Pelvic Solutions

FAQ's

Frequently asked questions

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  • What is Pelvic Floor Physiotherapy?

  • Do I need a referral?

  • What does a Pelvic Floor Physiotherapy appointment involve?

  • Why would a Physiotherapist be doing vaginal or rectal exams?

  • How will I feel after an internal examination?

  • Are all Physiotherapists able to treat pelvic floor dysfunction?

  • How many treatments will I need?

  • Is it only women after childbirth that need to see a Pelvic Floor Physiotherapist?

  • Is it OK to have an internal examination while pregnant?

  • If I am leaking urine, can’t I just do my “Kegel” exercises (pelvic floor strengthening) and I will improve?

  • I constantly feel the urge to empty my bladder. Can Pelvic Floor Physiotherapy help?

  • Is Pelvic Floor Physiotherapy treatment necessary if a person has already had surgery OR is planning to have surgery?

  • If a person has a diagnosed “medical cause” of his/her pain, will Physiotherapy help?

  • Are people’s daily habits related to pain, urinary or bowel dysfunction?

  • I have tried “Kegel” exercises and they did not work for me. Will Pelvic Floor Physiotherapy still be able to help?

  • What can I expect to gain from treatment?

  • I have a pelvic organ prolapse, is there anything that can be done conservatively without surgery?

  • Can my children come to the appointments?

  • Is my appointment covered by ACC?

What is Pelvic Floor Physiotherapy?

Pelvic Floor Physiotherapy is a special interest field of Physiotherapy, aimed at assisting those with pelvic floor dysfunction back to optimal pelvic health and continence.   For more information please click here 

Do I need a referral?

No.  You can make your appointment without a referral.  ACC and private appointments are available. If you do have a referral from your doctor or health care provider, then they will send it to Pelvic Solutions directly. To book now click here.

What to expect from a Pelvic Floor Physiotherapy appointment

During your initial appointment extra time is allocated to gather detailed information about your presenting complaint, bladder and bowel function, medical, gynaecological and surgical history, birthing history, sexual function, dietary habits, toileting behaviours, and lifestyle.

A thorough physical examination is then performed which includes assessment of posture, breathing mechanics, musculoskeletal testing, and if appropriate may include an internal vaginal or rectal examination. This examination is performed by observing and/or palpating the perineal region including the vagina and/or rectum. This evaluation will assess skin condition, reflexes, muscle tone, length, strength and endurance, scar mobility and function of the pelvic floor region (note: your therapist will explain the procedure completely and only proceed with your consent).

This allows us to form a working diagnosis. Your Pelvic Floor Physiotherapist will explain the diagnosis to you and discuss the different treatment approaches which may be appropriate. In some cases, referral back to your GP or another practitioner may be required.

Up to 55 minutes is allowed for the initial consultation. This allows for a thorough understanding of your condition and for initial treatment to take place.

Follow-up appointments may be required to achieve best results. Return appointments are up to 40 minutes. Extended 60-minute appointments are available for more complex and chronic problems. Your progress is reviewed at every appointment and the treatment adjusted accordingly. Some conditions may improve quicker with a prescription of specific exercises: your Physiotherapist will advise you.

Why would a Physiotherapist be doing vaginal or rectal exams?

Physiotherapists are experts at working with the musculoskeletal and neuromuscular systems of the body. With their additional specific training, Pelvic Floor Physiotherapists are well-placed to assess and treat muscle groups, including the pelvic floor. The muscles of the pelvic floor are found at the opening of the vagina (in women), urethra, and rectum. Thoroughly assessing the function of the pelvic floor is possible with an examination performed with one finger (gloved) inserted into the vaginal or rectal canal. There is a strong anatomical basis for this seemingly unconventional exam. Pelvic Floor Physiotherapists train in both internal and external evaluation and treatment techniques and current medical research backs this approach.

An internal assessment is the “gold standard” for comprehensive assessment of the pelvic floor. Some patients may be hesitant at first but then choose to go ahead with internal assessment. However, for patients who are not comfortable with internal examinations, there is no obligation to have one. Pelvic Floor Physiotherapists can assess the function of the pelvic floor by using external observation and cueing. A surface EMG (electromyography) biofeedback test can be used to assist this examination.

How will I feel after an internal examination?

Most people feel fine after an internal vaginal examination, no different than after a pap smear test usually. If treatment involves extended internal body work, releasing the pelvic floor muscles and trigger points, then some people can experience some aching after treatment (like after a massage!), but this generally resolves within a few hours. Some people can feel thirsty, have headaches, and feel tired after internal body work, especially if the muscles are chronically tight. Listen to your body and rest as you need to. It is important to hydrate with plenty of water. It is recommended that after an internal examination you drink a large glass of water, and empty your bladder as standard care. You will be provided with detailed aftercare instructions after your treatment.

If you have any concerns about how you are feeling after internal body work then please get in touch with Lisa by email here.

Are all Physiotherapists able to treat pelvic floor dysfunction?

No. To be able to practice in this highly-regulated profession, our therapists have completed extensive post-graduate training in this field to gain the knowledge and clinical skills necessary to treat this complex clinical area. Lisa and Ingrid studied through The Women’s Health Training Associates and Melbourne University, as they offer a comprehensive training for Physiotherapists in this field. To be competent to work in this area, Lisa and Ingrid’s professional development has included hundreds of hours of theory and practical study. Although our therapists can treat musculoskeletal injuries like ankle or shoulder sprains, she focuses on treating those with pelvic floor dysfunction, rather than standard injuries.

How many treatments will I need?

Some results can be felt immediately after the first session, however for permanent changes to be made it usually takes longer. Usually 3 treatments are indicated initially one week apart, then if needed a follow-up anywhere between 2-4 weeks later, and then further treatments less often if required. This is due to the complex nature of most cases Lisa treats, and usually the problems are chronic, meaning it takes time to change behaviour, and strengthen muscles and co-ordinate body systems to improve function. Lisa will strive to resolve your problem in the minimum number of treatments; the greatest success occurs when you are an active participant in your treatment program, and follow the advice given. Our therapists communicate directly with patients outside of appointments and are always available by email to discuss any problems or concerns you may have with your program.

**Due to high demand we encourage all new patients to book their initial and two follow up appointments two weeks apart to ensure you get the most out of your treatment. If you are progressing well, Lisa will advise you and ask you to reschedule your third and any follow-up appointments.

Is it only women after childbirth who need to see a Pelvic Floor Physiotherapist?

Lisa treats a wide range of patients, not only post-partum women. This includes young and old people experiencing a wide variety of symptoms, including urinary incontinence, difficulties in urination, bowel incontinence, constipation, sexual dysfunction, pelvic pain, vaginal or rectal pain, as well as people prior to or after having pelvic surgery. This list is not exhaustive: if you are unsure whether your condition can be treated by a Pelvic Floor Physiotherapist, please use the contact form and get in touch.

Is it OK to have an internal examination while pregnant?

There is no evidence that internal vaginal examinations during pregnancy cause miscarriage, however due to the higher risk of miscarriage in the first 12 weeks, Pelvic Floor Physiotherapists may not examine internally during the first 12 weeks of pregnancy if there is a history of unstable pregnancy or miscarriage.

If I am leaking urine, can’t I just do my ‘Kegel’ exercises (pelvic floor strengthening) and I will improve?

This is a very common misconception. Urinary incontinence is a failed system, not just a failed muscle. Having a strong muscle does not necessarily mean it is coordinated. To remain continent, people need a fully-functioning system including muscle groups which are strong but flexible, and which can coordinate how to tighten when they need to and relax when they need to. Assessment with a Pelvic Floor Physiotherapist involves looking at these muscle groups, including the pelvic floor muscles, abdominals, hip muscles, lumbar spine and diaphragm, as well as breathing mechanics, and how they function as an integrated system. Sometimes pelvic floor muscles can be shortened and irritated, and this can also lead to incontinence just as much as having a weak pelvic floor. Your Pelvic Floor Physiotherapist will advise you of the individualised exercises that are required to help your specific problem.

I constantly feel the urge to empty my bladder. Can Pelvic Floor Physiotherapy help?

Absolutely.  Bladder training and pelvic floor muscle exercises can help reduce these distressing symptoms. Advice about how to modify your lifestyle and diet can also help improve symptoms.

Is Pelvic Floor Physiotherapy treatment necessary if a person has already had surgery OR is planning to have surgery?

To help patients achieve optimal health, Physiotherapists usually work very closely with surgeons. Surgery can repair a structural problem, but it is equally vital to restore muscular control and function to accomplish the best results after surgery. Research has shown that physiotherapy prior to and after surgery improves patient outcomes, as well as reducing the need for future surgery. Pelvic Floor Physiotherapy can also help after procedures such as vaginal botox, to help with restoring muscle function, retraining of the complex core system including the breath, and optimising sexual functions.

If a person has a diagnosed “medical cause” of his/her pain, will Physiotherapy help?

Some diagnoses have a musculoskeletal connection. To give an example, endometriosis in women causes serious pelvic pain and can produce severe trigger points, connective tissue restrictions, and muscular restrictions in the muscles of the pelvis. Sometimes, in the case of a laparoscopy, removing the endometrial tissue does not ease the pain. This is due to the soft tissue restrictions that may remain. In the end, a multidisciplinary approach to treating pain proves to be the best way to help people recover optimal health.

Are people’s daily habits related to pain, urinary or bowel dysfunction?

It is a common misconception that longstanding habits are not a primary cause for certain problems, even if the problem is new. Often habits such as eating processed food, drinking coffee or sugary soft drinks, exercising too vigorously, straining to pass urine or bowel motions or long periods of sitting at a computer can strongly influence a person’s symptoms. It is essential for your Physiotherapist to evaluate all of your habits to help you comprehend the habits you can modify to improve your health.

I have tried “Kegel” exercises and they did not work for me. Will Pelvic Floor Physiotherapy still be able to help?

Rehabilitation for the pelvis requires much more than strengthening the muscle groups. Restoring function and improving muscular support around the pelvis are crucial, as are improving behavioural/dietary habits and re-training the body to perform movements that allow for optimal organ support and structural performance.

With that said, there is a large amount of evidence that supports pelvic floor strengthening exercises to help with pelvic floor dysfunction such as incontinence and pelvic organ prolapse. Many of the women Lisa treats are performing exercises incorrectly and ineffectively, often pushing down which is a potentially damaging action, rather that lifting up. Lisa often hears comments from post-menopausal women such as “if someone had assessed me properly (internally) 50 years ago and told me this information I probably could have avoided this problem” (commonly organ prolapse or incontinence).

What can I expect to gain from treatment?

Expect improved control, higher self-esteem, better sex, improved continence, increased confidence, better natural lubrication, improved sensation in the vagina and much more!

I have a pelvic organ prolapse, is there anything that can be done conservatively without surgery?

There is strong evidence that treating prolapse (Grade 3 or less) conservatively with Pelvic Floor Physiotherapy (for up to 6 months) can significantly improve or even reverse prolapse and symptoms. Grade 4 prolapse (outside of the vagina completely) usually needs surgical intervention to resolve.

Can my children come to the appointments?

While we strive to be family-friendly it can be beneficial for Mums if children are not present, so they can focus completely on the treatment. There is often a lot of new information to absorb and if internal treatment is required we want you to be as relaxed as possible. However, we will do our best to accommodate the needs of your family.

Is my appointment covered by ACC?

Pelvic floor/perineal injuries covered by ACC are usually only after instrumental deliveries (forceps and ventouse), or trauma caused in an accident e.g. broken pelvis. Generally, ACC will only cover treatment within 12 months of the date of injury. If an ACC claim has expired there is a possibility it could be reactivated. Your practitioner can discuss this with you.

If you have sustained a musculoskeletal injury due to an accident and it has affected your pelvic floor function, in most cases you will be able to lodge an ACC claim at the time of your appointment. If you have lodged a claim with your GP, or have had ACC-covered treatment from another therapist (e.g. Osteopath, Physiotherapist, Chiropractor or Acupuncturist), please bring the relevant information, such as claim number and date of claim, to your appointment.

ACC will only cover part of the cost of treatment, so there will be a balance to pay. Please click here for treatment rates. You will be required to pay the full private fee until you have provided the relevant claim information and it has been confirmed by ACC to be valid. If you need assistance understanding whether you are eligible for ACC, please get in touch with us.