Even if you’ve never had an appointment with a physio, chances are, you know what they do. But what about a women’s health physio? It wasn’t until I qualified as a pre and postnatal personal trainer that I heard the term, but, by the time I had my first baby two years later, I knew that nothing (not even a screaming newborn or government statutory maternity pay) would stop me making an appointment once I’d given birth.
Exposure to decades of diet culture and “bounce back” rhetoric means we tend to focus on how our post-baby bodies look rather than how they feel, but what’s going on internally – specifically, with our pelvic floor – can have an effect on everything from how soon we can return to exercise, back pain, how our stomach looks and our ability to cough without a little bit of wee coming out. FYI: that last one may be common, but it definitely isn’t something you should live with.
After two rounds of IVF, a 48-hour failed induction and a C-section birth, you’d think I’d be pretty chilled about strangers poking around down there, but I still found myself lying rigid, eyes fixed on the ceiling trying to think of small talk that didn’t involve my vagina, as my physio Jenny performed an internal examination. Thankfully, an ability to put you instantly at ease, wrap you up when you’re feeling fragile and give you the confidence to believe your body isn’t broken, it just needs a little help, seems to be prerequisite for becoming a women’s health physio. The results of my appointment confirmed that my diastasis recti (the separation of the abdominal muscles experienced by almost 100% of women during pregnancy) was healing well and, vitally, could maintain tension, but that my pelvic floor wasn’t so great at relaxing, (which explained why I found myself on the toilet every night trying to wee minutes after I’d just been) and my balance and posture had definitely felt the full effects of pregnancy. Instead of feeling despondent at these changes in my body, I left the physio feeling empowered, and armed with everything I needed to start feeling like me again.
A highly specialist strand of physiotherapy that involves assessing and treating conditions related to the pelvis and pelvic floor, women’s health physios tend to see clients around the time of huge physiological changes in their lives, such as during and after pregnancy and the menopause. That said, the symptoms leading to a women’s health appointment – incontinence, an over-active bladder, pelvic pain, prolapse and painful sex – can present at any time and have a huge impact on everything from your confidence to your quality of life.
While women like Ferne McCann have spoken out about their experience of post-birth prolapse in an attempt to open up the conversation around women’s health and encourage women to be proactive in seeking advice, Tena Lady ads continue to normalise leaking and a woman’s nether regions are still shrouded in mystery like we’re living in an episode of Bridgerton. Knowledge – and open dialogue – is power, so we asked women’s healthy physio Clare Bourne to demystify all things women’s health and explain when and why to book in with a physio. Clare’s informative Instagram account has amassed 23.9k followers, and gives women access to advice on everything from perineal massage to vaginal pessaries. In Clare’s world, there’s no such thing as TMI…
What exactly is a women’s heath physio Clare?
“It’s a physiotherapist who has done specialist training to care for women throughout their lives with any concerns around their pelvic health. Symptoms often relate to the pelvic floor, and are often symptoms of pelvic floor dysfunction, such as incontinence, prolapse or painful sex. However, we treat a whole range of conditions and symptoms. We care for a lot of women during and after pregnancy, as well as into the menopause.”
Why would we need to see one?
“If you have any symptoms that relate to your bladder, bowels or sexual function then a women’s health physiotherapist might be able to help. Also, if you are pregnant and got any aches and pains or if you have just had a baby and want to know more about your body, how it is recovering and how to return to exercise safely, a women’s health physiotherapist can support you.”
What happens during an appointment?
“We always start with a long chat to find out about you, your current symptoms and any concerns you have. We then use this information to shape the rest of the assessment. Depending on what you come to us for will depend on exactly what this will involve. If your concerns are around your bladder, bowels or sexual health, or a postnatal review, it is likely that a vaginal examination of your pelvic floor muscles would be included. This can feel scary, but we always do whatever we can to make you feel comfortable and we don’t use speculums so the examination should not be painful.”
How many sessions do you need?
“For lots of women a few sessions would be advised, as we often send you off with some exercises and advice to try and we want to review how this has helped your symptoms. For most gradual progression of exercise is needed over time. With symptoms like incontinence and prolapse often it can take months of hard work to see change, so support along the way is essential. We are your cheerleader! If you are going privately and can only afford one session, we can work around that, so do let us know in advance.”
What’s the difference between the postnatal 6-week GP check and a women’s health physio appointment?
“A lot! Your 6-week GP check is an essential appointment but there is a lot to cover in 10 minutes, from your mental health and physical recovery to contraception and anything else that may have come up since having your baby. For most women it does not involve a physical check, or if is does, it is brief – for understandable reasons. There is a lot of pressure put on this check as a clearance for exercise, however this just is not possible. A women’s health physio appointment is often an hour and is a head-to-toe assessment of your muscles, joints and posture, including the strength of your pelvic floor and abdominal muscles. One does not replace the other; they are both needed.”
Can you see a women’s health physio on the NHS?
“At the moment the NHS can only support women with symptoms. So if you suffer with incontinence, prolapse or pregnancy pelvic pain then you can be referred to your local women’s health physiotherapy service. However, the wait can vary considerably depending on where you live. It is not currently a routine postnatal service, as seen else where in Europe, such as France. I dream of a day where this does occur and there is a lot of work going into the awareness of pelvic health in postpartum women and the need for more support for both physical and mental health. There has been more money placed into pelvic health physiotherapy services which is amazing, but I think it will be a while before we see a total transformation.”
Why do you think there is such a lack of awareness about pelvic health in the UK?
“I think because we are the first generation where women’s health physiotherapy is becoming a more widely available service. Also, I think what we do is not that cool or trendy and what we deal with are often very private symptoms so not always easy to share with others and spread the word. Sadly, these topics are also still quite taboo to talk about and so that also delays the ripple effect.”
As a women’s health physio and mother, if you could give a new mum one piece of advice, what would it be?
“To listen to your body and trust what it is telling you. If something doesn’t feel right or you have symptoms you have never experienced before, don’t put it in a ‘well I’ve just had a baby’ box – ask questions and seek help.”
If you have symptoms but can’t afford to see a women’s health physio, is there anywhere you can look for free advice?
“Definitely! Education and reading of reliable information is so important. I highly recommend checking out the website for the Pelvic Obstetric Gynaecological Physiotherapists (POGP). They have loads of free educational resources and booklets. The FIIT YouTube channel has a whole FIIT Mum education section where I run you through lots of important topics about postnatal pelvic health including pelvic floor exercises and caesarean scar massage.”
You’re part of an amazing Instagram community of professionals flying the flag for women’s health. Do you think the conversation around the subject has changed recently?
“YES!! I really do and it is wonderful to see so many amazing physios and PTs pushing for change. It’s an exciting time and the more we all share, educate and empower women and work together, the more change we will see. I can’t wait to see where things are in the next 5 years.”
Clare’s Pelvic Health Insta Faves