Women’s Health Physiotherapy Consult: What is it?
Why do women have a women’s health physiotherapy consult?
Often after having a baby, women are often referred to see a physiotherapist. Sometimes women know why, other women do not exactly understand why but do so because their obstetrician or midwife told them to. This blog is going to outline what to expect from a post-natal physiotherapy review so you can attend prepared and with as little stress as possible.
Don’t stress – you can bring bub!
Firstly, many women stress if they are able to bring their baby or not to their consult. We understand that you cannot always have a baby sitter 24/7, and things come up and you may not have any help that day. Do not let that deter you from scheduling in a postnatal review. If something happens, and your baby cries their eyes out the entire consult, you can always wrap it up early and reschedule for another time. If you bub loves to be held, you can perform majority of your physiotherapy consult whilst holding your baby, so this is no worry at all. As physiotherapists with a special interest in pregnancy and post-natal, we love babies so never feel concerned about bringing your bub.
When do women have a women’s health physiotherapy consult?
Generally you will attend your postnatal review 6 weeks after your baby is born. This is because there are a lot of changes during the first 6 weeks postnatally. It will also coincide with your review with your obstetrician. If you are having back, neck, wrist or any pain which is impacting on your life and ability to care for your baby, these are examples of when you may come to physio sooner than the 6 week mark
At the consult
Generally how a post-natal physiotherapy consult will run is firstly you will sit down with your physio and perform what we can the subjective assessment. This is where we discuss all about your history. This includes:
Delivery of your baby
- Was this a vaginal delivery or cesarean delivery. How long was your second stage/pushing stage. Did you have any tearing/grazes/stitches? How heavy was your baby at birth? Did you have one baby, or twins, or more?
Pregnancy
- What exercise did you/were you able to participate in during pregnancy. Did you have any symptoms of urine leaking during pregnancy. Any feelings of heaviness in your vagina? Any back, neck, shoulder, wrist etc pain Do you have a history of constipation? Do you have a history of chronic cough eg asthma, recurrent bronchitis?
Pre-pregnancy
- What exercise did you participate in during pregnancy. Do you have a history of constipation? Do you have a history of chronic cough eg asthma, recurrent bronchitis?
Postnatal symptoms
- Do you have any symptoms of urine leaking with a cough or sneeze, when you laugh or lift? Any feelings of heaviness in your vagina? Any back, neck, shoulder, wrist etc pain? Are you experiencing constipation?
Your goals
- Strong pelvic floor? Get back to a certain type of exercise? Make sure everything is ok?
After completing the subjective, this is when we perform the objective assessment, what this is, is assessing the physical side of things. Depending on your goals, depicts what we will assess. For example, if you are concerned about your pelvic floor, then an internal exam will be suggested as this is the best way to assess for prolapse and pelvic floor strength. If you do not feel comfortable having an internal examination, real time ultrasound can be used to assess pelvic floor lift and transverse abdominus activation, but this is a less reliable way to measure strength.
What is an internal exam?
An internal exam involves the physiotherapist using their fingers or a device called a peritron to assess your pelvic floor muscle strength. You will lay on your back with your knees bent, covered with a towel, similar to a pap smear position. The physiotherapist will assess the contraction of your superficial pelvic floor by visually assessing what happens when you contract. They will then insert a finger or two into your vagina and you will then squeeze again. The physiotherapist will feel what the muscle contraction is like at the sides and the middle. The physiotherapist will be able to feel strength, how long you are able to hold the contraction for (endurance) and if there are differences side to side. They will also be able to feel muscle bulk. Your physiotherapist will also assess for prolapse by asking your to bear down, as if you are passing a bowel motion, which will show what happens to your pelvic floor when there is a downward pressure. This is an important one for getting back to exercise and heavier lifting etc. This part of the assessment is not as bad as it sounds! Your physiotherapist will make you feel very comfortable. It is important to have such a thorough assessment so you can confidently increase exercise, know if there are any deficits in strength or signs of prolapse, and make an individualised plan going forward.
In the objective examination we will also check your strength of different muscle groups around the pelvis area, eg your glutes, as we can also prescribe exercises to help with these which will improve rehabilitation postnatally. Your physiotherapist will also look at your posture and lifting techniques incase any tips or tricks can help you there to make life easier.
Making a plan to help you
After you have been through the subjective and objective examination – then a plan is put in place! Generally your plan will comprise of tips and tricks for protecting your pelvic floor and getting back into activity safely. You will also be given exercises to help strengthen and protect your body. The general tips I will go through will most women include
- Tips for toileting position – how to sit to pass a bowel motion whilst putting the least amount of pressure on your pelvic floor as possible
- Tips for lifting – how to bend your knees and breath to help make lifting easier
- Pelvic floor exercises – based on what you are trying to achieve
- Glute and abdominal exercises – based on what you are trying to achieve
If you are experiencing musculoskeletal pain then you will receive some hands on treatment to help reduce pain. This can include massage and joint mobilisation if needed. Taping can be helpful to help support areas whilst you are getting used to the physical requirements of caring for a baby! You will also receive exercises to help rehabilitate the certain area you are struggling with. Do not worry – you will not be sent home with a list of 20 exercises. Generally I believe it is realistic to send someone home with 3-5 exercises, including some stretches and some strengthening, to make it more realistic to be able to do your exercises amongst having to care for a baby.
From there, your physiotherapist may want a review with you to see how you are going with your exercises and progress. Sometimes, all that is needed is a postnatal check and you are all good to go on your way and get back into the exercise you love, it really is an individual thing and every woman will be different.
To read more about what areas of women’s health a physiotherapist can help you with click here>>
Emily Georgopolous (APAM)
Physiotherapist
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