Life as a first year physiotherapy student is pretty tough. We cover so many topics in such a small space of time. For example, we cover the respiratory system and related treatments, cardiovascular physiology and exercises, musculoskeletal anatomy and the related treatments, not to mention the amount of anatomy we have to learn. I have only mentioned a handful of topics, we cover so many things that you’d wonder how it’s possible to learn so much; it’s something I ponder on a daily basis! However, we do not cover one critical topic which can affect everybody. Pelvic health. This is why I wanted to explore this vital topic. I was very lucky to be offered a place on Pelvic Roar’s ‘Pelvic Health Conference’ which took place on 30th January ’21.
PelvicRoar Conference Topics:
1. Strength through yoga - practical
2. Hight Tone Pelvic Floor - Maeve Whelan
3. Pelvic Pain - Bill Taylor
4. Birth Injuries - Paula Igualadez Martinez
5. Product Slot - Efemia
6. Pessaries - Myra Robson & Gaynor Morgan
7. Menopause - Christien Bird, Positive Pause
8. Long Covid and Public Health - Dr Amal Hassan
9. Product Slot - Yvonne Brady / EVB
10. Newbies - Miriam Gamble, Aideen Farrell, Rachel Smith
11. Pelvic Health Considerations in Fitness Training - Louise Field
12. Long Covid - Lived Experience - Darren Brown
13. Nutrition and Pelvic Health - Jackie Lynch
14. Product Slot - Renew Medical
15. Strength through yoga - practical
16. Media Work - Elaine Miller
17. Book Reading: PMSL - Luce Brett
18. Post-natal Poster Presentation – Marie Fell
The term ‘pelvic health’ encompasses the bladder, bowl, nerves and a vast number of muscles which make up the pelvic floor. The conditions which fall under the umbrella of ‘pelvic health’ are vast, as you can tell by the list of topics and speakers above. Below are some examples of pelvic health related conditions:
Vaginal/Vulval pain: can cause pain during sexual intercourse.
Stress urinary incontinence: leaking urine during physical activity or during a cough or sneeze.
Pelvic organ prolapse
Faecal incontinence
Obstructive defecation: difficulty emptying bowels.
Overactive bladder: a sudden need to urinate.
Injuries in childbirth e.g., Perineal trauma, pelvic girdle pain.
Imagine what daily life would be like if you had to deal with one of the above health conditions. Think about how it would impact upon your self-confidence, your mental health, the relationships you have with friends and family, not to mention any sexual partners.
(https://www.royalfree.nhs.uk/services/services-a-z/therapy-services/physiotherapy/pelvic-health-physiotherapy/ ; https://www.imperial.nhs.uk/our-services/physiotherapy/pelvic-health-physiotherapy)
I learnt about many of the above conditions during the conference. For example, during Gaynor Morgan’s talk, ‘Pessaries and Prolapse Extended Scope’, she said that 50% of women aged over 55 years old are affected by prolapse. Gaynor’s talk was incredibly informative as she spoke about the different types of pessaries available, of which there are three categories. There are space filling pessaries, inflatable pessaries and support pessaries. The aim of pessaries is to help with prolapse. I think it’s important for women to be informed about their treatment options. This would allow them to pick the most suitable option for them and their body.
The second important change I learnt about was the menopause. Jo McEwan and Christien Bird presented ‘Positive Pause: Menopause’. Menopause is something which affects every woman. I think that it should be taught on the physiotherapy degrees due to the fact that it is something that affects half of the population and physiotherapists can implement preventative measures to help reduce the effects that changes in oestrogen levels cause. A decrease in oestrogen and anabolic steroids, caused by menopause, causes a decrease bone density decreases. This can leave women at greater risk of fractures and the effects of resulting inactivity.
During this presentation, McEwan and Bird said that the prevalence of urinary incontinence and prolapse increase due to vaginal delivery birth. These symptoms of menopause and childbirth can cause future problems with physical health due to becoming a barrier to exercise because of effects on self-confidence.
Health care courses need to focus on pelvic health. I don’t think the seriousness of the related conditions is fully understood and how they can lead to a domino effect with regards to a decline in overall health because of pain, poor mental health and being worried about how their body will respond to physical activity. For example, people with weak pelvic floor, due to gradual decline or injury, will worry about incontinence during exercises. This will just lead to less participation and an overall decline in health.
A big reason why women suffer with pelvic pain and injuries is childbirth. Paula Igualada Martinez talked about this during her ‘Childbirth related pelvic floor injuries’ presentation. I must admit that I was very surprised by the types of injuries that could be sustained, although I shouldn’t have been, knowing how traumatic childbirth is on the body; whether it’s a case of lack of education or burying my head in the sand about the consequences is debateable!
85% of women experience injury to the perineum during pregnancy which can lead to prolapse. Also, pudendal nerve can be damaged during pregnancy. Depending on the location of injury, the following symptoms are possible: pain in the vagina, pain during sexual intercourse, pain down the back of the legs, frequent need to urinate.
Following on from that, Bill Taylor did a very well rounded, informative presentation about pelvic pain. Bill talked about pelvic pain in the context of chronic pelvic pain syndrome (CPPS). Chronic pain is another subject which needs to be taught more thoroughly on healthcare degrees. Bill spoke about the importance of listening to your patient. This is the most important thing you can do, no matter what chronic pain condition they present with. Fortunately, well, perhaps unfortunately, chronic pain is an area I am knowledgeable in due to being a chronic pain patient myself; I don’t suffer with CPPS, however, the principle of managing pain is reasonably universal. I thought that Bill’s talk about CPPS was very well rounded, as he spoke about the biomedical model as well as relationships with other people and how this can impact on pain. This combination forms the biopsychosocial model of pain management, which I encourage you to read about. It certainly has helped me.
Talking about the symptoms of pelvic health problems is one thing, but PelvicRoar incorporated practical sessions into their conference. At the beginning and at the end of the conference we were encouraged to participate in yoga sessions which were led by ‘Strength Through Yoga’. This was a brilliant way to understand how the pelvic floor worked and to get us engaged before starting the theory-based part of the day!
A personal favourite of mine was breathing exercises lead by Louise Field. She taught us that breathing alters the pelvic muscle group and that good breathing mechanics alters the pelvic floor. This is something I had not thought about and I found it very interesting when we did breathe exercises and could feel the engagement of the pelvic floor.
I really enjoyed the PelvicRoar conference. I learnt so much about different pathologies, treatment options, and how female anatomy works. Thank you so much, PelvicRoar and all of the speakers, for organising and presenting on such a brilliant conference.
