Written By: Wendy Shum
Women's health physiotherapy is a specialized area in physiotherapy that helps deal with various health issues that only happen to women. Different from those of men, women go through a lot of physiological changes at different stages of their lives, especially during the time of pregnancy, post-partum and menopause. Studies have shown that 1 in 3 women will experience some women’s health problem during their lifetime. This blog highlights some common women’s health conditions, various aspects of women's health physiotherapy, and the role of Women’s Health Physiotherapists in managing and treating these issues for a healthy quality life.
During pregnancy, women go through a lot of physiological changes within their bodies that could potentially lead to muscle and joint pain as well as some women’s health issues. A Women’s Health Physiotherapist can play an important role to help resolving these problems at this stage.
Pelvic girdle pain (PGP) is a common condition that happens during pregnancy. It could be caused by hormonal changes, postural changes as well as the growing fetus. PGP includes sacroiliac joint pain, pubic pain, groin pain and very often it also causes hip pain and lower back pain. Physiotherapy is strongly recommended as it is a conservative treatment which is generally safe to both mother and baby. Physiotherapy management usually includes manual therapy to help maintain optimal alignment as well as to release some soft tissue tightness. Exercises are very often prescribed to improve muscle flexibility, maximize muscle strength and core stability. Postural advice and lifestyle modification are also important to reduce the risk of developing musculoskeletal problems later in the pregnancy.
Urinary incontinence is not uncommon especially at later stage of pregnancy. There are two types of incontinence – stress urinary incontinence and urge urinary incontinence. Stress Urinary Incontinence (SUI) refers to leakage of urine from the bladder occurring with physical activity or exertion. It may happen with coughing, sneezing, laughing, heavy lifting, jumping or exercising. Urge Urinary Incontinence (UUI) refers to a sudden strong urge to urinate associated with small or large amount of urine loss and increased frequency of urination. Physiotherapy management usually includes pelvic floor muscle training, core stability training and lifestyle modification during the time of pregnancy.
Pelvic organ prolapse occurs when one or more of the organs in the pelvis slip down from their normal position and bulge into the vaginal canal. These organs include the uterus, bladder and rectum. This can happen when the muscles and ligaments supporting the organs are weakened or overstretched. Although it is more common after childbirth, it can also occur prior childbirth especially to those who had multiple pregnancies or history of difficult or instrumental delivery. Physiotherapy management usually includes pelvic floor muscle training, core stability training and lifestyle modification during the time of pregnancy.
Birth Preparation is important especially to those who are planning to have natural delivery. Women’s Health Physiotherapist uses manual therapy to help optimize pelvic alignment which could potentially enable a smoother delivery. Perineal massage, which is a technique that involves releasing and stretching the pelvic floor muscles, can be carried out by a well-trained Women’s Health Physiotherapist beyond week 37 of the pregnancy to help reduce the risk of tearing and the need of episiotomy (surgical incision at the pelvic floor muscle) during childbirth.
The post-partum stage follows pregnancy to delivery. A woman’s body goes through a series of physiological changes as well as postural changes. Various musculoskeletal and women’s health issues could happen any time after childbirth. Women’s Health Physiotherapist is particularly important at this stage to ensure a full postpartum physical and mental recovery.
Musculoskeletal Pain is very common after childbirth. That includes back and neck pain, pelvic girdle pain or even peripheral joint pain. It could be due to various reasons such as poor posture, muscle weakness and core instability. Manual therapy is usually carried out by Women’s Health Physiotherapist to restore your body alignment and muscle balance. A tailor-made exercise programme, which usually includes stretches, weight training and Pilates, is then followed to help regain muscle flexibility, muscle strength and core stability.
Pelvic floor pain can be a debilitating condition that can cause a great deal of discomfort and inconvenience. The pelvic floor is a hammock of muscles that forms the floor of the pelvis. Its function is to control urination and defecation as well as supporting the bladder, uterus and rectum. During pregnancy and childbirth, the pelvic floor muscle can be overly strained or stretched which causes pain. Several treatments could be carried out by Women’s Health Physiotherapist depending on the underlying cause of the pain. Pelvic floor pain can be a difficult condition to manage, but with the right treatment, it is possible to find relief.
Urinary or Faecal Stress/ Urge Incontinence is very common after childbirth especially to those who had a vaginal delivery. During natural birth, your pelvic floor muscles undergoes a lot of stress. Some may need episiotomy or even other intervention, such as forceps delivery, to enable a smoother delivery. All these procedures cause the pelvic floor muscles to be overly stretched or even torn, which affects urinary control. Incontinence has a massive impact on the quality of life of the individual including reduced physical activities, social avoidance or even mental distress. Women’s Health Physiotherapy is important at this stage to ensure good pelvic floor muscle recovery post-natally. Management usually includes pelvic floor muscle strengthening. In some cases, vaginal electrical stimulation may be required to help stimulate the muscles.
Pelvic organ prolapse could happen as a result of the weakened or damaged pelvic floor muscles. Physiotherapy management usually includes manual therapy to optimise body alignment, pelvic floor muscle training, core stability training and lifestyle modification. Women’s Health Physiotherapist may also give you advice on how to manage symptoms and how to prevent the condition from getting worse. In some severe cases, prescription of vaginal pessary or even surgery may also be required.
Rectus diastasis is defined as a separation of the rectus abdominis (abdominal) muscles at the fibrous structure that runs down the midline of the abdomen known as the linea alba. This condition can occur during pregnancy as the abdominal muscles stretch and separate to accommodate the growing baby. After delivery, it usually presents as a gap between the two columns of abdominal muscles. In some cases, it may also present with a bulge from the gap during physical exertion. Treatment for rectus diastasis typically includes exercises that strengthen the abdominal muscles, regain core stability and help to close the gap between the muscles. Treatment effect is more promising within the first 6-12 months post-natally. However, in some of the severe cases, surgery may be needed especially to those who presents with symptoms such as lower back pain and weakness.
Sexual dysfunction post childbirth is not uncommon. It includes dyspareunia (painful sex), reduced or heightened sensitivity. Pain is the most common complaint. It is usually caused by the traumatized pelvic floor muscles or even overstretched nerves during delivery. Women’s Health Physiotherapist usually helps to identify the underlying cause of the problem and develop a treatment plan to address it. Management includes manual therapy to release to tight muscle, muscle relaxation technique and advice on lifestyle modification.
Women's health physiotherapy is not only for pregnancy related issues. Any women, whether they have experienced pregnancy or not, could also present with women’s health issues any time during their lives. Some conditions such as obesity, menopause, chronic respiratory diseases, lifestyle that required repetitive lifting etc, could also result in some women’s health issues. This section will look at some of these issues and how somebody suffering from these issues can get better with the help of a women's health physiotherapist.
Pelvic floor dysfunction. There are two main types of pelvic floor dysfunction: weakness and hypertonicity. Weakness occurs when the pelvic muscles are not strong enough to carry out its function, which can lead to problems such as incontinence or prolapse. Hypertonicity occurs when the muscles and tissues are too tight and unable to relax, which can lead to various kind of pain such as sexual pain or even difficulty emptying the bladder or bowel. Treatment for pelvic floor dysfunction depends on the underlying cause. For weakness, treatment may involve pelvic floor muscle exercises and other measures to improve muscle strength. For hypertonicity, treatment may involve manual therapy to release the tight muscle and pelvic floor muscle relaxation techniques.
Pelvic floor pain is a common condition in women. Apart from pregnancy and childbirth, it can be caused by a various factors including stress, obesity and aging. Pelvic floor muscle pain is usually due to hypertonicity (tight pelvic floor muscles). Women’s Health Physiotherapy very often includes manual therapy to release the tight muscles as well as relaxation technique to help relieve pain.
Urinary and faecal incontinence not only happen postnatally, it could happen anytime during a woman’s life if they have underlying weakness at the pelvic floor. It means even women who never experience childbirth can also have incontinence. Hormonal changes during menopause can also cause incontinence. Women’s Health Physiotherapist will usually do a thorough assessment, including vaginal examination, to find out the underlying cause of the problem. It could be related to pelvic floor dysfunction, core instability or even poor posture etc. Targeting treatments will then be given based on the assessment findings.
Pelvic organ prolapse, like incontinence, could also happen to any women any time during their lives. Pelvic organs prolapse is most common after childbirth, but can also be brought on by aging, menopause, obesity, and other factors. In most cases, physiotherapy is usually the first hand treatment. In more severe cases, pessary prescription or even surgery may be needed.
Overactive bladder is a condition in which the bladder muscles become overactive and contract too often, causing urinary urgency and frequency. Women's Health Physiotherapists use a variety of treatments to help women with overactive bladder, including pelvic floor muscle training, electrical stimulation and bladder training. Pelvic floor muscle exercises help to strengthen the muscles that support the bladder and help to control urinary leakage. Electrical stimulation can help to relax the overactive bladder muscles and reduce urinary frequency. Bladder training helps the patient to control the urge to urinate and to reduce the number of trips to the bathroom.
Bowel issues such as constipation can be treated by a Women's Health Physiotherapists. Although diet and lifestyle are the major reasons that cause constipation, it could also be due to pelvic floor hypertonicity. Women’s Health Physiotherapists will do a detailed assessment to find out the cause of the bowel issue in order to prescribe appropriate treatment, which often aims at relaxing the tight pelvic floor muscles and modifying diet and lifestyle in order to help improve the symptom.
Sexual dysfunction such as vaginismus and vulvodynia are common conditions that can cause pain during sexual intercourse. Vaginismus is when the muscles around the vagina become very tight, making penetration difficult or impossible. Vulvodynia is chronic pain or discomfort in the vulvar area (the area around the opening of the vagina) that can occur during sex or even when not engaging in sexual activity. For vaginismus, women’s health physiotherapy usually involves manual therapy to release the tight muscles as well as relaxation and breathing techniques to help patient relax the tight pelvic floor. For vulvodynia when hyperactive nerves maybe the cause, electrical stimulation may also be used to help desensitize the sensitive nerve in order to help relieve pain.
In conclusion, women’s health issues are common and could happen to any women any time during their lives. Although some women may be embarrassed to seek for help or some even think it is a problem that they need to accept due to childbirth, aging or menopause, most of the women’s health issues can be successfully treated by well-trained Women’s Health Physiotherapists. If you have any concern regarding any of the above conditions mentioned, please do not hesitate to contact our Women’s Health Physiotherapist at OT&P.