IvoryRose | Physiotherapy for her

What does an antenatal pelvic floor assessment involve?

An antenatal pelvic floor assessment with our Physiotherapist will allow you to make ensure that you are progressing through your pregnancy with reasonable strength in your pelvic floor muscles and adequate support of your pelvic organs. This has shown to be advantageous in identifying any early pelvic floor weakness, or those who may have identifiable pelvic floor risk factors that may impact their decisions surrounding birth.

The assessment often involves an internal examination of your pelvic floor muscles, to assist you in identifying where these muscles are located and how to contract them appropriately. We will also perform an assessment to determine your baseline pelvic floor function and take some objective measurements which are then useful for us to establish realistic goals for improvement and progression throughout your postnatal recovery.

What if my pelvic floor muscles are weak?

If we identify that your pelvic floor muscles are weak, then your Physiotherapist will be able to teach and assist you with ways you can strengthen your pelvic floor and minimise risks of developing symptoms. Of course, if you are already suffering from pelvic floor symptoms, an assessment will enable us to assist you in considering options for management in the pre and/or postnatal period.

I have heard that some women's pelvic floor muscles are too strong? Will you be able to identify this?

Yes, there are some women whose pelvic floor muscles may be referred to as being “too strong”, however it is often more likely that these muscles are incredibly tight. This tightness can also lead to other symptoms such as painful intercourse or difficulty with use of tampons. Women who may fall into this category are important to identify in pregnancy as they will greatly benefit from our assistance in learning how to relax these muscles “down” to enable a safer and often shorter vaginal birth of their baby.

Is an assessment beneficial in minimising my risk of developing pelvic floor issues following the birth of my baby?

Unfortunately there is no way to guarantee that a woman won’t sustain some form of pelvic floor injury during their pregnancy or birth, as both of these events are highly variable. Despite this, research has shown us that many pelvic floor conditions are more successfully treated when early detection is possible. If we are able to identify that you are at risk prior to the birth of your baby, then this will allow us to monitor your condition and in doing so, implement earlier intervention where necessary. This will often lead to more favorable outcomes.

Is there an optimal time to have my antenatal pelvic floor assessment?

Where possible, between 20 and 26 weeks gestation is the most optimal time to have your pelvic floor assessed, however if you have any symptoms prior to this then you are encouraged to make an appointment at any time as long as you have completed your first trimester of pregnancy.

Will my pelvic floor assessment be covered by Medicare or Health Insurance?

If you have an insurance policy which includes cover for physiotherapy services then you should be able to cover some of the cost of your antenatal assessment through your health fund. Alternatively, Medicare may cover part of the cost of a physiotherapy appointment, however you must be referred under a 'Management Plan' from your GP to be eligible. If you are unsure then please contact us at IvoryRose Physiotherapy, or you may wish to contact your health fund directly for more information.

I have heard that some women's pelvic floor muscles are too strong? Will you be able to identify this?

Yes, there are some women whose pelvic floor muscles may be referred to as being “too strong”, however it is often more likely that these muscles are incredibly tight. This tightness can also lead to other symptoms such as painful intercourse or difficulty with use of tampons. Women who may fall into this category are important to identify in pregnancy as they will greatly benefit from our assistance in learning how to relax these muscles “down” to enable a safer and often shorter vaginal birth of their baby.

Do I need to have exercised previously before falling pregnant?

It is not necessary for you to have any prior level of fitness or experience to enable you to join our pre-natal pilates classes. We do however require every participant to attend a short appointment for an assessment with the physiotherapist, to ensure you are safe to commence the group exercise classes. Additionally, it can also be a good idea to talk to your midwife or doctor about exercise and make sure you do not have any reason for them to be concerned about you participating in pre-natal pilates. We understand that not all exercises are suitable for pregnant women so our classes are especially designed to nourish and support your pregnant body, whilst enabling you to improve your overall strength and fitness.

How many people are in the classes?

Due to the nature of our pre-natal pilates classes, there is a maximum of 8 spots available per class. For this reason, there is a 9 hour minimum cancellation policy for all class bookings.

How do I make a booking?

All class bookings are made using our Mindbody online booking system. You will need to pre-purchase your class/es prior to saving your spot. This can be done be clicking here.

Why do I have to wait until 6weeks for my postnatal check?

Following the birth of your baby, it is normal to experience some bleeding (lochia) for up to 6 weeks. For this reason, it is suggested that you wait until this bleeding has ceased to allow for a full assessment of your pelvic floor muscles. This timeframe is considered optimal to enable the earliest commencement of your pelvic floor recovery whilst also minimising any chance of infection.

What does my assessment involve?

The postnatal pelvic floor assessment often involves an internal examination of your pelvic floor muscles, which is particularly useful if you have had a vaginal birth. This assessment will enable you to re-connect with the correct muscle groups and begin to work on strengthening them appropriately. Often we will also perform measurements that we can compare to your baseline pelvic floor function (this was assessed in your antenatal visit). These measurements are useful for us to determine realistic postnatal goals for improvement and specifically target your exercise program appropriately. The other area that the physiotherapist will be able to assess for you is your abdominal muscle separation (also referred to as rectus diastasis). It is well documented that 66-100% of women will obtain some level of abdominal muscle separation throughout pregnancy, however the necessary postnatal rehabilitation of these muscles can vary from woman to woman. For this reason, a thorough assessment of the abdominal muscle wall is useful in allowing us to individually cater to each new mum.

I did not have antenatal assessment. Should I still get my pelvic floor muscles assessed postnatally?

YES!! Whilst it is an added bonus to have had an antenatal assessment of your pelvic floor muscles, it is not a necessity.

I think I might already be getting some pelvic floor symptoms, will you still be able to help me?

Yes. Unfortunately, it is not uncommon for women to have already developed some symptoms of pelvic floor muscle weakness in the early days/weeks following the birth of their baby. Fortunately, with earlier detection and commencement of pelvic floor muscle rehabilitation, we are often able to assist you in improving your symptoms and minimising any further progression.

There are various treatment options available for those who have developed pelvic floor muscle weakness. These options range from basic muscle rehabilitation to the use of vaginal support devices (Pessaries) which can assist in relieving symptoms such as pelvic organ prolapse, urinary leakage and bowel dysfunction.

I would like to return to exercise as soon as possible. When is the “right” time?

At IvoryRose Physiotherapy, we believe there is no blanket rule for return to exercise as this is highly dependent on your unique body and birth history. Basic guidelines for return to exercise can be found at www.pelvicfloorfirst.org.au/pages/returning-to-sport-or-exercise-after-the-birth.html Along with these guidelines set by “pelvic floor first”, we suggest that you begin walking and pelvic floor exercises as soon as you feel comfortable, however recommend that you wait until you have had you post-natal pelvic floor and abdominal muscle “check” with us, prior to returning to more vigorous forms of exercise and/or group classes.

What is Vaginismus?

Vaginismus is a term used to describe a persistent or recurrent difficulty in achieving vaginal penetration, despite an expressed wish to do so. There is often an associated involuntary pelvic floor muscle contraction, which can cause the vaginal entrance to present as smaller in appearance. This condition may or may not be associated with marked pain on light touch applied to the tissues surrounding the entrance to the vagina. The condition can also be associated with pain on insertion of tampons or use of a speculum (such as with a pap smear).

What Causes Vaginismus?

There are a small percentage of women in whom a physical and/or psychological trauma has influenced the onset of their symptoms, however for many women, the underlying cause may be a direct result of another medical condition. Examples of conditions which are often associated with this type of pain include endometriosis, urinary tract infections, chronic constipation, and bladder/bowel urgency/frequency.

Will Physiotherapy Help Me?

If you are experiencing difficulty in achieving comfortable vaginal penetration, are suffering from severe pain associated with light touch applied to your vaginal tissues, or are suffering from symptoms of chronic pelvic pain, then we encourage you to consider a consultation with our Physiotherapist at IvoryRose Physiothetapy. It can be a good idea to organise this alongside care of your GP and/or Gynaecologist (although this is not a necessity).

An assessment with our Physiotherapist will enable a differential diagnosis, and allow the most appropriate treatment and follow up to be determined. Fortunately, if there is an issue with excessive pelvic floor muscle tone and/or sensitivity, then there are a number of treatment options available to assist in improving this. We are confident that treatment with us will enable you to achieve a more normal sexual function, and assist you in developing your sexual intimacy in more fulfilling ways.

My friend had a surgery to help her to stop leaking urine when she sneezed, but I would like to avoid this if possible. Are there non surgical treatments available for this type of urinary incontinence?

Yes, there are several non surgical options that can be highly effective in the management of this condition, however success rates of each option can differ depending on the precise cause of your leaking. A detailed pelvic floor assessment will assist us in our diagnosis and allow identification of all contributing factors. We can then discuss with you your treatment options and help you to make decisions regarding appropriate intervention.

How does a normal bladder work?

The way we often describe bladder mechanics is similar to that of a balloon filling with air or water. Urine is produced by our kidneys and is passed through to the bladder via tubes called the ureters. As the bladder fills, the muscular walls of the bladder will stretch to accommodate the fluid. In a “normal” bladder system, urine is kept inside the bladder by the urethral system, which enables us to prevent the involuntary loss of urine whilst we fill our bladder, until there is an appropriate time and place to empty. There are many factors which contribute to our urethral closure pressure, one of which includes the muscles of the pelvic floor.

How often is considered “normal” to empty my bladder?

Approximately 4-7 times throughout the day, and possibly once at night is considered normal.

What are the symptoms of overactive bladder?

Overactive bladder syndrome is defined by a combination of the following symptoms:

Urgency – a sudden, intense need to pass urine that is difficult to defer.

Frequency – a need to empty your bladder several times throughout the day which you consider to be bothersome (usually more than 7);

Nocturia – waking up more than once at night to go to the toilet.

What are the causes of overactive bladder?

The causes of OAB can be multifactorial however essentially are often due to the bladder muscle (detrusor) squeezing to empty your urine either too often, without warning or when you specifically do not want it to. Unfortunately, if you have had a previous surgery for stress urinary incontinence you may also be more likely to experience symptoms of overactive bladder.

Do I need to have exercised previously before falling pregnant?

It is not necessary for you to have any prior level of fitness or experience to enable you to join our pre-natal pilates classes. We do however require every participant to attend a short appointment for an assessment with the physiotherapist, to ensure you are safe to commence the group exercise classes.

Additionally, it can also be a good idea to talk to your midwife or doctor about exercise and make sure you do not have any reason for them to be concerned about you participating in pre-natal Pilates. We understand that not all exercises are suitable for pregnant women so our classes are especially designed to nourish and support your pregnant body, whilst enabling you to improve your overall strength and fitness.

How many people are in the classes?

Due to the nature of our pre/post-natal Pilates classes, there is a maximum of 4 spots available per class. For this reason, there is a 9 hour minimum cancellation policy for all class bookings.

How do I make a booking?

All class bookings are made using our online booking system. You will need to pre-purchase your class/es prior to saving your spot and this can be done over the phone or in person.

Why is it important to exercise?

During pregnancy exercise has been shown to minimize your risks of developing pregnancy complications such as preeclampsia and gestational diabetes, and is useful in managing excessive weight gain. It has even been suggested to shorten labour!

Throughout the post-natal period, many women find it difficult to get back into exercise safely. Often there is a lot of changes happening within your body and going to a Physiotherapist in a small group setting for your exercise regime, allows us to individualize your program and focus on what YOUR body needs. You can also bring bub along up until they become mobile – BONUS!