How can I help?
During pregnancy many women experience problems including pelvic pain, hip pain, back pain and symptoms of urinary incontinence. Many pregnant are keen to prevent problems during their pregnancy and post-natally and hence are interested in safe exercise in pregnancy, preventative back care, perineal massage and pelvic floor conditioning before labour and delivery.
I have spent 6 years working on post-natal wards supporting women who have had more complicated vagina birth or caesarean sections or troublesome symptoms. This incudes perineal wound assessment and management of swelling/bruising, pelvic floor strengthening, anal sphincter strengthening following 3rd or 4th degree perineal tear, management of episiotomy scars or caesarean scar, symptoms of urinary incontinence (with sit-to stand, coughing, laughing, on route to the toilet) or faecal symptoms (urgency, difficulty controlling wind) and separated tummy muscles.
We know that 1 in 3 women have symptoms of incontinence, but many are too embarrassed, too frightened about surgery to seek help. I think lots of women think incontinence is part and parcel of having babies, which is not the case. The government recommends that most women should see a Women's Health Physiotherapist before considering surgery. I am pleased to say that a very high percentage of patients that attend physio will be cured of their problems, or reach a point where the symptoms have very little impact on their quality of life.
The main bladder symptoms I treat are
1. Stress urinary incontinence (leakage of urine with coughing, laughing, sneezing, running, jumping, exercising, sit-stand, walking, lifting, during sexual intercourse)
2. Urge urinary incontinence - which is having to suddenly rush to the toilet and not quite getting there in time
3. Void frequency - needing to go to the toilet all the time
4. Nocturia - night time weeing
5. Incomplete/difficulty emptying - not feeling empty after going to the toilet, needing to go back minutes later, pushing straining to empty
At both Saint Mary's Hospital and Queen Charlotte's I was the lead physiotherapist for Gynae oncology and treated ladies as inpatients and out patients following surgery (abdominal or vaginal) or following treatment (chemotherapy, radiotherapy and braccytherapy). Common symptoms following these interventions are vaginal or abdominal pain, bladder incontinence, bowel problems - constipation, bowel urgency or difficulty controlling wind. Following vaginal surgery or internal radiotherapy (braccytherapy) pain during sexual intercourse is extremely common. Ladies are often given vaginal dilators to use but these can be overwhelming and painful.
At Chelsea and Westminster and Queen Charlotte's hospital I worked within specialist clinics delivering care to patients with sexual problems. This could be painful sexual intercourse (dyspyrunia), pelvic floor muscle over contraction (vaginismus) vulval pain (vulvodynia) or patients who are unable to have penetrative intercourse, either as a new problem or one that they have always had (non-consumator), vaginal laxity/looseness following vaginal delivery leading to reduced sensation and pleasure. Many of these conditions are caused/affected by the pelvic floor muscles and hence why treatment by a Women's Health Physiotherapist can be extremely successful. I frequently guide and support women through pelvic floor muscle relaxation/strengthening techniques, complete manual muscle/fascia techniques and the use of vaginal dilators.
At Chelsea and Westminster hospital I worked within the Colo-rectal multi-disciplinary team (Consultants, specialist nurses) treating patients with bowel symptoms including faecal urgency and faecal incontinence, flatal (wind) incontinence, chronic constipation and difficulty emptying the bowel. Many of these conditions are caused/affected by the pelvic floor muscles and hence why treatment by a Women's Health Physiotherapist can be extremely successful.
Pilates is a safe way to exercise during the second and third trimesters of pregnancy. Ante-natal pilates can increase core muscle strength (deep abdominal muscles, pelvic floor muscles, glut muscles ) which should help prevent or manage back or pelvic pain, prevent or manage continence problems, facilitate good postures - despite your changing shape, maintain abdominal muscle strength and prevent separation of these muscles (rectus diastasis), increase energy and sense of well being.
Postnatal Pilates classes offer one of the best ways to get back into shape quickly after having a baby. Pilates quickens postpartum recovery , strengthens the body & mind for the new demands of motherhood. Whether you have had a vaginal or Caesarian delivery, a safe Pilates workout is developed to target particular muscle groups.
It is recommended that you wait a minimum of six weeks after delivery to start exercising again. However, if you have had a caesarean section, then it is highly recommended that you wait eight to twelve weeks before starting postnatal Pilates. However, always consult your doctor
Babies are welcome too.
Pilates is excellent exercise for strengthening the pelvic floor muscles. In Pilates, the pelvic floor muscles are used in their role as natural muscular support for movement. The muscles are worked/switched on together will the abdominals as the beginning of every exercise. Pilates is a good form of exercise to add in some variety/additional challenge to the basic pelvic floor muscle exercise.
What to expect from your appointment
I wish to provide the full range of my physiotherapy services in the comfort of your own home. By providing an at home service I hope to remove the hassle of you having to attend a clinic when you are in pain, struggling with mobility, have a young family or new baby, do not drive and rely on other to attend appointment which makes leaving the house difficult.
I provide a plinth (treatment couch) and any other equipment that is required to complete assessment.
You do not have to be referred by your GP or wait for an NHS appointment. I am flexible with appointment times and can offer appointments during the day time (Fridays only), evening appointment between 5pm and 8pm (Monday to Friday) and even weekend appointments. I work closely, and communicate with NHS and private Consultants and GP's to offer a complete service.
I will take a thorough history, including any relevant medical history. The consultation is a two way process, so the more that you can tell me about how the problem started, where you feel your symptoms, and what aggravates and eases them the better.
After discussing your problem I will then complete a detailed examination, to try and reach a diagnosis of your condition. This examination could involve a vaginal or ano-rectal examination, depending on your presenting problem. This will be discussed in full and any questions/queries will be answered fully. There is no pressure to consent to an internal examination, however it is helpful for diagnosis and treatment and many women actually find it very helpful.
Finally I will discuss an individual treatment plan and how long we expect that it will take you to recover.
How long is the appointment ?
An initial assessment is one hour and follow-up is 40 minutes