I was recently asked to write an article about pelvic health physiotherapy and the changes I have seen over the course of my career by Women’s Agenda – an online hub sharing the latest news and views affecting how women live and work. Women’s Agenda are a small team of journalists and editors who look at politics, business, leadership, tech and life from the perspective of professional women and female entrepreneurs. Their mission is to share news and views that matter to women and get more women heard on the issues that matter. Here is a link to the article in it’s online format but as I wrote the article – the text follows below.
Artist Arabella Walker with the beautiful artwork of The Pelvis that I commissioned
Pelvic health issues have been around since time began. Images depicted in Egyptian papyruses show various treatments for prolapse with women suspended upside down and pomegranates cut in half as early pessaries to help give them support.
Pelvic floor problems transcend all genders and ages – but women, due to their pregnancy and childbirth roles, have higher prevalence of pelvic floor dysfunction than men.
Children can suffer with significant pelvic health issues which can create life-long problems for them.
The impact of the silence and shame of pelvic floor dysfunction
Every day, my Australian pelvic health physiotherapist colleagues and I treat countless people living with conditions like urinary and bowel leakage, constipation, pelvic organ prolapses, and pelvic pain.
We know incontinence affects 1 in 4 adult Australians, with an estimated 37 percent of women in Australia are living with some degree of urinary incontinence.
Given this problem has been so debilitating for humans for so long, why hasn’t it been spoken about more commonly over the years?
The consistent feature surrounding pelvic floor dysfunction over time is the silence – mostly due to the private areas that are affected, the fact that women are affected in higher numbers and the negative narratives consistent with shame, disgust and uncleanliness surrounding pelvic health.
When there is silence, the true prevalence of these disorders is unknown. This leads to stagnation with funding for research, health planning and ready access to pelvic health physiotherapists.
How can we improve pelvic health in Australia
There is no doubt that the big change that has happened in the pelvic floor world is the advent of social media smashing this silence.
Years ago, I would beg editors of the health magazine in Brisbane newspapers to include articles about pelvic health, but there was always a steadfast ‘No – it is too confronting for women to read over their breakfast cereal’.
Instagram, TikTok, Facebook, Podcasts and Blogs have opened opportunities for pelvic health physios to embrace the reach we can achieve and they are using all mediums to spread important treatment and preventative health information for women and men regarding their bladder, bowel, and pelvic floor.
Even comediennes are hopping on the pelvic health bandwagon! This raises awareness in the eyes of the sufferer that treatment is available, accessible, not overly complicated, and entirely doable.
Educate to change outdated habits and beliefs
Pelvic health physiotherapy is science-based but it’s not rocket science.
Education is the cornerstone of our treatments and once patients understand what is normal with bladder and bowel function, prolapse and pelvic pain and what goes wrong, it makes it easier for them to implement the strategies required to solve their problems.
With greater attention through social media channels, comes the realisation that some of the beliefs, behaviours and old habits we use daily (often passed down through the generations) are the culprits.
Going to the toilet ‘just in case’, deferring bowel messages, thinking period pain is normal and that sex is an obligation and not necessarily pleasurable – these are just a few of these false narratives that pelvic health physios set about reframing in their clinic appointments with patients.
So many things have dramatically improved with the management of pelvic floor dysfunction over the past 30 years.
The emergence of the staggering numbers of women (men and children) who suffer pelvic pain and the rapid expansion of knowledge around treating this pain and the effectiveness of these treatments has been life-changing for so many people.
Improving early intervention and understanding risk factors
Endometriosis often takes 7 to 10 years to get an appropriate diagnosis, and in this time, girls and women suffer debilitating pain, which becomes entrenched and unrelenting, affecting every facet of their lives. Their ability to work, socialise and have a family is a constant financial and emotional burden to carry. Mothers are now more conscious that early intervention in managing persistent pain can change the outcomes for these young adolescents.
Another dramatic change in the pelvic health area is the emerging body of evidence about certain factors that increase the risk of significant pelvic floor damage with vaginal birth. With our expanding knowledge about levator avulsion (a muscle injury peculiar to vaginal birth) we are able to look at risk factors that may be relevant and present this evidence to the patient.
The soon-to-be mother’s age, height, family history, pelvic floor status pre-pregnancy, baby’s predicted birth weight and head circumference are just some of the factors that are considered by pelvic health physiotherapists when seeing women ante-natally for assessment and advice. Listening carefully to the woman’s wishes and liaising with obstetricians and midwives with relevant findings is a part of the consultation in preparation for birth.
Boosting access to pelvic healthcare
Pelvic health physiotherapists have an emerging role in assessing and fitting pessaries to help women with prolapse. These advances have meant many more women’s lives are transformed if they can wear a pessary while exercising and they may even be able to postpone surgery until their later years. Physiotherapists work in close consultation with GP’s, gynaecologists and urogynaecologists when helping patients with pessaries.
Luckily there has been a dramatic increase in the numbers of physiotherapists upskilling in pelvic health physiotherapy because there are burgeoning numbers of women and men (and their children) seeking help.
Research from all corners of the world overwhelmingly supports the fact that seeing a pelvic health physiotherapist for conservative assessment and management of pelvic floor issues is an important early consideration in any treatment pathway. According to studies, up to 80% of patients with stress urinary incontinence can be cured or show significant improvement with their urinary leakage with pelvic health physiotherapy strategies.
Let’s make 2023 the year we commit to big change
In my 35 years of working in pelvic floor dysfunction, it’s been great to see such dramatic change for the good.
And I am humbled and grateful to all the patients who through the years have led me to this final place of receiving an OAM for services in 2023 to the community and my physiotherapy profession.
It’s been another opportunity to highlight the impact of pelvic health – including on mainstream news channels.
So, let’s continue to use this year to advance the conversations, messages, stories and the change needed to help those affected by pelvic health, and improve the livelihoods of countless Australians.
And let’s rid the silence and shame on this issue in Australia.
Sue Croft OAM
