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WOMEN'S HEALTH

Women’s health encompasses a huge variety of conditions that may affect women throughout their life. Such conditions include incontinence or leakage of the bladder or bowel; chronic pelvic pain that could include endometriosis (where tissue that normally lines the uterus grows outside the uterus) or muscle spasm; conditions associated with pregnancy and early parenthood such as back or sacroiliac joint pain in pregnancy, carpal tunnel syndrome and mastitis (inflammation of breast tissue usually due to infection).

What are the common conditions that can occur at different stages in women’s lives?

Prolapse is a condition that will affect 1 in 3 women in their lifetime, with a similar statistic for incontinence. Women in the western world are now at a 20 per cent risk of needing surgery for incontinence or prolapse — and 1 in 10 women will have surgery for these problems. Many women are not aware of the role physiotherapy and appropriate exercise programs can have on the ability to improve symptoms of both incontinence and prolapse. Physiotherapy methods will usually include:

  • biofeedback (using your mind to become aware of what’s going on inside your body to gain more control over your health)
  • pelvic floor exercises to improve coordination, strength and endurance
  • postural and breathing exercises
  • may include the fitting of a silicone pessary to provide support. Your physiotherapist will liaise with your GP or gynaecologist on this, however women’s health physiotherapists are experts in the fitting and management of support pessaries.

Menopause is another critical time for women with hormonal change, often uncovering problems with pelvic health that were only just being managed when their hormones were still adequate. During menopause, it’s common for incontinence or pelvic organ prolapse to become a problem for the first time, and is often related to pelvic floor changes that may have occurred when having babies. If you did not have access to a women’s health physiotherapist pre and post pregnancy, then you may not have had postnatal rehabilitation.

Some women modify or give up exercising because of incontinence or pelvic health issues. Exercise is important to avoid weight gain and to improve bone density, as 25 per cent of bone mass is lost in the 2 years either side of menopause. Often physiotherapists can assist women with the most appropriate exercise program to gain fitness and improve pelvic health.

MEN'S HEALTH

Men’s health refers to any issues related to the male pelvis and the surrounding area of the body. Men can develop problems with their bladder, bowel, sexual organs or pelvic floor muscles. In fact, these issues are fairly common. 1 in 8 men have a problem with their pelvic floor, bladder or bowel. 

What are common problems men can experience with their bladder, bowel and sexual health?

Problems may affect any part of the pelvic region and they have a variety of causes.

Bladder leakage or a poor urine stream can indicate pelvic floor or prostate issues. Weak muscles around the anus can cause soiling. Erectile dysfunction can be caused by weak pelvic floor muscles. Pain in the penis or anus can be from pudendal neuralgia (the pudendal nerve which supplies the pelvis). Despite the range of problems and causes, many of these can be assessed by a pelvic floor physiotherapist.

Problems may occur gradually over time or be brought on suddenly. For example, after prostate removal or radiation for prostate cancer, urine leakage, erectile dysfunction or incontinence is common.  However, things like a poor stream may develop more gradually due to prostate enlargement, or you may find you need to visit the toilet frequently due to poor bladder habits that have formed over many years.

The common problems and their causes are outlined below:

Prostate problems

Prostate enlargement is normal for men over 50, but can cause bladder outlet obstruction or a slow, incomplete emptying.

After prostate surgery for prostate cancer, many men find that they have trouble with incontinence. As the prostate is removed, part of the mechanism that keeps men dry is also removed. The leakage may be very mild (eg, a few drops when exercising) or severe (eg, the bladder not storing any urine at all). In the weeks to months after surgery the leakage should reduce as the pelvic floor strengthens.

Bladder problems

Bladders are designed to store urine. Frequent emptying of the bladder or going ‘just-in-case’ will reduce its capacity. They need to be stretched regularly, which is achieved by ‘holding on’. Boys and men of all ages can unintentionally reduce their bladder function by not holding on, causing frequent urination, urgency and urgency incontinence.

Sexual function

Any damage to the muscles, the blood supply or the nerves of the pelvic floor can cause problems with sexual functioning. The penis is also a great indicator of male heart health. If erections are not as strong as they once were, it could indicate that the circulation has been compromised, with for example high cholesterol.

FRACTURES

To fracture or break a bone is a common injury throughout childhood and adult life, yet most of these fractures heal without problems. The rate of fracture increases with age and is greater in women than in men. The majority of fractures will be treated with a cast, splint or minimal intervention to immobilise (keep the fracture still) the fracture for comfort and to protect it while it heals. A smaller number may require a procedure to put the broken bone into the correct position so it heals correctly.

What are the different types of fractures?

There are many types of fractures:

Simple undisplaced fractures are the most common type of fracture where the bone is broken but is still in good position. Greenstick fractures are where the bone is broken on one side. These are commonly seen in children, as the bones are more flexible. Buckle fractures are also common in children where the bone only creases or buckles.

Treatment for all the above fractures usually involves just a cast or a splint.

A fracture caused by repetitive stress is called a stress fracture and when they are caused by an underlying disease they are called pathological fractures.

More complex fractures include displaced fractures, where the bone is out of position and needs to be realigned; open fractures, where the skin is broken by the fracture or injury; fracture dislocations where the fracture has caused the joint to dislocate and comminuted fractures are where the fracture is in several pieces. These more complex fractures usually require a procedure by an orthopaedic specialist to realign and stabilise the fracture. Sometimes metal plates, screws or nails are used and occasionally a joint replacement may be required.

Less commonly, if a person already has a metal plate in their bone or an artificial joint, they may sustain a fracture at the end of the metal or joint replacement. This is called a peri-prosthetic fracture.

PRE & POST NATAL

Pregnancy and post-natal (post-baby) issues commonly include pain in the low back, hips, groin and hands, as well as pelvic floor problems such as incontinence and prolapse. Pelvic floor muscle exercises are often an important part in helping many of these issues.  Every person is different so finding out why you have a problem is essential to proper recovery.

How can physiotherapy help me during pregnancy?

Common muscle and joint aches and pains in pregnancy, such as pain in the low back, hips, pelvis, hands, and neck can be relieved by physiotherapy treatments. These may include:

  • educating you on what is wrong and why
  • advice on your posture
  • assessment and exercises to help strengthen and coordinate your abdominal and pelvic floor muscles
  • using certain belts or compression pants
  • treatment  such as massage or ultrasound
  • advice on using heat and ice
  • activities and positions you should avoid to help decrease your pain.