Women's Health Physiotherapy
Looking for quality women's health physiotherapy services in the Penrith, Blue Mountains and Western Sydney areas? Our team is here to help!
Take The First Step Towards Better Pelvic Health
Your Women's Health Physio Can Support You At Every Stage Of Life
Our experienced team of pelvic health physios are here to support and guide you to recovery.
From the teenage years to pre and post pregnancy, through to mid life and into menopause, we are here to help you achieve better pelvic health.
We can help with a range of pelvic and sexual health conditions. Find out more below.
How Can We Help You?
Bladder Physiotherapy
If you experience bladder leakage, urgency or difficulty emptying, you don't need to put up with it. We can help!
Vaginal
Prolapse
Women's health physios can help you recover from bladder or uterus prolapse to get you back on track.
Physiotherapy for Bowel Problems
Straining, incontinence, urgency or prolapse? We help with a range of bowel problems.
Pelvic Surgery - Prep & Recovery
We can help you prepare and recover from a range of pelvic surgeries including hysterectomy.
Sexual
Problems
Painful sex, vaginal surgery and recovery following gynaecological cancer can all cause sexual problems. Our pelvic physios can help.
Regain Your Core Strength
If you've had a back injury or surgery, hip replacement or abdominal surgery, you will need to address your pelvic floor strength! Ask us how.
Breast
Care
No, it's not the pelvic floor but it is very much part of our Women's Health service. From breast cancer to mastitis management, we can help.
Pregnancy and Postnatal
We can help ease some of the physical discomforts during pregnancy, prepare you for birth and assist in your birth recovery. Find out more below.
Bladder Physiotherapy
Bladder Leakage | Physiotherapy for Urinary Incontinence
Do you leak when you cough, sneeze, move suddenly, or exercise? Did you need to wear a pad last time you were sick? You probably have stress urinary incontinence which means that your waterpipe can’t take the strain. Research shows that pelvic floor muscle exercises with a properly qualified physiotherapist has a 50% complete cure rate, without any of the risks of surgery. An additional 25% women will be significantly improved with supervised pelvic floor muscle training for stress urinary incontinence, meaning that 75% of women who complete this treatment end up satisfied with the outcome.
However, up to fifty percent of women who do pelvic floor muscle exercises (also known as Kegel exercises) don’t actually switch on the right muscle! A proper pelvic floor assessment is the only way to be sure you are doing pelvic floor exercises properly.
Your pelvic health physiotherapist can also fit an anti-incontinence vaginal support pessary for exercise or for when you are sick, to provide more immediate help. A continence pessary is a silicone device, a bit like a tampon, that supports the bladder neck during impact or exertion.
Bladder Urgency | Physiotherapy for Overactive Bladder
Do you need to pee all the time? Do you get a huge busting urge but only pass a small amount of urine? Are you scared to travel too far from a toilet in case you don’t get there in time? You may have an Overactive Bladder.
Our assessment will help to narrow down the cause. You might have weak pelvic floor muscles or weak connective tissue that just can’t hold the weight of your bladder. Or you might have developed a conditioned response and have lost the ability to stop bladder signals from your spinal cord or brain. There might even be an outside source of irritation like a full bowel or tender points in your pelvic floor muscles, tight or sore tummy or hip muscles, a dry vagina, or a bladder infection.
We will help you find the cause and together we will sort out an effective solution.
Recurrent Urinary Tract Infection, Urethral Pain or Bladder Pain
Do you feel like you always have a UTI (urinary tract infection) but the tests come back negative and you feel like you are going out of your mind? Maybe antibiotics actually help a bit, but the symptoms keep coming back.
You might have a sensitive waterpipe or bladder which could be caused by an irritated nerve, a tight sphincter muscle, tender points in the pelvic floor muscles, or scar tissue. We can help!
Difficult or Incomplete Bladder Emptying
Do you sometimes know your bladder is full, but when you try to urinate, only a trickle comes out?
If you have recently had a baby, this is called post-partum urinary retention and it is caused by bruising to the nerves that make the bladder contract. The nerves can also get damaged during pelvic surgery, because of neurological disease, or from a back injury.
Incomplete bladder emptying can also be caused by a bladder prolapse. Sometimes the nerve supply to the bladder gets slowed by stress or anxiety or even by some medications. Sometimes the muscle around the waterpipe just won’t let go.
We can help find the cause and come up with the best solution for you.
Physiotherapy for Vaginal Prolapse
Physiotherapy for Bladder Prolapse
Have you ever felt as if there is an air bubble caught in the vagina? Or a tampon doesn’t go in or stay in as easily as it used to, or the tampon leaks more easily now? These might be early warning signs of vaginal prolapse. You might have noticed a reduction in vaginal sensation or grip during intercourse. Perhaps you’ve felt a soft bulge at the vaginal entrance when you are washing or wiping. If you look with a mirror, you might see a protrusion the size of a marble, a boiled egg, or even larger. It might rub on your underwear, feel heavy, get itchy or dry, create a feeling of urinary urgency, or cause difficulty with bladder emptying.
It is always easier to manage a prolapse before it becomes bigger, so don’t ignore the warning signs. Get yourself assessed if you have any concerns, even if your concern is as vague as ‘something just doesn’t feel right’ down there. Management can vary, from pelvic floor muscle training, to support pessary fitting, to finding better ways for you to move in order to ‘share the load’ so that the weakened tissue isn’t being strained all the time. This may mean teaching you how to use your abdominals differently, strengthening your hip, or freeing up restrictions elsewhere like in your ankle or shoulder or ribcage.
Physiotherapy for Prolapsed Uterus
The cervix (the entrance to the uterus or womb) normally sits just out of reach of an examining finger, right up the top of the vagina. This part of the vagina doesn’t have much sensation, and for this reason we are not normally aware of the cervix. If the uterine ligaments stretch, usually after vaginal delivery, the result can be sacral low back pain, abdominal heaviness or congestion, difficulty with bladder or bowel emptying, and a shorter vagina. The cervix could get bumped during intercourse, which can feel unpleasant.
By the time the cervix has descended into the lower third of the vagina where it can be felt, it will have stretched quite a long way! Initial symptoms are likely to be intermittent, more likely after exercise or at the end of the day, or just before your period. They can become progressively more annoying and intrusive, so it is wise to seek an assessment sooner rather than later, before everything feels like it is going to fall out.
Physiotherapy for Bowel Problems
Obstructed Defecation
This term is used to explain the situation when you know poo is there but you can’t get it out. If you repeatedly strain you can cause all sorts of other problems like haemorrhoids, an anal fissure, a vaginal prolapse, or even a rectal prolapse.
Maybe you pass small amounts of stool often, perhaps even every time you go for a wee, always with a sense that you have left some behind and that you should have done better. One of those left-over pellets might even slip out when you stand up or bend over. You might be living with bloating and tummy discomfort.
Some women solve the problem by digitating (putting a thumb into the vagina and pressing backwards), and there is even a special device to help you do this more hygienically. We can see if this works for you, but we can also give you advice about stool regulators, bowel routine, and toilet posture and pushing techniques that will help clear the rectum better. If you are planning a posterior wall repair (also known as a Posterior Colporrhaphy or Rectocele Repair), see us beforehand so you are better informed and know how to protect the surgeon’s work so the bulge doesn’t reoccur.
Straining
Some people have really ‘back-to front’ pelvic floor muscles. In other words, the muscles contract when they should relax. The rectum closes up when it should be straightening and opening out. You might have been told you have a ’paradoxical pelvic floor contraction’, or ‘anismus’. Unfortunately, the harder you push the more blocked up you will become. You can end up in a vicious cycle of pain, bleeding, poor emptying and distress.
This condition really is another form of obstructed defecation. We will use biofeedback to help your pelvic floor learn to relax when it is supposed to!
Prolapse (Rectocele)
Are you aware of a pocket that retains poo, or perhaps you feel a sense of vaginal heaviness and bulging particularly before or after a bowel movement? You may have a rectocele, which happens when the back passage pushes into the vagina. It is caused by a stretch or tear in the connective tissue in the back wall of the vagina.
It often follows vaginal childbirth, but sometimes it occurs just from hard physical work, strenuous exercise, or repeated straining. We can help with techniques to clear the pocket, pelvic floor muscle training, and load management strategies to reduce strain into the area, and we can help prepare you for surgical repair if that is your preferred option.
Rectal Prolapse
An intussusception is a partial rectal prolapse, when the lining of the back passage starts to separate from its underlying muscle layer, collapsing into the rectum or anus. This can be mistaken for stool. Or it might create urgency and trigger a bowel contraction that is then hard to control. Or it might block the rectum and make it difficult to pass anything.
Firming up your stool, managing loads, and strengthening your pelvic floor muscles can help. If you have been told to have surgery (a Delorme’s procedure or a Ventral Rectopexy), we can help you prepare and recover.
Physiotherapy for Bowel Incontinence
A third- or fourth-degree anal sphincter tear sustained during vaginal delivery is called an OASI, or Obstetric Anal Sphincter Injury. It is normally repaired soon after the delivery. Long term results are good, as long as good postoperative advice is followed.
An undetected tear can cause bowel control to suffer in the first few weeks post-partum, but sometimes symptoms don’t appear until closer to menopause. The first sign of weakness might be poor control of wind. Every woman who has had an anal sphincter injury should be offered specific anal sphincter muscle training, the sooner the better.
The repair can often be quite tight and resuming sexual intercourse can feel frightening, so it is important that the tissue regains its flexibility too. See us for advice.
Bowel Urgency
If you’ve ever had a bowel accident as a result of urgency, you know how devastating this can be. It will affect your self-confidence, you will reduce your activity levels, and your world will become smaller.
Food, coffee, worry, or exercise can be a trigger. Underlying causes can be birth trauma, bowel resection surgery, inflammatory bowel disease, or nerve injury.
We can help you identify bowel irritants, improve your bowel routine, calm your bowel using gut-directed hypnotherapy or electrical stimulation, and strengthen your anal sphincter and puborectalis muscles.
Hysterectomy and Other Pelvic Surgery - Preparation and Recovery
Hysterectomy (removal of the uterus and sometimes the fallopian tubes and even the ovaries) is major surgery and it can take many months to feel ‘right’ again. There is a risk that the top of the vagina (known as the vaginal vault) can prolapse after hysterectomy, especially if the hysterectomy was done for a prolapse of the uterus in the first place, or if you have risk factors for a uterine prolapse. You have the best chance of a safe recovery if you consult us before the procedure, so you can learn what to do and what not to do in the critical first few post-operative weeks. You may not be able to see us until 6 weeks’ post-op, and you won’t be able to drive for the first 3 weeks, so preparation is best!
It is also a wise idea to see us prior to any vaginal repair surgery. These procedures carry a risk of failing, as high as 40% reoccurrence by 5yrs. Managing loads in the first few weeks, learning to move without bearing down, learning to brace your pelvic floor muscles at the right time, using your abdominal muscles appropriately, and learning to recognise and manage constipation may be helpful.
Seeing us prior to laparoscopic excision of endometriosis could help in reducing painful postoperative pelvic floor muscle spasms. Normalising your bladder and bowel habits, reducing your stress responses, and improving pelvic mobility as much as possible beforehand can reduce the ‘cross-talk’ between pelvic nerves that can otherwise exacerbate pain. See us after your endometriosis surgery if you haven’t has as much relief from surgery as you were expecting.
Seeing us before or after a suburethral or midurethral tape procedure for stress urinary incontinence may improve your leakage outcome. The tape alone cannot completely close off the waterpipe. You will need a well-functioning sphincter muscle to get the final seal!
Regain Your Core Strength After Back or Hip Surgery
Have you had a back injury or surgery (for example, discectomy, lumbar fusion, or laminectomy), hip replacement, or an abdominal hernia repair or diastasis rectus abdominus repair/plication? A typical rehabilitation program may not give the pelvic floor the specific attention it may require.
Some women are actually unable to contract their pelvic floor muscles AT ALL when they are first assessed. This cannot be determined by an external musculoskeletal evaluation! Inability to contract the pelvic floor muscles may compromise the safety and effectiveness of the whole core exercise program.
It is wise to have a pelvic floor evaluation before starting a Pilates exercise or gym strength program too, especially if you have risk factors for incontinence or prolapse.
As well as offering core strengthening programs after surgery, we can provide physiotherapy for lower back pain and other muscle and joint aches and pains.
Physiotherapy for Sexual Problems
Vaginismus (Painful Sex)
If sex is painful and penetration is difficult or impossible, and the vagina feels tight or blocked at the entrance, you may have vaginismus. The cause is spasm of the pelvic floor muscles at the entrance to the vagina. Intercourse, internal medical examinations and use of a tampon may be impossible with this condition.
Vaginismus is an example of a protective muscle response that has become way too strong and efficient. Vaginismus is usually successfully managed with pelvic floor muscle re-education.
Recovery After Gynaecological or Anorectal Cancer
Radiation or resection surgery to the vulva or vagina may cause scarring and vaginal adhesion. This can lead to difficulty with intercourse, pelvic pain, and bladder or bowel storage problems.
Myofascial release, nerve mobility techniques, and dilator therapy are some of the ways we might work with you.
Scar Pain after Hysterectomy or Vaginal Repair Surgery
Likewise, vaginal surgery can cause soft tissue adhesion and restriction which can impair function and cause pain, and can be managed as above.
Persistent Genital Arousal
This distressing condition is now referred to as Genito-Pelvic Dysesthesia. It is characterised by unwanted, bothersome and intrusive feelings of genital arousal without any feelings of sexual desire. The erectile tissue (in females it is hidden under the surface of the inner labia) can feel persistently engorged, or you might feel like you are constantly on the verge of an orgasm.
There may be buzzing, itching, pain, tingling, throbbing sensations in any part of the genital region, including the clitoris. Having sex doesn’t relieve the symptoms and can sometimes make things worse.
Genito-Pelvic Dysesthesia may happen because of tight or tense tissues, nerve entrapment, other musculoskeletal factors, or hormonal changes. It can respond well to pelvic floor muscle and myofascial release, nerve mobilisations, and even electrical stimulation.
Rehabilitation after Vaginoplasty (Reconstructive Surgery)
A new vagina (neovagina) may be created during gender reassignment surgery or after cancer treatment, or to manage a congenital malformation. Pelvic floor therapy is essential in these situations.
Sadly, women are sometimes just given a set of dilators and left to fend for themselves. Dilator work can be challenging and we don’t think you should be left to struggle with it on your own.
We offer specialised physiotherapy services for those who have had gender reassignment surgery. Check out our Transgender Physiotherapy page for further information.
Breast Care
Not quite the pelvic floor we agree, but as advocates for women’s health we are pleased to offer this service too. We can help if you need to regain mobility before or after treatment for breast cancer or if you have pain or scarring after reconstructive or breast implant surgery. For more information on mastitis management see our Pregnancy Physiotherapy section.
