A day in the life of a pelvic floor physiotherapist – with Anniken Chadwick
September 28, 2020
What do people think of pelvic floor physiotherapists?
Every week a client will say to me with great curiosity “Can I ask you how you ended up doing pelvic floor physiotherapy??”
And every day I surprise a client with what I can offer them because they had no idea what I actually do.
People don’t know what we do. They don’t understand pelvic floor physiotherapy, and that’s a problem.
Why people need to know what pelvic floor physiotherapists do
Because
- 1/3 women experience incontinence
- 1/2 women over 50 have prolapse
- 1/4 women experience sexual pain over a lifetime.
And these are just the stats for women. Because historically we were known as doing ‘women’s health’ physiotherapy.
It’s a problem because pelvic health physiotherapy (a more appropriate gender-neutral term) is vital for the health of ALL folk.
We are vital for the pelvic health of
- women
- men
- trans and gender non-binary
- athletes
- elderly
- teens
- children
That’s all people with a pelvis!!!!!
https://www.instagram.com/p/CCV_rAlBIcZ/?utm_source=ig_web_button_share_sheet
Why don’t people understand pelvic floor physiotherapy?
Some people even in our own profession don’t get what we do. Pelvic health has been so lacking in healthcare historically that the profession is now having to play catch up. But we’re working hard and catching up big time.
So what do pelvic floor physiotherapists do?
There have been huge advancements in physio approaches to pelvic health over the last decade or so. We figured out how the pelvic floor and core work and interact with your whole body. That means issues that we couldn’t improve before, we now can, because we’re seeing the big picture and treating you holistically.
We don’t treat any other body part in isolation. Remember the song? The foot bones connected to the…
Physios don’t treat a knee without considering the whole leg. So why did this happen in the pelvis?
Clue: Because people think it’s ‘inside’ and scary and to do with sex and embarrassing stuff so we like to keep it separate.
So… we just focussed on the pelvic floor and taught people to do kegels and it looked like this, and only like this
Now, every day at work I have to right that wrong.
“I know you do your kegels but a weak pelvic floor isn’t your problem, and that’s why you’re not getting better.”
“But every blog and trainer and yoga instructor and my mum and all my friends and doctors said I had to do my kegels”
“I know. And I know you’ve been working really hard, but unfortunately, the beautifully intricate dynamics of the pelvic floor has been reduced down by all of medicine and society to a single strengthening exercise named after a man, and it’s just more complicated than that”
I paraphrase but you catch my drift.
Side note: if you see a pelvic floor physio who just gives you kegels and you’re not improving, then go see a better one.
What makes a GOOD pelvic floor physiotherapist?
We who practice physio for the pelvic floor are no different from normal physios. We should assess the whole body from top to toe, we work out what’s wrong in your unique case and treat you appropriately.
- Sometimes your pelvic floor is weak.
- Often your pelvic floor is tight.
- Frequently the problem isn’t in the pelvis at all.
A gynecologist once told me a classic gynae joke; that gynecological surgery is like fixing the engine of a car through the exhaust pipe.
Well, physio for pelvic floor often means fixing the whole car to get the exhaust pipe in the right place, then we go in through the pipe and fix the engine too.
What should you expect from your pelvic floor physiotherapist?
It’s our job to investigate and problem solve until we have it all figured out, and treat you until your free of your issue, and free of any worries about your issue.
Unfortunately, it’s also part of our job on the daily to reframe, re-educate, myth bust, reassure, and explain. Because no one knows what we do.
The client’s expectations can be low. They can come in with their goals super minimized. So we talk you round and tell you
“Yes you can jump on a trampoline again”
“No leaking is not normal”
“Yes you can have fun pain free sex again”
“Yes I can help you with ALL these issues, not just the leaking”
“No there is no ‘TMI’ here”
Why I do what I do
For me it’s frustrating sometimes that my work got political. I got into this profession because I like people, and I like helping people.
But when I got into the pelvic floor, I had to work to even get to the place where I could help someone.
Because all the miseducation and historically poor healthcare for the area is working against me. Because people’s expectations are so low for their pelvic health.
On the other hand, it’s SO rewarding to help you go from peeing their pants to continent and running again. Or to help you get through painful sex from trauma to a fulfilling sex life. Or to support you through conception, pregnancy birth and recovery.
https://www.instagram.com/p/B1EDieJgLyT/?utm_source=ig_web_copy_link
My answer to my clients when they ask me how I ended up in this role is this…
I don’t quite know how I got here. Curiosity and a love of the intimate and the juicy I think.
But what I do know is that when I started this work, and I got to change people’s perceptions about the life they could have. When I got to show them the path to move and make love freely without fear of pain, to have supported active pregnancies and postpartum recovery, to let go of the pads and anxiety about where the bathroom is…I felt I was really helping people change their lives. And then I just couldn’t get excited about ankle sprains anymore.
What should you do if you have pelvic health issues?
Pelvic floor physios can likely do more for you than you think. Call in and talk to us. We can let you know if there’s more we can offer you.
Even if you’ve seen someone before and it hasn’t worked, book in and give us a try. We’re evolving and improving every day, and we’d love to help you.
5 things to look for in choosing a pelvic floor physiotherapist:
- Training in sports or orthopaedics as well as pelvic floor
- Training in chronic pain and or biopsychosocial approach
- Trauma aware care
- Assesses and treats the whole body (not just kegels)
- Is willing to talk to you on the phone first if you’re unsure
Check out our awesome team here.
FAQ’s:
What is pelvic floor physiotherapy?
Pelvic floor physiotherapy is like regular physiotherapy but with advanced training so we can assess inside the pelvis (vaginal and/or rectal exams).
We treat bladder, bowel, sexual and pregnancy / birth related conditions.
We also treat a lot of chronic pelvic conditions, such as chronic back tailbone or SI pain, endometriosis and post pelvic surgeries.
What does a pelvic floor physiotherapist do?
We assess you top to toe, often including an internal exam of the pelvic floor muscles. We don’t do an internal exam if it’s painful or you’re not ready.
We may treat you using a variety of approaches depending on your preference and need.
Approaches may include
- Hands on manual therapy
- Exercise to strengthen or release
- Education
- Acupuncture
- Specific movement retraining
- Posture retraining
- Coaching for return to exercise
- Strategies for pain or symptom management
What happens during a pelvic floor physiotherapy assessment?
An internal assessment may be vaginal, rectal or both. A speculum is not used just a gloved finger and lube. It shouldn’t hurt. If there is pain that is something we should address.
We go slow, and you’re involved in the process. It’s never a grin and bear it exercise.
We may ask you to kegel, cough, bear down or move so we can assess your muscle function and strength.
