So Much More Than The Pelvic Floor. Meet Catherine, Our Pelvic Floor Physiotherapist
Catherine is our Pelvic Floor Physiotherapist at Mind and Movement Clinic and a wealth of knowledge when it comes to the physical and emotional aspects of pelvic floor health, an issue often ignored due to lack of awareness and social stigma. She is passionate about trauma informed care and supporting patients move, feel and live with greater confidence and we sat down for a great chat about pelvic floor health.
Hey Catherine thanks for chatting to us about this important issue, we’d love to know, what inspired you to specialise in pelvic floor physiotherapy?
I really enjoy doing pelvic floor physio because it can be really life changing for someone. People can be anxious talking about their symptoms and I enjoy reassuring them that they are common. Education is a big component and there are a lot of self management strategies that people aren’t aware of.
Who is most at risk of pelvic floor dysfunction?
It can affect anyone but for an assigned male at birth, it’s those with an enlarged prostate or who have had surgery for prostate cancer who I see more often. For assigned females at birth - it’s those in pregnancy, post childbirth and menopausal phases.
What are some common causes and symptoms of pelvic floor dysfunction and how might they differ between individuals?
There are generally two categories - pelvic floor muscle weakness and pelvic floor muscle tightness. Pelvic floor muscle weakness can be caused by pregnancy, childbirth, chronic constipation, heavy lifting, or post surgery such as prostatectomy or gynaecological surgery. Symptoms can include bladder leakage, a strong urge to wee, bowel urgency, bowel accidents or a heaviness or dragging sensation in the pelvis (prolapse).
Conversely, pelvic floor muscle tightness (or over-activity) can often mimic the signs of pelvic floor muscle weakness, but doing the strengthening exercises can actually make it worse. Concurrent conditions can include endometriosis or adenomyosis & a past trauma history or current life stress/anxiety can often (but not always) correlate with tense pelvic floor muscles. Past bladder/genital infections or painful bowel issues e.g. anal fissures and hemorrhoids can also contribute to a tight pelvic floor. When a muscle is tight, it doesn't function as well as it normally should. Symptoms can include pain with sex or internal assessments, trouble emptying bowel or bladder, bladder urgency or pain, abdominal pain or severe period pain.
Could you briefly describe what a typical pelvic floor therapy session entails?
Sure. So firstly, I would ask lots of questions relating to everything to do with pelvic floor dysfunction. Asking about general life, levels of physical activity, medical history, current exercise levels, everything about bladder function, bowel function and sexual function. Then depending on symptoms, we chat about what physical assessments are available. If the patient is comfortable, I would often suggest an internal assessment but we certainly don't need to do this at the first assessment (or ever!) if a client is not comfortable to do that. Other alternatives would be using ultrasound or seeing what information we can get from external muscles & breathing. I also often ask clients to complete a diary of their bowel or bladder pattern for a short period of time. After the assessment, we go over an exercise program whether focused on strength or relaxation, fluid intake and bowel advice. We might talk about exercise modification to avoid unnecessary strain on pelvic floor. I would usually review someone in 4-6 weeks to see how it is going.
How can pelvic floor issues impact various aspects of life, such as physical activity, intimacy and overall wellbeing?
People often become less physically active when they are experiencing pelvic floor issues. They might be scared to do exercise or participate in physical training as they may be scared of weeing while exercising or of making a prolapse worse. It may affect intimacy because often painful intercourse can be a factor that affects libido and relationships. It can effect overall well-being as pelvic floor can be associated with back pain and it can affect their ability to get out and about, e.g. if they are always worried where toilets are.
What are some benefits of pelvic floor exercises?
There’s really good evidence that strengthening your pelvic floor in pregnancy & post-natally will reduce your risk of having leakage or prolapse after birth. A strong pelvic floor can also lower your risk of bowel or bladder issues generally, help with low back pain and can improve sexual function.
Are there specific pelvic floor exercises or techniques that are effective in strengthening the pelvic floor muscles?
A key way to strengthen your pelvic floor muscles is to make pelvic floor exercises part of your everyday routine. I know from experience that the hardest thing is remembering to do them! I often tell my patients to do them at traffic lights, or while doing anything that reminds them. The other thing that can be a good tip is to brace your pelvic floor muscles before doing anything that put a load downwards through the pelvis eg coughing, sneezing, lifting, jumping etc. It can be good to do short contractions as well as long. Everyone’s pelvic floor is different, so it’s really important to have an assessment to see where your pelvic floor muscles are at and whether you need to strengthen them or relax them. People can do them incorrectly a lot, so it’s important you check that you are doing them in the right way for you.
Are there lifestyle adjustments (e.g. diet, exercise) that people can make that complement pelvic floor therapy?
There is a lot you can do to manage symptoms - it may mean modifying your fluids, reducing caffeine and increasing water intake. Bowels are probably the most important to get right before doing pelvic floor management - if you’re constipated or straining the bowels, that can lead to lots of symptoms of pelvic floor dysfunction. Doing simple things like increasing dietary fibre and using a foot stool when sitting on the toilet can help.
What has been the most rewarding part of your journey as a pelvic floor physiotherapist?
Probably touching back on that ability to reassure people when they come in for an assessment - that they are not alone and there are lots of things they can do to work towards getting in better pelvic floor health. A lot of people put up with symptoms for 20-30 years which can really affect their quality of life. I get really excited when a client comes back to tell me that they could run without weeing themselves or have had pain free-sex for the first time in years.
What can be done to raise awareness about the importance of pelvic floor health in the wider community?
The media have an important role & it's been great to see increasing noise around menopause, birth trauma & endometrosis recently. I think healthcare providers have an important role in asking about things like incontinence, even if the client does not bring it up themselves - people are often reluctant to start the conversation. It's great that younger people do seem to be more comfortable chatting with friends or families about bowel or bladder problems or pelvic pain these days. This goes a long way to reduce the stigma.
What advice would you give to anyone who is embarrassed or hesitant to seek help for pelvic floor issues?
Be aware that you are very likely not the only person to be experiencing these symptoms, and that even after having symptoms for decades or years, there is a lot that can be done to turn these symptoms around. And even though they are common, they are not normal. There are lots of management symptoms to make life better. I always say, you will never shock a pelvic floor physio with your symptoms. I always encourage patients to tell me as much info as they are comfortable doing.
Are there any resources (books, websites, support groups) you recommend for women wanting to learn more about pelvic floor health?
Sure. Here are some really good ones:
Incontinence prevention, management & support | Continence Foundation of Australia
Catherine is a Pelvic Floor Physiotherapist and works at Mind and Movement Clinic every Wednesday. Head to the bookings page to book in with her.