What is a Women’s Health / Pelvic Health Physiotherapist and why should I see one?

Our first ever guest post is by women's health physio (and my eternal Woman Crush Wednesday), Mischa Bongers. Take it away, Mish!

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Most people are not aware of the important role a physio can play in the care of their pelvic health, such as for endometriosis-related pelvic pain, painful sex, and bladder/bowel dysfunction.

“…but don’t physios just help people with sports injuries?”

Why, no! (Don’t feel bad – some GPs and gynaecologists don’t even know what we do!) 

Women’s, Men’s and Pelvic Health Physiotherapists* (sometimes otherwise known as “Women’s Health”, “Continence and Women’s Health”, “Pelvic Floor”, or “Obs/gynae” physios – how confusing!) are a group of specially trained physios who have a special interest in the management of an array of conditions, including but not limited to:

• Bladder/bowel health and continence
• Pre and postnatal advice/education and treatment of musculoskeletal pain
• Sexual pain/dysfunction
• Pelvic pain.

Most people are comfortable with physiotherapy as a profession that is called upon for the odd bout of neck/back pain, a rolled ankle, etc. These are musculoskeletal (MSK) physiotherapists. If you live in a remote or regional area where all you can access is a generalist/MSK physio, chances are they may not have much experience with the above conditions. They’ll still do their very best for you, and treat your symptoms as best they can, but they may need to refer you on to someone more experienced.

How can a Women’s/Pelvic Health Physio help me?

Ideally, a Women’s/Pelvic Health Physio will first take a thorough history. We’ll ask personal questions about your sex life and toilet habits to get the full picture (don’t worry, we’ve heard it all before and just want to help!) before moving onto a physical examination. Depending on your story, we may look at doing several things (with your informed consent, of course!):

• Education about bladder/bowel function in relation to the pelvic floor
• Optimise breathing, “core” function, and muscle condition around the pelvic region
• Internal vaginal examination checking sensitivity and pelvic floor activation. (This is typically less uncomfortable than other examinations you may have experienced before, such as pap smears or a pelvic examination with a gynaecologist.)
• Ultrasound and electrical stimulation/biofeedback training (essentially using different equipment to help you find and use your pelvic floor muscles better).

Your management plan will be guided by what is found on assessment, taking into account each individual woman’s treatment preference and goals. You know your body best, so we’ll collaborate and problem-solve together.

Women with pelvic pain (with or without endometriosis)

I thought I would give this a special mention considering many posts on Tonic & Tea are dedicated to endometriosis. Contrary to popular belief, “Kegels” or pelvic floor strengthening regimes are not ideal for everyone. For a woman with pelvic pain we would likely work on properly relaxing the pelvic floor (and surrounding) muscles, through muscle release/massage techniques and conscious muscle relaxation control. Tight and overactive muscles are sore muscles – they’re tired from being “on” all the time, so they lack good blood flow and are not functioning well anymore, likely contributing to the pelvic pain experience.

We would typically also spend some time discussing:

• The complex interplay between pain, sleep, stress, exercise and diet (do not underestimate the simple stuff!!! Highly important – take that nice hot bath, find time for that meditation session; take care of yourself girlfriend!)
• Normal bladder/bowel function and how to optimise this. Lots of people with endometriosis appear to have co-existing food sensitivities/IBS-like symptoms, so it may be beneficial to also work with a dietitian to help with this.
• How the pelvic floor relates to continence, and how poorly functioning pelvic floor muscles may be contributing to bladder/bowel issues and driving some of your pain.
• Appropriate exercise type/dosage. Australian physical activity guidelines suggest 30 mins per day for general health, so we’ll work together to come up with a plan suitable for you. High-intensity exercise may not always be ideal for someone with overactive pelvic muscles, so low-impact options like walking, swimming and stretching/yoga may be more appropriate than things like running and CrossFit for now (but this varies with each woman).
• Sexy times – get ready to hear the words “outercourse” and “lube”! Pain has the potential to cause some serious barriers to our sex lives, both physically and mentally. If you’re anticipating pain every time sex is on the cards, this may cause subconscious anxiety, pelvic floor muscle tightening, and a lack of arousal/lubrication (further perpetuating that pain cycle). You may wish to take a break from/discontinue penetrative sex if your pain levels are too high even with relaxation techniques, foreplay and lube** (but by all means keep up with the outercourse! Romance, kissing, touching, oral sex etc is all good if you’re all good). If anxiety and fear is a factor for you, it may be beneficial to have a psychologist/sexologist in your corner too.

Your pain is NOT “all in your head”, and it’s certainly not as simple as “just relax” – persistent pain is very real and very complex. Living with pain can cause ripple effects to all areas of your body, your mind, and your life and relationships; managing it often requires a holistic approach with an understanding multidisciplinary team and support network, which hopefully involves a good Women’s/Pelvic Health Physio.

To find a Women’s/Pelvic Health Physio near you, I recommend visiting the “Find a Physio” link through the Australian Physiotherapy Association website (or a good old-fashioned Google search).

*This is the current title preferred by the Australian Physiotherapy Association, who are the peak body representing Aussie physios and their patients.

**There are appropriate types of lubricant for different situations (which is a whole other topic in itself… maybe at a later date, Tonic and Tea? [T&T: Yes!]) but basically water-based is usually best for toy and condom use, hydrating intimate areas and for not staining the sheets; oil and silicon-based are better for longer lasting lubrication without reapplication but are not condom/toy-compatible. Beware of cheap supermarket/off-the-shelf lube, as they can irritate sensitive skin and disrupt natural pH levels of the vagina. Personally I recommend the organic brand “Yes”. See here for lubricants, pelvic floor training devices, and vibrators/massagers.

About the author: Mischa Bongers is an MSK, Clinical Pilates, and Women’s, Men’s and Pelvic Health Physiotherapist. She recently opened her own practice in Central Queensland where she lives with her two energetic dogs (one naughty, one nice), two cats (she’s a rehabilitating dog person), and her partner (he’s a rehabilitating cat person). She likes walks on the beach with her doggies, yoga and triathlons – mostly just to earn the post-exercise coffee and chill.

Please note that the above information is not a replacement for individualised medical assessment, and that it is recommended you seek a pelvic health physiotherapist (or other suitably-trained medical professional) for further advice.