FAQ: Who should you see if you have problems with your pelvic floor?
This is a great question. Ideally, you would see a physiotherapist who has had extensive Musculoskeletal (MSK) Physiotherapy training AND training in Women's Health (WH) Physiotherapy. Unfortunately, there aren't too many of these physios around. They are definitely out there but not all MSK physios know about the pelvic floor very well and not all WH Physios know about the rest of the MSK system.
Also, in my opinion, a thorough understanding of the thorax and pelvis is lacking among physiotherapists. I know for a fact that most Masters programs do not address these 2 areas very well. As an exercise (if you are a health professional), close your eyes and imagine the anatomy of the knee - most physios can picture this in good detail with bones, ligaments, cartilage and muscles all in the right place. Now do the same with the thorax...not so clear huh? Can you name all 13 joints that exist for the 4th Thoracic Ring (T3, T4, L+R 4th rib, Sternum)? I rest my case!
I look at a person holistically - for a review of this, click here - and consider what regions are important to look at. For example, a patient might come in with difficulty controlling the bladder during exercise. Is it a joint, muscle, nerve, visceral or brain/beliefs problem? Is their pelvic floor strong enough? Does it relax enough? Is it on too long or too hard? Is it under pressure from other muscles or joints? Is the pelvic floor actually damaged?
All of these things are important to identify and investigate.
Now, the way that things work is this: If I want to be trained in Women's Health, I have to do courses. However, whilst they would let me do the theory, it has been suggested to me that it would be highly unlikely that the other participants would allow me to do the internal examination practicals that I would need to do to learn. In theory, there are male obstetricians so male WH physios shouldn't be a problem. In theory, it is sexist and discriminatory. In reality, I don't mind. There are plenty of good female therapists around who I can refer to. I don't need to be able to do internal examinations to be a good physio. I can live without the fear of being sued or charged with sexual assault!! There is enough work for everyone so let's just share the love!!
So, when there is a patient who looks like their primary problem is a damaged pelvic floor, I refer them to a WH physio I can trust. I will always check all the MSK systems to make sure that I have taken care of everything I need to make the WH physio's job easier. I also write a letter explaining what I have found and what I think the potential problems may be and specific issues I would like an opinion on.
Too often, patients get categorised into a WH physio problem or a MSK physio problem. This is an issue because it isn't a holistic approach.
The type of WH patients I can help are those that don't seem to be improving their bladder/bowel control, have an endurance problem, have pain...basically anyone who is not improving!
If you are a suffering from pelvic floor issues and your treatment doesn't seem to be working, then ask your WH physio for a MSK physio referral. If you need help finding one, just ask me!
Better understanding between MSK physios and WH physios needs to occur. Thankfully, the last 15 years has seen a great improvement in the communication between the 2 groups!
If you are a women's health physio, I invite you to comment below and make sure you add your website or FB/Twitter page to your comments. That way, patients can locate you!
If you are a patient who has issues with your pelvic floor, please feel free to ask questions below about who you should see. Any good physio would be ok with you asking if a referral to a MSK or WH physio would be helpful 🙂
Remember, 1 in2 to 1 in 3 women will have pelvic floor issues in their lifetime. Let's solve the problem, not just use panty liners!