Prostate cancer is the most common cancer in men. It is known to affect 1 in 6 men over the age of 65 years (1).  Fortunately, the treatment options AND outcomes are improving.  The role of physiotherapy is often overlooked and not considered in the treatment journey. This post aims to raise some awareness on the impacts of cancer and how physiotherapy can play a crucial role in the recovery. Prostatectomy is one of the treatment options your surgeon may advise, which is the removal of the whole prostate (radical prostatectomy). ​

A review of the anatomy, the image below shows the pelvic floor muscles (red) these are a group of muscles and connective tissues which create a supportive sling underneath the bladder and bowel for men. The prostate is located underneath the bladder. The valves that control the bladder are known as the internal and external sphincter as shown. The internal sphincter can be affected with surgery resulting in urinary incontinence. 
 
​The role of pelvic health physiotherapy 
Physiotherapy can be beneficial prior to surgery to assist with this common side effect of urinary incontinence. A pelvic rehab specialist works to help you identify and train the pelvic floor muscles which assist with continence. These muscle house the external sphincter(pic) that has a role in bladder function too.  Identifying and training these muscles is important to help with regaining continence earlier after surgery (2). It is recommended to start therapy before surgery in addition to after.

​Pre-operation rehabilitation aims to 

• Improve better outcomes post surgery
• Minimize complications 
• Address any pre-existing concerns regarding bladder or bowel function
• Assist in early recovery of incontinence and/or erectile dysfunction 

At Inner Active Pelvic Health Physiotherapy our physiotherapists aim to work closely with you, your surgeon and healthcare team to help reach your goals in achieving optimum recovery and health. Treatment encompasses education, holistic pelvic health and physical health alongside prescription of a graded exercise program to help you to return to doing the things you love. 
If you or know of anyone faced with the effects of prostate cancer treatment and are having issues, a pelvic health physiotherapist can help. 
Contact us here  or can send an email to info@inneractivephysio.com.au 
Telehealth appointments are also know available. 

Author 

Tafy Seade
BSc Honours Physio, Post Grad Cert Women’s Health, Pelvic Floor and Incontinence 

References:
(*images courtesy of the Continence foundation of Australia)
1) Understanding Prostate Cancer, Cancer Council Australia © 2020. Last medical review of source booklet: March 2020. 
2)Filocamo MT, Li Marzi V, Del Popolo G, et al. Effectiveness of early pelvic floor rehabilitation treatment for post-prostatectomy incontinence. Eur Urol. 2005;48:734–738. doi:10.1016/j.eururo.2005.06.004 

In this month's blog, Tafy had the opportunity to interview Dr Simon Glance, a gastroenterologist based in the Northern Suburbs and part of the health care team at the Bundoora Health Specialist centre. ​

As pelvic health physiotherapists we treat conditions impacting both bladder and bowels. Constipation continues to be major problem worldwide and common complaint in Australia.
In this interview we talk about the importance of seeking help and recognizing when bowel habits are not normal. Chronic constipation can be primary or secondary and often can be accompanied with other issues the longer it continues including the musculoskeletal system and the pelvic floor muscles!

Topics covered are:

• Common conditions seen by a gastroenterologist (2:12)
• What is constipation? (3:10)
• Common causes of constipation (04:46)
• Brain and Bowel connection (06:05)
• The role of the gastroenterologist in managing constipation (07:19)
• The role of the pelvic floor physiotherapist in constipation assessment and management (10:20)

For more information on the following, see resources and links below: 
Dr Simon Glance- GastroNorth 
Bowel anatomy - Continence foundation of Australia
Looking after your bowel booklet - Continence Foundation of Australia

If you would like to know about how a pelvic physiotherapist can help you with your bowel concerns, please reach out and contact us at info@inneractivephysio.com.au

Although it may appear to be a definition with a somewhat obvious simple solution: RELAX ......it is actually a lot more complex than that. Many women are faced with this problem and unfortunately despite ongoing research findings and evidence they are continually told JUST RELAX when these muscles are not cooperating. The aim of this post is to help highlight what it means having an overactive pelvic floor muscle, what can be involved and who may be needed in your care team to help you manage.
An overactive pelvic floor muscles can be a result of

• Trauma -directly and indirectly to the pelvis or pelvic floor - for example accidents result in a fall, or abuse)
• Injury such as from childbirth- assisted deliveries e.g. forceps or vacuum extraction), 
• Surgery in particular abdominal or pelvic surgery that can result in adhesions and scar tissue impacting the organs and muscles 
• Pathology (for example underlying conditions) 
• Chronic pelvic pain 
• Issues with posture
• Use of the pelvic floor muscles incorrectly 
• Psychosocial/emotional issues     

As a result of the above this type of muscles result in 

• Urinary problems such as incontinence and/or voiding issues 
• Bowel issues including emptying properly
• Pelvic pain 
• Trauma 
• penetrative pain 
• Psycho-social and emotional issues
• Postural issues 
• Pathology
• Sexual dysfunction such as pain with intercourse (dyspareunia) 

It becomes clear the management of these muscles is not as simple or a "one size fits all" approach. As shown several factors can be reason or a result in addition to having more than one cause or effect. Therefore treatment requires an individualized, multidisciplinary approach that can  include : 
1) Medical - doctor, specialists  such as urogynecologist, urologists, 
2) Psychologists specialising in pelvic pain 
3) Specialized Pelvic Health Physiotherapists - 
At Inner Active Pelvic Health Physiotherapy our physiotherapists are trained in the management of overactive pelvic floor muscles that can result in pelvic pain and/or bladder and bowels issues. We work closely with other healthcare providers to ensure a holistic approach. Treatment is based on taking a very detailed history of your condition and understanding your story.  An assessment that is suitable and appropriate to your situation can be done of the pelvic area, including the pelvic joints, muscles, movement and posture assessments.  Treatment can include the following: education, manual therapy, use of biofeedback or electrical physiotherapy, use of trainers or graded exposure therapy. 

If you suspect you may have overactive pelvic muscles that may be associated with your condition, reach out and see how our physiotherapists can help. Contact us  HERE 

Author 
Tafy Seade (Pelvic Health Physiotherapist) 
​August 2020
 References 
1) Messelink B, Benson T, Berghmans B, Bø K, Corcos J, Fowler C, Laycock J, Lim PH, van Lunsen R, á Nijeholt GL, Pemberton J, Wang A, Watiert A, Van Kerrebroeck P Standardization of terminology of pelvic floor muscle function and dysfunction: Report from the Pelvic Floor Clinical Assessment Group of the International Continence Society. Neurol Urodyn 2005;24(4) 374-380.

Written by Sarah Henderson

​Take a look at this video which details the intricate relationship between the endocrine system (hormones) and the menstrual cycle.
​It’s so important to understand “normal” menstrual function in order to identify times when this process is disrupted or impaired. Although there is natural variability amongst women, a typical menstrual cycle is around 28 days and is essentially the body’s monthly response to not being pregnant (i.e. the egg released by the ovaries is not fertilised and thus the endometrial lining is shed).
The delicate interplay of hormones, genetics, nutrition, physical health and behavioural factors can all play a role in the female menstrual cycle. These influences are incredibly important to maintain normal cyclic menstrual function and if necessary, they can be used to address any changes or abnormalities that may arise throughout the female lifetime (e.g. menopause).

How to check for an abdominal muscle separation.
In clinic a thorough a assessment can be  carried by one of our physiotherapist that aims to establish the integrity of these muscles and tissues but measuring the width, length,depth, tension and surrounding muscle activity. 
However at home you can assess yourself for the width and the tension. ​

​A measurement of 2 fingers or more represents a separation & will require further rehabilitation. Although generally not painful abdominal muscle separation can consequently result in poor truck and pelvic floor support due to the weakened abdominal wall. 
Usually this separation becomes apparent when women start noticing a bulge or doming in this area when getting out of bed or a chair. 

To be continued.......

​Written by Sarah Henderson

What causes it?
A study has found that 100% of women experience some form of DRAM during pregnancy (Mota et al , 2015) due to the following factors:

• Weight gain & increase size of tummy
• Hormonal Changes
• Abdominal weakness

 
What happens after pregnancy?
Abdominal separation is a natural mechanism of pregnancy to accommodate for the growing foetus.
The separation itself is not a medical emergency, however, the impaired abdominal wall function & weakened deep core muscles can result in back pain, pelvic pain, constipation and in rare cases a hernia. In addition, this condition can be associated feelings of negative body image & reduced self-confidence
This separation generally resolves within 6-8 weeks post-partum. In some cases, this laxity remains and varying levels of separation can result.
Those women that may be at greater risk of persistent post-natal separation:

• Aged > 35years
• Increase in weight or size of baby/babies
• Previous pregnancies (>3 especially)
• Pre-existing separation

Further risk factors for DRA include:

• Heavy or poor lifting techniques
• Chronic straining (constipation, cough etc)
• Excessive abdominal loading (i.e. exercise)

Coming soon Part 2 How  to check and manage a DRAM......

If you suspect you have an abdominal separation and need further advise or guidance contact us via email  on info@inneractivephysio.com.au or make a booking  HERE 

By Sarah Henderson 
Sarah has completed post-graduate study in women’s health & manual therapy of the pelvic floor, gaining experience in conditions relating to the pelvic region including pregnancy-related pain, postnatal rehabilitation, urinary incontinence, pelvic organ prolapse, diastasis rectus abdominus, as well as pre & post-surgical recovery of the pelvic region. 

What are we doing?
As per the requirements from the Department of Health, all team members who have been to traveled from the listed countries are excluded from returning to work for 14 days from the date they left that country. This is also the case for any team member who is feeling unwell or showing signs or symptoms of being unwell, will remain at home. We want to to assure you that we are working hard to keep you safe by he following: 
- Increased the cleaning frequency  
- Regular cleaning of all equipment including exercise equipment
- Use of hand hygiene and hand sanitizes use in and around the clinic including the front desk 

What can you do?
We request you follow the guidelines and recommendations set by the Department of Health and self-exclude if you have been to any of the countries with exclusion periods or have been in contact with someone with confirmed or suspected COVID-19. We also ask that you not attend the practice when you are unwell regardless of whether you think this may be COVID-19 or a cold or flu.

Please make sure you are practicing excellent hygiene as hand washing and containment of bodily fluids continue to be the best defence against the spread of cold, flus and COVID-19.

In addition simple measures we can all take to help prevent the spread:

• Wash your hands with soap and water for a minimum of 20 seconds, use hand sanitiser when you don't have access to a sink
• Avoid touching your eyes, face and mouth
• Sneeze into a tissue or your elbow and cover your mouth if you need to cough.

Cancellations
Please respect our policy to cancel your appointment if you feel sick. if you cancel outside of the 48 hour period or cancel due to sickness, there will be no fee charged. We do however, request you provide us with as much notice as possible as we have a lengthy list of people waiting for appointments.

If you do wish to keep your appointment and would like to instead complete a video session with your clinician, please feel free to contact the practice and we will be more than happy to arrange this for you.

We will continue to keep you updated if there are any changes or concerns, however if you have any difficulties at all, please do not hesitate to contact us on 03 94708300 (Bundoora Health) or 03 97171200 (Mernda) or email info@inneractivephysio.com.au

​What is endometriosis? 
This is known as an inflammatory condition that is known for the presence of endo-like tissues outside of the uterus that commonly affects the ovaries and lining of the pelvis. As a result, pain can be associated with the surrounding compartments that is the bladder and/or bowels and dyspareunia (pain with sexual intercourse). It is suspected this inflammatory state affects the pelvic floor muscles and other muscles inside the pelvis becoming a source of pain or create referred pain.
The muscles length tension is often comprised, impacting its range of movement. Limited movement may in turn influence the pelvic floor muscle to function properly, leading up to problems with bladder and/or bowel control, or emptying and/or penetrative pain.  
Given the nature of this condition it often needs a multidisciplinary approach. That is a gynaecologist, psychologist, dietician and a pelvic physiotherapist. Physiotherapists trained in pelvic health are able to assist those with endometriosis in a number of ways.
This may include assessment of bladder and bowel habits, education of fluid intake and known irritants. Assessment of the pelvic floor muscles to determine their contribution to symptoms. Treatment options may include stretching of the external muscles, pelvic floor down training, internal soft tissue manipulation, and desensitization, relaxed breathing and mindful. Further strategies can be employed to help reduced inflammation such as TENS, pain neuroscience education and a graded exercise program.   
As the month of March continues with endometriosis awareness month, our hope is that the awareness continues to improve and women continue to arm and advocate for themselves in their health journey and recovery.
Get the care you deserve.
If you would like to see one of your pelvic health physiotherapists to assist with you with pelvic pain contact Here for Mernda and Here for Bundoora. 

Recently Victorian committee member Tafy Seade, principal physiotherapist of Inner Active Pelvic Health, sat down with founder and creator of the Mitton pelvic belt support, Ingrid Mitton.
Physiotherapists who treat pregnant women are well-acquainted with the use of pelvic support in managing pelvic girdle pain in pregnancy, also known as pregnancy-related pelvic girdle pain (PPGP).
The Mitton belt is designed to provide support of the pelvic joints in the presence of pelvic girdle dysfunction that is commonly seen in pregnancy. PPGP refers to pain that is felt in the sacroiliac joints or pubic symphysis. In pregnancy, this is closely linked to hormonal, biomechanical, metabolic and genetic factors. It affects up to 50 per cent of women who are pregnant and can lead to significant physical disability that affects daily activity such as walking, changing position, standing, turning in bed and general mobility.
Ingrid Mitton is the physiotherapist who created the belt over 30 years ago. She delved into the area of women's health early on after her own pregnancies and instantly fell in love with the field. She started running childbirth education classes and progressed into exercise classes with 'Changing shape'. It was around this time that physiotherapy in women’s health was starting to evolve into what we see today.
It was while conducting classes that she noticed the gap, quickly realising that there was not much available for this particular group in terms of effective support they could use to help them continue with their activities. Ingrid took on the task to find a better way. Incidentally, she got hold of some material from her children’s school fete, pulled out the sewing machine, and within months the Mitton pelvic belt was birthed.
During the early stages, many expectant Mums began noticing significant benefits of the belt, so they naturally endorsed and spread the word--which is as good PR as a product designer could hope for. To ensure proper and fit-for-purpose use, Ingrid has tried to make sure that the belt was sourced through a healthcare provider, because it was designed to work 'in conjunction with a good assessment, exercise therapy, manual therapy and education'.
The Mitton belt, now 30 years old, continues to be manufactured in Melbourne. It is now readily available in various hospitals, both public and private, as well as in private practices across Australia. Originally made to address the challenges of pelvic girdle pain in women, this belt has been used in different sectors, including pelvic trauma in the elderly and in men with osteitis pubis.
The Mitton belt is available in various sizes, ranging from 85 cm to 150 cm, either black or white. Ingrid still prefers that the belt is supplied by a health practitioner to ensure fitting, care and instructions are followed through. She encourages those interested in creating products, especially in the field of women’s health, that if you have found a need, give it a go. 
If you would like more information about the Mitton pelvic belt check out Ingrid's website.


References
Vleeming A, Albert HB, Östgaard HC, Sturesson B, Stuge B. European guidelines for the diagnosis and treatment of pelvic girdle pain. Eur Spine J 2008;17(6):794–819. doi: 10.1007/s00586-008-0602-4. 
Pierce H, Homer CSE, Dahlen HG, King J. Pregnancy-related lumbopelvic pain: Listening to Australian women. Nurs Res Pract 2012;2012:387428. doi: 10.1155/2012/387428. 

If you have been recently diagnosed, your doctor or obstetrician may prescribe various treatment methods to help you manage with this. Physical activity and resistance training is recognized as a helpful adjunct to managing GDM. The benefits of exercise are in pregnancy alone are countless but in GDM this also offers: 
- improved physical health and well being 
- improved control of blood sugar levels
- reduce the risk of type 2 diabetes beginning in the postpartum period
- weight management 

At Inner Active Pelvic Health, our physiotherapists are specially trained in working with pregnant women who have gestational diabetes. If you doctor has given you the all OK to exercise during this time one of our physiotherapists can assist and help you identify an effective and safe program. When choosing to exercise with GD they can help you with the following:

1. Type of exercise - identify an exercise that is appropriate to your level of capability and most importantly something that you ENJOY! Swimming, walking, low impact aerobics, modified aerobics, light weight strength training are just a few examples of activities considered safe during pregnancy.
2. Frequency - how often and when to exercise are important parameters to establish and ensure your workout is safe and effective
3. When to stop: It is important to understand the warning signs to reduce or stop exercising 
   1. pain: chest, pelvic, back 
   2. vaginal bleeding, amniotic fluid loss/leakage
   3. swelling- hands, feet, legs or face 
   4. dizziness, faintness or nausea, shortness of breath
   5. high heart rate 
   6. poor balance 
   7. reduced foetal movements
4. Intensity - understand how to monitor level of work: use of the talk test, heart rate and exertion rating scales are some of the strategies we are able to assist you with. 

If you would like more information about exercising and GDM and how physiotherapy can help, then don’t hesitate to get in touch. Contact us at the Mernda clinic or Bundoora clinic or can leave a message in the chat box below. 

Get the care you deserve. 

 With the cold winter weather here it is hard to avoid the sniffles that comes with it. Unfortunately for some, this time of the year is a harsh reminder of pelvic floor problems. Coughs and sneezes are known activities that cause an increase in the intra- abdominal pressure and in the presence of a weak pelvic floor muscles can result in urine loss also known as Stress urinary incontinence. So what can you do about this? ​

1) Seek help 
Do not ignore a persistent cough. Speak to your health care provider to make sure you have covered all ground. Commonly ignored is chronic sinusitis, nasal polyps, post-nasal drip or asthma/chronic bronchitis. Further investigations may need to be done to rule out something more serious. 
2) Check your pelvic floor 
A pelvic health physiotherapist can assist you in your pelvic health problems by assessing your muscle strength and coordination. If weakness has been identified it is important to get a individualized exercise program that is specific to your needs and abilities. 
3) Practice the Knack
The knack is a technique where the pelvic floor muscles are squeezed before an activity that increases the abdominal pressure, in this case coughing. This aims to increase the resistance on the downward pressure consequently preventing urine loss. 
4) Maintain a healthy weight 
It has been found that abdominal weight does increase the pressure on the pelvic floor. Research supports weight loss promotes continence even as little as 10% of the body weight.  
5) Manage constipation
Chronic constipation inevitability places pressure on the pelvic floor. Increase fibre intake through diet to keep bowels soft and easy to pass. 

A pelvic health physiotherapist can help you in managing stress urinary incontinence. It is important that you are assessed and taught how to perform your exercises correctly to prevent your symptoms from getting worse. Further advice can be provided regarding appropriate exercises that effective, fun and most importantly pelvic floor safe. 
If you would like to know more about how a pelvic physiotherapist can help you to manage your pelvic floor during this winter contact either Mernda or Bundoora clinic to make a booking. 
Get the care you deserve!

My Breast Cancer Story
It is something you often hear about, happening to others but never imagine it is something that can happen to you. At 53 years of age, in 2000 I was diagnosed with Breast Cancer. Married with 4 children my concern quickly went to my family and not wanting them to see me suffer.
The journey all began one morning whilst having a bath I felt a lump in my right breast. Breast cancer awareness was not something that was readily shared or seen in the media or news, but I had read enough to know it was something that I had to get checked out. After visiting my doctor, I was advised to have a biopsy. Results confirmed the cancer.
I was overwhelmed with questions of many which I knew no one could give me answers to.  
Within a week, I had a mastectomy done followed by months of chemotherapy and then radiation.  I was fortunate to have been surrounded by amazing care staff in particular my oncologist who contributed greatly to my healing process. Early on I choose to be proactive in my recovery and that meant seeking as much information on what I can do to help my recovery. I attended counselling, I got involved in a support group, watched my diet and took up regular exercising. I know look back and realize I was driven by wanting to be there not only for myself but for my family.  This gave me the strength to move forward even when there were times that I wanted to give up.
My survivorship journey continues, but in that journey, I am most grateful and blessed to be present for my family. Being a mother and seeing your own children become mothers and fathers is something I never take for granted.
I am now an active volunteer of my local cancer centre, reaching out to many women who are at different stages in their cancer journey. The valuable support I received throughout my journey I can only pay it forward and help other women, being there for them providing them support and friendship. Raising awareness continues to be ongoing work for all women to be breast aware.
  
 
  This last week we wanted to highlight some helpful tips moms out there can do to care of themselves and consequently be able to care for thoses around them. Tip 5 Breast Care Awareness is so crucial in your self care! More information check out https://www.cancer.org.au/about-cancer/types-of-cancer/breast-cancer/

Get the care you deserve Mamas! 
Happy Mothers Day!

Author

​Tafy Seade

 Bladder 

• Do you accidentally leak urine when you exercise, play sports, laugh or sneeze? 
• Do you get up often over night to go empty your bladder? 
• Do you constantly need to go to the toilet? 
• Do you find it difficult to empty your bladder? 
• Do you experience pain with bladder emptying? 

Bowels 

• Do you suffer from constipation or strain to empty your bowels?
• Do you accidentally loose control of your bowels?  or accidentally pass wind? 

Pelvic organs

• Do you struggle to empty your bladder or bowels completely?
• Do you feel a heaviness, pressure, discomfort, pulling or dragging sensation around your vagina or back passage? 
• Do you experience frequent stop/start of urine stream?

Sexual Function

• Do you experience any discomfort or pain during or after intercourse or sexual activity? 

If you answered YES to more than one of these help is available. 
A pelvic health physiotherapist can provide you with a thorough assessment and treatment plan to help manage your concerns and help you get back to doing the things you love.
Contact us now and Get the help you deserve! 

• Optimize bladder and bowel function:  It is important that the bladder and bowels are working effectively through good habits. A thorough assessment of the bladder and bowel function is carried out and appropriate advice and management is given. It is important good habits are started early to enhance your recovery post surgery. check out out blog on healthy bladder and bowels HERE
•  Assess your pelvic floor muscles function: Evidence shows up to 50% of women do not know how to exercise their pelvic floor muscles correctly under verbal instruction and at least 25% performing this activity make symptoms worse. We are trained to assess these muscles and identify what is specific to you and your abilities when customizing your pelvic floor training program. Often times the weakness is secondary to underlying issues such as muscle tension, fatigue or poor coordination. It is important these muscles are trained in the right way to achieve maximum results. 
• Assess your breathing, posture and movement: Your breathing muscles that is your diaphragm works very close with your pelvic floor and it is important the two work close together. Good posture improves your core muscles that is your deep abdominal and pelvic floor muscles. When it comes to movement we ensure that this is safe and effective. Prior to surgery this may involve teaching you ways to be able to get in and out of bed or positions of rest. 
• Management of pain: this can be pain in any part of your body that can affect your movement, function and strength and as a result this can impact your recovery. Common areas that can be issues of pain are lower back, hip pain or pelvic pain that consequently affect can commonly affect how your pelvic floor muscles are performing. 
• Understand your physical activities: By understanding your current level of fitness before surgery, this allows us to set up a treatment plan that is realistic and holistic in helping you to return to doing the things that you enjoy after surgery. This is also useful in mapping out ways to execute household chores, work duties and daily tasks. Our physiotherapists work with you to establish safe and effective ways for you to return to these activities, use of modifications or alternatives were necessary. Your physiotherapist is able to guide you in a specific graded exercise program that is pelvic floor safe and individualized to your needs and  your surgeon's post operative protocols.
• Addressing any other issues: With any kind of surgery it can be a stressful time emotionally and physically. We aim to work very closely with your surgeon, doctor and other healthcare providers to make sure that you receive the support you need.  
• Useful link for more information: http://www.ugsa.org.au/patient-resources/www.ugsa.org.au/patient-resources/

We are also able to support you after surgery and offer guidance in maximizing your recovery with a thorough evaluation.

Book in with our women's health physiotherapist at Bundoora clinic or Mernda clinic

What can I expect in pelvic floor rehabilitation?
At your first visit, your therapist will take a thorough history to better understand your complaints, establish goals for treatment, and to screen for conditions that require medical treatment.  This will include your history with cancer, types of treatments you received, and symptoms you may have had prior to your treatment for cancer.  Your therapist may then perform a physical examination to include movement, muscle strength, and range of motion. Pelvic floor physical therapy often requires a detailed examination of the pelvic floor.  This can include internal or external examination, often both. Your therapist will talk you through the process of the pelvic examination and give you the opportunity to ask questions or express concerns.  Your therapist will always make sure that you consent to the examination, and you can stop the exam at any point if you feel uncomfortable. The internal examination involves assessing the pelvic floor muscles manually, checking for strength, flexibility, and tone.  The examination may reveal tender spots known as trigger points that refer pain to other areas of the body. The therapist will also assess for fibrosis or muscle spasm, and will check for normal range of motion in the pelvic floor muscles.


 Based on the results of your examination, your therapist will provide treatment.  Treatment might include pelvic floor strengthening, relaxation, muscle stretching, or trigger point treatment.  Patients may need to use tools called dilators to stretch the vaginal tissues and soften fibrosis in the perineal region.  Treatment might also include stretching for your legs and low back, breathing exercises, scar massage, bladder and bowel training, or establishing an exercise regimen.  No two patients are alike, and the treatment protocols change based on the patient’s particular history, needs, and goals.
Pelvic floor rehabilitation is always based on a foundation of informed consent, and mutual trust between the provider and patient.  Communication is of utmost importance, and your therapist should listen openly to your concerns, questions, goals, and observations.  The success of pelvic floor rehabilitation is dependent on a correct assessment of the source of the dysfunction, the correct treatment plan provided by the therapist, and the patient’s adherence to the plan. 
What’s next?
If you think you might have symptoms of pelvic floor dysfunction (or even if you just want to find out if you do), speak to your healthcare providers, gp, nurse or oncologist or can contact a pelvic health physiotherapist directly. There is care available for these issues that are sometimes difficult to discuss. With the right treatment, it is entirely possible to decrease or eliminate symptoms of pelvic floor dysfunction.  Contact us with any questions you might have, to schedule your consultation!



About the Author: Lisa Cheek, PT, DPT, CLT-LANA
Lisa is a physiotherapst , certified  Lymphedema therapist based in Colorado, USA. She is progressing through her pelvic health certification through the Women’s Health APTA. Her treatment philosophy emphasizes care for the whole person, and considering the big picture when treating musculoskeletal dysfunction. Lisa believes in empowering patients through education and incorporating principles of modern pain science.
References

1. Huffman LB, Hartenbach EM, Carter J, Rash JK, Kushner DM. Maintaining sexual health throughout gynecologic cancer survivorship: A comprehensive review and clinical guide. Gynecol Oncol. 2016;140(2):359-368. doi:10.1016/j.ygyno.2015.11.010
2. Hazewinkel MH, Sprangers MAG, van der Velden J, et al. Long-term cervical cancer survivors suffer from pelvic floor symptoms: A cross-sectional matched cohort study. Gynecol Oncol. 2010;117(2):281-286. doi:10.1016/j.ygyno.2010.01.034
3. Bergmark K, Åvall-Lundqvist E, Dickman PW, Henningsohn L, Steineck G. Vaginal Changes and Sexuality in Women with a History of Cervical Cancer. N Engl J Med. 1999;340(18):1383-1389. doi:10.1056/NEJM199905063401802
4. Bernard S, Ouellet M-P, Moffet H, Roy J-S, Dumoulin C. Effects of radiation therapy on the structure and function of the pelvic floor muscles of patients with cancer in the pelvic area: a systematic review. J Cancer Surviv 2016;10(2):351-362. doi:10.1007/s11764-015-0481-8
5. Rutledge TL, Heckman SR, Qualls C, Muller CY, Rogers RG. Pelvic floor disorders and sexual function in gynecologic cancer survivors: a cohort study. Am J Obstet Gynecol.  2010;203(5):514.e1-e514.e7. doi:10.1016/j.ajog.2010.08.004
6. Hazewinkel M, Sprangers M, Taminiau-Bloem E, van der Velden J Burger M, Roovers J-P. Reasons for not seeking medical help for severe pelvic floor symptoms: a qualitative study in survivors of gynaecological cancer: Pelvic floor symptoms in survivors of gynaecological cancer. BJOG Int J Obstet Gynaecol. 2010;117(1):39-46. doi:10.1111/j.1471-0528.2009.02411.x
7. Bergmark K, Avall-lundqvist E, Dickman PW, Henningsohn L, Steineck G. Lymphedema and bladder-emptying difficulties after radical hysterectomy for early cervical cancer and among population controls. Int J Gynecol Cancer. 2006;16(3):1130-9.

Image credits
1) http://www.drjenniferashton.com/

 Stress incontinence is the loss of urine when there is an increase in the pressure in the abdomen that in turn presses down on the bladder. This is more common in women due to the effects of pregnancy, birth and menopause that place stress on the pelvic floor muscles but this can occur in men especially seen after prostate surgery.
So here are some helpful tips to help you manage your bladder concerns during this time of the year.

• Seek help.  It is important to not ignore these symptoms as any form of leakage is NOT normal. It usually indicates a failure in the continence system and if left untreated has the potential to only get worse.
  • Speak to your doctor about your concerns, this may also include reviewing your medication that you are taking and seeing that it is effective in managing your symptoms
• See a pelvic health physiotherapist. A pelvic health physio is able to carry out a complete evaluation including that of the pelvic musculature to help identify and find solutions to your problems. You do not require a referral.
• Do your exercises. Once it has been identified that muscle weakness is in fact your main problem, it is important to adhere to the exercise program you are given to see the results you need.
• Practice the “knack”, this is a protective movement of bracing or engaging your pelvic floor muscles before you cough and sneeze.
• Stay well hydrated, unless advised otherwise by your doctor aim to have at least 1.5litres to 2 litres of fluid in a day. Unfortunately, many men and women fall into the trap of cutting down their fluid intake. This can cause bladder irritation which can become a further problem. Keeping well hydrated also aids with your bowel health which ensures stool are soft and easy to pass. If not, this can lead to constipation which place further stress on your pelvic floor worsening your symptoms.
• Minimize your exposure-
  •  check out the weather/ pollen forecast in advance if you are heading out
  • Avoid areas were grass is being mowed

 
 
At Inner Active Pelvic Health Physiotherapy, we can help with your bladder concerns, and help you get back on track Get you back doing the things you love in keeping active and healthy.

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1) Check in with a pelvic health physiotherapist
A trained pelvic health physiotherapist is able to carry out a full assessment to identify where the problem is and how best it can be addressed. Part of that may include giving you strategies to manage pain, weakness and loss of movement.  This is a great way to be able to get a complete evaluation and get a program that is individualized and specific to you and your needs. 

2) Engage in low impact exercises

• Walking is a great low impact exercise that can be adapted to your concerns. Special attention is given to pace, posture and progression. 
• Water based exercises are great way to reduce pressure on your pelvic floor the buoyancy of the water significantly lightens the load on your pelvic floor and joints This is a great way to get a fully body workout that helps strengthen your core
• Stretching and flexibility exercises – these can help increase the blood flow to your muscles and in turn help muscles perform more efficiently, improving range and movement.

3) Keep well hydrated
Unless told otherwise by your doctor aim to drink 1.5 to 2 litres of fluid throughout the day. Poor fluid intake not only impacts bladder health but also bowels which can further exacerbate issues with your pelvic floor muscles. In particular, constipation. This can lead to behaviors of straining in order to empty the bowels which in turn weaken the pelvic floor worsening symptoms.   

4) Eat a healthy balanced diet
This not only aims to maintain a healthy weight, but it enhances gut movement and prevents constipation which is essential for long term pelvic health. 

Help is available in getting you back to complete health.  Contact us and see how we can help you. 

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The pain can make it difficult for women to walk or participate in activities of daily living such as sitting, going up and down steps, turning in bed,  and exercising. This can occur at any time during pregnancy from 1st to 3rd trimester.  
The most important factor is early and correct assessment so that appropriate treatment can be taken. 
At Inner Active Pelvic Health Physiotherapy we are able to help you manage the pain, address fears and concerns working closely with your support team (midwives, doctors or obstetricians) to help you restore function, movement and most importantly enjoy your pregnancy!
Some of the strategies we incorporate may include:

• prescription of an individualized program for you which includes specific exercises to optimize the deep abdominal muscles and pelvic floor such as gluteal strength exercises 
• recommend use of appropriate support wear specific to your condition
• advice on  care and considerations for postitions and movment whith labour and birth.  
• advise on strategies to movement and exercises that are pain free, such as advice on positions with sitting, standing and sleeping

Research  reveals up to 25% of women can continue to suffer with pelvic girdle pain after pregnancy. Its never too late to seek help. 
​
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​October 2018

Going to the toilet is a big part of our lives. But unfortunately, it’s not something commonly discussed. As a result not many of us have a great sense of what is normal and what is not when it comes to bladder and bowel habits.  ​

This past weekend a friend and I went to the local parkrun and yes were one of the “first timers”
It was great being part of such a large group of 200+ of like-minded people, cheering each other. It had a sense of community, belonging and fun. We were all coming from different walks of life but shared the common goal of pursing fitness and wellbeing. I spoke to one woman who said he had been doing this for over 20 years! Absolutely amazing! ​

However, this prompted me to think of a different kind of group, women who may be suffering in silence or not able to take part in running due to pelvic floor dysfunction (incontinence, pelvic pain or prolapse) Most commonly reported with running is stress incontinence. This is loss of urine due to an increase in the abdomen that pushes down on the bladder.  In running this is due to the impact of the body through the feet on the ground that causes an increase in abdominal pressure. This pressure acts on the bladder and if the pelvic floor muscles are weak results in leakage. This usually happens when running hard, running downhill and sprinting.
Just like pain, bladder leakage must be treated with the due care it deserves. It is not NORMAL, and in fact it’s presence is one of the ways the body tells you that something is not quite right or not working as it should. Its reported about 30% of women suffer from incontinence, these are only the reported cases. With any dysfunction if left untreated it has the potential to only get worse. More so with running due to the force pressures involved acting on the pelvic floor muscles.
Stress incontinence is more common in women due to the effect of pregnancy and childbirth but can also be present in those without children. Chronic constipation, chronic coughing and obesity are other risk factors. 
If you are running and are experiencing the above here are a few tips to consider:
 
Pelvic floor muscle awareness - Have you got a sense of what your pelvic floor muscles are doing? Are you able to tighten and lift them as well as relax and let go?  It is important to be able to carry out the two movements for effective muscle function and hence strength training.  Being able to have a consistent training program in place for your pelvic floor muscles is a good way to get effective results. (see article on essentials of pelvic floor workout).
Breath work - Breathing well is an important role of working the inner core/muscles. Ensuring the diaphragm (breathing muscle) is moving and doing its job allows good coordination and connection with your pelvic floor muscle. These two-work hand in hand for optimum core strength and stability.  
Do not dehydrate yourself- common misconception less in less out. This is far from the case during a physical activity.
Check your speed -Be mindful of how you are increasing your intensity. Stride length and pace rate can also impact your pelvic floor movement (that is faster pace results in an increase in abdominal pressure).
Check your form - As we run faster our body alignment can often break down as the body adopts compensatory movements to make up for any weakness and imbalance.
Last but not least a few self-assessment questions to ask yourself:

1. How is my footwear?
2. How is my posture?
3. What is my running track like – surface type, flat or uphill/downhill?

At Inner Active Physiotherapy, we have women’s/ pelvic health physiotherapist that specializes in pelvic dysfunction can help you with the above. They can screen your musculoskeletal system and carry out a full assessment of your pelvic floor muscles. They would be able to provide you with the information and steps you need to resolve this. Information is empowering!
​
 If you are considering on starting or getting back to running after birth, surgery or injury please see your women’s health physiotherapist. At Inner Active Pelvic Physiotherapy we take a patient-centered  approach and create an individualized treatment program designed to address your specific concerns and help you to get back to doing what you love. 
 
Get the help you deserve!