Pelvic floor weakness is experienced by the majority of women at some point in their lives, often after childbirth when it is estimated that 80% of women sustain damage to their pelvic floor, and during Menopause when the reduction in oestrogen causes thinning and weakening of muscles, although symptoms can occur at any time. Regardless of when this happens, a pelvic floor dysfunction can manifest in temporary and sometimes long-term urinary or faecal incontinence, pelvic organ prolapse or sexual dysfunction (pain, leakage, reduced awareness). Despite how common these symptoms are, with 1 in 3 women experiencing incontinence in adult life, it takes on average women 7 years to mention symptoms to her doctor and only 25% will seek professional help. These symptoms are inconvenient at best and debilitating at worst and conditions for which physiotherapy can help. While NICE guidance recommends referral for supervised pelvic floor muscle rehabilitation and bladder retraining as the first line of treatment for women experiencing urinary incontinence, it is not taken up by many who are often unaware that effective conservative treatment exists, or even worse, assume the condition is normal.
The pelvic floor muscles run from the pubic bone to the tailbone, supporting pelvic organs, such as the uterus, bowel and bladder. The muscles are shaped like a sling and relax when the bladder contracts, allowing urine to escape.
Pelvic floor muscle training is proven to be effective in restoring the pelvic floor, according to Clare Pacey, Pelvic Health Specialist Physiotherapist at Kings College Hospital and Nuada Medical. It appears, however, that many women are never made aware that Women’s Health Physiotherapy even exists. We commissioned a survey last month revealing that a referral to this type of specialist support was only made in just over a quarter (28%) of cases.
The effects of incontinence are vast, with some sufferers reporting a psychological morbidity, such as depression, and nearly a quarter taking time off work due to their condition. Furthermore, over a third of women report that urinary incontinence has significantly affected their relationship. Clare Pacey feels strongly about this:
“It is shocking that women are suffering in silence, particularly when NICE guidelines so clearly state a defined treatment pathway. There is no need for women to continue to endure the physiological and psychosocial effects of urinary incontinence, when it has been demonstrated that three months of supervised pelvic floor muscle training with a Women’s Health Physiotherapist is often all that is needed to improve or resolve symptoms. Furthermore, the guidelines state that internal examinations should always be completed to ascertain whether pelvic floor exercises are being carried out correctly. Research shows that up to 44% of women do exercises incorrectly, with verbal instruction only.”
The importance of a healthy pelvic floor holds great value in other European countries, such as France, where Women’s Health Physiotherapy is commonly prescribed. Clare, who has extensive experience treating a variety of patients with pelvic floor weakness and dysfunction, continence problems, pelvic pain and sexual dysfunction, continues:
“In France, all new mothers are offered up to ten sessions with a Women’s Health Physiotherapist as part of standard postnatal care. Through this, it has been ascertained that a quarter of women have a problem, whether urinary or faecal incontinence, issues with abdominal muscle separation, pelvic organ prolapse or sexual dysfunction. Rehabilitation is offered routinely. This begs the question – why is this not the same in the UK? We could help so many more women and prevent future issues by offering the support as par for the course.”