Sat 16, Jun 2018
Irmina is Assistant Professor, Clinical Education Coordination at the University of Canberra and works as a pelvic floor physiotherapist in private practice. She is very passionate about continence promotion, as well as research into the assessment and management of incontinence.
After working as a physio for 10 years, I did a post graduate certificate in pelvic floor rehabilitation at Melbourne University because it seemed like an interesting course back in 2001. Prior to that, I had only had minimal exposure to women’s health. What really got me thinking was the opportunity to be part of a Men’s Continence Clinic, that the Canberra Government was hoping to set up. I discovered that there was no research available to support the treatment of male continence issues. We were taking evidence from female research and applying it to men. That just seemed wrong to me. There are many differences in male and female continence and it is more than the dangly bits. So, I did a Masters and then a PhD to find out how we can best assess and treat male pelvic floor dysfunction.
I treat men and women as well as children’s continence and pelvic floor dysfunction now. I am still focusing my research in the male pelvic floor but also research in the other areas.
Leaking urine, going to the toilet frequently or urgently and altered control over the back passage are some of the more common symptoms that people with poor pelvic floor health experience. However, some people also get pain in the pelvic floor, which can be really debilitating. What is most important is that we talk about this more. Most people with bladder or bowel issues keep it to them selves rather than talking about this.
Embarrassment and thinking our habits are normal are our biggest barriers. “Nice people don’t talk about what they do in the bedroom or on the toilet”. If we do not talk about these things, how do we know that what we do is right or wrong? Why do we see these topics as being disgusting or taboo? Many people are worried about talking to their GP. This is the first person you should talk to if you have a concern about continence or pelvic pain. Pelvic floor physiotherapists and continence nurses are specially trained to talk to people about these issues as well. You do not need a referral to see a physiotherapist, just check first that they are a pelvic floor physiotherapist.
When I see a patient for the first time, I will spend an hour finding out what the problems are. I will ask about when it started, how severe it is and how much it impacts on them. The questions do get very personal, and I will cover what happens in the bathroom, as well as the bedroom. There are no wrong answers, as everyone experiences pelvic floor problems differently. After working in this field for more than 15 years, there is nothing that I haven’t heard before so there is no need for embarrassment either.
Once I know what is going on, I can formulate the why and then the treatment options. Pelvic floor exercises are only a part of the large array of options I have to help manage and treat pelvic floor dysfunction and pain.
Pelvic floor exercises are very good when the muscles below the bladder and bowel are weak and cause leakage when pushed. However, pelvic floor exercises may not be as effective when it is the control of the bladder from the brain that is the problem, or when the pelvic floor is so tense that it causes pain. This is why completing a good assessment is key to effective treatment. Not everyone leaks urine for the same reason.
My research has also shown that how we train the pelvic floor needs to be individualized. Women who have given birth for example, have a stretched weak pelvic floor after 9 months of carrying the baby and delivering it. Men who have their prostate removed for prostate cancer do not have a weak pelvic floor muscle, but need to retrain how and when they use the muscles to compensate for the change in control due to removal of part of the continence mechanism.
Yes, in some cases doing pelvic floor exercises can cause pain in the pelvic area. For some people their pelvic floor is too tense and working to tighten it more can and does cause pain. A careful assessment, which includes an examination of the muscles internally, can identify this. Then we use ‘down training’, relaxation and other techniques to rectify this. Pelvic floor tension can also be caused by pain caused by other conditions such as endometriosis, recurrent cystitis or severe urgency. An experienced pelvic floor physiotherapist will assess the issues and help develop a treatment program.
When properly assessed and diagnosed, the pelvic floor should start to show signs of improvement within a few weeks. How long it takes will depend on how motivated someone is to work on it and how severe the issue is. Pelvic pain usually is a little slower but with careful management can also improve greatly.
The key is to have a good assessment done by an experienced pelvic floor physiotherapist or continence nurse.
For information and advice on any bladder, bowel or pelvic floor related issues call the National Continence Helpline on 1800 33 00 66. They can also assist you in locating your nearest physiotherapist or continence service.