Menopause and physiotherapy

Women have often heard about the more common symptoms of menopause such as hot flushes, mood swings and night sweats.

However, there are a whole range of symptoms associated with the decrease in oestrogen levels that involve the nether regions that often aren’t spoken about.

Oestrogen is important for keeping the vulva, vagina and lower urinary tract healthy and working well. Oestrogen maintains optimal genital blood flow and as oestrogen levels decrease there is a subsequent thinning of the vaginal skin and loss of elasticity of the tissues. This can lead to issues ‘down there’ including vaginal dryness, painful intercourse, urinary incontinence or development of vaginal prolapse.

Women frequently report they were unaware that these symptoms could be a feature of menopause or that there is any treatment available. As a result women often fail to mention these things to their health provider and subsequently many women suffer in silence. The new term in the medical world is the ‘genitourinary syndrome of menopause’.

Women generally go through menopause between 45 and 55 with 51 being the average time. Menopause is defined as  having been free of menstrual periods for 12 months. It is usually diagnosed on the presence of vasomotor symptoms including hot flushes as well as the absence of periods.

menopause

What can a physiotherapist do for menopause? There is often plenty to be done!

If you are experiencing any of the symptoms of the genitourinary syndome of menopause (GSM) then a pelvic floor physiotherapist is well placed to help you with your predicament.

If you’ve started leaking wee, you’ve started rushing to the toilet; sex has become painful; or you have a sensation of heavinesss or dragging through the pelvis then a pelvic floor physiotherapist can help you in assessing and treating your individual symptoms.

Often the pelvic floor has weakened over time, with pregnancy, during childbirth, and over a lifetime of heavy lifting or coughing and needs a bit of personalised one on one instruction to get it up and running again.

You might have been told old wives tales about how best to look after your bladder and be unnecessarily visiting the toilet and driving up your bladders irritability and ultimately causing you to need to go to the toilet more often.

A physiotherapist can talk to you sensitively about what’s going on with your vagina when it comes to sex and provide you with practical tips and tricks on vaginal moisturisers and lubricants or provide some release work to tight and tender muscles.

If you are feeling heaviness through the vagina (pelvic organ prolapse) then a physiotherapist can assist in strengthening the support structures and help you to better manage your symptoms or in many cases become symptom free.

We can also help to get you exercising as your bone density and avoiding falls as we age is also a very important part of preventative health care which your physiotherapist is well placed to assist you with.

Some useful links:

Australasian Menopause Society https://www.menopause.org.au/

Find a physiotherapist: https://cfaphysios.com.au/ or contact me and I can help you find one in your local area

Jean Hailes: https://jeanhailes.org.au/health-a-z/menopause

 

 

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Physiotherapy and endometriosis

Women don’t always open up about the full extent of the effect of their endometriosis during our first session. Once I get to know a woman and she feels more comfortable often a bit more will start to come out and the full impact of her pain, her search for answers and her ultimate diagnosis of endometriosis starts to become evident.

Endometriosis can be (but is not always) a crippling concern of pain, worry and burden for women. A condition in which the lining of the uterus grows on and around other organs in the body often causing significant pain, especially around menstruation and often having an impact on bladder, bowel and sexual function. Not to mention all the flow on effects from this. In a systematic review of the research around women’s experience of endometriosis https://srh.bmj.com/content/41/3/225 there were a staggering number of areas women felt the effects of their condition. To mention but a few these things included lack of support from their healthcare provider, family and friends; difficulty complying with their prescribed healthcare regime; sick days; problems with fatigue, nausea and diarrhoea; side effects of medication; infertility concerns and the list goes on.

living with pelvic pain_

Patients admit to me ‘I’m late handing in all my assignments to uni because I can’t manage the workload’, ‘looking after the kids is really hard sometimes’ or ‘my relationship is struggling because sex hurts and I don’t have any drive any longer’. The amount of women’s stories I hold in my mind are really adding up and I want to be doing more in helping women get the help they need. My opinion is that the best help comes from a good collaborative multi-disciplinary team. This should involve a team with knowledge and interest in treating the condition including a women’s health GP, a gynaecologist, a physiotherapist , a dietitian and any other complementary therapy or other allied health personnel that provide benefit to the patient.

I’m a women’s health physiotherapist and my role in caring for a woman with endometriosis is to work holistically in assessing the whole person and what do they need but generally in my role I am assessing their pelvic floor; bladder and bowel health; sexual function; pain education and management; and exercise. The issues that I’m treating vary significantly person to person so there is no cookie cutter approach to any one woman as her experience of endometriosis will be very different to the next.

Some basic tools of the trade when dealing with a woman with this condition are to start with the basics by:

  • Encouraging women to eat well and if needed referring to a dietitian
  • Encouraging women to drink well- ensuring that they are drinking enough to be hydrated but not so much their bladders are bursting as well as avoiding caffeine, sugary drinks and those with artificial sweeteners
  • Encouraging women to move well. Really helping them to understand what their body is capable of despite their condition. Perhaps they need a new approach, a bit of encouragement, some pain management strategies or even just some reassurance that they’re on the right track. Perhaps they push too hard and need to do things more gently or vice versa.
  • And finally encouraging women to think well. Pain can be all consuming and stop you from doing things. We need to ensure that these women have mental strategies to help them cope with their condition. Such techniques as body scanning, belly breathing, mindfulness or getting out in nature can help quiet down the central nervous system. If women are stressed and running on empty then they are fuelling an adrenaline/cortisol cycle which tends to have the effect of amping pain up. Ensuring women are aware of the effects of a stressed system via some good pain education and support in learning these techniques can be very meaningful in managing pain without medication or on reduced regimes.

The gold standard diagnostic tool for endometriosis is a laparoscopic exploratory surgery and then excision or removal of the endometrial tissue if it is found within the abdominal/pelvic cavity. This process of having surgery and the stress and cost can be a significant burden on a woman affecting her ability to perform her activities of daily living and exercise. A good women’s health physiotherapist should be able to support patients both before and after surgery in ensuring that they are doing all the right things to support their already stressed bodies through another stressful time. Basically I am here to help at any age or stage that a woman is experiencing pain or problems associated with her endometriosis.

Some local healthcare professionals and myself who have an interest in endometriosis are putting on an event for local women to come and learn a bit more about endometriosis up here in tropical, stormy, rainy Cairns for any local readers. Details below.

One-Day Flash Sale (1)

Some useful links and resources if you or a loved one have endometriosis and need some more information are:

Men’s health physiotherapy

When I started to go down the road of becoming a pelvic floor physiotherapist I really only thought about my role working with women. Earlier this year I was lucky enough to begin working alongside a group of urologists in treating men who are being treated for prostate cancer often by robotic prostatectomy. Thus commenced my journey of learning about all things prostate cancer and prostate cancer recovery.

I thought it might be worthwhile jotting down a couple of the things I’ve learnt so far for any budding physiotherapists or patients out there wanting to understand a bit more about this area and some of my personal experiences with the process.

First things first you need to get the bladder and the bowels sorted. Make sure there is enough water in the system to keep things moving through the urinary system and to keep the bowels soft. If you’re not someone who goes to the toilet regularly to do number 2’s or spends a long time pushing and straining to get it out it’s time to sort it out. Eat some more fibre- fruits, veggies, wholegrains or some kind of fibre supplement. Move more. Bowels love a good long walk. Eat regularly and give yourself a chance to go when you need to ie don’t shy away from the toilets at work or rush out the door so quickly in the morning that you don’t have time to get things sorted. Also if you’re not drinking much water and you’re only drinking coffee or tea- it’s quite simple- drink some more water. Grab a glass and fill it up first thing in the morning and then do that a few more times throughout the day. If you don’t like water consider herbal tea or something non-caffeinated as caffeine can irritate the bladder and cause bladder urgency.

Second thing you need to look at is your weight. When I meet men I will often weigh them and measure their abdomen. Then I’ll head to the heart foundation BMI calculator and bring up their BMI on the screen for them. You can do that here: https://www.heartfoundation.org.au/your-heart/know-your-risks/healthy-weight/bmi-calculator

I find a lot of my patients (but not all) are overweight and are carrying significant abdominal obesity. This makes surgery more difficult.  We don’t have any really good statistics about whether being overweight or obese makes urinary incontinence worse in men we know this to be the case in women so we can make a rough guess that added weight sitting on top of the bladder and the pelvic floor might make it harder to keep all the wee securely inside the bladder until we are ready to let it out.

Next question is always- do you exercise. Again, the majority aren’t meeting the recommendations of 150 minutes of moderate intensity exercise per week. In fact, most aren’t even coming close. I don’t mind what you do for exercise. Walking probably isn’t going to get you over the line in terms of meeting the recommendations but it’s wayyyy better than nothing and a bit of added walking or activity in your day alongside a healthy, calorie restricted diet will probably help shed a few extra pounds. There is plenty of research being released currently about exercise as medicine for cancer and can both prevent and reduce the incidence of cancer. It is a developing area but doing a quick google will yield plenty of results about the benefits of exercise in cancer.

Next is learning about your pelvic floor muscles. The group of muscles that sit at the base of the pelvis. The cues I tend to use are ‘lift up your testes’ and ‘try and shorten your penis’. Using these two cues together will generally get you a reasonable squeeze and it’s also good to emphasis letting the rectal portion of the pelvic floor relax and avoid letting it take over as it’s often stronger and has a tendency to do that. Another thing to keep in mind is that men will tend to think that harder is better so I usually spend a lot of time getting technique right before I focus too much on strength or endurance. Often I will assess the movement using transperineal ultrasound which gives the men a fairly good visualisation of their urethra and the effect of a pelvic floor muscle squeeze on urethral closure.

Once they’ve got the hang of things (usually by the second session) I’ll progress them to some endurance holds and some functional exercises like a squeeze prior to sit to stand, cough (the knack), lift, etc.

After surgery the catheter stays in for a week. Once this comes out usually the flood gates open for a few days and men experience a fair amount of leakage. I try and demonstrate some male specific continence pads to the men prior to this as often they have never bought pads before.

The men can commence pelvic floor muscle training (gently) once the catheter comes out and their effort should be able to increase within the first few weeks.

Basic post op recommendations usually apply ie the old no lifting >5kg thing for 6 weeks. I just suggest to men that if they do start lifting anything again prior to the recommended period that they consider starting slow and building up. Robotic surgery has the advantage of being relatively painless so alot of men will just want to jump back into things so I usually throw them a line about not deciding to change over the engine in their car or paint their house during their sick leave period.

That’s where I start and then depending on their post op continence I will address issues of leakage, urgency, hesitancy or pain as they arise. Hope that helps and give me a yell if you want some further advice.

amy@controlphysio.com.au

portrait photo of man in white crew neck t shirt with assorted hand tools in background
Photo by Juan Pablo Arenas on Pexels.com

But, what’s a 6 week ‘check’ even for?

I tell all the women I see in clinic, on the maternity ward or in antenatal class that it would be ideal if they came and saw me 6 weeks after the baby comes out, regardless of how they came out for a ‘6 week check’. “But I feel fine” they cry, “I’ve done this before” they say. Ah yes. I’m glad you do and that’s great but I still recommend you come and have a ‘check’ with me to make sure you hit the ground running (but don’t start running just yet).

I thought I’d write down a few words about what it is that might happen during this appointment and why it’s so important and should be a part of standard postnatal care. If you’re about to say “but my obstetrician/GP/midwife saw me at 6 weeks and said I’m all good” then that’s also great news but nevertheless come and see me or another friendly women’s health and continence physiotherapist at 6 weeks postnatal. If you’re really proactive I’d like to see you at 20 weeks gestation too. And if you’re weeks, months or years past the prescribed 6 weeks then never fear we will be happy to see you nonetheless. Having a baby makes you much more likely to suffer from prolapse or incontinence in your lifetime and we’re here to help.

Women’s health physiotherapy isn’t a new thing but it’s slow to gain ‘awareness’ with other health professionals and the general public. Which is a shame because we can be of great assistance in and around pregnancy and childbirth and are masters at demystifying the pelvic floor, where it is and just how to exercise it ‘properly’.

So what happens during this check-

  • We talk through your birth and look for any specific risk factors that might predispose you to pelvic floor dysfunction such as an assisted delivery (vacuum or forceps), episiotomy, a long second stage (that’s the pushing bit), etc.
  • We discuss bladder and bowel habits ensuring things are working well and addressing anything specific going on with your nether regions. This might including needing to rush to the bathroom, not being able to hold on to your wind, constipation and many more!
  • We educate you on what the pelvic floor is, what it does, how to find it, what problems you might run in to due to your pregnancy such as incontinence, pelvic organ prolapse, diastasis rectus (that’s the gap in your tummy muscles) and more.
  • If you feel comfortable we physically check the pelvic floor and talk to you in detail about what might have changed and how that might affect you and returning to the things you love safely.
  • We prescribe you exercise for the pelvic floor specific to your level and show you how to perform you exercises correctly. Consider us your pelvic floors personal trainer.
  • We discuss your return to exercise goals whether they are a daily walk, caring for your children, running a marathon or playing competitive level sport. Then we specifically recommend timeframes for you returning to particular activities that are specific to you and your ‘healing’.
  • We inspect healing tissue and scars, and then help you to implement any management strategies that might assist with healing.
  • We discuss returning to intercourse without pain or problems and explicitly discuss time frames and strategies to assist.

So I’d love to see you at my clinic to ensure you get the best recovery possible from your pregnancy or birth. Or if you don’t live in Cairns or surrounds and would like to find a women’s health physiotherapist closer to you try https://cfaphysios.com.au/ or send me a message and I can help you track one down.

african pregnant lady

So you’re interested in pelvic health?

As a young physiotherapist I knew right from the beginning I wanted to become a women’s health physio. I have always been intensely passionate about women’s access to healthcare and felt that this little known corner of physiotherapy would suit me well.  Sometimes I found it difficult to work out what was next in terms of courses or conferences and deciding when to pursue postgraduate study. As such, I thought it might be worthwhile to have available some of the info about various women’s health physio events and courses that I have attended. This is by no means a comprehensive list of what’s available in Australia but rather some of the things I’ve been to and can comment on. For those physios just starting out in this area this might be worth a read.

Do an introductory course!

Initially I attended the 5 day introductory women’s health physiotherapy course run by the hugely talented women’s health physiotherapist Taryn Hallam of Women’s Health Training Associates. This wonderful course gave me an overview of the bulk of what women’s health physios come across and how I might begin to tackle them.

Taryn has a comprehensive list of courses, from introductory through to advanced, women’s health and pelvic floor courses which run all throughout the year. She is wonderful at providing summaries of the most recent evidence and powering through a lot of content in a few short days. Clinically she works in the eastern suburbs of Sydney at Alana Healthcare and has a special interest in pelvic pain.

To check her out go to:

http://www.womenshealthtrainingassociates.com/

The Australian Physiotherapy Association also regularly run introductory women’s health physiotherapy short courses.

The Continence Foundation!

continence foundation

The Continence Foundation are a government run organisation that provide lots of free clinical resources, run a toll-free hotline manned by very experienced continence nurses, run numerous public information nights and put on an excellent yearly conference for health professionals. I have called their continence nurses to ask clinical advice countless times and always been greeted warmly and at times when working in the Northern Territory where I had little clinical support they were an excellent clinical resource. I have attended the conference a number of times now and always left feeling buoyed by my new knowledge and feeling of understanding of transdisciplinary issues within continence. This year the conference is in Sydney and will run from 25-28 November, 2017. Each year the Continence Foundation awards ten scholarships to physiotherapists and continence nurses working in continence to attend the conference. I was lucky enough to receive one of these scholarships in 2015.

Listen to a podcast!

the pelvic health podcast

I regularly listen to the pelvic health podcast with Antony Lo and Lori Forner who interview clinical experts in the field of pelvic health and pelvic floor health. They are an engaging team both working in this clinical area. It is for both health professionals and the general public.

To listen to the podcast: http://physiodetective.com/pelvic-health-podcast/

Do some clinical shadowing or find a mentor!

The field of women’s health physiotherapy can be daunting as often we don’t know what it entails and the prospect of this field of physiotherapy that deals with issues below the belt can be overwhelming if you’ve been treating hips and knees mostly. I am lucky enough to have had some great mentors in my time and was welcomed warmly by other pelvic health physiotherapists in letting me come in and spend time clinically shadowing them to understand what pelvic health looked like in practice. Almost everyone I have ever contacted has been receptive to me doing some clinical shadowing.

Take the leap and study a postgraduate degree in Pelvic Floor Physiotherapy!

Last year I completed my Graduate Certificate in Pelvic Floor Physiotherapy at the University of Melbourne. The course is split in to three components- 2 subjects and a clinical placement. The introductory pelvic floor subject incorporates anatomy labs, practical vaginal assessment and assessment/treatment of common conditions relating to the bladder. The advanced pelvic floor subject deals with bowels, paediatrics, men and pelvic pain. Both subjects run in a two week intensive block on campus at Melbourne University. The quality of teaching is high, there are plenty of opportunities for interaction with professionals working in the field, the focus is on evidence based practice and you build a strong women’s health physiotherapy community to call on when you have tricky patients.

I completed my studies over 2 years and for me this was the better option as the academic load in terms of assignments after each subject is high- expect weeks of gruelling late nights. However, lots of the women completed the entire course in one month long block.

Course fees are Australian standard postgraduate level cost and I think it cost me about $10,000.

So that’s some of my learning journey so far. Hopefully it helps you work out your next steps.

When you’ve got to get to the toilet RIGHT NOW

Bladder urgency and frequency is a common problem. Sometimes it’s paired with urinary incontinence but often it’s just that feeling of ‘I’ve got to go right now!’. Women will often report that they are going to the toilet ten or more times per day and often they see that as being just a normal thing that happens and they’re completely unaware that with a few strategies they can regain control of their bladder.

I liken an urgent bladder to a 2 year old child- provide it with no discipline or direction and you will have a naughty bladder that screams at you that it wants to go to the toilet now, absolutely can’t wait and isn’t taking no for an answer. We just need to implement some basic discipline and it will begin to behave.

So exactly how do I look after my bladder you say?

Somebody about a hundred years ago came up with the ‘fact’ that we need to consume  2 litres of water to be healthy and health professionals have been spouting that ever since. Humans consume an awfully big range of fluids each day and your needs will vary depending on your body size, activity levels, how hot it is where you live, etc . There isn’t a perfect amount of water you need to drink each day. Studies have shown that we stay hydrated and cell function continues within large ranges of fluid intake. A good rule is to have a look at your wee and if it’s got anything more than a light straw colour or an odour you should probably take a bit more in. If it’s completely clear then it might be time to lay off the fluids for a little while. Don’t forget than any kind of fluid is fluid- it can enter your body via watery foods, cups of tea or coffee, juice or herbal tea. Just be mindful that some bladders are sensitive to too much caffeine, alcohol or certain foods such as chilli or artificial sweeteners. The take home message: sip regularly throughout the day, avoid too much caffeine or other irritants and monitor the colour of your wee!

water

Another common problem is people going ‘just in case’. When we leave the house, before a road trip, before we leave for the shops it seems commonplace that even though our bladder isn’t making a squeak of noise we think it’s probably best we empty it lest it gets full when we’re in a public place. Now I see the logic because some of us are not so fond of a public toilets but if we tell our bladder that at half capacity all the time it needs to be emptied it gets used to that and so each time it gets half full it starts telling you that it’s time to go. And so begins the cycle of the reduced bladder capacity. Maybe it started when you were a little kid and Mum wanted everyone to go before you left the house so you weren’t stranded by the side of the road. The good news is it’s not too late- before you catch yourself going just because stop and think ‘no I’ll just wait’.

Some women experience triggers, such as the key in the lock when they first get home or running their hands under the cold tape. Over time when we respond to these triggers by going to the toilet we are strengthening the idea that our bladder/brain has that each time we get the key out it’s time to go to the toilet. Avoid responding to triggers and wait until the urgency has subsided before you rush off. You might find you don’t need to go to the toilet just yet.

If you’ve got a bladder that takes you to the toilet more than 8 times a day, more than once at night, if it yells at you that it’s got to go right now and makes you rush or if you’re not making it in time it might be time for a trip down to your local women’s health physiotherapist to work out some of the particulars. Women’s health physiotherapists can help you with retraining your pelvic floor to hang on to your bladder for longer, strategies for calming your bladder down and provide individualised assessment and treatment of your bladder concerns.

Don’t get caught out ever again- get back to doing the things you love and don’t let your bladder rule your life!

 

lady car

 

 

 

 

Welcome!

Welcome to Amy Lamb Physiotherapy where I talk about all things physiotherapy related from before birth and beyond. If you’re a new mum; somebody keen to get back to exercise after birth or injury; or a physiotherapist or personal trainer with an enquiring mind then this site is for you. I enjoy working with both women and men in managing incontinence; pelvic organ prolapse; sexual dysfunction and pelvic pain; return to exercise post injury, surgery or birth; and lots more. Let’s do this thing and learn some things.IMG_4932