I sat down with the very talented Alison Jeffrey, Director and Physiotherapist at Chevron Island Physio. Alison is extremely passionate about women’s health and we work together with our clients to provide continuity of care.
What do you see most in pregnancy and how to relieve symptoms?
Pregnancy is such an exciting time in a woman’s life but it also puts a huge amount of pressure on our bodies.
Most commonly we will see patients with pregnancy related musculoskeletal pain like pelvic girdle pain or lower back pain, we see them for pregnancy education including safe exercise, pelvic health and preparing for birth as well as pelvic floor dysfunction – both for weak and overactive pelvic floor muscles.
Treatment for these conditions will vary depending on each individual presentation but may include:
Soft tissue therapy/massage and/or joint mobilisations to the affected area
Prescription of a sacro-iliac joint brace – these are great for women with hypermobility issues during pregnancy
We will often prescribe strengthening and mobility exercises for the pelvis and changing posture during pregnancy
We will always discuss and prescribe pelvic floor exercises as appropriate
We are also seeing women present for pre-birth assessments. In these sessions, we go over individual risk factors which may be associated with an increased risk of sustaining a pelvic floor injury during a vaginal delivery. Informing women of the risks and complications associated with both vaginal and caesarean section is so important to enable them to make an informed and well-educated decision on their birth choices.
What can I expect in a postnatal assessment?
An internal vaginal examination is exactly as the name suggests. A trained women’s health physiotherapist will examine inside the vagina.
We will give you time to derobe and lie comfortably on our treatment table with a towel over your lower body & legs. After this we will use a gloved hand to examine the vagina. We begin with a single finger inserted into the vaginal opening to feel the pelvic floor muscles. We will then ask you to do several pelvic floor contractions and if needed we will give you verbal cues to improve your contraction.
After the examination is complete, we will give you a chance to get re-dressed before explaining the examination findings.
Why do an internal vaginal examination?
It gives us the most accurate information about your pelvic floor muscle contraction strength, endurance & co-ordination. Both the deep layer of the pelvic floor muscles and the outer layer. For those women experiencing vaginal pain, it can help us determine what part of the pelvic floor muscles may be contributing to this. We may also visually examine the vaginal opening to assess for any suspected pelvic organ prolapse.
What else will you check in an internal examination?
We will also see what your pelvic floor muscles do when you cough and/or do a crunch.
We will check what position your pelvic floor muscles sit in comparison to your sit bones (bottom part of the pelvis).
On the outside surface, we will measure the distance between the anus and urine opening (urethra) while you are resting and when you bear/push down.
All of this will help us INDIVIDUALLY prescribe your pelvic floor exercises & other appropriate physical exercise (from clinical experience, no two women are the same).
After the internal vaginal examination what happens next?
We will clearly explain the results of the examination, this will help you understand our suggested management plan. We may give you written handouts relevant to your issue to help you understand even better.
An internal vaginal examination can be daunting. However, hopefully this illustrates how much important information we can find by doing an internal vaginal examination. Please remember we are physiotherapist’s trained specifically in this area and we examine many women on a daily basis.
What are the common signs and symptoms of prolapse?
Prolapse can present following excessive stretching of the ligaments, fascia and muscles that support the pelvic organs causing them to sit lower in the pelvic cavity. The word prolapse literally means to ‘fall out of place’
There a many types of prolapse including bladder, bowel, uterine and intestinal prolapse.
Prolapses can occur for a number of reasons:
The most common reason being childbirth.
Regularly straining on the toilet
Repetitive lifting
Repetitive lifting of heavy weights in the gym or at work
Excess weight
Chronic lung diseases with coughing
Some of the symptoms of prolapse may include:
Pelvic heaviness
Feeling a lump or bulge at the entrance or through the vagina
Increased discharge
Lower back pain
Difficulty emptying bowels or feelings of incomplete emptying of the bladder
Sometimes difficulty with sexual intercourse
Can it be fixed?
As with all injuries to the body, the individual presentation of a lady with prolapse will influence the type of treatment required. For some very mild prolapses minimal treatment will be required, some pelvic floor strengthening, advice on avoiding excessive straining on the toilet, weight loss (as needed) and continuing with pelvic floor safe exercises is all that will be needed.
In more significant prolapses we may prescribe what is known as a pessary. A pessary is used to add support to the organs by reducing the amount of downward movement available in the pelvis when there are increases in intra-abdominal pressure – like running, coughing, jumping, HIIT sessions. A pessary can help to prevent further progression of a prolapse and in some post-natal cases can actually help to improve the prolapse more long term.
Unfortunately, 1 in 9 women with prolapse may be required to have surgical correction in order to improve their symptoms to a level they are comfortable with.
Can I still exercise with a prolapse?
Yes. You can most definitely exercise with a prolapse. Exercise has so many benefits for the body and we always find a way to get women back to safe exercise. For some women, modifications in the exercises or type of exercise you do will be required to ensure there is no progression of symptoms. Again, we will often prescribe a pessary for use in higher impact exercise should a lady present with prolapse.
What would happen if I don’t manage my prolapse when exercising?
A poorly managed prolapse during exercise can lead to an accelerated progression of a prolapse and therefore will increase your symptoms. Once prolapses become more significant it can become more difficult to resolve symptoms with conservative management.