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Urogynecological physiotherapy is a relatively new field. It is mainly dedicated to women with problems in the area of the smaller pelvis, but not only to them. The activity of a urogynecological physiotherapist in a way complements the work of a gynecologist. Patrycja Skrzypek, a specialist in the Sublimed Medical Center from Krakow, tells about all this.
- A urogynecological physiotherapist can help with urinary continence or lower pelvic organs
- It can also be helpful in ailments related to pregnancy, childbirth and the postpartum period
- Can a urogynecological physiotherapist help?
- You can find more such stories on the TvoiLokony home page
The list of health problems with which a patient can refer to a specialist of this type is long and varied. It is worth discussing the main ones.
Troublesome ailments
What problems are we talking about? – First of all, it is very frequent urinary incontinence, but also stool, gas and vaginal gas incontinence, so a complex of quite embarrassing, troublesome matters – the physiotherapist lists the most common situations with which she treats her patients. Another urogynecological problem is, for example, pollakiuria.
– It is also possible to deal with it, thanks to exercises in this field. Another problem that is worth mentioning is the lowering of the pelvic organs, i.e. the bladder, uterus and rectum – explains Patrycja Skrzypek.
A different group of problems that may cause patients to be referred by a gynecologist to a urogynecological physiotherapist are pain, e.g. during intercourse.
– They can be either primary (the patient has been struggling with the problem “always”) or acquired. Then they result from reasons such as pregnancy, childbirth, past infections or inflammation, and may also have a psychological basis. In the case of acquired ailments, it is only after the occurrence of the aforementioned reasons that problems begin to appear, and patients begin to link the occurrence of certain ailments with specific events – the specialist explains, adding that the opposite feeling is also a frequent situation, i.e. the lack of feeling any pleasure during sex . Another common problem in which urogynecological physiotherapy can provide noticeable relief is painful menstruation.
Help in pregnancy
A large group of patients also seek help during pregnancy, before the delivery and the subsequent puerperium. The ailments associated with this condition constitute a separate group of problems. In such cases, patients visit physiotherapists for various reasons, very often with simple back pain. The specialist can then comprehensively take care of the patient, helping in the proper preparation of her body for childbirth.
- The puerperium – course, ailments, disturbing symptoms [WE EXPLAIN]
Another example are patients who were physically active all the time before pregnancy and would like to continue this activity. So they come for advice on how to keep fit in the context of a changing physiognomy. Still others visit the office for control purposes, wanting to check their pelvic floor or abdomen (e.g. if it is already large, they want to make sure that the white line divergence is so large that it may be a problem for them).
It is worth emphasizing that patients visit doctors and physiotherapists more and more often in such situations. They care not only about the health of the future child, but also about their own physicality. This is a certain change of common attitude, which specialists are very pleased with.
Muscle tension
Patients often visit a physiotherapist also after delivery, e.g. if they want to consult the condition of the scar after a cesarean section, incision or rupture of the perineum. Sometimes they also report urinary incontinence, e.g. when coughing or during certain motor activities.
– Then we focus strictly on examining the pelvic floor muscles. It is a transvaginal test – this is how the function of the various layers of the pelvic floor muscles is checked. It may be that the patient has a problem with excessive tension in one of the layers, while another is, for example, too relaxed. Therefore, it is difficult to determine that the problem and its cause should always be the same, explains Patrycja Skrzypek.
- Kegel muscles in women and men. How to exercise your Kegel muscles?
The types of ailments with which patients report to the urogynecological physiotherapist may result from too much, and on the other hand – too little muscle tension. It is not always the case that the cause of, for example, urinary incontinence is only too little muscle tension. It is visible not only in the pelvic floor, but also in the tense muscles of the abdomen, which may result in, for example, gastrointestinal problems.
Women with such ailments also have a general high tension in the body, which is why they often complain about, for example, tense arms or grinding of teeth. In such cases, it can be concluded from the initial interview that she is a stress patient. Such women may feel pain during intercourse, for example because their body is too tense. On the other hand, patients with too little tension are often characterized by a “tired” posture – their tissues are flaccid, their abdomen protruding, and their backs are rounded. On the basis of this type of ailments, a specialist can often conclude what problems the patient is dealing with.
- “Women seek confirmation that they are not alone, that this is not a problem that only concerns them”
In such cases, the most common work is not with the pelvic floor muscles themselves, but with the entire posture. How?
– We will try to reduce this tension for the patient of tension through a number of different manual techniques, massages, taping and general techniques to relax the pelvic floor and the whole body. In turn, in patients with too little tension, training is introduced, starting from the pelvic floor, through the paraspinal or abdominal muscles. In this way, you work on the general attitude of such a patient in order to maintain the effects of the therapy – explains the physiotherapist.
Cooperation of a physiotherapist with a gynecologist
To a large extent, the activity of a urogynecological physiotherapist is related to the work of a gynecologist. – The activities of specialists in these two fields are related to each other on the basis of cooperation – explains the specialist.
– If I am not sure about something during the examination of the patient, then I refer her to the gynecologist. For example, that he would perform additional tests to the extent that I am not able to do it myself. Often, however, it also works the other way around: the knowledge or skills of gynecologists are also not developed to that extent in the field of physiotherapy. It is in such cases that the time comes for physiotherapeutic activities. These are therefore strictly complementary activities, concludes Patrycja Skrzypek.
- The shameful suffering of women
Urogynecological physiotherapy has been operating in Poland for about ten years and is still a developing field. As a result of the therapy, the patient can count on very good results, provided that she does not give up exercise too quickly. The confidence of doctors in this interdisciplinary field (most often associated with gynecology, but also urology, proctology, psychology, but also sexology) is clearly growing, which gives hope for its dynamic development in the coming years.
We encourage you to listen to the latest episode of the RESET podcast. This time we devote it to the problems of the perineum – a part of the body just like any other. And although it concerns all of us, it is still a taboo subject that we are often ashamed to talk about. What do hormonal changes and natural births change? How not to harm the pelvic floor muscles and how to care for them? How do we talk about perineal problems with our daughters? About this and many other aspects of the problem in a new episode of the podcast.
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