Pelvic Floor Muscle Training
Pelvic floor muscle exercises / kegels are proven to be very effective in treating a wide variety of pelvic health problems.
Routine examination of the pelvic floor is recommended before a supervised pelvic floor muscle training program is commenced (NICE 2013). Our highly experienced and specialist Women’s Health Physiotherapists can complete this at one of your initial appointments, and review your progress as appropriate throughout your treatment.
Following examination you will be prescribed a specific program to improve your pelvic floor activity. This will be individual to you and your symptoms, and will be adapted and progressed at regular intervals based on the training effect. Exercises may involve working on either/both strengthening/relaxing the muscles, depending on your symptoms, and may incorporate the use of manual therapy, biofeedback, NMES, vaginal weights. All treatment is tailored to your requirements using best clinical evidence. You are welcome to ask as many questions as needed and all decisions on treatment are made based on your informed preferences.
Soft Tissue Release
As part of your assessment your physiotherapist will check for any soft tissue tightness around the abdomen and pelvic floor. This may be due to dysfunction of breathing, abdomen or pelvic floor muscles, scar tissue from old injuries or surgery, incomplete recovery following pregnancy and delivery or rectus adbominus divarication (RAD). If this is found then treatment techniques may be used to help release these muscles and improve their synchronisation and function, such as abdominal massage, trigger point / soft tissue release or visceral mobilisation. This is usually coupled with advice on appropriate maintenance with breathing control, exercise and/or postural work.
Biofeedback
Biofeedback for pelvic floor muscle retraining is a painless procedure whereby special sensors on a small probe inserted into the vagina, pick up muscle activity which is then displayed on a computer screen. Biofeedback is a fantastic learning and training tool for patients to be able to see how well they can contract or relax their pelvic floor muscles, and with practice, improve their control of this. Information remains confidential and is stored securely so that comparisons between sessions can be made. Unlike some centres where you may be restricted to lying or sitting on a plinth, all of our biofeedback units operate through Bluetooth, therefore once the probe is inserted you can dress in loose clothing and move around the room. This has the added benefit of allowing our therapists to observe how your pelvic floor muscles respond to more functional movements and progress your training specific to an activity which may cause your symptoms- ie jumping, bending, lifting etc.
Neuromuscular Electrical Stimulation (NMES)
If patients are unable to voluntarily contract the pelvic floor muscles, they are found to be very weak, or there is reduced sensitivity in the vagina, NMES can be used to assist pelvic floor muscle training. A small probe is inserted into the vagina, and attached to a battery operated device (see below). This will be programmed according to your needs and delivers intermittent electrical impulses (usually around 5 seconds of stimulation and around 5-10 seconds of no stimulation) over around 10-30 minutes , although this will vary according to your needs. Stimulating the muscles cause them to contract, and the patient then joins in with this to improve awareness and strength of the pelvic floor. The stimulation is not painful and usually generates a ‘tightening’ or ‘buzzing’ sensation in the pelvic floor. The patient remains in control of the intensity of the sensation throughout the treatment. If you have been recommended NMES it is important that you use it regularly. We have a number of devices which we can loan out during the course of your treatment so that you can continue your training at home.
Bladder Retraining
Bladder retraining is a method offered to assist in the treatment of overactive bladder (OAB) which may include symptoms of urinary frequency and urgency. It can also be used for people who are having difficulties in fully emptying the bladder.
In keeping with National Institute of Clinical Excellence (NICE) Guidelines, bladder training is recommended as a ‘first line’ treatment for OAB. Our therapists will carry out a series of assessments to identify your current bladder habits. This may involve the completion of a bladder diary. You will be advised on lifestyle, physical and behavioural methods to improve bladder control, often alongside other treatments for the pelvic floor. You may be taught techniques to ensure your bladder is emptying effectively and we will liaise closely with your consultant or GP if you require any additional investigations or medical support.
In keeping with National Institute of Clinical Excellence (NICE) Guidelines, bladder training is recommended as a ‘first line’ treatment for OAB. Our therapists will carry out a series of assessments to identify your current bladder habits. This may involve the completion of a bladder diary. You will be advised on lifestyle, physical and behavioural methods to improve bladder control, often alongside other treatments for the pelvic floor. You may be taught techniques to ensure your bladder is emptying effectively and we will liaise closely with your consultant or GP if you require any additional investigations or medical support.
Acupuncture
Acupuncture can help with any number of conditions but is mostly used in Western medicine for the treatment of pain and musculoskeletal disorders.
If you are experiencing pelvic pain, acupuncture may be used to help in treating this.
There is also some evidence to suggest that acupuncture can help to relieve symptoms of overactive bladder (OAB), and although not the ‘first line of treatment’ this can be a good alternative to patients who are unable to take bladder medication due to their interaction with other medical conditions or medications they may be taking, or those who cannot tolerate their side effects.
Lauren is fully qualified in acupuncture and is a member of the Acupuncture Association of Chartered Physiotherapists (AACP). She would be happy to discuss acupuncture as a treatment option if you think this may benefit you.
If you are experiencing pelvic pain, acupuncture may be used to help in treating this.
There is also some evidence to suggest that acupuncture can help to relieve symptoms of overactive bladder (OAB), and although not the ‘first line of treatment’ this can be a good alternative to patients who are unable to take bladder medication due to their interaction with other medical conditions or medications they may be taking, or those who cannot tolerate their side effects.
Lauren is fully qualified in acupuncture and is a member of the Acupuncture Association of Chartered Physiotherapists (AACP). She would be happy to discuss acupuncture as a treatment option if you think this may benefit you.
Postnatal Check-Up and Recovery
Our Physiotherapists offer a one-off postnatal check –up, and a more comprehensive recovery and rehabilitation program if required. This appointment will include checking for abdominal separation, a pelvic floor assessment and postural check. Our specialist Physiotherapists can advise on any concerns with bladder, bowels or returning to exercise. You will be informed on how to help your recovery at home and a specific pelvic floor exercise program will be provided, but should you chose to follow a more comprehensive recovery program we can arrange further appointments to suit your requirements.
Pessary Assessments
Vaginal pessaries have been used since the time of Hippocrates and provide an often life-transforming treatment option for many women who feel unable to go about their normal life, or exercise routine due to prolapse or urinary incontinence. Although not suitable for every woman, they offer less risk than surgery and can be managed by the patient very well, with periodic check-ups from their clinician or GP. They can also offer a solution to women who do not want to, or cannot have surgery.
There is a common misconception that pessaries are only used by older women, and few women know this is a valid conservative option for them. Pessaries can be used by all adult age groups, whether that be all of the time, or intermittently for exercise, and there are a huge variety of types and sizes to suit each individual’s needs.
Both of our Women’s Health Physiotherapists are trained and experienced in assessing and fitting several different types of vaginal pessary for the treatment of prolapse and urinary stress incontinence. We stock different types and sizes and offer a pessary trial service to see whether you may benefit. We work closely with your consultant or GP and can request certain pessaries on prescription. If this is not available or you choose to purchase one independently we can advise on type and suppliers of pessaries to suit your requirements.
There is a common misconception that pessaries are only used by older women, and few women know this is a valid conservative option for them. Pessaries can be used by all adult age groups, whether that be all of the time, or intermittently for exercise, and there are a huge variety of types and sizes to suit each individual’s needs.
Both of our Women’s Health Physiotherapists are trained and experienced in assessing and fitting several different types of vaginal pessary for the treatment of prolapse and urinary stress incontinence. We stock different types and sizes and offer a pessary trial service to see whether you may benefit. We work closely with your consultant or GP and can request certain pessaries on prescription. If this is not available or you choose to purchase one independently we can advise on type and suppliers of pessaries to suit your requirements.