with this!
What can Physiotherapy do?
Physiotherapy can teach you how to relax and/or desensitise your pelvic floor muscles, which might be over sensitive and contracted. This may help to increase blood flow to the nerve and in turn decrease any irritation of the nerve. We can also help you to get moving and perform daily activities more easily. You may also need to manage painful tender points (these are commonly know as Tigger Points but there is much controversy about what they actually are) in your pelvic floor muscles. You will benefit from specific external exercises and stretches and you may need to address your movement and posture whilst modifying activities that may flare your pain. Your physiotherapist will also encourage you in general cardio conditioning to help with pain, maintain your fitness and strength and help with both your mental and physical health. We can also help you plan your daily bladder and bowel management routine which can be invaluable in this condition.
Pelvic Girdle Pain and Back Pain in Pregnancy
Pelvic Girdle Pain is common in pregnancy. It occurs more in frequency in the later stage of pregnancy but can present at any time. Pain can be in the back, hips, lower limbs or pubic area. Walking may be painful and sleep disrupted.
The source of pain is usually from joints or muscles. This can be effectively treated by our specialist women’s health team at Taylor Physiotherapy. We use gentle joint techniques, treat muscle spasm and teach exercises to help you through pregnancy. As well as treating patients Bill Taylor teaches courses on Pelvic Girdle Pain to Women’s Health physios and The Mummy MOT programme in London.
The links will take you to a full section on our Mummy MOT screening https://taylorphysiotherapy.com/womens-health/mummy-mot/
Post Natal Return to Sport
Following pregnancy and birth returning to exercise can be less straightforward than expected. Some new mother’s experience diastasis recti (increased tummy gap), low back pain or urinary leakage.
Some women post natal experience problems from birth trauma, such as pelvic organ prolapse and pelvic pain.
Our specialist team are experienced to treat post natal symptoms and guide patients back to safe and appropriate exercise post natally.
Real Time Ultrasound
At Taylor Physiotherapy we have trained physiotherapists using real time ultrasound as part of treatment. This allows is to view how abdominal and pelvic floor muscles affect your bladder function
This is a useful biofeedback treatment which patients find very beneficial.
Vaginal Pessary Fitting
Vaginal pessaries can be very useful in treatment of women’s health conditions. Elaine Walpole our specialist has completed training to fit pessaries. This is considered after a full women’s health assessment.