Lead the Way.ca

Women's Health

 

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Women have special health needs. That is why the Lead the Way Group has developed 'SHE' our Women's Health Program. Pain and problems associated with pregnancy, urinary incontinence and osteoporosis are all conditions a woman may experience at some time in her life. Our program provided by specially trained Physiotherapists can help minimize or even relieve the symptoms and improve function associated with these conditions.

Women's health Physiotherapy allows women to take a more active role in managing their health, it is an excellent compliment to primary medical, obstetric and gynaecologic care.

Please review the sections below  on Pelvic Floor Problems & Urinary Incontinence, Prenatal & Postpartum Issues and Osteoporosis for frequently asked questions and information about our  programs and services. You can download a copy of our SHE brochure here or call/visit the clinic to receive a copy.

If you are unsure if Physiotherapy can help you, please call 705-652-6999 for clarification of any questions and ask for Kim Payne, PT or email Kim at kim_lpfhc@bellnet.ca



Frequently Asked Questions


Pelvic Floor Problems & Urinary Incontinence

How do these problems develop?

Approximately one in four women suffers from urinary incontinence and as many as 50% of women over the age of 65 report urinary leakage. It is often due to weakening or disuse of the muscles under the bladder. Sometimes during labour and delivery, or a pelvic surgery such as a hysterectomy, there is damage to these muscles. When these muscles are not functioning properly, you may develop a prolapse (bulging or descending) of the bladder, uterus or rectum. The muscles may develop an area of muscle spasm ('knots'), which can lead to pelvic pain. Nerves in the pelvis may become irritated, and lead to pain or tingling into the back, hips, or legs. Since the pelvic floor muscles attach to the tailbone, pubic bone, and are near the hip and back, lower back pain may occur.

How will I benefit from treatment?

You may suffer from urinary urgency or incontinence that interferes with your ability to perform your work, hobbies or sports. Perhaps you have pelvic pain that interferes with sleep, activity, sexual function and relationships. You may have tried exercises without success. With our treatment, you can experience relief of these difficulties and significant improvement to your quality of life.

How is the pelvic floor assessed?

First, we ask about your symptoms, any previous pregnancies or surgeries, or other medical conditions. The pelvic exam involves observation, and palpation (feeling) of the soft tissue and muscles around and inside the vagina and rectum. This is similar to how your doctor does an internal exam. The rectal exam is an important part of the exam: it allows more accurate palpation of the pelvic floor muscles, and of the tailbone. The therapist assesses the pelvic floor muscle's tension, strength, power and endurance, and the presence of pain or spasm in the muscles.

Are there any risks to this treatment?

We are very careful to create a private and sterile environment during assessment and treatment. We utilize a private treatment room, non-latex gloves and hypoallergenic gel, and wash or dispose of equipment properly. Your dignity and comfort is our highest priority. There is a risk that you might feel discomfort in the pelvic area after a treatment, particularly if it has involved stretching or trigger point massage to tight or tender muscles. Not all Physiotherapists are certified to treat Pelvic Floor dysfunction. In order to perform internal examinations, your Physiotherapist has taken specific training, has written a certificate exam.

How do I book an assessment?

You can call Lakefield Physiotherapy & Foot Health Clinic and state that you are a Women's Health patient and would like to book an initial assessment for Pelvic Floor Treatment. We will require a special referral from your physician which will delegate components of the evaluation and treatment to the Physiotherapist. The receptionist will facilitate this referral process for you.

What should I bring to the assessment?

Bring information about any relevant medical examinations (eg. urodynamics, urine culture) that you may have had. Know which medications you may be taking, particularly those related to the bowel/bladder.

Can the examination be done at any time?

It can be done when a woman is menstruating, if it is at or near the end of the menstrual phase.

How long will the examination take?

The initial assessment is approximately 45-60 minutes in length. Please arrive 20 minutes early to complete paperwork. Follow up treatments are 30-45 minutes long, and involve one on one treatment time. It is very important that you arrive on time for all treatment sessions, as the Physiotherapist has set reserved one on one time to treat you.

What are the fees?

Sessions are $110; please call to confirm the current fee schedule. Most patients have extended health coverage for Physiotherapy, and it can be used for pelvic floor therapy. You also may be asked to purchase specialized exercise supplies to augment your home program.

How many treatments will I need?

Treatment is usually once per week for 6 weeks , then less frequently (eg. once every 2-4 weeks) for 2-3 months. Each woman’s needs will vary, this is only an approximate timeline your Physiotherapist will discuss your individual treatment plan after the initial assessment.

What is Urinary Incontinence?
  • There are several types of urinary incontinence, but in general incontinence refers to the leakage of urine at inappropriate times.
  • Stress incontinence is leakage of small amounts of urine when there is increased pressure on the bladder. This can happen with exercise or with sneezing, coughing, lifting or other activities.
  • Urge incontinence is the leakage of medium to large amounts of urine when a person feels a sudden strong urge to urinate.
  • Mixed Incontinence includes symptoms of both stress and urge incontinence.
  • Functional Incontinence is urine leakage that occurs when a person cannot get to the toilet in time.
What causes Urinary Incontinence?

Stress incontinence usually results from weakness and lack of support in the muscles of the pelvic floor. These are the muscles that attach to the bottom of the pelvic bones and run front to back, forming a bowl-like structure that lifts to support the internal organs and controls the sphincter muscles. The pelvic floor muscles also work to strengthen the low back, stabilize the pelvic bones, and help with sexual function.
Women with stress incontinence often have “under active” pelvic floor muscles.

Causes of under active pelvic floor muscles include:

  • Pregnancy and Childbirth
  • Injury or trauma
  • Surgery in the vagina or rectum
  • Episiotomy (during childbirth)
  • Lack of exercise and lack of use

Women with urge incontinence (characterized by an “over-active bladder”) often have weak pelvic floor muscles. Urge incontinence is also called "Overactive Bladder – OAB" or "Detrusser Instability – DI". People with urge incontinence void more than 7 times per 24 hours.

Possible causes of mixed incontinence can include any combination of the causes of stress and urge incontinence.

Functional incontinence can be caused by:

  • Joint pain or muscle weakness
  • Problems with mobility
  • Confusion, dementia or delirium
  • Environmental barriers (i.e., the bathroom is too far away, use of a walker or cane, too many obstacles to navigate around)
  • Psychological problems such as depression or anger
How can Physiotherapy help with urinary incontinence?

Because many symptoms of urinary incontinence are caused by pelvic floor muscle weakness and dysfunction, a specially trained Physiotherapist is the ideal provider to help you gain control over your symptoms. Physiotherapists use their specialized training to completely evaluate and design a treatment program that is individualized for each patient.

Physiotherapy can:

  • Give you control over your life and your bladder
  • Save money and embarrassment by allowing less use of pads and undergarments
  • Reduce use of medications for incontinence
  • Possibly prevent the need for surgery

Physiotherapy Treatment may include:

  • Education on diet and nutrition to avoid food and drinks that may irritate the bladder
  • Advice on how to change behaviors that make symptoms worse
  • Techniques to help you find the right muscles and learn to use them correctly
  • Pelvic floor exercises to strengthen the pelvic muscles
  • Exercises to stretch and strengthen other important muscles
  • Ways to decrease urinary urge and frequency
  • Biofeedback that shows you how your muscles are working
  • Electrical stimulation to improve awareness and strength of the muscles
What is Pelvic Pain?

Pelvic pain is described as pain in the lower abdomen, pelvis, or perineum and is considered to be chronic when symptoms have been present for more than six months. The pain may be described as aching or burning in the area of the perineum or abdomen.

What causes pelvic pain?

Pelvic pain can be caused by problems such as pelvic joint dysfunction, muscle imbalance within the muscles of the pelvic floor, trunk, and/or pelvis, lack of coordination in the muscles related to bowel and bladder function, tender points in the muscles of the pelvic floor, pressure on one or more nerves in the pelvis, and weakness in the muscles of the pelvis and pelvic floor. Pelvic pain can also be related to the presence of scar tissue after abdominal or pelvic surgery. There can be organic disease processes related to pelvic pain as well therefore it is important to consult your physician to fully determine the cause of your pain.

What are the symptoms of pelvic pain?

Symptoms of pelvic pain, in addition to pain in the lower abdomen and pelvis, may include: pain in the hip or buttock, pain in the tailbone, limited sitting tolerance, pain in the joints of the pelvis, pain with sexual intercourse, tender points in the muscles of the abdomen, reduced range of motion in the hips and lumbar spine, urinary frequency, urgency, or incontinence, painful bowel movements, constipation and/or straining with bowel movements

How can Physiotherapy help with pelvic pain?

Physiotherapists are trained to evaluate and treat joint dysfunction, muscle tightness, weakness or imbalance in muscle groups, and nerve entrapment- all potential signs of pelvic pain. Physiotherapists trained specifically in the area of pelvic health can identify the possible generators of pelvic pain and develop a treatment plan specific to the woman suffering from pelvic pain. A Physiotherapist trained in this area may utilize hands on techniques to address muscle tightness or targeted exercises to improve muscle strength and reduce faulty patterns of muscle recruitment. Other treatment strategies may include biofeedback, retraining of in-coordinated muscles, postural training, and strengthening of the abdominal core muscles

Prenatal & Postpartum Issues

What musculoskeletal issues are associated with the Prenatal and Postpartum periods?

The prenatal period is a time of great change for a woman, physically, emotionally, and hormonally. As the fetus grows, the overall musculoskeletal system is challenged by altered posture, shortened muscles, potential muscle imbalances, and changes in spinal mobility. These changes may cause pain and dysfunction. In the postpartum phase, fluctuating hormone levels combined with additional physical changes as a result of delivery may also result in musculoskeletal problems such as excessive joint mobility, weakness of the core stabilizers, and altered spinal mobility and function.

What causes dysfunction in the prenatal and postpartum periods?

Fluctuating hormone levels in both the prenatal and postpartum phases may cause excessive joint mobility which can cause pain and dysfunction. Because of the postural changes associated with pregnancy, some muscles become tight to support the changing posture, while others are stretched and become weak. This results in muscle imbalance and a potential for decreased stabilization. Mobility of the spine can be affected in both the prenatal and the postpartum periods as the spine adjusts to the changing posture as the fetus grows.

What are symptoms of musculoskeletal dysfunction during the prenatal and postpartum periods?

Symptoms of dysfunction may include pain in the joints of the pelvis or spine, muscular pain in the hips and L/E's, or numbness into the extremities. Weakness may be present in the abdominals, resulting in pain with transitional movements or lifting. Weakness may also be manifested as urinary incontinence in the postpartum period. Muscle imbalance may also cause pain or contribute to urinary issues in the postpartum phase.

How can Physiotherapy help in the prenatal and postpartum periods?

Physiotherapists are skilled in evaluating and providing patient centered treatment of musculoskeletal problems. Physiotherapists trained in the area of women’s health have further knowledge about issues directly related to women as they move through different stages of life, from childbearing years to the post menopausal period. Physiotherapists can provide hands on treatment to address spinal and pelvic joint dysfunction, instruct in exercises to address muscle weakness and imbalance, and provide guidance and instruction related to modifications of activities of daily living that may be difficult during the prenatal and postpartum phases.

Osteoporosis

What is Osteoporosis?

Osteoporosis is a condition in which bones become thin and brittle and break more easily. Normal bone is constantly being built and broken down. When not enough bone is built, or too much is broken down, osteoporosis results. The bones become brittle and break more easily. Thousands of hip fractures, 3 times more common in women than men, occur every year because of bone thinning. One third of all women over the age of 50 will have broken bones in the spine due to osteoporosis.

Several factors that you cannot control place you at increased risk for osteoporosis:

  1. Family History—blood relative with disease
  2. Age—older adults have increased risk
  3. Gender—women are at greater risk than men
  4. Race—Asians and Caucasians have increased risk
How can Physiotherapy help women with Osteoporosis?
Our trained professionals are certified in the Melio Guide program which provides safe and effective exercise programs for people with osteoporosis, osteopenia and low bone density. It has been used by thousands of people around the world to improve the strength of their bones, reduce their risk of fracture, build their confidence and give them the freedom to move with confidence.

When can a Women's Physiotherapist Help?

Those with:

  • Trouble leaking urine during normal daily activities
  • Urine leakage with sneezing, coughing, or laughing
  • Trouble starting the urine stream
  • Trouble holding urine when feeling a strong urge to go
  • Trouble with frequent urination (more than every 3-4 hours during the day, up more than once to urinate at night)
  • Trouble getting to the bathroom because of other problems such as knee or hip pain or balance problems
  • Back, sacral, hip, pelvic, rib pain
  • Pain in the neck or upper back
  • Headaches
  • Sciatica, carpal tunnel, thoracic outlet or other nerve symptoms
  • Decreased ability to do normal daily activities
  • Weak or tight muscles
  • Pelvic pain with sexual intercourse, use of tampons or gynecologic exam
  • Osteoporosis, osteopenia or risk factors for developing these conditions
  • Desire to start or continue an exercise program

Forms to Complete Before Your Appointment

Pelvic Floor Therapy Questionnaire

Incontinence Screening Form

Consent for Pelvic Evaluation & Treatment Form

 

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