For many women Pelvic Health Physiotherapy is life-changing but is it really worth it?
One of the most common statements we hear from our patients about pessaries when we have a successful pessary fitting is “This pessary has been life-changing!” Now every pelvic health physio who fits pessaries knows that when they hear that from a woman with prolapse, it literally warms the cockles of their hearts.
Dani explaining some of the features of a pessary fitting
But we hear the word life-changing with many other of our pelvic health treatments.
When a woman has had such severe dyspareunia (painful sex) that she has never had penetrative sex, arrives in to show her new baby to you – we know that the many treatments she has undertaken in her pelvic health journey have been life-changing.
When a woman can run again post-partum without leaking ….. again life-changing. When someone arrives to their follow-up appointment and describes passing a bowel motion is now easy, without pain and no recurrence of their anal fissure? Life-changing!
Of course, these are all topics that will not be discussed at the Christmas lunch table with the family, so the life-changing virtues of pelvic health physiotherapy remain relatively silent, until it affects a woman, man or child directly.
What is the cost of these life-changing interventions?
As you know, I recently sold my practice and a new pricing structure has been introduced. To be honest, I was initially reticent about the changes in price, but I understood that my old structure of pricing was incompatible with the business breaking even and being able to pay the staff well. At the same time some things happened in my personal life that made me re-think my concerns about the pricing changes.
In May, after four and a half years, I finally succumbed to COVID, after attending the National Conference on Incontinence (NCOI2024) in Brisbane.
Happy days at NCOI 2024 until I got COVID two days later
I was generally hacking and coughing and feeling miserable, so I decided to do a Telehealth with the GP and see if I could get antivirals prescribed. I was told by some friends who had been given them that they make you feel much better, much quicker. I knew that generally the age to get them was 70 (I am 2 years shy of this), but I was hopeful my tale of woe may have secured them for me. Six minutes later I found out there was no way around the age cut off and that 6 minute appointment cost me $90 (which multiplies out to $900 per hour). I didn’t flinch as I gave my credit card to the receptionist.
I am sure many of you have had a need to consult a solicitor for advice over the years. Everybody knows that solicitors have what is called ‘billable hours’. What that means is, that charges are made in 6 minute time grabs. So if the charge is $600 per hour plus (GST), every 6 minutes costs $60 (plus GST). Solicitors learnt a long time ago that their advice is worthy of a certain amount of money. And you certainly can’t read a law book and give yourself appropriate legal advice!
Over the years, we have had to call for help for an ailing dishwasher. The cost was clearly and unapologetically stated at $199 for the first 30 mins to see whether the dishwasher was fixable and then $36 per 15 minutes after this to get it repaired. We had no choice, because as talented as Bob is, he cannot repair our dishwasher (he is at least a chance – I am zero chance).
Everyone knows that they can’t or don’t even want to unblock a blocked toilet, or install a power point. All these examples I’ve cited show a level of acceptance that we generally have around pricing – and I haven’t even mentioned a visit to the dentist.
Strangely, there is less acceptance around valuing the charges of a physiotherapist, let alone a pelvic health physiotherapist. There have been some comments around the new charges which is understandable. I have myself been guilty of undervaluing our own provision of services across the four stressful pandemic years. Ask my husband and my accountant. The fact is these fees align with new fee structure about to be released by our professional body, the Australian Physiotherapy Association.
I have had an epiphany recently when I had a (traumatic and definitely not inconsequential) fall at the top of Split Rock Mountain at the beautiful Warrumbungles in NSW. I sustained 3 fractures of the fibula and a hairline fracture of the tibia.
Split Rock Mountain, Warrumbungles – where it happened and me the next day about to embark on a ten hour drive back to Brisbane to Greenslopes Hospital.
Fortunately, two of the five (only) people we passed on the hike were a pharmacist Dave and his partner Tash, who unbelievably were setting up a hiking company and they were trying all the walks out at the Warrumbungles to learn the level of difficulty for the future guided walks. They heard my screams after I fell over and came running with a compression bandage (Dave always carries two for snakebites!) and some magic pain relief. Dave strapped my leg, gently put on my shoe and then they accompanied us across some rocks which required very difficult scrambling, to make sure we got across them. The walk down the mountain to the campsite was slow and arduous – but I got there thanks to Bob’s sturdy hand, my walking pole and Taylor Swift Era’s Tour on loud. Thanks again Tay Tay.
I saw the orthopod who referred me to a specialist physio (in obtaining good outcomes following fractures) and this physiotherapist is charging similar fees to our new structure. Of course this injury has meant all my future Dolomite hiking was flashing before my eyes. Here I was with more time to explore, hike and have adventures after reducing my hours down to half-time, but perhaps potentially be unable to walk in the mountains again on uneven, rocky surfaces thanks to this broken leg. (Yes I was definitely doing some catastrophising!)
Michael (my physio) sold me a couple of wonderful devices (a Jetboot and a Vacoped moon boot to walk in) which have been lifechanging – my swollen boggy foot now has some shape and contour.
The Jetboot compression device and my right ankle after 9 days using the boot and the Vacoped moon boot
They were not cheap, but what price do I put on hiking in the Dolomites (or even Mt Coot-tha again)? It is priceless to be honest. Michael also talked and reassured me about my future walking, gave me sound advice and made me stick to his strict regime with the fancy devices. It was the words that mattered, as much as the devices.
And that is what pelvic health physiotherapy often involves – a lot of words, education, reassurance, advice, restoring confidence, calming strategies. It definitely may not involve an internal examination every visit – that is not the be-all and end-all of pelvic health physiotherapy. When undertaking an internal examination, it needs to be required (necessary), trauma-informed, accurate, pain-free (as much as is possible) and reassuring regarding findings.
That means it takes time, it can’t be rushed.
Pelvic health physios can’t be impatient, they have to watch the patient’s face – is the patient dissociating meaning is the patient even knowing what is happening or has some previous trauma suddenly surfaced and causing extreme anxiety for the patient?
For this reason, we need to know when it is important to stop. We need to listen carefully to the patient. This takes time. That is why our appointments are longer and when they are longer, they become more expensive.
Prioritization of Health
Valuing the cost of pelvic health treatments encourages women to prioritize their health. Many women may overlook symptoms related to pelvic health dysfunction, because of the perceived narrative that these problems are normal following childbirth and that somehow you are weaker or whingey if you talk about them.
Many women may overlook symptoms related to pelvic health dysfunction due to perceived costs or lack of understanding about treatment options. By recognizing the potential long-term benefits of treatment, such as improved quality of life, enhanced physical function, and reduced pain, women (and men) may be more inclined to invest in their health proactively rather than reactively.
We do know that the earlier women start on the journey of rehabilitation after a birth, regardless of the way the baby is delivered, the better the outcomes will be in the longer term. There can be significant natural recovery in the 12 months following the birth, but a pelvic health physiotherapist does more than just rehab the pelvic floor. If there has been a traumatic vaginal delivery, there can be tremendous emotional and psychological support needed for the new mum, to help her come to terms with her new normal.
So is pelvic health physiotherapy worth the investment?
I hope that I have sown some seeds of thought around this and have provided some insight for you – because it is unlikely that women are going to necessarily be comfortable blabbing to their friends and family about their life-changing experiences with their pelvic health physiotherapist.
One woman recently wrote an article anonymously for The Guardian about her long struggle with pelvic health issues. Click on the link to read the following article as it is a jarring insight into one woman’s experience. It is moving and her writing is brilliant. Read it slowly and take on board what she has endured over the years. This can be the sacrifice that some….many women make in order to fulfil their dreams of having a family and to populate the earth.
Again, if only men could experience this treasured gift of growing a child.
Maybe then they would universally understand why women may suffer in the post-natal period and for some throughout their life…….and why women are in pain, seeing images on the news night after night, of babies and children dying in futile conflicts around the world.
If you want to understand more about pelvic floor function and dysfunction, you can contact your local pelvic health physiotherapy clinic – just check the APA Find a Physio website for names and phone numbers.
Megan, Cat, Dani, Samantha, Haleh, Laura, Lea and myself are available to help you have your own life-changing moment at Active Women’s Health Physiotherapy – just ring the girls on 0407659357.
As a starter for learning evidence-based education about the pelvic floor written in an easy-to-understand way, you can purchase my books here .
Was it worth it? Here is the view of the beautiful Warrumbungles from our campsite!
