KATIE IS EXPERIENCED IN A WIDE RANGE OF WOMEN’S PELVIC HEALTH AREAS INCLUDING:

• Pregnancy and Postnatal Services

• Rectus Abdominis Diastasis (RAD)

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Pregnancy and Postnatal Services

Pregnancy Ante-Natal Assessment

A physiotherapy assessment is suitable for any time throughout your pregnancy.  Pelvic Health Physiotherapists can assist with pelvic floor and abdominal function, low back pain and pelvic pain. Katie will create a tailored management plan, including activity and exercise advice, specific to your individual needs and goals.

Post-Natal Assessment

During pregnancy and childbirth, a woman’s body goes through a huge amount of change, transformation and healing. There are changes to the pelvic ligaments, fascia and muscles that occur because of hormonal changes as well as increased load due to the weight of your baby.  

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From 4- 6 weeks following either a caesarean or vaginal birth, women can have a thorough post-natal assessment by a Pelvic Health Physiotherapist. A post-natal review allows you to discuss and manage any problems that you are experiencing, prevent any injuries from occurring, return safely and pain free to exercise and sexual intercourse; and to ensure that your body fully heals following pregnancy and birth.

Rectus Abdominis Diastasis (RAD)

RAD, commonly known as abdominal separation is when the outer layer of the abdominal muscles separates through the centre of the abdominal wall. This is a common occurrence during pregnancy as the muscles and fascia needs to stretch to accommodate a growing baby.

Assessing your abdominal wall, and in turn RAD will form part of your post-natal assessment. When checking for RAD there are a few considerations.

Width of the RAD- The measurement of separation between the left and right rectus abdominis muscles. This is also known as the inter-recti distance (IRD). We want to assess what happens to this distance under different loads and positions.

Length of the RAD- The distance along the midline above and below the belly button

 Depth of the RAD- This indicates the quality of the connective tissue (Linea alba) you have available to transmit force across the abdomen.

 Linea alba Integrity & Tension- The Linea alba is the connective tissue which connects the abdominal muscles in the midline. It is a very important structure which transmits force across the abdomen while maintaining optimal intra-abdominal pressure. The Linea alba widens and softens during pregnancy to allow for the growing size of the pregnant belly however sometimes after birth, the Linea alba remains widened which reveals the “gap” or separation between the abdominal muscles.

 Transverse Abdominis Activation and general abdominal wall control

The transverse abdominis is the deepest layer of the abdominal wall and represents the front of your “core” canister.  This muscle can be checked on real time ultrasound or via palpation to ensure correct activation patterning. The pelvic floor is closely linked with transverse abdominis and can be checked on ultrasound at the same time as we assess your abdominal muscles. Research tells us that it is not just activation of the Transverse Abdominus that is important but strengthening the entire abdominal wall to ensure good support and functional control. Following a thorough examination, an exercise program can be devised which will help to strengthen the abdominal wall safely and effectively.

C Section Recovery (more of a blog/ info post)

A caesarean delivery, or C-section, may be planned or unplanned, but either way it is major abdominal surgery. We often find women are unsure on how to best look after their bodies after such surgery. Here are a few tips to aid in recovery over the first 6 weeks after a caesarean delivery:

1. Listen to Your Body

It is normal to experience some general discomfort and stiffness following your C- Section.  Take pain relief as required in the early days, as this will allow you to gently move around more comfortably. If  you are experiencing increasing or heightened levels of pain then it may be a good idea to talk to your GP or care provider. You will become more mobile each day, but be sure to listen to your body, if you over-do it you may experience more pain or swelling around your incision, take that as your cue to take a break.

2. Catch Up on Some Sleep

This one is easier said than done. If you have support or help at home, try and make the most of it and take the opportunity to sleep and rest. Supine rest is one of the best things you can do to aid your recovery.

3. Be Mindful of How You Move

Aim to log roll out of bed to avoid any extra pressure over your incision.  If you are standing up from a chair, gently contract your lower abdominals or use your hand to support your belly to give your incision some extra support.

4. Consider Using Compression Support Garments

Support shorts, leggings or tubi grip can provide compression around your abdominals and pelvis.  The compression can help make your tummy feel more comfortable and promote blood flow to the incision for healing!

5. Gentle Movement

As you begin to feel more comfortable, you can begin going for short walks. Gentle exercise that focuses on your pelvic floor, breathing and movement.

PELVIC GIRdLE PAIN (PGP)

Many women may experience pregnancy related Pelvic Girdle Pain. This condition can have a negative impact on a woman’s quality of life, impacting on her psychological and emotional health.  

PGP is described as, any pain occurring  in the pelvis (specifically between the iliac crests and the gluteal fold, particularly in the vicinity of the sacroiliac joints). The pain can radiate down the back of the thigh (known as the posterior thigh), and can also occur in conjunction with, or separately in the area between your left pelvic bone and your right pelvic bone, known as the pubic symphysis. This pain can cause a reduced capacity to stand, walk and sit.

PGP can be successfully managed with physiotherapy. It is important to have a thorough assessment to determine what is contributing to developing PGP.

What are some reasons why I am experiencing PGP?

Like other pain conditions, development of PrPGP is often multifactorial.  During pregnancy, the structures of the pelvis are more sensitised, compared to non-pregnant women. Biological, psychological, and social factors all contribute to the complex and individual nature of PGP.

To accommodate a growing baby, postural changes and changes in muscle activity can influence the motor control around your pelvis, hips, abdomen and lower back. These changes influence the forces going through the pelvis and can lead to the development of pain. Women are far more likely to experience PGP, if they have previously experienced pelvic or lower back pain. Similarly, women who experience high stress, depression or anxiety are significantly more likely to be impacted by PGP.

How long does it take for PrPGP to go away?  

Not everyone is the same when it comes to pelvic girdle pain, so the required physiotherapy treatment and exercise plan may depend on the contributing factors and severity of your symptoms. How long it takes for the pain to reduce will depend on your physical wellbeing and the issues that you’re experiencing. Physiotherapy is recommended before and after childbirth to optimise your pregnancy and birth experience. Your initial visit to determine the recommended treatment plan will be defined by the type of pelvic girdle pain you’re experiencing.

Physiotherapy treatment may help you to manage your symptoms and maintain some gentle movement during your pregnancy.  

Bladder Dysfunction

Incontinence is a widespread condition that ranges in severity from just a small leak to a complete loss of bladder or bowel control. Incontinence affects one in three Australians and has a detrimental effect on quality of life, confidence and longer-term commitment to physical activity. To look even further ahead, it is one of the most common reasons for admission into aged care.

The good news is, incontinence can be very well managed, and in most cases, completely overcome with conservative management. Education, pelvic floor muscle training and good bladder and bowel habits are cornerstones in such management.

Katie is trained to help identify what type of incontinence you have, and provide a specific, individualised and evidence-based management plan to help you overcome such symptoms.

There are 3 main types of urinary incontinence:

1. Stress Urinary Incontinence

Stress Urinary Incontinence is when urine leakage occurs with activities that increase pressure in the abdomen and push down on the bladder, ie coughing, sneezing, laughing, and jumping. Stress urinary incontinence is often due to weakness and/or stretch of the pelvic floor muscles. In women, it is often associated with pregnancy, vaginal delivery, and menopause. Stress urinary incontinence is also prevalent in athletic women, particularly women involved in high impact sports due to the load such sports place on the pelvic floor muscles.

Pelvic floor muscle training has level 1A (highest possible) evidence in treating stress urinary incontinence. It is important that the pelvic floor muscle exercises are performed correctly and consistently to achieve this result. Katie will assess your pelvic floor muscle function through  a vaginal assessment and/ or Real Time Ultrasound. Katie will discuss the different assessment techniques and provide advice on what is most appropriate for you. You will be given the opportunity to ask questions and discuss any concerns you may have. Following your assessment Katie will prescribe a specific program for you.

2. Urge Urinary Incontinence

Urge Urinary Incontinence is a sudden and strong urge to urinate. It is often with small bladder volumes and can sometimes be referred to as an Overactive Bladder. Urge incontinence can be associated with leaking on the way to the toilet, but not always. The mechanism behind urge incontinence is more complicated than stress urinary incontinence, but a combination of pelvic floor muscle exercises (and not always strength exercises), bladder and brain retraining is effective in regaining control over the bladder. In some cases, your physiotherapist may suggest the use of TENS ( transcutaneous electrical nerve stimulation) , which may assist in reducing the urgency symptoms by neuromodulation to sacral nerve roots which supplies the bladder. Katie will help guide you through the most appropriate management plan for you.

3. Overflow Urinary Incontinence

Overflow Urinary Incontinence is when the bladder is unable to empty properly and frequent leakage of small amounts of urine occurs as a result. Signs of Overflow Incontinence can be straining to urinate, slow urine stream/flow, regular urinary tract infection or urinary frequency. It is important to identify the reason behind Overflow Incontinence in order to manage it. Such reasons can be pelvic organ prolapse, tight pelvic floor muscles, poor bladder emptying techniques and some medications. Your physiotherapist will work with you to identify why you may have overflow incontinence and determine the most effective management to overcome it.

Post-Micturition Dribble (PMD)

Post-Micturition Dribble (PMD) is the involuntary loss of urine after a person has finished going to the toilet. Unlike other bladder conditions, PMD is far more common in men than women. PMD is irritating and can be embarrassing, as it is often associated with men wetting their pants and clothes. Katie will identify the reason why you have PMD and provide an individual management plan to overcome it.

Nocturnal Enuresis

Nocturnal Enuresis is bedwetting, and affects up to 1 in 100 people. Nocturnal Enuresis can be either primary (starting in childhood) or it can occur in adulthood and may have a significant impact on a person’s quality of life. It is important that your physiotherapist works with you to take a throughout history and assessment. This allows for correct management, and on occasions will involve other care providers to ensure that there is no underlying medical conditions that may be contributing to symptoms. Often there are simple things that can make a big difference to reduce Nocturnal Enuresis and improve the quality of life of patients suffering with it.

Bowel Dysfunction

Constipation
It is normal for you to open your bowels 3 times a day to every 3 days. You should get a good, controllable urge. You should be able to empty your bowels without straining and you should feel empty after. Katie can assess and assist with the management of bowel issue, including constipation.

Faecal Incontinence

Leaking faeces/wind, smearing on your underwear, or not being able to wipe clean are all associated with faecal incontinence. Faecal incontinence has many causes and correctly identifying them are key to management. Katie is  trained in rectal assessments and management of faecal incontinence.

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