The awareness of the benefits of having a post-natal pelvic health check from a women’s health physiotherapist is slowly improving. Usually most people will book this appointment after their 6 week check up with their obstetrician/GP, which allows the body to heal with time as it is designed to do. Although it is important that if you are experiencing any symptoms that bother you PLEASE get assessed sooner.

Some of these changes that may occur include:

• Bladder symptoms: incontinence, urgency, urinary retention, increased frequency, stop/start flow.
• Prolapse symptoms: vaginal heaviness, lump or bulge in the vagina, feeling like you have a full tampon in without there being anything there.
• Perineal pain – from trauma during birth, pain from your tear or episiotomy
• Musculoskeletal symptoms: pelvic girdle, neck, wrist or back pain
• Bowel symptoms: incontinence, painful haemorrhoids, urgency, constipation, difficulty voiding

Early intervention is key. We will be able to assess and guide your management to optimise your recovery and give you one less thing to worry about in the newborn bubble.

What does a Post-Natal Women’s Health Physiotherapy appointment look like?

Your initial appointment will be an hour of talking ABOUT YOU. We want to find out your story by starting with a debrief on your pre-conception, pregnancy, birth story, goals and if there is anything you want to address.

We then need to clarify what is your WHAT – what symptoms bother you and what do you want to get to the bottom of. There will be a lot of questions regarding your past medical history, pelvic health, sleep, diet, fluids, aches/pains, breastfeeding, sexual function, social situation, general well-being and exercise.

Depending on your goals and symptoms, I will then do an assessment. This will help us figure out the WHY to your WHAT and help us get to the HOW we can help you achieve that.

What assessments are performed?

Common assessments may include:

• Functional movements
• Breathing
• Posture
• Diastasis Recti and deep core strength
• Musculoskeletal assessment if experiencing muscle/spine aches or pain
• Perineal tear/episiotomy or c-section scar healing
• Readiness to return to exercise
• Pelvic Floor assessment – looking at strength/weakness/tone of the pelvic floor muscles and ligaments, prolapse and pain.

To assess the pelvic floor I can perform a real-time ultrasound using a probe on your lower abdominals, assessing the movement of your bladder base with a pelvic floor lift. This will enable me to see the pelvic floor contract and relax, and your endurance. However, if you have had fascial or sacral ligament damage during childbirth there may be limited bladder base movement. This is also a great tool to see if you are retaining urine, and your co-ordination with your lower abdominals and how your pelvic floor reacts with increased intra-abdominal pressure.

The other option is an internal examination which is classed as the gold standard, and the best way to assess your pelvic floor tone, strength, co-ordination, what happens when your bear down and when you squeeze and ligament and fascia laxity. This is also the best way to assess for pelvic organ prolapse and vulva sensitivity.

Please remember that you are the boss. We will ask consent at every stage and you should not feel pressured through any part of the process. You do not have to answer any questions that you don’t feel comfortable with and you can so no to any assessments we want to perform. There is so many things we can do to help at each stage of the assessment, and the first session consists of a lot of education.

After a really detailed assessment, we are going to have a better idea of WHY you are experiencing your bothersome symptoms and HOW we can help fix that.

Your treatment and management will be guided by the whole appointment, what your most bothersome symptoms are and what your goals are. It may consist of a pelvic floor muscle training program, addressing defaecation dynamics, bladder training and suppression techniques, pelvic floor release, a home exercise program targeting your mobility, core and pelvic stability, scar management, education and a plan for returning to exercise, and the conversation if a support pessary could be beneficial.

It is never too late for a ‘6 week check’, as a lot of symptoms may not start until your kids are toddler age, or after your second or third child. It is better to know when things are common, but not normal, and that there are things that can be done. Please know that you are never alone in the postnatal journey!