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Incontinence and Bowel Management for Women, Men and Children.
Women’s Health Physiotherapist Brisbane, Australia.
Pelvic Floor Dysfunction Treatment.

Invasion Day – Always was, always will be

Today I am at work rather than kicking up my heels at an Australia Day barbie out of respect for our First Nations people. I just don’t understand why we continue to disrespect our Indigenous Australians by continuing to choose this day to celebrate all that it is to be Australian, on the day they lost their lands to white invaders.**

Don’t forget it was only in 1994 (24 years ago) that the date of 26 January started to be celebrated by all the Australian States and Territories as Australia Day and officially became a public holiday. Only 24 years ago.

We could celebrate Australia Day on the 1st January, Federation Day, the day Australia became a nation when the British Parliament passed legislation enabling the six Australian colonies to collectively govern in their own right as the Commonwealth of Australia. It was a remarkable political accomplishment that had taken many years and several referenda to achieve.

Or really, we could celebrate it on any other day.

This year in 2021, we celebrate the Queen’s Birthday in Queensland on 4th October; in Western Australia it is 27th September; in Victoria, NSW, Tasmania, South Australia, Northern Territory and ACT it is 14th June. BUT her actual birthday is 21st April?? If the Queen can cope with that, I am sure she would be relieved to know we have looked at our history and decided it is wildly inappropriate and stupidly defiant to choose to celebrate all the good things about our nation, on 26th January every year – such a demonstrably unsuitable day for us to choose. Probably the ONLY day we shouldn’t have Australia Day………if we are a thinking, caring, in-touch nation.

Big changes can come in many ways.

Every year I see more conversations about this. Mostly from young people who seem to get it.

But from our Prime Minister a few days ago, we hear that apparently ‘it wouldn’t have been too flash either on the boats that arrived in Sydney‘ 233 years ago. I agree with Greens Senator Lidia Thorpe who said it was disrespectful and offensive to compare the experience of First Nations people with those aboard the First Fleet ships.

“The prime minister has an opportunity to unite this country, not to divide it. And that starts with telling the truth about this country’s history,” she said.

Truth telling and self-education is vital and unlearning may be necessary. History books are laced with the false pretence of a peaceful discovery of Australia to legitimise invasion. In 1938 as part of one of the first civil rights movements in the world, First Nations people had already declared 26 January a Day of Mourning – well before 26 January became a national public holiday. (Taken directly from a guide for respectfully and mindfully navigating the day with some tips to invoke change in Peppermint Magazine prepared by Yorta Yorta woman Taneshia Atkinson. Read more of this excellent blog here. )


1938 Day of Mourning

I know this Prime Minister cannot possibly lead by making this big change. He cannot make changes on climate change for the same reason. He is constantly looking over his shoulder (backwards and sideways) instead of looking forwards to the future. Last night I watched many impressive people doing many impressive things at the Australia Day awards. I heard some remarkable, inspiring speeches from people who were unafraid to speak their mind, to discuss difficult topics on a national forum – periods, menstruation, rape, inequality for indigenous Australians. I recommend you take the time to watch the whole show. 

For all of the day on 26th January (so it may have clicked over to the 27th in some countries), $5 from any book purchase will be donated to the Dhadjowa Foundation. Donate to help establish an organisation that supports and amplifies the voices of families whose loved ones have died in custody.

Come on Australia – I would like to think that we can generate a mood for real and immediate change in 365 days. Do we keep having to waiting to do this in a ‘timely fashion’….seriously?

Map of Indigenous Australia – so you know what the Indigenous name of your suburb/region is. (Purchase from this website)

**The First Fleet, the group of ships which left England to create a penal colony abroad, actually arrived in Botany Bay on 20th January, 1788. On 22 January, 1788, due to the unsavoury nature of the water and land at Botany Bay, Governor Phillip sailed north to Port Jackson with a small expedition party. There he selected a sheltered site for anchorage which he named Sydney Cove. Returning with the remainder of the Fleet on 26 January 1788 – now celebrated as Australia Day – the first permanent European colony on the Australian continent was established. (Taken directly from the NSW State Library display on the arrival of the First Fleet)

What is HADA?


Dr Judith Goh and Dr Hannah Krause helping fistula patients in Africa

Back in 2017 as one of my New Year’s pledges I decided to ask my family and friends to give a donation to HADA -the organisation which fund-raises for the fistula and prolapse repair work that Professor Judith Goh and Dr Hannah Krause do in Africa – instead of giving me a present for my birthday and Mother’s day. I’ve written many blogs about the incredible life-changing surgery Judith and Hannah (and Neroli, Miriam, Barb and many others) perform for the women, who suffer shocking birth injuries, which leaves them with constant urinary and faecal incontinence.  This incontinence often leads to ostracising of the woman from their family and even their community.

But early in 2017, it also occurred to me that I too could also give a donation to HADA in lieu of a present, to all the people I usually give presents to in a year – family, friends, staff – and most importantly all of them went along with it and thought it was a great idea! And for my Mother’s Day and my birthday everyone also complied and gave a donation to HADA on my behalf and in the twelve months from January to December, I donated $844 (which is tax-deductible also!).

It wasn’t hard at all. In fact it was very satisfying.

2020 Christmas also saw members of my staff remember that I love donations as presents and between them they gave $150 to HADA. My son also gave my husband and I a $100 donation each to the World Wildlife Fund on our behalf.

So in 2021 I have decided again to do this. I will be making donations on behalf of family, friends and staff to HADA and other charities instead of giving people more ‘THINGS’! I think most of the people I know have plenty of ‘things’ – I also love getting ‘experiences’ now rather than more ‘bits and pieces’, but the experience of giving to others who do not have much is also very worthwhile. There is lots of inequity in the world and this is a small something I can do and may I suggest that if everyone thought about a $10 donation to their favourite charity and reduce the cost of the present you are buying for friends and relatives by $10 it would be a win for the charity such as HADA and a win for the ‘feel good factor’. If you are donating to HADA, then make sure you stipulate that it goes to Medical Training in Africa and Asia as this is the work that Judith and Hannah do. 

Over the Christmas break, my son gave me a very long podcast by Sam Harris #228 Doing Good to listen to which was totally worth it- but you need to put aside quite a bit of time to listen to it (104 minutes). In this episode Sam Harris talks with Will MacAskill about how to do the most good in the world. They talked about Effective Altruism using evidence and careful reasoning to decide what to do with donation money and suggested that there are some charities that really make a difference in the work they do – things like providing nets in countries where malaria is rampant actually saves thousands of lives. Sam also recommends reading Doing Good Better book by Will MacAskill.  

Another way of ‘doing good better’ is if you are young and contemplating what career path to take for the rest of your life, Will MacAskill talks about how important it is to give significant thought to your choice of career in order to make a difference in your impact on issues that affect the world. He suggested checking out the Eighty Thousand Hours website .

The other interesting comment in his podcast was – if you were asked what salary would you have to earn to be in the top 5% of the world’s salaries? Would you think it was $50,000? I didn’t. But if you just earn $50,000 per year, you are in the top 5% of global earners (most people would not comprehend that). Many people in many countries live on the equivalent of $2 per day.  So the richest people in the world are many times richer than the poor. People earning professional salaries in countries like the US and Australia are usually in the top 5% of global earnings and sometimes in the top 1%. This gives them a disproportionate ability to improve the world. We just need more people to embrace it.

Just a thought for 2021.

So my important 2021 New Years Pledges are (you have more chance of fulfilling them if you say them out loud):

  • More donations, less things
  • I am going to try and go 95% vegetarian (it’s going well so far)
  • Exercise is going to be upped in 2021 – ‘Rona really messed up my gym routine last year.

Life-saving mosquito nets to prevent malaria

All Overactive Bladder blogs in one area (or How to Manage Urinary Frequency, Urgency and Urge Incontinence)

The Overactive Bladder can be the bain of a woman’s existence. It can limit social activities, restrict distances that women can walk, therefore their exercise frequency and fitness is affected and make women feel anxious, therefore affecting their mental health. As with prolapse and pessaries, men’s health and pelvic pain, I have collated some blogs together on urgency, urge incontinence and urinary frequency. Here is a collection of many of the blogs I have written about the Overactive Bladder.

Here is the link to the first blog

Here’s another blog from 2014 on the Overactive Bladder

Elaine Miller, Scottish Pelvic Health Physio and comedienne

Here is the videoblog I did on the Overactive Bladder

Here is a blog about a patient’s story about managing her OAB

There are lots of strategies to treat this bladder condition and each of them are important – think of them like slices of apple pie.

Here’s a blog about Confidence and the Bladder

Here is another blog about the overactive bladder

Here is a blog which I called First Aid for Bladders

Here is a blog outlining the difference between the words Continents and Continence

This blog is rather personal story about two near misses I had when travelling in London one year.

Four out of six toilets out of action at Brighton Station, UK, 2017

If you want to learn more about the bladder, bowel, what is prolapse, even how to treat children’s continence issues – make sure you pop online and check out my two books- Pelvic Floor Essentials and Pelvic Floor Recovery: Physiotherapy for Gynaecological and Colorectal Repair Surgery.

I hope you get some help by bringing these blogs together.

A magical end to this 2020 pandemic year.

Warning: Sweary words with asterisks appear through this blog. It’s 2020 and it’s been a tough year. I hope you understand.

Well here we are at the end of a year like no other in my lifetime.

It started in Australia with horrific bushfires and the main headline story through the year being our new unwanted friend ….. COVID19, but today I am finishing on an amazing positive note with a story of love, persistence and perservence.

Like any of my 2020 blogs, the point is to record low points and high points in this pandemic year, so I can personally remember what has gone down. It is hard to believe, understand…comprehend what has gone on this year, but I know there has been a lot of swearing and the Oxford dictionary has said the Word of the Year has been……F**k, Really? But I think that could be Fake News or at least a joke! But it could also be true because I’ve thought it and said it many times this year.

We know that pivot, unprecedented, lockdown and Fake News are worthy of Words of the Year – mainly because we are all sick of the repetition of using them or petrified about their implications. Especially Fake News because it is so universally associated with the outgoing (hallelujah) 45th President of the US (bring on January 20th, 2021) and most especially lockdown because that has seriously effed up many a life plan in 2020.

Which brings me to the high point for our family to end 2020 on. On July 31st, 2019, my second daughter and her partner announced their engagement when walking the Mont Blanc Trail in France.

Soph and Jimmy announcing their engagement on 31/7/2019

Walking the Trail is seen as an endurance test (especially when you misread a map and head down a long way and then have to head right back up again) and halfway around, Jimmy chose the most scenic spot to propose. As they have been remarkably excellent at coming home for different occasions, we anticipated that we may be having an Aussie wedding to look forward to in 2020, but the whole Italy elopement thing could definitely have been contemplated.

When 2020 erupted into flames in Australia on January 1st and then we first heard whispers and then shouting from the rooftops about COVID19/Coronavirus/The Rona, little did we truly understand, as we wandered in February (2020) with Soph around the olive trees and grassy fields of the proposed wedding venue in Australia, what was about to happen. There was a sh*tstorm and a clusterf*ck that erupted and kept on erupting all year. It’s been exhausting, yet at times exhilarating and satisfying, but mostly, challenging and disappointing.

The disappointment has been that many, many plans for this union, mooted by my daughter and her partner, have been completely turned upside down, inside out and spat out, never to be contemplated again thanks to COVID and 2020. The new evolving plan was like everything that took place in 2020…it was to be via zoom.

No I hear you say… surely not!

Regular zoom chats to them both in the UK; a zoom dinner for us, while she ate her breakfast; a zoom trivia night with our friends; many, many zoom Telehealth consultations with my patients; a couple of zoom doctor’s appointments for myself and I ended up even co-chairing the CFA #NCOI2020 zoom conference – zoom has certainly been a frequent part of our lives this year!

But how could a zoom wedding truly be a Wedding to Remember (in a good way)?

Well I can assure you that I have now experienced a zoom wedding, preceeded by zoom speeches to and from the family to the bride and groom and a zoom cutting of the cake.

And to my complete surprise and elation, it was the most beautiful, intimate, memorable wedding, full of love, tears, laughter and pure joy.

Yes there’s a nephew who is only five years old up at 11pm enthralled with proceedings

There was physical distancing – about 16,515kms to be exact – but we all still felt the love regardless of which room we were in – and there were many. Many lounge rooms, many kitchens, many bedrooms, and even the Council Chambers of the Islington Town Hall (which was extremely grand). It was like we all willed them over the line because depite the time differences, there were many, many friends and relatives who were zoomed in from around the world and watched as Jimmy and Sophie managed to pull off the Wedding of the Pandemic Year that was 2020.

Friends and relatives from far and wide tuned in to this Wedding of the Year

I think you will agree that as usual, the pictures are worth a thousand words.

You can see the love, the feeling is palpable


You can see the happy / sad emotions, the tears are real.

Physical distancing (across the oceans) prohibited the Father of the Bride walking her down the aisle, having the literal life squeezed out of his hand; there were no kisses and hugs for the mothers’ of the bride and groom and no thrill for my eldest daughter in reciprocating for her sister as the bridesmaid. And yet we were all exhilarated at the joyous celebration that was Sophie and Jimmy’s wedding. We were all heartened for them both to realise that there was so much positivity after months of disappointment, as plan after plan got shredded by the COVID shredder. And I can positively say that this wedding was truly one to remember forever, for all the right reasons, not the wrong ones.

So as I finish with some wedding photo spam, can I say to all who have had their plans shattered this year, learn from Sophie and Jimmy’s experience.

Pivot quickly in these unprecendented times splattered with lockdowns and fake news – say ‘f**k really’ as many times as you like, but don’t think you can’t feel the love and have a ball tying the knot if you haven’t been able to have the usual wedding. In fact I think these two have totes re-set the thinking about weddings and may have created a new trend.

Hens…have two not one – one at lunch time with six girls and another at dinner with another six. (Definitely schedule a recovery day the next day).

Memories – because so many girls from Australia couldn’t make the hens, have a very special friend get them to record a video and also write a message of love and fave photos for you, which she has placed in a book for the bride to review for all time.

Reception – have it five days before the actual ceremony, with thirteen people at the cutest restaurant in London. (Another recovery day required).

The Nook, London – cute as all hell and word has it, beautiful food -arranged a reception with less than 24 hours notice

Wedding dresses – have one for the reception (see above) and then decide to buy another one from the internet…..three days before the wedding because your partner has decided to wear a tux (and boy did he look good). Weirdly, then the dress actually arrives on Friday just two days after it was purchased….. the actual day before the wedding and looks so stunning you would think that it was made to measure with an incredible designer, multiple fittings and viewings over months and months.

My goodness you look stunning Soph

Speeches– have with the family before the wedding ceremony and because it’s via zoom, we can hear every word and absorb the context, meaning and love that the speeches convey and because it’s able to be recorded via zoom, it is there for posterity forever.

So because zoom has allowed us to attend this beautiful wedding at the height of a third wave of the pandemic, ‘Zoom’ is defintely my Word of the Year – I only wish I had bought shares in Zoom all those months ago…..

Both parents to this amazing bride and groom got married in 1978 and both have celebrated their 42nd wedding anniversary this year in 2020. We wish you two the same – a partner for life who makes you feel comfortable, makes you feel supported and makes you laugh. And most importantly loves the beach and the mountains. Win, win I say.

Definition of perserverance: ” It always seems impossible until it is done”

Love to you both xx

And a Happy New Year!

May 2021 bring health, wealth, happiness and did I mention good health? – to all my patients, blog followers, friends, pelvic health physiotherapists and especially my family. Fingers crossed that 2021 is boring, calm and peaceful.

Five Top Tips for Prolapse and Pessaries

Sue, Katie, Sophie and Micheal (in utero) ,January 1991

I remember the day I was standing outside my children’s school and a friend told me she had a prolapse and I said to her “How do you know?” -which was pretty funny/weird because I was a physiotherapist taking antenatal classes and heavily pregnant with my third child!

She said: “I can feel it every night in the shower when I am washing and some days I can feel it when I am just walking – it feels like a tampon is dislodged”. 

A few months later, after I had my third child, I unfortunately knew exactly what she was talking about.

They call it ‘Livin’ the dream’.

Soon after that realisation, an unexpected job came my way. My baby was only a few months old but they needed someone at QE2 to do a 4 hour a week locum to replace the Head of Department, so she could attend a meeting. What soon followed was my introduction to Women’s Health ‘proper’. The girl who was doing women’s health was leaving and they asked me would I like to take it on. I jumped at the chance and started with the courses and conferences that would become a ritual for me for the next 30 years. I became passionate about Pelvic Health and the passion has never diminished over the years.

I have always said that my own pelvic floor dysfunction has made me a better pelvic health physiotherapist, but there have been times when I have wished that wasn’t the case and that I didn’t understand so much of the physical and emotional burden that comes with having problems ‘down below’. 

But what that insider knowledge has given me is a bird’s eye view to the treatments and strategies that make a difference to pain, heaviness, fear and all the ‘joyful’ sensations that do accompany the diagnosis of prolapse.

So I have decided to write this blog with some Top Tips to most effectively managing prolapse and how to stay sane if you feel your prolapse is restricting your ability to exercise through your post-baby life.

TopTip 1

Know the stats!

50% of women who have a vaginal delivery will have some degree of prolapse, but only 15% will be symptomatic! 

So it is a very common occurence, but not everyone is going to be symptomatic – so if you get told by your obstetrician, GP or Pelvic Health physiotherapist that you have a prolapse – try hard not to freak out. Facebook and the Internet have turned Prolapse into Superstar Celebrity Status, whereas for many years, prolapse just couldn’t get a gig (article) in the papers. Fortunately, prolapse is well managed by conservative strategies such as pelvic floor muscle training, bracing or the knack, defaecation dynamics (an easy position and coordination for emptying your bowels) and other lifestyle changes.

The Australian Commission on Safety and Quality in Health Care have a number of documents that help women understand what the course of treatment should be when considering any pelvic health treatment progression and they have one for prolapse making it easy for you to read and consider the best approach. Interestingly, the first one is Do Nothing! As a natural interventionist (ask my husband and children) I struggle with this, because if we Do Something (Physiotherapy) then we may not need the third one which is Surgery. 

I have written many blogs on managing prolapse and have brought many of them together in this one blog.

Top Tip 2

Stop feeling with your fingers/looking with a mirror

Women are often encouraged to look at their perineum and vulva to learn about all their anatomy ‘down below’, but when you have just had a baby, the ‘look’ of the area can change and look quite distorted, scary even. Things may still not be drastically symptomatic of prolapse (bulge, heaviness, drag)- but if you keep looking, and keep feeling and keep checking Facebook and Instagram (yes there is a site which has comparative pictures for women to look at and assess whether they have a Grade1,2 or 3 prolapse – all of which can magnify the representation of the prolapse on your sensori-motor cortex- the sensory brain map), then your anxiety levels will go through the roof and it will feel worse than it may actually be. This blog talks about how your anxiety can make the prolapse feel worse than it actually is.

Get an assessment from your pelvic health physio at 6 weeks and let them reassure you that it is early days and that there is often considerable improvement once you start a physio home programme. If you are unsure who to see, the Continence Foundation of Australia have a register of pelvic health physiotherapists in each state and the Australian Physiotherapy Association also have a Find a Physio register on their site.

Top Tip 3

Don’t let your fear of exercising with a prolapse ruin your life


Exercise is the elixir of life!

Our knowledge about prolapse and exercise prescription is a work in progress. The evidence is evolving constantly and like Coronavirus has taught us – it’s important to follow the evidence. Dr Jenny Kruger from Auckland is working on a device to check the effect of intra-abdominal pressure rises in women undertaking certain exercises or manouvers. Other researchers around the world such as Dr Ingrid Nygaard are asking questions about what truly constitutes necessitating the banning of a certain exercises. Exercise is important for so many reasons – bone density, maintaining good cardiovascular function, sustaining excellent mental health, maintaining muscle mass, keeping joints well lubricated and working well and finally helping to manage weight.

So suddenly stopping exercise because you have a prolapse is a serious thing to contemplate and needs to be justified and well thought out. Top Tip 4 will assist you in understanding how you can still exercise – even with a significant prolapse and levator avulsion injury. There are many ways to exercise and get around the new normal after a difficult birth that has changed your anatomy. Your treatment needs to be individualised for your pelvic floor and progressed carefully as you get stronger and fitter. What women go through when having a baby, needs to be respected! Just because for centuries women have been basically popping babies out and then getting back to their chores around the house or out in the fields, doesn’t mean we have to keep doing the same old thing now that we know more. Get your pelvic floor assessed early at 6 weeks by a pelvic health physiotherapist and keep in touch with her for the 12 months after your baby is born and prior to and following subsequent pregnancies.

Remember the benefits you reap from exercising throughout your life far outweigh the risks with prolapse – but respect your pelvic floor and tailor your programme to what you can manage.

Hiking in the Swiss or Italian Alps is my elixir of life

Top Tip 4

Pessaries can be a game changer!

Pessaries – there are lots of shapes and sizes


Probably one of the most satisfying things I have ever learnt about is fitting pessaries for women with prolapse. They literally can free up a women to resume exercise and allow them to do so with gay abandon. A pessary works like a splint to help support the structures to stay in a better position – sometimes they aren’t perfect, but they are better than exercising with nothing.

The evidence is not there yet to prove categorically that a pessary prevents prolapse from occuring if a woman has a levator avulsion injury, but it seems logical that a mechanical support of some type is going to help oppose downward forces. If there is an avulsion injury, pessaries are much harder to fit and of course with the joy of changing a women’s life with a pessary, also comes the disappointment when the physio can’t make one work in someone with avulsion. Physios have all seen the women who come with 6-8 pessaries (and sometimes more) in a plastic bag that they have purchased but they have failed, hoping like crazy we will find something that will stay in.

Levator Avulsion illustration

Pessaries have to be treated with respect. There is nothing worse than the forgotten pessary or getting an infection (bacterial vaginosis) which is a serious infection in the vagina from not removing and washing the pessary as it’s supposed to or getting a fistula from a pessary that may have migrated into the wrong position and caused a communication into the rectal wall. Following the rules with pessaries will help prevent any of these unfortunate complications.

Top Tip 5

Do your pelvic floor exercises!

The evidence is clear. Doing pelvic floor exercises strengthens muscles, thickens them to improve support for the vaginal structures and helps prevent a prolapse from getting worse.

I put it to you: Nobody ever says…Sue I’ve cleaned my teeth twice a day religiously for 6 months…but you know I am very busy with the kids. I drive them to sport, I am working fulltime and cooking, shopping and cleaning. I have no time for teeth cleaning. 

And yet… we have this thing called pelvic floor muscle training which is proven to help with prolapse prevention (and urinary incontinence improvement) and women often say – I am very busy with the kids. I drive them to sport, I am working fulltime and cooking, shopping and cleaning. I have no time for pelvic floor exercises. 

Try and make it a routine, remember them, add them into your general exercise programme and don’t forget to relax your pelvic floor muscles plenty of times and keep breathing as you do them, holding for 10 seconds. If you are looking for a new product to help you make pelvic floor exercises more fun, a Perifit is a new pelvic floor exercise device which we are selling now at the rooms and I do like it as it rewards relaxation as well as tightening. It has a number of games that you ‘play’ as you are exercising through an app on your phone.

I hope you find some of these tips useful and don’t forget to see a Pelvic Health Physiotherapist if you have any embarrassing problems that are limiting your enjoyment of life. Embarrassing problems are our core business. 

(It’s been a while since my last blog. Probably the longest break I have had from writing since I started my blog 9 years ago. It was because the Continence Foundation of Australia’s 29th National Conference, which I was Co-Chairing with Dr Peta Higgs, was happening at the end of October and in the lead up and afterwards it was insanely busy. It feels good to have that big responsibilty successfully completed, but I just want to say a big thank you to everyone who virtually attended and especially to all those who presented. It was a wonderful collection of presentations and because it was a webinar rather than a face-to-face conference, those recordings will be up on the Conference App until mid January. As wonderful as it was, I do hope that 2021 allows us some mercy and we can attend in real life in Melbourne for the combination ICS and CFA Conference 12-15th October, 2021. We need to be able to dance at the Conference Dinner!)

Women’s Health Week and International Physiotherapy Day (8th September 2020)

Pelvic Health in Regional and Rural Queensland

Small Business Grant Win: Extending the scope of Telehealth in rural and regional Queensland

Today (8th September) is World Physiotherapy Day, plonked right in the middle of Women’s Health Week and it is a good time to chat about an exciting new project that we have undertaken. In the weeks that followed us closing the door on 25th March, 2020 to face-to-face consultations with patients and pivoting (new 2020 Word of the Year, only just pipping unprecedented) to completely Telehealth consults, the Queensland Government encouraged small businesses to apply for Small Business Grants to the value of $10,000.

Not knowing what the future held and having ten staff to continue to employ, I decided to apply for a grant based on trying to extend the reach of Telehealth to rural and remote areas in regional Queensland.

As a background to the choice of our application for rural and regional Queensland Telehealth, we know that incontinence and pelvic floor dysfunction is a silent epidemic with women with severe incontinence experiencing more health issues, restrictions or limitations than women without severe incontinence. For example, 2 in 3 people (76.6%) with severe incontinence were restricted or limited in their physical activity or physical work, compared with 44.8% of people without severe incontinence. We know that incontinence is socially isolating, causes anxiety and depression and limits physical exercise, thus compounding their emotional and psychological burden. If these issues are not addressed it will mean that the problem progresses and ultimately affects our older age with around 77% of nursing home residents in Australia being affected by incontinence. 

And those stats are just about urinary incontinence. They don’t address vaginal or rectal prolapse, faecal incontinence or pelvic pain- the stats of which are also massive.  Childbirth is definitely implicated, but also we know that women who have had Caesarean births or are nulliparous (never had a baby) may eventually have some pelvic floor dysfunction, if they remain uninformed about the science of the bladder, bowel and pelvic floor.

So we know we need to get the message out there about good bladder and bowel habits and the role that pelvic health physiotherapy plays in treating these conditions. At my practice, we had already been doing quite a lot of telephone consults for regional women (men and children) prior to COVID19, but the rapid switch to 100% Telehealth once we temporarily stopped our face-to-face consultations meant that I had to make the process more user-friendly for my staff and the patients and therefore adapted our handouts and information to a user-friendly platform which was well received by both the physios and the patients.

My books enhance any education we give at the Telehealth consultations

Fortunately, education is the cornerstone of effective pelvic health treatment once a comprehensive assessment has been undertaken. Therefore Telehealth lends itself nicely to the majority of the requirements for effective treatment of our patients. We acknowledge there are some drawbacks when we cannot immediately follow the education with an internal examination, but we have ensured that the patients are asked probing questions by the physio in their assessment regarding:

  • What can they feel when they attempt a pelvic floor contraction?
  • Do they feel lift and squeeze or do they feel descent or bearing down?
  • Are their other pelvic muscles working overtime?
  • Are their abdominals ‘overswitching on’?
  • Are they holding their breath to do the contraction?
  • They are given many cues to check for correct activation of their muscles
  • Do they have a vaginal bulge which may indicate a prolapse which can alter their ability to empty their bladder (meaning any frequency they may be suffering is related to residual urine left in their bladder rather than an overactive bladder).
  • They are asked to fill in a bladder diary and return it to us as soon as possible.

All of this close questioning is to ensure ‘we do no harm’ with our telehealth treatment plans.

We also immediately started streaming our supervised exercise classes also because the patients who attended our classes at Hampstead Road and the studio at 194 Gladstone Road were devastated that we had to stop them so abruptly. This has been a revelation. They work so well that, until there is a vaccine, we will not be having our group classes in the small gym at Hampstead Road, but we will be still having some occasional small dance classes at Gladstone Road – althought the majority are still streamed.

But Telehealth does have its drawbacks. Obviously we are unable to do that very important internal assessment to assess the status of the pelvic floor muscles (are they weak? is there a possible avulsion injury? or are they overactive with tender points? is there a prolapse?) or the ultrasound to see if patients are completely emptying their bladder, but there is so much that we can do that the pluses definitely outweigh the minuses. What has happened is many of the patients have eventually had other reasons to come to Brisbane and have had a face-to-face appointment with their physiotherapist and the necessary examinations and then their consultations have continued back in their own homes via further Telehealth appointments.

What began as a less than suitable substitute, became a fantastic way to reach women (men and children) who live more remotely and who may have had no idea that there was an effective treatment for their very distressing bladder, bowel, pain or pelvic floor problem available.

The wonderful news is that in August, we heard that we had won the grant and so began our journey of offering Telehealth Pelvic Health services to regional and rural Queensland. The grant money cannot be used for wages to provide the Telehealth services. It is designed to set up the infrastructure so to speak, of developing this type of service. Since this news arrived, I have been doing a lot of thinking and researching about how to do this in a way that is inclusive to all the hardworking and fantastic pelvic health physiotherapists in rural and regional areas and also about the opportunity this presents to amplify the value of pelvic health for women, men and children throughout Queensland.

In the beginning we will be offering Telehealth appointments throughout regional and rural Queensland and then trying to link with pelvic health physios who are in the vicinity of the towns where the patients may be located so they can have a face-to-face internal pelvic assessment. Of course if patients are coming to Brisbane for other appointments, we can tee up a face-to-face with them then.

If pelvic health physiotherapists are interested in being on a register of rural and regional contacts please email me on (perhaps with some indication of the courses you have covered).

The evidence is strong that pelvic floor muscle training and education about good bladder and bowel habits should be the first line of treatment for many pelvic health conditions. A study by Doumoulin et al 2018: Compared with no treatment or inactive control treatments, women with stress urinary incontinence (SUI) who were in Pelvic Floor Muscle Training (PFMT) groups in this study were 6 times more likely to report being cured or improved. (PFMT 72% Placebo/Control 11.4%). Another study by Fitz et al in 2017 showed the success rate for PFMT for SUI varies between 60-75% when performed in the outpatient setting under the supervision of a physiotherapist. With the availability of Telehealth, this supervision can also be via the computer and even by streamed classes when the ideal situation of seeing a patient face-to-face is thwarted by the tyrrany of distance such as we see in Australia

We can also recommend some strategies to ensure there is safety around Telehealth appointments.

For example screening for a Urinary Tract Infection (UTI) can be undertaken if there is access to a GP – request a microurine if there is increased urinary urgency and urge incontinence as this can be worsened if there is an infection. It also helps to check for the clarity of the urine (cloudy urine can signal infection) and colour (it should be pale yellow- the more concentrated the urine the more irritating for the bladder). If your urine is clear, a nice pale yellow, there is no odour and no stinging when you void or blood in your urine, then it is unlikely there is infection. 

Another important ‘revealer’ of important data is to undertake a 48 hour bladder diary to see what you can hold in your bladder – measured volumes should preferably be between 350-500mls for the adult bladder. This bladder diary gives us an amazing amount of information – the capacity of the bladder; the degree of urge with each void (from zero urge, mild, moderate, to busting); the spacing of the voids throughout the day; the number of urinary leaks and at what volume of the bladder; the number of voids at night and the amount of fluid voided through the day versus the night; the balance of your fluid input versus your fluid output; the types of fluid that you are drinking; the total volume of your intake; the times you are drinking etc.

Access to getting an ultrasound in a regional centre can also reveal voiding dysfunction – if with questioning symptoms seem to indicate retention of residual urine.

If you are suffering in silence with urinary incontinence, if prolapse is interfering with your farm work, or if constipation is a daily burden – now is an opportunity to seek help. The strategies taught via Telehealth are simple and easier than you think to implement. If you would like to make a booking for Telehealth, contact our secretaries on 0407659357 or (07) 38489601.

If you want to make a headstart on things prior to making an appointment, these things are comprehensively covered in my two books Pelvic Floor Essentials (if you haven’t had or not intending to have surgery) and Pelvic Floor Recovery: Physiotherapy for Gynaecological and Colorectal Repair Surgery(the surgical book). You can check them out on my book website.

Finally, thank you to the Queensland Government for our Small Business Grant and if you are a business struggling as a result of COVID19, check our the Qld Govt website for future small business grants.

The pelvis model – a perfect phone holder for zoom meetings! 




COVID Update for posterity: August 2020

I have to own up to it. I’m suffering from burnout.

It’s not burnout from work, although we are all working very hard lately.

And it’s not burnout from keeping up to date with the necessary reading of research and available professional development that has sprung up left, right and centre since we all moved our ENTIRE lives online.

No- it’s burnout from listening to, participating in and combating futile arguments, discussions and behaviours associated with COVID.

I have wanted to keep writing updates on what has happened in 2020 because quite frankly, I reckon it will end up being like childbirth – you blank out the worst parts of it in order to stay sane. And some of it is so damn ridiculous I can hardly believe it’s actually all happened.

The Battle for the Last Roll of Toilet Paper Circa March 2020

I became aware of this the other day when a patient raised with me one of the ‘discussions’ I wrote about in an earlier blog with a Health Fund representative, who I had to relate what a pelvic floor physio actually did each day when treating patients with prolapse/ pelvic pain / faecal and urinary incontinence.

I had already completely forgotten about that nightmare day when this particular fund made us jump through a few more hoops than we were already jumping through, just to facilitate a patient receiving a $40 refund for their Telehealth appointment. This lady laughingly said she could imagine me red in the face, walking through the Yeronga park, laying down the law about the indignity and discomfort for the patients that they face when they have pelvic floor dysfunction.

That was a horrible day because it was the culmination of a difficult few weeks and a twenty something young guy was trying to tell me he understood about women’s issues and there’s nothing I could tell him that he didn’t already know. He insisted that it was very important that each patient write faecal incontinence or painful sex or whatever their most personal body failing was, on this special extra form they were requiring to be filled out and fax it in before they could get their $40. I had completely blotted that 57 minute conversation from my memory until she reminded me.

But we have had many useless, futile conversations and arguments over the past 6 months. Hundreds (no actual lie or exaggeration here) revolve around the phones and the internet. I know that Australia would become a Superpower of Productiveness if we could raise the bar with our technology providers. The number of hours lost to sorting out the internet and receiving and making phone calls has been insane and it’s a national disgrace. The communication from the employees of all Telcos (being that their primary role is to enhance communication) is appallingly difficult. We are still grappling with a major phone issue that neither Optus or Telstra can fix. So if you ring my landline at work and you get an odd message – definitely ring the mobile (0407659357) and there will be a secretary or the correct message on the other end.

Then there have been the ridiculous arguments from people about wearing a mask or complying with police directions or following rules.

Just wear a mask when you need to!

What is it that people object to? Have they not seen enough people night after night on different news services who have had COVID and telling us – take it seriously, it isn’t the flu?? Have they not been hearing that young people are succumbing to this virus – yesterday a man in his 20s died in Victoria and a 30year old in Queensland earlier in the week.  And then there are the purile political point-scorers – politicians who think it’s ok in the middle of a pandemic to bash on about their opposite number in the Parliament – and that is directed at all politicians regardless of their party.

But there is no point in burning out at this early point in the pandemic because despite today Russia reporting (claiming) they have Won The Race to get the first vaccine up and running, I think we have a long time to go in dealing with COVID. Poor Melbourne is suffering badly at the moment and is in Stage 4 Lockdown – it seems there may have been some shananigans in hotel quarantine. It seems incredible that so much suffering can be traced back to that alleged indiscretion. There is an inquiry tasked with getting to the bottom of that. 

New Zealanders under Jacinda Ardern has had a brilliant success with their Elimination Policy………until they spoke out loud about it and jinxed it. 100 days free of COVID – make a public announcement and back into Lockdown. Now this is increasing daily – started at 4 then up to 14, today 32. It’s more evidence of the contagious-ness of this virus. Jacinda has gone in hard again – particularly after watching Victoria’s experience this may be a good move. Let’s hope that it doesn’t continue to escalate out of control.

Aged care has been a disaster through COVID. There have been many outbreaks in many Aged Care residences and many deaths and it appears that a shortage of PPE and a lack of training has been part of the problem. There is an inquiry drawing to a close soon and the evidence is not looking good. The outcome will be for a future blog.

The final word on burnout is that I have come to realise that holidays are not only a wonderful elixir when they are actually happening, but the months planning them, preparing itineraries for them, thinking about them and imagining them actually contributes to anti-burnout. Those beautiful overseas holidays we have had since 2011 have kept us energised into our 60s – given us a purpose to working very hard so we can explore and have adventures in new and old lands.

Fortunately I have thousands of photos to remember them by. And thankfully Facebook throws up regular ‘Memories’ so I can look back and re-imagine those beautiful days. As we approach the end of August 2020, there will be daily reminders of last year’s very special trip to lots of mountains and of catch-ups with our kids overseas.

One day I hope we can do that again.

I hope we can get on a plane and not be petrified that we will arrive at the other end COVIDed. I hope we can hug our kids – a real bear hug not those elbow bumps. My son has come home, but my daughter and her partner are still in London and if it seemed a long way away before, it seems a million miles away now. I hope we can travel again without allowing two weeks at either end to sit in a hotel room quarantining. I hope we can afford travel insurance or that there is even such a thing as travel insurance.

For this we are relying on scientists. Clever people who are paid a pittance to keep us healthy and safe. If someone can tell me why a footballer or a cricketer are paid a gazillion dollars to play sport and scientists have to burn the midnight oil to put in grant application after grant application to sustain their very existance…….

So until there’s a vaccine, here’s some more mountain spam.

Gornergrat, Switzerland, 2019 -I long to see you again!



A very short blog on Movement

Today I did a short five minute segment on Katherine Feeney’s show on 612ABC radio – she is having short top tips for COVID from lots of health professionals and she is brave enough to allow me to talk about …………really anything. Today I was going to talk about persistent pain disorders and how all the prolonged sitting in front of computers doing multiple zoom meetings with reduced movement and increased anxiety from COVID was causing a spike in all sorts of pain conditions.

Luckily I came on and listened to Kat’s show about 5 minutes early and heard her play this (fantastically appropriate) song called Movement by Hozier. It truly should be everyone’s anthem. And we should all be moving like Hozier. Give it a go!

And if you want the link to the top tip for this week press on here 

I did also mention that women learning how to Sit Like a Man with their legs relaxed and apart, tummy relaxed and belly breathing regularly through the day can calm their brain, help settle anxiety and help relax overactive pelvic floor muscles. Of course there’s a lot more to treating conditions that come under the umbrella of Genito-pelvic pain/penetration disorder (encompassing previous conditions known as vestibulodynia, vaginismus), PGAD or Peristent Genital Arousal Disorder than just sitting like a man and getting help from a pelvic health physiotherapist is very worthwhile.

The silence around these distressing conditions is deafening and we need to speak about these conditions to help women seek help.


The actor who plays Jamie Fraser kindly demonstrating Sitting like a Man 

#movemore #moveoften #movewithgayabandon #movelikeHozier

CPOP pessaries: An observation

This is a CPOP pessary – you can read about its design and how it came about here in this earlier blog. It’s a great pessary which continues to surprise me because sometimes it works when you never think it will on quite significant prolapses. As you can see it’s a different shape and that is one of the keys to it’s success. 

But the new observation about it relates to urinary incontinence. A patient had used a silicone ring pessary for years, but as she was getting older her finger dextirity was declining and she was finding putting the stiffer ring in and out weekly was becoming a chore (stiffer because it was a size 3 and the smaller they are the stiffer they are to manipulate). She had also recently found she had increasing urge incontinence on the way to the toilet – just small amounts, but distressing for her.

Due to increasing difficulty manipulating the ring, I decided to try a CPOP pessary with her – because this particular pessary has TGA approval for leaving it in for 28 days, which means that she would only have to change it 12 times a year instead of 52. 

The interesting thing is that when she returned for followup she not only was ecstatic about the ease of getting the softer silicone pessary in and out, but her leakage on the way to the toilet had almost completely disappeared. I have since offered a change to a number of ladies with similar small amounts of leakage and they are reporting the same effect. The different shape of the pessary at the front may be the reason. 

When you are due for a new pessary, it may be worth considering a change if there is small amounts of urinary incontinence. 




Merry Christmas in 2020 – a very COVID19 year!

Drone photo Sunshine Beach

Looking back over 2020, one of the important life lessons is the value of getting away from work and routine to replenish the spirit – even if it’s for a very short time. Today, I am writing this Christmas blog from the beach, making sure I follow through with my own advice.

We all risk burnout if we don’t mind our physical and mental well-being.

Thankfully I realised this a few weeks into lockdown back at the beginning of the pandemic and booked a few weekends away over the year to get through the very torrid nine months, since we temporarily shut the doors on 25th March, 2020 and went 100% Telehealth. (We are back to full face-to-face now and I say that out loud with every single one of my fingers and toes crossed as our Sydney wave unfolds).

Sunshine Beach got me through this year – and everytime I came away to the beach, I was reminded about the consistency of the beach. Regardless of how crazy everything is in the world, those waves keep moving in and out with regular precision, the beach is there beckoning – come for a walk and the breeze blows endlessly, keeping us cool as summer hits with a vengeance.

Burnout is something that can have an impact even if you aren’t working. The endless cycle of news telling us about the tragic numbers of Coronavirus infections and deaths overseas, the terrible stories about our politicians behaving badly and now as we face Xmas, the outbreaks as we’ve recently seen with Sydney Northern Beaches, all raise anxiety levels as Xmas plans are decimated and families are plunged into another cycle of sadness and disruption.

I have a great life-long friend (who is an OT) who wrote me a blog about burnout many years ago. She has some great advice in this blog about how to avoid burnout. A key one is mindfulness. She writes how the neuro-physiological and health benefits of mindfulness are well documented and include reducing the cognitive decline associated with normal ageing processes, decreased stress levels, improved immunity, reduced chronic pain and improved sleep. The cortical areas that are thicker in people who engage in focused attention practices include the insular and prefrontal lobes. These are associated with attention, self-awareness and sensory regulation.

So being mindful at the beach – consciously wondering about the waves and the moon and the tides; being observant about the stars and taking an interest in star formations and literally just breathing in the salty air deep from your belly, are all having positive effects on your brain, your body and therefore your health. Every day I remember this and breathe in my stocks of beach scenes and smells to last me for the upcoming year.

As I get older, I constantly ponder the potential for declining physical and mental health. While I feel very healthy and mentally ‘with it’ at present – we are all just a bit of bad luck or genetics away from a less than healthy existance. I am grateful that at 50 I discovered the joy of walking and exercising. It also coincided with my kids getting older, therefore more independent by being able to drive themselves places, so I wasn’t needed so much after work and I could start more regular exercise.

Walking has many benefits. It may seem less dynamic and block-busting compared to running and cycling, but the physical and mental health benefits are widely documented. The Heart Foundation even helps with pointing you to walking groups that you can join if you don’t have a partner, friend or neighbour to walk with.

Walking for an average of 30 minutes or more a day can lower the risk of heart disease, stroke by 35% percent and Type 2 diabetes by 40%. But it’s not just your heart and muscles that benefit from walking.

Regular physical activity can help:

  • reduce your risk of heart disease and stroke
  • manage weight, blood pressure and blood cholesterol
  • prevent and control diabetes
  • reduce your risk of developing some cancers
  • maintain your bone density, reducing your risk of osteoporosis and fractures
  • improve balance and coordination, reducing your risk of falls and other injuries
  • improve our daily mood which cumulatively leads to better mental health (1)

My new mantra for patients for 2021 is that every walk matters. Have a belief that you need to walk somewhere, every day. If you think that walking 3 times a week is all that matters, then if it’s raining on your third day, you’ll miss it and only get to walk twice that week and you will miss out on those wonderful benefits.

Walking improves your balance. Good balance prevents falls. Falls cause injuries and this sets into motion some devastating ageing effects. Back to the important point-walking improves balance.

When you see the endless beach…walk on it.

That beach is beckoning every day ‘Come for a walk’

When you see a rainforest….walk through it.


McInally Drive walk, Sunshine National Park 

When you see a mountain to walk up or down it, (a hill will do)… it.

On the way to the Ice Cave, Mont Blanc

Don’t stop walking because of a diagnosis of knee arthritis. Osteoarthritis (OA) occurs when the cartilage inside a joint breaks down causing pain and stiffness. People over 45 are more at risk, but younger people can be affected too. Exercise is one of the best ways to manage osteoarthritis.

The evidence tells us that the treatment should not be rest, but movement. The treatment maybe shouldn’t be an operation and pain relief, but movement and walking. But if you have pain, then try what’s called graded exposure. Start walking from a more distant carpark at the shops; walk once around the block and slowly add to the distance; or do two 10 minute walks a day – one in the morning and one in the afternoon. Every step matters!

OA was once thought to be an inevitable part of ageing, a result of a lifetime of ‘wear and tear’ on joints. However we now know much more and understand that it is complex and in many cases preventable. Things like reducing the overall fat you carry – fat releases molecules that contribute to low but persistent levels of inflammation across your whole body. This in turn increases the level of inflammation in the joints affected by OA. (2)

So as we head into the ritual of eating chocolate for breakfast, Prosecco for morning tea and three helpings of plum pudding – ie Christmas Day -think about scheduling a walk or three to help keep the inflammation down and the mobility of the joints up.

May the 25th December mean everything you need it to,and for those who celebrate Christmas, I hope you were able to join some family, speak to a friend and feel happy.

And after the year we have had, this is sage advice….

Good luck to us all with COVID


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