Clinical Specialist Chartered Physiotherapy Clinic

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Women's Health Services

What is Women's health Physiotherapy for?

Women’s Health and Continence is a specific area of Physiotherapy focusing on prevention, treatment and management of women’s health and pelvic issues.  A physiotherapist specialised in women’s health can help with a vast range of conditions relating to the pelvic floor area, such as bladder and bowel control problems, pelvic organ prolapse, pregnancy and postpartum, pelvic pain, painful intercourse (dyspareunia, vulvodynia, vaginismus), gynaecological problems (endometriosis, menopause, hysterectomy recovery, post cancer treatment and surgeries).

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Pelvic Physiotherapy

Pelvic Physiotherapy helps to improve pelvic floor function, preventing and treating the pelvic area through exercises, lifestyle modifications, education and hands on treatment to decrease symptoms of pelvic floor dysfunction and chronic pelvic pain. By assessing a group of muscles called pelvic floor that are involved with urinary, bowel, postural and sexual function and completely connect with your core muscles, the pelvic physio is able to offer the best approach for your treatment or a preventive program. If these muscles aren’t functioning properly this can lead to symptoms such as incontinence, increased urgency and/or frequency, retention (not being able to empty your bladder or bowels), and pelvic or lumbosacral pain. 

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Pregnancy / Antenatal Physiotherapy

During PREGNANCY the woman’s body goes through a huge TRANSFORMATION. The muscles stretch, especially those in the abdomen and pelvic floor, and ligaments soften. The gravity centre of the body changes, the PELVIC FLOOR and CORE MUSCLES are even more required because of the need to SUPPORT the uterus growth and the baby weight. Being aware that it will all happen, we need to work on PREVENTING injuries and pain (Low back pain, Pelvic Girdle Pain, Symphysis Pubis dysfunction).

At HER PHYSIO, Juliana has developed a method to prepare your body, working with specific exercises, individualisation and prenatal education, that will help you through pregnancy and delivery. 

LOW BACK PAIN, PELVIC PAIN and PELVIC FLOOR DYSFUNCTION, are the most common musculoskeletal complaints during PREGNANCY. 

We can help you through your pregnancy with accurate assessment, diagnosis and prevention! We can manage or alleviate any discomfort or pain throughout pregnancy.

A very relevant point about PHYSIOTHERAPY DURING PREGNANCY, is to PREPARE YOUR BODY FOR A HEALTHY DELIVERY (vaginal or caesarean). We aim to PREVENT POSTPARTUM ISSUES (Pelvic organ prolapses, perineal tears, urinary and faecal incontinence, pelvic pain) focusing on the best approach to work on your MOBILITY, STRENGTH, BREATHING TECHNIQUES, PREPARING TO PUSH, BEST BIRTH POSITIONS and PELVIC FLOOR EXERCISES to preserve integrity of your perineum and pelvic floor muscles. 

It is important to do exercises to strengthen your pelvic floor and abdominal muscles while you are pregnant. It’s also important to continue these exercises after the birth of your baby.

When should I start my antenatal physio? 

As soon as possible! It gives us more time to prepare your body and make sure you will be fit during your pregnancy and delivery. If you have any concerns and prefer to wait until you pass your 1st trimester, it’s also completely fine! Remember that exercises are well evidence based advised during pregnancy.

Can my husband/companion be present at physio consultations with me?

It’s totally up to you. We recommend that you have someone with you, the person that you chose to accompany you on your labour and delivery, for only one appointment after 30 weeks of pregnancy (usually at 34 or 35). 

How often should I see a physio during my pregnancy for the best antenatal care? 

We recommend one consultation per month if you are having a healthy pregnancy, with no complaints. If you are presenting any issues during your pregnancy, such as pelvic girdle pain, lower back pain, symphysis pubis dysfunction or incontinence, you might need to be seen more frequently than that. 

What to expect from my physio sessions?

On your first appointment the Physiotherapist will have a conversation with you for evaluation of your general health and baby’s health. After that, she  assess your posture, and it is important to check your pelvic floor function. The pelvic floor check it’s made by intra vaginal assessment, using one or 2 fingers (see PELVIC FLOOR ASSESSMENT). There is no issue to assess a pregnant woman’s pelvic floor. It won’t cause any harm for the baby or mother, the pelvic floor muscles are checked far away from the cervix, we don’t get even closer to that. It’s totally up to you if you wish to have your pelvic floor assessed in this consultation, but it is important to know that this is the only way to check your pelvic floor function. 

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Postpartum

Your body needs CARE AFTER CHILDBIRTH doesn’t matter the type of delivery you had (vaginal or caesarean). A lot of women ignore postpartum rehabilitation, but it’s VERY IMPORTANT! Just think about all the transformation your body went through. Your posture, abdomen, pelvic floor, perineum, lower back, everything changed.  

PREGNANCY and CHILDBIRTH increase the risk of WEAKENING and INJURY to the PERINEUM and PELVIC FLOOR MUSCLES, and it has been estimated that approximately half of postpartum women may lose some of the supporting function of the pelvic floor muscles after delivery. Loss in pelvic floor muscles function may cause defecation dysfunction, sexual dysfunction, Pelvic Organ Prolapse (POP) or involuntary loss of urine (urinary incontinencE) or stool and gas (anal incontinence). 

PELVIC FLOOR MUSCLE EXERCISES are effective as first line prevention and treatment for URINARY INCONTINENCE in the adult female population. 

DIASTASIS RECTI ABDOMINIS (DRA) is simply a separation or widening between the left and right sides of the muscle. A certain amount of separation in pregnancy is normal as it allows your abdomen to expand and make room for the growing baby. You may have noticed, doming, or bulging forwards of the abdominal muscles during pregnancy, this happens due to the ABDOMINAL SEPARATION (DRA) and needs to be treated with physiotherapy. The gap or separation on your abdominal region, it’s much more than an aesthetic issue, your abdominal muscles are part of your CORE (stabilization) and together with your pelvic floor muscles are fundamental for POSTURE and PELVIC FUNCTION. 

You can start seeing a Women’s health Physiotherapist 6 weeks postpartum, and even if you have already passed this time in months or years, it’s never too late to seek help!

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Pelvic floor dysfunctions

  • PELVIC FLOOR DYSFUNCTION (PFD) refers to a broad constellation of symptoms and anatomic changes related to ABNORMAL FUNCTION of the pelvic floor. The disordered function corresponds to either increased activity (hypertonicity) or diminished activity (hypotonicity) or inappropriate coordination of the pelvic floor muscles.

    Pelvic floor dysfunction refers to a broad range of clinical scenarios , including lower urinary tract excretory (BPS, Bladder Pain Syndrome) and defecation disorders, such as urinary and anal incontinence, overactive bladder, pelvic organ prolapse, chronic pelvic pain and sexual disorders, Vaginism, Dyspareunia, Vulvodinea.

    A wide variety of conditions are attributed to PFD due to hypertonicity, hypotonicity, loss of pelvic support, or mixed concerns.

    • Difficult urination
    • Pelvic Organ Prolapse: – Cystocele: bulging or herniation of the bladder into the vagina (anterior). – Uterine prolapse: herniation of the uterus via the vagina beyond the introitus. – Rectocele: bulging or herniation of the rectum into the vagina (posterior). – Vaginal prolapse: herniation of the vaginal apex beyond the introitus.
    • Urinary incontinence: involuntary leakage of urine.
    • Faecal incontinence: involuntary leakage of stool.
    • Dyspareunia: pain with or following sexual intercourse.
    • Vaginismus: involuntary tensing or contracting of muscles around the vagina.
    • Vulvodynia:  persistent, chronic, unexplained pain in the vulva.
    • Constipation
    • Pelvic pain: chronic pain lasting more than three to six months, unrelated to other defined conditions.
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Photobiomodulation/ Laser Therapy

Low-level laser (light) therapy (LLLT) is a fast-growing technology used to treat a multitude of conditions that require STIMULATION OF HEALING, RELIEF PAIN and INFLAMMATION, and RESTORATION OF FUNCTION photobiomodulation refers to the use of photons at a non-thermal irradiance to alter biological activity.

The main medical applications of LLLT are reducing pain and inflammation, augmenting tissue repair and promoting regeneration of different tissues and nerves, and preventing tissue damage in situations where it is likely to occur.

Application in Women’s Health  Physiotherapy:

  • – Vaginismus
  • – Vulvodynia
  • – Myalgia
  • – Healing Episiotomy or perineal laceration postpartum
  • – Cesarean scar
  • – Vaginal and anal fissure
  • – Nipple fissure (during breastfeeding period)
  • – Mastitis
  • – Hemorrhoids
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* The number of sessions for positive results, depends on the patient’s diagnostics and the phase of it.

Ultrasound Therapy

Ultrasound therapy is indicated for soft tissue injuries and may (or may not) be accompanied by other types of physical therapy treatments. Its action is aimed at REDUCING PAIN and INFLAMMATORY STATES, offering greater functional mobility and reducing patients’ recovery time.

Ultrasound therapy for Blocked Ducts and Mastitis

Blocked ducts can be defined as when “the breast has an area of localised milk stasis.” At times, this can result in Mastitis, an inflammation of the breast that may be due to blocked ducts. Mothers can also experience blocked ducts without severe breast engorgement or mastitis. Blocked ducts are associated with breast engorgement and may result in a localised tender breast lump or area of blushed colour, the breast may feel hot, and there may be a white, painful bleb on the end of the nipple. Therapeutic ultrasound can help address the symptoms and treat mastitis and blocked ducts. It can also be associated with massage and lymphatic drainage. The average number of sessions needed are between 1 to 3 sessions. 

Biofeedback

In pelvic physiotherapy, we call Biofeedback the device used to capture information from the pelvic surge musculature and transform it into visual information for the physiotherapist and the patient. This information is mainly related to muscle contraction and relaxation capacity. A Biofeedback device is capable of capturing information from the musculature through an electrode (internal or external) providing information in real time to the patient in the form of displays on the computer screen. According to the patient’s complaint, we can prescribe different protocols according to the different benefits, among them we can highlight:

More accurate assessment of the pelvic floor musculature

Increased muscle awareness 

Facilitating pelvic floor relaxation

Potentiation of muscle strengthening

Kinesiology Taping for Pregnancy and Postpartum

Kinesiology tape is an elastic textile, colourful adhesive tape, which is used to help/support muscle movement. It’s a thin, flexible tape that is meant to relieve pain, reduce swelling and inflammation, and provide support to joints and muscles. In special techniques it is applied to the skin and can be helpful for some complaints in pregnancy and postpartum.

  • Back pain
  • Symphyseal complaints PSD or PGP
  • Diastasis recti
  • Scar tape for caesarean section
  • Breast blocked ducts and Mastitis

 

Kinesiology taping improves pain and IRD in women with postpartum LBP indicating increased facilitation of the abdominal muscles and thus kinesio taping along with abdominal exercises might act as an effective exercise protocol in its management.

Dry Needling

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Dry needling is an invasive technique used by physiotherapists to treat myofascial pain that uses a dry needle, without medication or injection, which is inserted into areas of the muscle known as Trigger points (TrPs). A trigger point describes a taught band of skeletal muscle located within a larger muscle group. Trigger points can be tender to the touch and can refer pain to distant parts of the body. Physiotherapists work with dry needling with the goal of releasing/inactivating the TrPs and relieving pain.

 

Physiotherapy Services

– Antenatal Physiotherapy

– Pubic Symphysis Dysfunction (PSD) and Pelvic Girdle Pain (PGP) treatment

– Sciatica pain in pregnancy

– Postnatal rehabilitation

– Abdominal separation – Diastasis Recti

– Pelvic Floor Dysfunction, Prolapse treatment, Continence issues

– Pre and post abdominal/gynaecological surgery management (endometriosis, hysterectomy, prolapse repair surgery)

– Dry needling

– Biofeedback

– Laser treatment 

– Therapeutic Ultrasound Treatment (Mastitis, Breast blocked ducts, scar tissue, Diastasis Recti)

– Kinesiology Taping antenatal and postpartum