Our women’s health physio, Toosie Bawden, talks about the most common problems that she deals with.
So Toosie, you’re a women’s health physio. Not everyone knows what that means – can you tell us ?
Women’s Health physiotherapy treats conditions relating to obstetrics, gynaecology – anything pelvic in nature, specifically for women. It covers everything from pelvic pain to incontinence and is available for women of any age.
What are the top three sorts of problems that you see?
Hypertonic (very tight) floor,
Post natal weakness.
So that means muscles in the pelvis making it difficult to let go?
Yes, muscles get too tight from overuse or overload, which then means they can’t relax and that will cause pain and / or difficulty in function.
What do you mean by overuse or overload?
Overuse means you are working the muscles too hard: too many pelvic floor squeezes or abdominal / core strengthening exercises without stretching.
Overload means: keeping the muscles of the pelvic floor under strain for too long; that could be clenching through anxiety or bracing or holding on for long periods of time such as during endurance training.
So let me get this straight; you see women who have problems because their tummies are too flat? Too tight? Too strong?
Yes, but remember – too tight and too flat may not always equate to strong.
So flat doesn’t always mean strong?
Not at all. Sometimes it’s just good genetics, you inherit your body shape and so you may have a flat tummy but it may not be strong.
Others overtrain their abdominal muscles and get a flat tummy that way but they may have become unnaturally tight and this can lead to difficulties.
Lots of women strive for the flat tummy look – does that risk damage to the pelvic floor?
It’s important to make sure that you are activating the pelvic floor as you do the stomach exercises and remember to stretch both afterwards.
And what kind of symptoms do they have, is it pain on … what? Or difficulty with …. what?
Often too tight a stomach will give you pain when exercising in your lower abs, sometimes difficulty breathing deeply or just restriction in movements, especially twisting (think yoga or boxing or dancing torso twists).
And too tight a pelvic floor will give you ..?
Bladder and bowel disruptions, pain that feels more internal and possibly issues with intercourse and tampons.
Okay, so tell me about prolapse – we hear that term getting bandied about but what does it actually mean?
There are different types of prolapse but it basically means something is out of place. Your internal organs can descend or your pelvic floor muscles can weaken to the point where they are unable to hold the organs up (or they feel like they’re not holding everything up).
So it feels like a sort of pressure? Heaviness, dragging?
Yes, sometimes you may feel something in your vagina entrance or even be able to see it.
And how do you fix it?
If it is too far out of your vagina you will need to see a Gynaecologist but if not we can fix it with pelvic floor specific rehabilitation.
So is that the same sort of exercise as for post natal weakness?
Similar. Pelvic floor strengthening and assessment your core muscles and how they are influencing everything.
Do you see women of all ages?
Yes, sometimes I see teenagers, often I see young women in elite sports and of course lots of women around childbirth and those older women pre and post menopause.
And sometimes you use techniques to release their oblique abdominal muscles?
Yes, we use a variety of manual therapy techniques to soften the abdominals which then offloads the pelvic floor and contributes to restoration of balance.
You might also find this article in the Guardian about how to look after your vulva useful.