Pregnancy Related Pelvic Girdle Pain and Breast Feeding
Pelvic Girdle pain affects 1 in 5 pregnant women. The pelvis can increase in mobility secondary to hormonal changes. The muscles attaching to the bones of the pelvis may become stressed as they try to compensate for the increased mobility and lack of stability. They may tighten up, often developing trigger points and becoming painful.
Research has shown that asymmetry between the two sides of the pelvis i.e. hypermobility (too mobile) on one side and hypomobility (too stiff) on the other side is also one of the major cause of pain.
Pelvic Pain Risk Factors
- Previous pelvic trauma
- History of low back pain
Pregnancy: What Changes?
- Hormonal changes = decreased pelvic stability
- Increased abdominal diameter
- Increased load due to advancing pregnancy
- Altered motor/muscle control
- High work load e.g. lifting
- Inflammation due to changing load on tissues
Further research has shown that the pelvic floor muscles compensate for the increased mobility of the pelvis and also in response to increases in pain. This means that if the pelvis has become unstable during a pregnancy then the pelvic floor by way of working very hard becomes more and more taut and therefore weaker.
Our Physiotherapist Rebecca David has been trained with the latest evidence based management of women with pelvic girdle pain.
Treatment for women with breastfeeding difficulties, such as engorgement, blocked ducts and Mastitis. Our Physiotherapist Rebecca David has trained in the latest evidence based management of these very painful and very treatable conditions. Treatment aims at treating the inflammatory process during Mastitis and treatment options range from use of Electrotherapeutic modalities, massage, taping techniques etc.
Also, women with breastfeeding difficulties can now access the evidence based advise and management for low milk supply, lactation benefits for the mother, attachment issues and postures to facilitate breastfeeding.
The role of Physiotherapist is to promote:
Position = Postures to enhance breastfeeding
Position = Empowering breastfeeding and facilitating milk flow
Mastitis = Treatment of this very painful yet treatable condition
Learning to trust her body, to listen to her infant, and to let comfort needs guide her behaviour can help restore comfort to the feeding situation and in this way, help the feeding mothers stop the vicious cycle of symptoms.
Pelvic Organ Prolapse
What is a vaginal (pelvic organ) prolapse?
Your pelvic organs include your bladder, uterus (womb) and rectum (back passage). These organs are held in place by tissues called 'fascia' and 'ligaments'. These tissues help to join your pelvic organs to the bony side walls of the pelvis and hold them inside your pelvis.
Your pelvic floor muscles also hold up your pelvic organs from below. If the fascia or ligaments are torn or stretched for any reason, and if your pelvic floor muscles are weak, then your pelvic organs might not be held in their right place and they may bulge or sag down into the vagina. This is known as a pelvic organ prolapse (POP).
What are the signs of prolapse?
- a heavy sensation or dragging in the vagina
- something ‘coming down' or a lump in the vagina
- a lump bulging out of your vagina, which you see or feel when you are in the shower or having a bath
- sexual problems of pain or less sensation
- your bladder might not empty as it should, or your urine stream might be weak
- urinary tract infections might be reoccurring, or
- it might be hard for you to empty your bowel.
What causes a prolapse?
Childbirth is the main cause of a prolapse. On the way down the vagina, the baby can stretch and tear the supporting tissues and pelvic floor muscles. The more vaginal births you have, the more likely you are to have a prolapse.
Other things that press down on the pelvic organs and the pelvic floor muscles that can lead to prolapse are:
- chronic coughing (such as smoker's cough or poorly controlled asthma)
- heavy lifting (washing baskets, supermarket bags or children), and
- constipation - chronic straining to empty the bowel can cause prolapse.
Types of prolapse
Pelvic organs may bulge through the front wall of the vagina (called a cystocele), through the back vaginal wall (called a rectocele or an enterocele) or the uterus may drop down into the vagina (uterine prolapse). More than one organ may bulge into the vagina.
What can be done to prevent prolapse?
It is much better to prevent prolapse than try to fix it! If any women in your close family have had a prolapse, you are more at risk. As prolapse is due to weak pelvic tissues and pelvic floor muscles, all women should keep their pelvic floor muscles strong - no matter what their age.
Pelvic floor muscles, just like any other muscles, can be made stronger with the right exercises. It is important to have your pelvic floor muscle training checked by an expert such as a pelvic floor physiotherapist or a continence nurse advisor.
If you have been told you have a prolapse, these experts are the best people to help plan a pelvic floor muscle training program to suit your needs.
What can be done to treat prolapse once it has happened?
Prolapse can be dealt with simply or with surgery depending on the level of prolapse. It can often be treated without surgery, chiefly in the early stages, and when the prolapse is mild. The simple approach can mean:
- pelvic floor muscle training, where a program of treatment is planned to suit your individual needs, with the advice of a pelvic floor physiotherapist or continence nurse advisor
- making needed lifestyle changes, such as improving your diet, fluid intake, exercising and losing weight
- being aware of good bowel and bladder habits to avoid straining on the toilet, or
- having a pessary (a plastic or rubber device that fits into your vagina) carefully measured and placed into the vagina to provide inside support for your pelvic organs
One in three women leak urine when they cough, sneeze or run. Some don’t make it to the toilet in time. Others experience uncontrolled loss of ‘wind’ and faeces. These problems are all different forms of incontinence.
Urinary incontinence (or poor bladder control) is a common condition, that is commonly associated with pregnancy, childbirth, menopause or a range of chronic conditions such as asthma, diabetes or arthritis.
Poor bladder control can range from the occasional leak when you laugh, cough or exercise to the complete inability to control your bladder, which may cause you to completely wet yourself. Other symptoms you may experience include the constant need to urgently or frequently visit the toilet, associated with 'accidents'. Men having surgery for prostate cancer commonly need help to regain bladder control – Pelvic floor physiotherapy can help here too, both before and afterwards
There are different types of incontinence with a number of possible causes. The following are the most common:
- stress incontinence
- urge incontinence
- incontinence associated with chronic retention, and
- functional incontinence.
Urinary incontinence can be caused by many things, but can be treated, better managed and in many cases cured.
People with poor bowel control or faecal incontinence have difficulty controlling their bowels. This may mean you pass faeces or stools at the wrong time or in the wrong place. You may also find you pass wind when you don't mean to or experience staining of your underwear.
About one in 20 people experience poor bowel control. It is more common as you get older, but a lot of young people also have poor bowel control. Many people with poor bowel control also have poor bladder control (wetting themselves).
Faecal incontinence can have a number of possible causes. The following are the most common:
- weak back passage muscles due to having babies, getting older, some types of surgery or radiation therapy
- constipation, or
- severe diarrhoea.
Pelvic Floor Therapy
Pelvic Floor Physiotherapy can help treat
- Loss of bladder or bowel control
- Sudden bladder & bowel urgency
- Slack pelvic floor muscles
- Difficulty emptying bowel
- Low-grade prolapses of the bladder and bowel
Why Pelvic Floor Physiotherapy helps:
Childbirth, ageing, constipation & surgery can all weaken the pelvic floor, leading to some of the conditions listed above.
Although ‘pelvic floor exercises’ seem simple to do, many people do them quite wrongly and thus ineffectively. Incorrect exercise technique can actually worsen the problem! And there’s usually more to treatment than exercise alone.
Individual problems need individually prescribed treatment and training. General exercise does not help the pelvic floor area.
Luckily, pelvic floor muscle control can be learnt at any age with the help of a specifically trained physiotherapist.
What to expect at a Pelvic Floor Physiotherapy (PFP) visit:
- Pelvic floor muscles may be tested.
- Appropriate Pelvic floor muscle training or use of biofeedback to facilitate muscle activation and contraction will be taught.
- Muscle training and PFP treatment usually requires 3 to 5 visits over 3 to 6 months, depending on the client's needs, with benefits quickly seen.
- Pelvic floor physiotherapy consultation are offered by Rebecca David at all our 3 locations
- Please see the reception team for an appointment
- Please allow an hour for your Assessment and treatment session
- Please wear loose clothing.