Women’s Health Services

Men and women are both biologically and physiologically different which results in a set of health concerns unique to women, many of which being related to the female reproductive system. Recognising, addressing and providing adequate treatment for such health conditions unique to females can help women to enjoy healthy, pain-free lives.

Women’s health services include women’s physiotherapy, diet and nutrition, Pilates, yoga and other exercise classes as well as specialised services for mother and baby. This range of services is designed to support women through all stages of life from adolescence, the childbearing years, pelvic floor problems, post-natal conditions, to the menopause and beyond. 

Women’s Health Concerns

Weakened Pelvic Floor

The pelvic floor is a complex structure comprised of a group of muscles which support the pelvic organs and span the bottom of the pelvis, bladder, bowel and uterus. Effective support for these organs requires a strong pelvic floor. These muscles are held in place by ligaments which also support the organs in a hammock-like form.

As with all muscles, the pelvic floor should be kept active – strengthening the muscles can have a wide range of benefits. It is estimated that as many as one-third of all women experience problems with the pelvic floor muscles at some point in their lives. 

Symptoms of a Weak Pelvic Floor

When pelvic floor muscles are weakened, internal organs lack full support, this makes it harder for the individual to control the release of urine, wind or faeces.

Typical symptoms of weak pelvic floor muscles include leaking urine when coughing, sneezing, laughing, running or during intercourse. Other common symptoms may include overly frequent visits to the toilet, vaginal pain, lack of vaginal sensation and in some cases a distinct bulge at the vaginal opening. Pelvic floor exercises are designed to improve muscle tone and help to prevent the need for further treatment. It is especially important to do pelvic floor exercises during pregnancy and to continue following birth to help tone the muscles and rebuild strength.

Why Do Pelvic Floor Muscles Become Weakened?

Pregnancy and Childbirth

Supporting the weight of the baby in the uterus during pregnancy and any subsequent tears caused during vaginal birth can put the pelvic floor under considerable strain. A complicated vaginal birth such as an episiotomy, a significant tear or a large baby, can all cause further complications and weaken the muscles.

Repeated Heavy Lifting

This increases abdominal pressure which may put the pelvic floor under strain.

Chronic Constipation

Constant straining when emptying the bowels can cause weakness and over-stretching of the muscles. However, for some women, the opposite is true and poor relaxation can cause difficulties emptying the bowels.

Obesity

Excessive weight puts a strain on the entire body including the pelvic floor muscles.

Menopause

Hormonal changes such as lower levels of oestrogen can make the pelvic floor weaker following pregnancy.

Physiotherapy offers a wide range of benefits and is particularly useful for strengthening the pelvic floor muscles in women, regardless of their age.

Incontinence

Women may be affected by both urinary and bowel incontinence at some stage in their lives. Urinary incontinence generally occurs more frequently in women, affecting up to 30% of women by the age of 65 years. Stress urinary incontinence is common during pregnancy, these symptoms often occur due to the increasing weight of the baby, hormones and the pressure this exerts, resulting in less available space for the storage of urine.

Some women may also experience problems with the bowels such as leakages, inability to control the passing of wind and issues with the bowels themselves, this is often due to weak pelvic floor muscles, although in some cases it may be a result of another condition.

Pelvic Girdle Pain

Pregnancy-related pelvic girdle pain refers to general pregnancy-related pelvic pain – symphysis pubis dysfunction (SPD) is a type of pelvic girdle pain. Pelvic girdle pain and SPD typically arise as a result of musculoskeletal dysfunction and are characterised by a set of painful symptoms which may include pain around the perineum, the pubic bone, and general pain in the region of the pelvis during activities. Physiotherapy is one of the most effective forms of treatment, comprised of a variety of rehabilitative and strengthening exercises which focus on the pelvic floor muscles.

Chronic Pelvic Pain

There are many reasons that women may experience pelvic pain, sometimes it is difficult to pinpoint the exact cause and efforts may be focused on trying to find a discernible cause arising from one of the organs, such as the bladder or uterus, rather than investigating possible muscular origins. In some cases, the cause of Chronic Pelvic Pain may be mistaken for another condition or missed entirely. Myofascial pelvic pain can manifest as a result of tightness and irritation to the pelvic floor muscles and can affect women of all ages. Pelvic physiotherapy can help with a range of pelvic related complaints, including myofascial pelvic pain and pelvic floor related issues – helping to stretch tight muscles and prevent excessive cramping.

Pelvic Organ Prolapse

This disorder occurs when the pelvic floor muscles and supportive ligaments become considerably weakened and looser, resulting in an inability to support one or more of the internal organs and subsequently allowing them to slip down from their normal position and bulge into the vagina. The four main types of prolapse include prolapse of the bladder also known as anterior prolapse, uterine prolapse (prolapse of the womb), posterior wall prolapse when the bowel bulges forward into the back wall of the vagina), or prolapse of the vagina, when the top of the vagina drops down (this may happen following a hysterectomy.

Symptoms

One of the first symptoms of this disorder is experiencing sensations of heaviness, or that something is ‘coming down’ in the vagina, some women describe this as a feeling of dragging discomfort inside the vagina. A lump may even be visible or possibly be felt coming down from inside the vagina. Other symptoms may include difficulty passing urine, stress incontinence or passing urine more often.

Causes

The following are possible causes of developing pelvic organ prolapse:

• Pregnancy and childbirth
• Repetitive lifting of heavy items
• The menopause
• Being overweight
• Chronic constipation

Treatment

Treatment options available for pelvic organ prolapse may include targeted pelvic floor exercises and improving general health and fitness levels. Hormonal treatment, vaginal pessaries and in some more severe cases, surgery may be required.

Diastasis Recti

This refers to a condition when the abdominal muscles over-stretch and separate down the midline, this typically occurs during pregnancy, but in some cases may also arise due to obesity, hypermobility and chronic straining.

Diastasis Recti can be measured by a physiotherapist or other type of health practitioner. Physiotherapy can provide effective treatment for diastasis recti by creating an exercise program which focuses on shortening the muscle fibres, improving pelvic alignment as well as toning and flattening the abdominal wall. It can also help strengthen surrounding supportive muscles, the core and pelvic floor muscles.

Endometriosis

This condition can affect women of any age – it refers to the growth and formation of tissues and cells of a similar nature to those found in the womb, found in other parts of the body, such as on the ovaries, the fallopian tubes, or less commonly in other parts of the body. These can swell and bleed in much the same way as the lining inside of the uterus does each month during the menstrual cycle, however, in the case of endometriosis, the tissue grows in areas where it can’t easily leave the body.

Such formation of tissue may block the fallopian tubes and cause cysts, the inflammation can also form scar tissue and adhesions, making it more difficult to get pregnant.

Endometriosis can cause painful symptoms, often similar to those of menstrual cramps, other women may experience chronic pain around the region of the pelvis and the lower back, bowel movements may also be painful and in some cases, pain is felt during or after intercourse. Endometriosis can also lead to bleeding or spotting in between periods, infertility or digestive problems. All of which can have a significant impact on a woman’s life and in some cases lead to chronic fatigue, depression, anxiety, isolation and difficulties managing work and social commitments as well as causing complications in intimate relationships.

There are many different treatments which may be considered to help relieve painful symptoms, improve fertility, slow the growth of excess tissue and to stop the condition returning. Frequent treatment methods include pain medication, hormone treatment and surgery – some women find lifestyle changes can also be helpful, specific exercises can help to strengthen the pelvic floor muscles and targeted physiotherapy can be useful in relaxing muscle tightness which is created in response to the painful symptoms. Massage therapy can also help with general relaxation and well-being.

Dyspareunia

Dyspareunia describes pain before, during or after intercourse – there are numerous possible causes of dyspareunia, ranging from various other diseases and infections as well as conditions such as endometriosis. There are a range of different treatments for this condition, some women are referred to a physiotherapist to address any musculoskeletal component of their pain, helping them to improve their ability to control the muscles and promote vaginal relaxation.

The Menopause

During the menopause women are likely to experience some or all of the associated menopausal symptoms which typically include mood alterations, fatigue, interrupted sleep, hot flushes and sweating, pelvic prolapses, urinary incontinence, weight gain and loss of bone density. Hormone replacement therapy is often prescribed to combat these symptoms. However, lifestyle changes can also be highly beneficial, with targeted physiotherapy strengthening the pelvic floor muscles and a good exercise and healthy eating routine in place.

How We Can Help

ProPhysiotherapy offer a range of services which cater specifically for women’s health issues. Many women feel distress and even embarrassment when discussing intimate health concerns. Our women’s health physiotherapists are able to assess, treat and support women experiencing uncomfortable or painful symptoms in a professional and reassuring manner.

For more information on our services, please get in touch with our team for advice or to book an appointment.