What is women’s health rehabilitation?
This is the area of specialization in physiotherapy that deals with the unique problems experienced by women. This includes incontinence treatment and pelvic floor strengthening. It also treats conditions and problems experienced during pregnancy and post birth such as back pain, swollen legs, mastitis and safe exercise.
Incontinence occurs when the muscles controlling bladder or bowel function stop working properly. This results in “leaks” as the patient does not have the muscle strength or endurance to control these body functions. The cause of incontinence can vary, but is usually due to aging, multiple pregnancies, organ prolapse or nerve dysfunction. The treatment received will depend on the type and cause of the incontinence.
– occurs when the pressure in the abdomen increases and the pelvic floor muscles are not strong enough to prevent leaking when coughing, laughing, sneezing, exercising or heavy lifting.
– occurs when a patient cannot keep urinary control when they feel the urge to urinate. The ability to hold the muscle contraction is lost and results in leaking.
Mixed type incontinence
– This is when both of the above mentioned problems occur together in the same patient
THE 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. These 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, as well as uncontrolled wind and stool. The muscle tone of the pelvic floor also helps vaginal tightness and prevents possible prolapse which happens when the 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 the 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:
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.
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 musculo-skeletal dysfunction as: Sacroiliac and Lumbo-sacral Pain, Coccygodynia (tailbone) Pain,Hip or Low Back Pain, Diastasis Rect
How long does it take to recover function of the PF?
The tone of the pelvic floor is achieved over time. Generally, between 10 and 20 sessions with your physiotherapist are needed to find a sufficient elasticity and tone of your pelvic floor. However, it is imperative to follow the self-rehabilitation exercises which will be explained and shown you by your therapist
About the sessions:
The sessions are prescribed 2 to 3 times per week. During your first session, your therapist will talk to you, ask you 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.
PREGNANCY AND POST PREGNANCY RELATED CONDITIONS
During pregnancy, and the period that follows it, a lot of changes will occur in a woman’s body, some of which can be painful or uncomfortable. The hormone levels fluctuate, the weight of the baby places stress on the spine and lower limbs and fluid retention is also common. This can result in swollen legs, low back pain, pelvic pain and carpal tunnel syndrome.
Looking after yourself during these times is very important and a good exercise program and balanced diet are always recommended. Physiotherapy is useful to treat and manage pregnancy induced pains. Your physiotherapist can also prescribe exercises that can be done safely, even late into pregnancy. This helps keep mother and child healthy, maintain a healthy weight and decrease problems such as low back pain.
Pre and Post Natal Yoga and Pilates classes are a very good and safe form of exercise during and after pregnancy when conducted under the supervision of reliable and expert instructors.