Menopause Pelvic Health | How a pelvic health physio can improve pelvic floor issues

How can a pelvic health specialist physiotherapist help menopausal women?

Weakened pelvic floor muscles caused by a drop in oestrogen can lead to miserable menopause symptoms that many women are too ashamed to seek help to resolve. The sad fact is that in most cases, these menopause symptoms can easily be improved with the help of a women’s health physio, therefore preventing more severe issues that can arise post-menopause.

News Flash!

In February 2023 the Royal College of Obstetricians & Gynaecologists (RCOG), called for more action to reduce the number of women living with poor pelvic floor health, posting survey results of 2,000 women* that revealed one in five (21%) experienced urinary incontinence and a quarter (25%) experienced a frequent urge to wee. Despite symptoms being common, over half (55%) do not currently do, or have never done pelvic floor exercises, with nearly a quarter (23%) not knowing how to do them.

The survey also revealed that:

• The majority (69%) of women had not spoken to anyone in the NHS about their pelvic floor health.

• Over half (53%) of the women who had experienced symptoms of pelvic floor dysfunction did not seek help from a healthcare professional. Of these, 39% thought their symptoms were normal and 21% were too embarrassed.

• Only 22% of women do their pelvic floor exercises regularly.

• 15% could not identify any common symptoms caused by a weak pelvic floor.

Christien Bird is a Chartered Physiotherapist, specialising in Women’s Health Physiotherapy and Ultrasound imaging of the pelvic floor muscles and perineal evaluation.

Christien treats women who haven’t fully regained urinary or bowel control following delivery, as well as older women who appear to have made a good recovery but go on to develop incontinence or organ prolapse, years later.

Shocking statistics published in the NICE guidelines about ‘Urinary incontinence and pelvic organ prolapse management’, say ‘the prevalence of pelvic organ prolapse is high; in primary care in the UK, 8.4% of women reported vaginal bulge or lump, and on examination prolapse is present in up to 50% of women. One in 10 women will need at least 1 surgical procedure, and the rate of re‑operation is as high as 19%.’ Who knew that?

Much of Christien’s work is in supporting women in 'third age’ (peri and post menopause), when hormonal changes lead to loss of oestrogen, weakening of the pelvic floor muscles, incontinence, prolapse and vaginal dryness. Too many women suffer symptoms in silence , thinking it’s fairly normal, or are too embarrassed to look for help and support.

The dynamic practice owner of the White Hart Clinic, Christien puts her patients at ease she treats the 3 Ps: prolapse, poo and pee -all associated with pelvic floor issues. Good news - in most cases these issues can be reversed with the right treatment programme. Find out what she recommends.

As a Women’s Health Physio I started researching the menopause when I realised that some of my irrational outbursts were lasting for a suspiciously long time, I clearly had landed in the peri-menopause phase, that period when your hormones fluctuate and are all over the place. After 5 years of reading clinical and opinion articles, I was left slightly more confused and it was no surprise that our patients, my friends and sisters felt the same.

Working together with GP’s, physios, Gynaecologists, nutritionalists and information resources like Positive Pause our practice has developed a pick and mix of menopause solutions to help patients navigate around this phase of life in the most optimal way.

In the ideal world, we would like you to take complete control before the peri- menopause surprises you, so you are ready and prepared. Preventing these embarrassing symptoms that are far too common yet never normal.

What can women proactively do pre-menopause to help themselves?

Focus on your pelvic floor

Pay some extra attention to your Pelvic floor. They are the muscle group that are responsible for some pretty important functions like, bowel and bladder control, better sex as well as managing and preventing prolapse.

A study showed that women with continence issues often increases during the menopause, will wait for 6 years before they seek help. And only then will mention it to their doctor, if she is female, looks interest and is old enough.

We would recommend downloading the Squeezy App today and start your pelvic floor muscles exercises. If you are still not sure, book an appointment with a specialist Women’s Health Physio.

Happy Bowel Movements

Nothing causes more misery in people’s lives than bowel problems. With changing hormone levels during the menopause bowel problems can increase whether it be constipation, incomplete emptying, faecal incontinence, problems with controlling wind, rectal prolapse, haemorrhoid’s, or pain from anal fissures– and sometimes quite a few of those symptoms can occur at the same time.

Here are a few tips how to achieve a regular happy bowel movement:

• Position matters. Your knees need to be higher than your hips. When your knees are higher than your hips it is like unkinking a water slide. Use a bambino stool, squatty potty, or one of my patients used to wear her stilettos, which is a pretty stylish way!

• Have patience, you can’t just empty the tap, take your time

• To push or not to push, don’t push in the traditional way. If you strain, it is like squeezing toothpaste from the top, it makes it more difficult to empty your bowels completely. Straining is also a risk factor in the development of prolapse, if you strain regularly, talk to your GP or Women’s Health Physio.

Dealing with Vaginal Dryness

About half of menopausal women suffer from vaginal dryness and painful intercourse. Your vagina is very well oestrogenised, so reduced oestrogen might lead to itchiness, pain, you might not be able to wear your favourite pair of jeans and sex can be painful, which is miserable. Yet less than half of those women seek help.

If sex is painful or your sexual experience is changing, seek help from a Women’s Health Physio and use a good vaginal lubricant or ask your GP for topical Oestrogen (HRT).

AND FINALLY

Ask for support! Talk to your friends, mother, sisters and daughters; keep asking even if that is not your natural style. Women’s health needs to be talked about more, we are not simply men with boobs and tubes, we have different physiologies and need individualised treatment. As a women’s health specialist we have some great public health message to share, too often we keep it tucked behind the closed doors of clinics.

Christien Bird is running an online women’s health physio Menopause MOT service. For details Email: The White Hart Clinic

Originally posted September 2019

Updated in 2023

Find a menopause trained women’s health physio in your area

Not all women’s health physios have an education or understanding of the complexities of menopause, so how can you find a menopause trained physio?

Our sister business Menopause Movement has trained women’s health physio’s and fitness professionals to be able to confidently treat or train menopausal women. To find specialist menopause support in your area, search the Menopause Movement Directory.

*The survey of 2,000 UK women was conducted between 30th September and 4th October 2022 by Opinium on behalf of the RCOG.