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

Electrotherapy for urinary retention (NOUR)

The following blog is from one of my physios Martine Lange who attended a brilliant course run by Fiona Rogers, who is a pelvic health physiotherapist who owns an online pelvic health supplies business called Pelvic Floor Exercise. Fiona has been taking her one day course around Australia this year and is on the road next year to New Zealand and the UK. If you are a physiotherapist working in pelvic health I strongly recommend this course to you for its completeness and evidence base.

Non-obstructive urinary retention (NOUR), when it doesn’t respond simply to positional adjustment (see below), can be frustrating for therapists to treat and patients to live with, as it can often mean recurrent urinary tract infections and urinary frequency.

Position for voiding from Pelvic Floor Essentials (2018) by Sue Croft

Martine undertook Fiona’s course in July 2019 and immediately had a patient with this condition and had great success with implementing this treatment strategy as you can see in her account following.

TENS unit (image from Pelvic Floor Exercise online website)

The TENS (Trans-cutaneous Electrical Nerve Stimulation) machine has been used for years as a treatment for different aches and pains, in particular lower back pain. However, research is mounting that the humble TENS machine may actually be a viable treatment option for a number of bladder conditions such as OAB, persistent pelvic pain conditions (bladder pain syndrome, vestibulodynia, male pelvic pain), obstetric labour, faecal incontinence, period pain (primary dysmenorrhea) and what today’s blog is about which is non-obstructive urinary retention (NOUR).

NOUR refers to incomplete emptying of the bladder without any physical blockage. Often the reason for incomplete emptying maybe muscular (maybe the pelvic floor muscles or urethral sphincter muscles do not relax well) or it could be related to other conditions in the area, such as lichen sclerosus or lichen planus, cystitis, post-partum or post-operative complications.

The TENS machine is a small hand held device that emits an electrical current via 2-4 sticky electrodes which are attached to the skin. The sensation is of a tingling/ pins and needles type of feeling when it’s turned on. The machine is able to be adjusted in both frequency and intensity so that it gives a strong but comfortable sensation. This sensation tends to be calming for the nerves being stimulated, thus reducing both pain as well as reducing over-activity of the target nerves. Whilst we are not sure on exactly the mechanism of action of the neural stimulation, research does seem to indicate both a local effect on the organs and peripheral nerves as well as a central effect in the brain.

Using the TENS machine over the nerves that also supply the bladder and pelvic floor muscles has been demonstrated to improve symptoms of OAB (overactive bladder), BPS (bladder pain syndrome) as well as NOUR. The TENS electrodes are positioned to stimulate the posterior tibial nerve down near the ankle (this has a neuro-modulatory effect on the bladder and pelvic floor as they have the same spinal origin).

Image from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5730708/

Most studies suggest applying the TENS electrodes over the posterior tibial nerve (this technique is called TTNS) daily for 20-30 minutes has a positive impact within 4-6 weeks on bladder emptying, holding capacity, as well as on pain. TTNS has minimal side effects and it is safe for the large majority of people to implement.

As a case example I have a 40-year-old female patient with a 3-year history of urinary retention who had tried many things including urethral dilatation, self-catheterisation, bladder stimulating machines and correct bladder emptying positions. After a 4-week trial of TTNS she had halved her urinary retention volume and reduced her urinary frequency. After 10 weeks whilst she still felt somewhat incomplete in emptying, in clinic she actually had no residual volume on emptying.

It is important if you do have urinary retention, that it is properly investigated to rule out obstructive causes. Once that is given the all-clear, it is possible to start management such as correct position for bladder / bowel emptying, knowledge and understanding of good bladder habits, good pelvic floor muscle coordination and if they have not resolved the retention we can utilize TTNS to speed up the recovery process.

Thanks Martine – a great summary for us to remember and also thanks to Fiona Rogers for her great course and online shop.

As we head towards Christmas, and we have raging bush fires in Australia – consider purchasing Christmas presents from sites that support regional areas in Australia. The hashtag #buyfromthebush will find you lots of regional Australian businesses that are often supplementing the income of primary producers, so if you need some presents think about supporting these businesses. https://www.instagram.com/buyfromthebush/

Another useful Christmas present, particularly for women (even if I do say so myself) are either of my books – Pelvic Floor Essentials (if you haven’t had any surgery) and Pelvic Floor Recovery: Physiotherapy for Gynaecological and Colorectal Repair Surgery. You can purchase my books from my website Pelvic Floor Recovery books .

Another fantastic Christmas present is to do something altruistic and kind by donating to HADA – a charity which supports the wonderful fistula and prolapse repair work that Professor Judtih Goh and Dr Hannah Krause are undertaking in Africa every 3 months. The link is here. 

The forgotten pessary

I love pessaries for prolapse management. I wear a pessary for my own prolapse (perhaps oversharing a bit there) and fitting pessaries have been a great adjunct to all the other things (pelvic floor muscle training, engaging your PF muscles prior to increases in intra-abdominal pressure, lifestyle changes, excellent bowel management -correct position, defaecation dynamics and a Goldilocks consistency bowel motion – not too soft, not too hard, but just right) that we pelvic health physios teach to patients to empower them to keep everything where it should be while they are exercising or to support their prolapse.

There has been an explosion of talk on social media about pessaries in recent times. The beauty of that is that whereas only a couple of years ago barely anyone nobody knew what a pessary was, now every patient who has prolapse seems to have read about them already and they are asking would a pessary help them? The problem with that is that sometimes the girls who may benefit most from wearing a pessary, because they have suffered a serious muscle injury at childbirth (called levator avulsion), are the ones who can be difficult to fit with a pessary because of that significant injury, but it is definitely worth trying.

Illustration showing a levator avulsion injury

It can take multiple attempts with different styles/sizes of pessaries and this can be frustrating and disappointing for the patients. Persistence and perseverance is important with pessaries. Sometimes if you wear one type of pessary for a while and you are doing all those treatment strategies I outlined above, the prolapse can actually improve sufficiently to then mean a less bulky pessary or smaller sized pessary can be fitted.

But a warning: Pessaries need to be taken seriously.

There are rules that need to be adhered to. You need to follow the instructions of your treating pelvic health physiotherapist.

  • These include regularly taking the pessary out to rest the vaginal tissue if you have been fitted with a silicone self-managing pessary. The length of time depends on the type of pessary and the status of the patient’s vaginal tissue. For some women it may be every night; others every second night; some every seven nights and for the Gynaecologic pessary – they have just received TGA approval to be left in for 28 days before needing removal.
  • The pessary needs to be washed once it is removed in a liquid soap and dried and stored in some type of plastic container with a lid while it is out (we have had a spate recently of dogs discovering the pessary on a side table and chewing it to bits – which is definitely not good for the dog if they ingest it and is an expensive toy for the dog).
  • The pessary must be replaced every 12 months (this is the manufacturer’s advice and must be followed).
  • If the patient has self-referred rather than being sent by a medical practitioner, they need to see their GP for a speculum check and bi-manual examination as soon as possible after being fitted with a pessary and return yearly to their GP for a speculum check.
  • They must return for an appointment with their treating physio at between 2 weeks to 4 weeks after fitting to make sure all is going well and then yearly to get their replacement pessary and a check of their muscles, bowels, bladder function and general exercise programme.
  • It is important to continue with all the conservative strategies as mentioned above (especially pelvic floor muscle training and the knack so you maintain good strength in your muscles, especially if you eventually have to have surgery).
  • While it can be normal that the pessary causes increased vaginal discharge, you must visit your GP if there is bloody discharge (obviously not if it is a period) or smelly discharge as there may be an infection (bacterial vaginosis).
  • If you are menopausal you should discuss the use of local oestrogen with your GP as the risk of vaginal tissue erosion is increased with a pessary (which is why you require a regular yearly speculum check with your GP or a gynaecologist or urogynaecologist).
  • At our practice we get you to read our instruction sheet explaining all about the pessary and with all the above precautions and then get you to sign the form saying you understand about some critical factors (the new pessary 12 monthly, the speculum check 12 monthly and seeing your GP if there is blood or smelly discharge) and you will stick to those rules.
  • We also keep a log of all pessaries that we fit at the practice. We now attempt to audit the log every year to help our patients remember to come back and to remember to get a new one yearly. This is why you may get a call from our secretaries prompting you to return as there can be some significant issues if you don’t.

When a pessary fits well, it can be very easy to forget about it and it is for this reason that I have written this blog. The forgotten pessary is concerning. This is one reason why a patient who has dementia can only be fitted with a pessary if they have a designated carer who is taking them to a doctor 4-6 monthly for a pessary check, removal, wash, speculum check and re-insertion. This type of pessary is a PVC one (rigid pessary) and can stay in for longer periods of time and not usually removed by the patient (some younger women are able to self-manage a rigid pessary themselves and therefore it can be taken out and washed in a similar manner to the silicone ones).

Lately some incidents with pessaries have prompted me to write this blog.

The first one involves a lady who had her first pessary fitted in 2011 and who returned in 2014 for her next replacement one (but still had her old one at home). She unfortunately went on for the next few years using the pessary, not taking it in and out as often as she should have and forgetting about the important rules (this was before we instituted a regular audit). Sometime in these ensuing years this lady has found the original pessary and thought she didn’t have a pessary in and put this pessary in. Recently the patient rang up needing an urgent appointment because she felt uncomfortable and thought her pessary was no longer holding her prolapse, as she had heaviness, discomfort and drag. I was overseas at the time and despite there being other physios at my practice who could see her, she elected to wait for me to return. By the time I saw her, she no longer had the severe discomfort but definitely knew she needed a new pessary so arrived at the appointment.

After a chat about her history (and then a reminder about how important it was in future to definitely come yearly to get a new pessary), I examined her and found she actually had two pessaries in. The drag and heaviness she had experienced was probably an episode of bacterial vaginosis, which her body had been able to sort out itself (well done body), because those symptoms had completely resolved. We were both pretty shocked and I made her an urgent appointment at her GP who performed a speculum check and thank goodness gave her the all clear. This can so easily happen because a good fitting pessary can’t be felt and is too easily forgotten sometimes! I told her that I would like to write a blog about this because it would be a good learning blog for other patients and she consented to me telling this story.

The second event was a GP rang asking me to see a patient who had a cube pessary in, which had been fitted by a doctor, but the patient had not been removing it at all, had not returned for a new one and it was now disintegrating. The GP removed the pessary, the lady is starting on local oestrogen and then in a few weeks time she will be coming to be fitted for a new pessary and perhaps a different type of pessary from a cube.

So the moral of the story?

Take your pessary seriously.

Be vigilant about the rules.

Be aware of how long you have had your pessary in and how long you have owned it.

See the practitioner who inserted the pessary yearly for renewal and a revision of all the important conservative strategies and have a yearly speculum check with your GP or specialist.

Put reminders in your phone and a good idea can even be gradually moving the date of your renewal closer towards your birthday so you can more easily remember it if that is a problem for you.

And here are some reminders of what a pessary may allow you to do exercise wise.

Sue hiking at The Matterhorn Paradise Glacier Trail 2019

  

Yoga class at my old studio  Jane Cannan finishing her first marathon

Photos kindly supplied by Nadine Brown, Pelvic Health Physio who loves boxing

 

 

Listening through all the noise of life

Life is very busy these days. Thanks to the internet we can fit in about twice as much as we used to be able to do, but still feel guilty about what we haven’t done. Busyness makes us exhausted and also means we don’t prioritize our own self-care. We literally stop listening to our bodies!

We let things like sleep slip – going to bed to late, going to bed with a busy brain and being too tired to get up and write that amazing idea down which then means you lie awake hoping it will be locked into your memory, which further delays sleep and of course you wake in the morning oblivious to that amazing thought.

We can’t find time to shop for healthy food, so we eat on the run and often too much of the inflammatory foods like sugars which then make us feel terrible (and probably result in unwanted weight gain).

We are often dealing with family stresses and pressures and this can result in a sympathetic nervous system which is chronically switched on releasing adrenaline and cortisol which are detrimental to our body’s metabolism.

We never get to play and have fun – we have to say no to a movie night or the simple pleasure of reading a novel because the housework has to be tackled because we are working so hard through the day

We never get time to feel bored and just do nothing which is a useful activity to let the brain and body regenerate and relax.

We let things like general exercise slip which is critical for maintaining good muscle mass, bone density, cardio-vascular fitness and good brain health.

We don’t prioritize specific exercises such as our pelvic floor exercises or pelvic floor relaxation exercises or pelvic stretches whatever may be required to help any pelvic health problems we may have.

So take some time to listen to your body, hear what it’s saying.

Do you have trouble getting to sleep, staying asleep or do you snore? The answer is to review your caffeine intake (caffeine is a stimulant and can affect your ability to get off to sleep); seek help from a sleep physician who will assess whether sleep apnoea is contributing to your sleep issues; have a notebook and pen beside your bed to write down that amazing idea; and assess what best sends you off to sleep – is it reading a light novel or is it using your phone. Whilst many advise not using screen time in bed, for many it is a way to get tired and fall asleep – after all for many this is their new way of reading.

Getting ready for my sleep apnoea test

Do you feel sluggish including with your bowels? The answer is find the time to buy healthy foods, prepare in a healthy way and cut down on the inflammatory foods – biscuits, chocolates, soft drinks and alcohol. Treat your body like a temple and worship fresh, whole foods, simple foods not fast foods. Add fibre to your diet and use the correct positioning and dynamics for defaecation to evacuate completely and without effort.

 

Bowel evacuation position and baked eggplant with humus and pomegranate

Do you have too many thoughts and no idea as to how to sort them out? With regard to stresses and pressures – ‘control the controllables’ (1). There are some things that are under your control – like many listed here in this blog, but there are many that are reliant on the actions of others and are out of your control and these are the ones that are often the cause of the constant release of cortisol and adrenaline that actually stuff up your (calm, clear) thinking. Write lists of things you can do that may help the things out of your control, but come to terms with the reality that many times others have agendas that you could never predict and there is no solution at the present moment. Try not to dwell unduly because this is having an effect on your health – particularly your mental health.

Always schedule some play and fun as this is the way into your parasympathetic nervous system which helps to release the calming hormones of dopamine, oxytocin and serotonin. If you are twenty something it might mean a coffee date with some girlfriends or (safely) jumping off some rocks; if you are thirty something with kids it might mean a date night with your partner (and no kids); if you are fifty something it might mean discovering the joy of hiking in the mountains; if you are sixty something it might mean minding the grandchildren and totally immersing yourself in their conversations and delightful innocence that is so rare to see in grown-up life. And if you are seventy something it may be joining a club (bridge, bowls, book) and having that regular commitment out of the house. If you are older, it doesn’t mean you don’t get to enjoy pleasures – it often means your pleasures are simpler, but you must never stop trying to pursue them.

Some twenty and thirty somethings having some fun and play

 

Hiking and grandchildren – the joys of the fifties and sixties

And as for feeling bored and just doing nothing (without guilt) that is a tricky one- particularly if you are a woman, we seemed to be wired to use every moment, of every day, otherwise we feel like we are wasting time. But it is a skill I have no answers for because this is my biggest hurdle.

Do you have stiffness when you wake in the morning? The answer is keep moving and move more – not resting more and sitting more. Explore ways to fit in incidental exercise. Expand your horizons with exercise – think about new things to try that you feel are beyond you. Seek help from those who are trained in that activity to achieve your new goal or return to a much-loved pursuit after an injury or a birth. Remember, you are never too old/stiff/immobile/weak to start moving again.

 

Dance is a great new activity/exercise to start

Do you forget to do your specific exercises – such as pelvic floor muscle training (PFMT), pelvic floor muscle relaxation or pelvic nerve stretches? If you start leaking urine again, recommence your exercise and behavioural modification programme to get you back on track; if you feel pain return – acknowledge it, be proactive with the strategies that helped your pain before and then let go of any fear about the pain. 

What that equates to is listening to your body through all the noise of living.

The hardest thing in life is being consistent with things – whether it’s eating healthy, sleep hygiene or commitment to an exercise programme. And sometimes your body is literally yelling at you, but you are not listening. You are using band-aid measures to keep stopping up the gaps and making do, whereas if you truly stopped and paid attention and implemented things that you have learnt, your body would respond and repair and revitalize and renew.

So if you can relate to some things in this blog, take the opportunity to assess what changes you can make and little steps – introduce them one at a time.

Post-script:

The idea for this blog came from two places. One was a lady who virtually announced to me the framework of the blog. She was doing well, then she got busy. She knew there were things going wrong, “her body was yelling at her”, but she felt she was too busy to do what was required of her (do her exercises, sleep better, eat better, exercise regularly etc etc). And so she made an appointment to come back so I could tell her (what she actually knew, but it made her accountable to someone which she said she needed).

The second one was from a segment on The Drum, an ABC Current Affairs show at 6pm weeknights about a new book called The Woman Who Cracked the Anxiety Code: the Extraordinary Life of Dr Claire Weekes by Judith Hoare.  This new book about this amazing doctor, Claire Weekes, highlights her life and that she was perhaps the mother of Acceptance therapy – ACT which stands for Acceptance Commitment Therapy. She herself had problems with heart palpitations which she took years to understand what was causing them. If you read the link to the article you can understand more of the history.

When she ceased engaging so intensely with her symptoms, her heartbeat returned to normal.The keyword was “acceptance”.The turnaround was swift. If Weekes had been devastated by her lack of understanding of what ailed her, she now felt exhilarated, liberated by an explanation from what had been incomprehensible suffering. With this new understanding, she regained control. Here she learnt that panic and anxiety played a medley of dissonant bodily tunes, from breathing, swallowing and digestive difficulties to headaches, dizziness and muscle fatigue among many others. Weekes’ treatment protocol was just six words: face, accept, float, let time pass. She had a gift for discerning the relationship between the mind and the body – what was clinical illness and what were symptoms driven by fear and anxiety. Understanding fear and its relationship to physical illness had become a mission.” Read the rest of this edited extract from The Woman Who Cracked the Anxiety Code: the Extraordinary Life of Dr Claire Weekes by Judith Hoare (Scribe, $40), out October 1 in the link above.

Bob off to crack the macadamias with his followers (Great Gma’s grass has turned brown during our Brisbane ‘winter’)

(1) Many thanks to Michelle Lyons for this – I am not sure where she got it from.

Sicily, Scopello and The Tuna Factory

The iconic Tuna Factory at Scopello, Sicily

This is the last installment in my travel blogs about our trip to catch up with our children who live in London. This last weekend was in Scopello, Sicily. Bob and I first of all left Geneva (after the train trip from Zermatt) and flew into Palermo, hired a car and then headed off to look around Sicily for a few days before the kids arrived on Thursday at Scopello. A heads up about car hire in Sicily. I have established three essential rules.

  1. Never hire from a big name company (Hertz, Europe Hire, Avis etc) because the queues at Palermo Airport for those companies were ENORMOUS. We hired from Italy Car Rentals and there was no queue, the car hire rate was cheaper and the car was fine.
  2. ALWAYS, ALWAYS, ALWAYS pay the added amount each day to have zero dollars excess because it is virtually impossible to not have some car damage in Sicily because of the narrow roads, very tight parking and (crazy) Italian drivers. We had to get our car parked for us at one hotel in Castelmola and the car got brought back to us with a new scrape but as we had paid the extra charge we could relax and not worry.
  3. As from the previous blog, always use a normal credit card for any deposit or car hire charge rather than a debit card or cash travel card otherwise you will have the full amount deducted and your real money will be unable to be accessed.

The first town we headed to was Agrigento, the Valley of the Temples. It was strikingly arid, poor and there was garbage dumped literally everywhere and anywhere by the side of the roads on the drive down to Agrigento.

Extraordinary the way all freeway pullover spots are dumping grounds for rubbish!

On the way to Agrigento we called in at a natural wonder called the Turkish Steps or Scala dei Turchi. The photos do not do it justice.

This is a rocky cliff on the coast of Realmonte in Southern Sicily. The steps are formed by marl, a sedimentary rock with a characteristic white colour and there is a beach area close, with a restaurant with an amazing view to the steps. Here we had a beautiful Italian lunch with a view to die for and the food was pretty good also.

   

Lumie di Sicilia Ristorante, Turkish Steps

Beautiful seafood dishes

We then drove onto Agrigento and seeing the magnificent Greek temples in very good condition was certainly worthwhile and if you go late in the afternoon, then you see a glorious sunset with the temples and ruins lit up at night, which gives a hauntingly beautiful aspect to the scene.

 

Statue of Zeus              Archaeological Site of Agrigento

View from our hotel in Agrigento with a view of the Valley of the Temples

The next day we headed to a very small village called Castelmola perched high on the mountain above Taormina. We had originally planned to stay at Taormina, but we were worried about the terrible parking situation in there and so changed to the elevated village of Castelmola. It was such a good move. It was peaceful and quiet and with spectacular views across to Mt Etna and the hills beside.

Castelmola perched above Taormina The long walk down passing some quaint buildings

The first day we walked down from Castelmola to Taormina down hundreds of steps. My quads were definitely shaking by the end of the walk. We explored the village, checked out the pottery shops and had a lemon granita and generally we were so relieved that we could escape back up to the quiet of Castelmola at the end of the day.

   

View to beaches from Taormina Botanical Gardens and a cute alleyway in Taormina

Lemon Granita was delicious A statue in the Taormina Botanical Gardens which encapsulated me at the end of each day

We caught the local bus back up there for 1.8 euro and admired the spectacular view from the bus on the winding trip. Our room in Castelmola had a beautiful view of Mt Etna which had been obscured by cloud all day but then suddenly at midnight she revealed herself and gave a special display, which we later heard did not happen all of the time!

   

After the cloud hiding the top of Mt Etna lifted at midnight the fiery display was revealed 

The following day we saw the beauty of Mt Etna for the first time.

 

Mt Etna and a panorama of the rolling hills opposite Castelmola from Hotel Villa Sonia 

The next day we caught the local bus to the funicular in Taormina to take us down to a beach below called Isola Bella. There are a number of beaches along the coastline, but our hotel had an arrangement with the place we chose, so the beach lounge and umbrella were 10 euros each for the day. There is a cafe with food and drinks which were very reasonably priced and there’s something special about walking up to bar and ordering food and drinks and especially more granita and then lying back on a lounge to read a book.

This is a typical rocky beach which really requires special plastic rock walkers to enable beach walking or swimming without looking ridiculous and suffering enormous pain. Unfortunately I didn’t see the guy selling them for 5 euros until we left the beach, but I bought a pair for the next stage of our holiday at Scopello which also has only rocky beaches.

Scopello was our final destination in Sicily and we saved the best for last. Its a tiny village with the BEST town square where you could easily stay for a month and just relax and do nothing. When you buy drinks at the bar above, the lovely waiter brings you ‘presents’ of free food and I’m not talking about a bowl of chips but delicious slices of pizza, calzone and yes there were some chips. In the afternoon after a long, hot day walking to and from the beach, the square is in deep shade and the big comfy lounge chairs just swallowed you up.

 

The bar which was so enticing and Jimmy and Mike kicking back at the end of the day.

The place we stayed at Scopello was Pensione Tranchina and my daughter had stayed twice before and had been raving about the hospitality and especially about the beautiful breakfasts. Marisin Tranchina (the owner) greeted us like we were family and as we arrived before Sophie it was very special. She guided us to our room (which she called Sophie and Jimmy’s room – thanks Soph for making the ultimate sacrifice) and it did have a verandah with a view to die for and was spacious and extremely comfortable.

Sue, Marisin and Sophie outside the beautiful Pensione Tranchina and the view from our room

The breakfast was all fresh produce grown or produced by locals – honey and fresh ricotta, sour dough bread baked on the premises, juiced fruits of all types and home-made jams and cakes. Yum. Marisin also has a five course dinner available at night where you start with a welcome wine outside the front door of the Pensione and meet the other guests and then move in to eat a seafood feast. They also cater for vegetarians and we all were very well fed that night.

Seafood feast about to be devoured

Fortunately there are kilometers to be walked before the beaches are accessed, so many calories are burnt during the day, allowing not only for enormous meals to be consumed, but also many gelatis.

A little bit of magic at Scopello

Matching Budgie Smugglers at Scopello and a pair of daredevils in Budgies

We walked the National Park the next day and it was hot (searingly hot) and I almost threw in the towel and gave up, but thank goodness we reached a beach and I staggered down and fell in the amazing water and revived myself enough to continue the rest of the day’s walking. The coastline is rugged and spectacular, but I have to say I will never whinge about the climb up from Sunshine Beach again after the hills of Scopello.

We bid Marisin and Pensione Tranchina farewell and drove off to a small village called Erice – an historic town in the province of Trapani in Sicily – to fill in some time before the airport and we were lucky enough to chance upon some time trials for racing cars at the top. People may have planned for 12 months to make sure they made this event and sometimes when you are travelling you come across these priceless moments.

 

Erice racing car time trials

After the excitement of the racing cars (and traversing the extreeemely narrow roads up and down the mountain, we arrived at the airport to go our separate ways. Airport farewells are always sad, but we were so lucky to have had some precious time with our kids and cherished every moment. Facetime, Whatsapp, Messenger and Skype calls allow us to see our faraway loved ones (for free) but they haven’t mastered the feel of a hug and that’s why we spend their inheritance and travel for 24 hours to see them. Hugs are special and irreplaceable.

So ends our 2019 trip. Now it’s back to bladders, bowels and the like and dreams of 2020.

View from the rooftop garden of our Rome hotel (which made up for the stinky bathroom and kitchen)

 

 

 

 

 

The elusive Matterhorn

As promised, there has been plenty of holiday spam and today’s blog is no exception. It’s hard to play catch-up with writing when you are partying every night with your close family (living distant), so I am here is Rome writing in the dark, staring at this beautiful coppola to play catch up with my writing for the last couple of weeks so I don’t forget this beautiful holiday.

The view of the Mausoleum of Augusta, Rome from the rooftop veranda of our accommodation

So back-tracking to the beginning of September, the next set of mountains after Ortisei were the mountains surrounding Zermatt including the (elusive) distinctive Matterhorn, used by a much-loved chocolate as its inspiration. I am of course talking about Toblerone and while we consumed plenty of it while we were visiting, the weather precluded the obvious gag-photo but we tried.

Zermatt is a lovely village which is car-free with only small electric vehicles allowed in the streets of the town.

We had a change of weather after some brilliant sunny weather in The Odle Mountains and despite having a room with normally a perfect Matterhorn view, it was unfortunately shrouded in cloud for most of the weekend we were there and we only caught the glimpse below of the majesty of The Matterhorn one evening at 7pm. It was very exciting.

The Matterhorn peaking out from behind the clouds

On our first afternoon after arriving via train, we caught the gondola up to Furi to see the Hanging Bridge – a suspension bridge which I very bravely walked over. (I have a terrible fear of heights and especially when there are holes in the walking bit and rushing water underneath). We walked down to Zermatt in light rain which was not unpleasant and the walk was through beautiful forests.

Prior to arriving in Switzerland we had purchased a Swiss Rail Pass which entitles you to half price tickets on all the gondolas and trains, but they are still very expensive, especially with our (rubbish) dollar at the moment. But honestly we ate at The Co-op (a grocery store where we bought delicious BBQ chicken and salad for 10 CHF) so we could spend the money on the gondolas and rail trips because that’s what is so beautiful about Switzerland – seeing the mountains so very close up.

The second day we caught the Matterhorn Glacier Paradise Gondola up to the top – and like so often in the Alps we got to the top and there was a collective gasp from the 10 or so people in the gondola as we saw the panorama at the top – a ring of spectacular snow-clad mountains and then just as quickly (or before I could whip the phone out and catch the photo of it) it was shrouded in clouds.

After the obligatory hot chocolate at the top, we caught another gondola back down to Trockener Steg and then walked down the Matterhorn Glacier Trail to Schwarzsee. This was a huge walk (with lots of up as well as down) but the magnificence of the mountains surrounding was so worth the hard work of hiking. For a normal speed of good hikers it should have taken 2.5 to 3 hours but it took me (us) 4 hours, but again I would totally recommend it. There was some scrambling on loose rock but it was generally relatively manageable.

That was steeper than it looks

There was a time I could have thrown in the towel on that walk, but I pulled my big girl pants on and socks up when we bumped into a family coming in the opposite (and seemingly much more difficult way) with twin babies – each parent had one in a baby carrier and two other young children – say 4 and 6 years – all walking confidently and happily. Needless to say I finished the walk with much greater gusto after that.

Zermatt village from above

The third day we caught the Gornergrat Train attempting to get to the top, but the weather was very cold and snowing and the train couldn’t run because of iced-up wires so we got off the train half way up at Riffelberg and had a hot chocolate waiting for the crews to sort out the iced-up wires and allow the train to keep going. (This is where some bad luck – or negligence on my part – stepped in because that’s where I lost my Qantas Travel card and unfortunately I didn’t realise until I was about to step onto the train to Geneva as we were leaving later that afternoon).

The scenery at the top of the Gornergrat was spectacular. It was minus 4 degrees (-4C) and snowing and whilst the Matterhorn was shrouded in cloud, the Gorner Glacier was visible in all its glory. The trouble when you are mixing up a holiday with snowing weather and sunbaking weather it requires a wide assortment of clothes and whilst I was cursing carting around all that winter gear for the majority of the holiday, I was grateful this particular day for all the warm clothes I had packed.

Gornergrat

We caught the train back down – we had vacillated about spending the money on this as it was 98 CHF for 2 people which was half price on our Swiss Rail Card and the webcam view was terrible while we were deciding whether to go- swirling cloud and low visibility – but when we eventually got there is was truly spectacular and totally worth the trip.

We left Zermatt vowing to come back again one day to see The Matterhorn in all its glory and added it to the list of magnificent mountains we have NOT seen due to cloudy weather. But as my son says that’s the beauty of mountains – they are unpredictable and glorious.

A gobsmacked cat of Scopello

The final blog will be about beautiful Scopello and Roma. The end of the holiday is nye.

Beautiful Scopello

 

 

 

RUOK Day and Faecal Incontinence following a 3rd or 4th degree tear.

The 12th September is RUOK ? Day. A day which Gary Larkin began in 2009 after his own father died by suicide. Soon after his father’s death, Gary himself started to have suicidal thoughts. As an advertising executive, he used his marketing skills and high-profile contacts to create a national day of awareness to encourage people to have a conversation with their family and/or friends if they are suffering with depression or anxiety and are having suicidal ideation. This day has become much more visible and since its inception has been responsible for helping people to have those difficult conversations, seek help and for sure has saved lives.

Many things can be the cause of depression and anxiety. In my world of pelvic floor dysfunction, there can be many women (and men) who are profoundly affected by dysfunction such as constant pelvic pain, prolapse, urinary and faecal incontinence and for men erectile dysfunction. Because of the personal nature of pelvic floor dysfunction it can really add to the anxiety because these areas are so private and even seeking help from professionals can seem so damn embarrassing!

Except it needn’t be, because pelvic health physios are so used to the problems you are experiencing that they are definitely in their comfort zone even if you are way out of it – and they will put you at ease and be reassuring and calming as you are telling your story.

So what prompted this blog?

Today one of my pelvic health colleagues sent me this meme.

This came at a time when I had been lamenting the loss of my Qantas travel card. (See the full story of this at the end of this blog) Now I was pretty down about this, but when I saw this meme, it reminded me that the issues that women have to endure such as faecal incontinence (FI), with the added anxiety of not knowing when the FI may occur, make my silly issue with my card pale into insignificance.

Faecal incontinence can follow the life-changing event of a traumatic vaginal delivery with a 3rd or 4th degree tear which can change a once athletic care-free young woman into a housebound, worried mother who spends the first twelve months not only caring for a new baby but also wondering ‘what the hell just happened?’ So much around pregnancy and childbirth is cloaked in ‘rose-coloured glasses’ imagery, so that when the unexpected catastrophe happens – it is completely out of left field for the woman (and her partner).

Once the immediate six week recovery period has passed, where the treatment following a 3rd or 4th degree tear consists of adequate pain relief, stool modification to keep the stool soft and easy to pass and Sitz baths for good healing, it is important that women are routinely referred for pelvic health physiotherapy assessment to see what the state of the anal sphincter is like.

At that initial appointment with your pelvic health physio, there will be extensive education about good bowel habits including defaecation dynamics (the correct way to pass a motion, to get more complete evacuation of the stool), the role of the internal and external sphincter –  some that the internal is comprised of smooth muscle and the external sphincter is striated muscle and this is the one that can be strengthened with specific strengthening exercises and enhanced with electrical stimulation.

A type of E-stim machine to help regain strength in the external anal sphincter

Your pelvic health physiotherapist will instruct you how to use the machine and it is something that you can purchase and use in the privacy of your own home on a regular basis. This may not only improve your strength, but also your sensory awareness which is important when treating faecal incontinence.

Manipulation of the stool is one of the key factors though when managing faecal incontinence. Using different products to give better bulk to your stool is useful (such as a bulking agent like Normafibe or Benefibre), Imodium to help slow the bowel motility or even a codeine based product depending on the situation.

This is just some of the strategies that your physio will help you with for any faecal incontinence you may be suffering. Don’t suffer in silence – see a Pelvic Health physiotherapist and getting help for these physical problems will also help any anxiety or depression about your changed physical condition following childbirth that you may experience. The physiotherapist can also advise you about the name of a psychologist who can be helpful with any anxiety or depression.

Also always remember to ask your friends, relatives and neighbours: RUOK?

You never know when you may start a conversation which will significantly help the mental health of someone.

Now about the Qantas Travel Card story: 

You can completely not worry about reading this part because it is, in the scheme of this serious topic, completely not a worry, but it is there for those to read who may use a debit type card overseas.

I have had a difficult relationship with this card this holiday because very early on, I foolishly (unaware of the catastrophic consequences of this action) gave the number to the car hire company for the ‘pending‘ payment for the rental and the security in case we had an accident. Except ‘pending’ with a travel card actually means the money disappears never to be seen again- so 1200euros for the deposit and 396 euros for the car hire later- my Qantas travel card was reduced to almost zero and that was at the beginning of the holiday.

About 25 phone calls and 10 days later, the pending status of my travel card had reverted back to its correct amount and suddenly I felt elated again. You’d think after that nightmarish experience I would treasure that card? But only a few days later, half way up a mountain in Zermatt, after purchasing a hot chocolate -the new substitute for the (hideous) coffee over here- I managed to leave it there and only discovered it was missing as we had to leave on a train for Geneva, so I was forced to cancel the card and again was rendered euro-less with weeks of the holiday to go.

I thought it important to alert you to this fact – you probably already know but if not it will stop you making the same mistake I did.

Women’s Health Week 2019: #walkwomenwalk The Dolomites

 

A typical day walking around the Dolomites for these ladies – this lady was 80!

September heralds Women’s Health Week each year (and World Physiotherapy Day on September 8th) and as I am currently on holidays overseas catching up with my kids in some truly special places, I thought I would suggest a new hashtag to try and get Australian women walking more. Due to the abundance of beautiful, magnificent, scenic vistas plus a climate which is much less harsh than Australia’s and possibly a better transport system, older European women seem to walk/cycle and generally move more than Australian women do. I think this is why so many of the older women are so damn healthy. I would love it if #walkwomenwalk got to become a similar catch-cry this Women’s Health Week just as #runForrestrun did many years ago. (If you don’t know the movie Forrest Gump then here is the link to a description).

There are very elderly women (and men) hiking everywhere in Italy (and Switzerland) but particularly around Seceda because it is relatively accessible. We even saw people in wheelchairs being brought up in a gondola to admire the stunning view.

We were literally gob-smacked at how beautiful Seceda was

 Hot chocolate and cake for us at Baita Daniel Hutte

If you had this area in your back yard, it would be easy to keep your walking up. Seriously as you can see from the photos the landscape is breathtaking. We walked for a whole day in the Seceda region and you couldn’t turn your head without another landscape confronting you with its majestic beauty.

To get here we caught the cable car that travels from Ortisei to Seceda, then we walked along the east face of the Odle Mountains. We had lunch at a refuge there- the food is always very reasonable at these refuges as are the drinks – but we often took our own sandwiches and just got a drink (hot chocolate or sparkling water depending on the need at the time – there was no beer drunk as it tended to make us sleepy and it was a long way home). We have discovered this trip that zero alcohol beer is easily obtained and tastes excellent (as opposed to the decaf coffee which seems to have become impossible to locate here and when we find it, it is ghastly. Why is it that coffee in the home of coffee, Italy, is so terrible?)

Santa Christina Val Gardena Rifugio Firenze Regensburger-Hutte 

We walked to the Col Raiser gondola and went down to Saint Christina township and caught the bus back. When you travel through this region and stay in a hotel you get free public transport on the buses.

 

Michael loving the Dolomites

I would recommend a 3 night stay as a minimum at Ortisei – we stayed at Hotel Garni but I would stay in the village of Ortisei next time as Hotel Garni was up quite a steep hill which is fine for just walking up and down but when you dragging luggage up and down, it’s a bit tricky. The local bus took us from Bolzano and dropped us to the Ortisei square and then we walked 20 mins to our accommodation. It was pouring with rain when our local bus negotiated the winding, narrow roads and it is definitely better not to look ahead or down as it is a bit precarious. Also it is not wise to distract yourself on your iPhone or you’ll end up bus-sick (learnt that lesson the hard way a few years ago on the Amalfi coast). The best value gondola/chairlift card to buy to access the high mountain areas is a 3 day pass which costs 70 euros each. This allows unlimited access to most of the gondolas, open chairlifts and the funicular to Resciesa.

The second day we went up the gondola at Mont Seuc while Mike walked up from the ground level – it is straight up – definitely not for us. We walked around for a while up top and then caught the chair lift from Al Sole to Sporthotel Sonne to meet Michael and had a sandwich and hot chips (as he had done plenty of exercise even though we hadn’t by rights earned it) and around the plateau towards Saltria. We then walked across Ortisei to the funicular to take us up to Resciesa. This was yet another view of The Dolomites – they say its the side of the Dolomites that is always in the sunshine. It was another special afternoon just gazing at those glorious mountains. The return trip was a trifle laboured as we did indulge on an Aperol spritzer or two up there and it was a decent walk across town after the return trip down on the funicular.

The next day we left Michael in Ortisei and headed to Verona to break our journey onto the next set of mountains in Switzerland, The Matterhorn and surrounds. It was very hot in Verona and I was sorry we hadn’t stayed in the mountains to be honest, but we now know what we truly love doing.

So my message (somewhat belated due to complete exhaustion at the end of each day after averaging 20-25000 steps each day) for Women’s Health Week and World Physiotherapy Day is make a pledge to yourself that you need to start moving, keep moving and by walking more regularly you will feel the benefits well into your old age. It helps your circulation, your muscle mass, your bone density, your joint status, your mental health, dementia prevention and is wonderful for your pelvic floor. So much goodness in the simple act of walking!

And if you want help being assessed at the beginning of this journey, give your local physiotherapist a ring and she/he will help you get started on a programme.

The striking flowers that are everywhere in Ortisei

The Hills are Alive……

Panorama Sound of Music bus

Is it too corny to start a blog about Salzburg off with that title? I have been totally into corny over the past few days and so I am going the Full Monty and writing the corny blog. I have loved the Sound of Music for as long as I have been alive – the Hollywood version was created in 1965 when I was nine years old and my mother who loved going to the movies took me to see it and the love affair commenced. Thankfully now with all the movie channels that are available, it seems a week can’t go by without it being shown again, so for those with a serious Sound of Music addiction it can easily be satiated.

The beauty of paying for a Panorama Sound of Music Tour (45 euros per person) is you get moved around Salzburg and the surrounds to all the iconic scenes of the movie and find out lots of interesting facts about the making of the movie and what has happened since. The most staggering of those titbits on our tour was that many German and Austrian people have never heard of The Sound of Music????

WHAT you say?

Yes apparently this is the case and we have since verified that ourselves as we wandered around Salzburg – nobody would acknowledge that they have seen it. Considering it has contributed significantly to Salzburg’s bottom line, I feel it should be compulsory viewing in Austrian primary schools. Tourism is one of the major contributors to the Austrian GDP so Austria probably owes Rogers and Hammerstein a lot for choosing so many iconic Salzburg sites to stage the movie.

But could Salzburg stand alone by itself on a must-visit bucket list? After five days in the region….absolutely. The old town of Salzburg and the surrounding “must-see” natural scenic sites make it a wonderful place to visit and I would thoroughly recommend it to you.

 

Salzburg Old Town  

Having flown from Australia via Dubai into Munich and then stepping onto the train to Salzburg, we arrived after 27 short hours of travel- who would have thought that it gets easier and easier to do this trip as we get older? We checked into our hotel and immediately headed out to see some Salzburg sites. We chose Hotel Europa Austria Trend because it was literally 100 metre walk from the train station (even more convenient when we departed today as it was pouring with rain). The rooms are a comfortable size and with good views across to the hills behind the Old Town.

We climbed a couple of hundred stairs to walk along the hill behind the old town and gained panoramic views down to Salzburg as we walked through a lightly forested area to the Museum of Modern Art.

View from the top walk above Salzburg 

There is a lovely veranda restaurant right at the top, which on this particular day was very busy – with the ladies and gents either very glamorously dressed or in Austrian national dress. But I was thirsty and have no pride, so asked the Maitre d’ could we possibly just get a drink. Without a stutter he gave us a fabulous table and we celebrated arriving in Salzburg with a Spritzer and a Campari and ice – our standard ‘Hey we are officially now on holidays’ drinks.

It was intriguing to watch the parade of Salzburgians arriving – it was so busy because it was the last weekend of the Salzburg Festival – this goes for 8 weeks and I would think would be a great time to visit if you were a music lover. Of course the other thing Salzburg is famous for is it is the birthplace of Mozart and there are many indoor and outdoor concerts held across the eight weeks.

After our drink, we continued on along this path and next stumbled across one of those magical places that become the reason why you travel – around every corner there is a little treasure to think about when you are back home and back to work. Stadt Alm was a rustic café with a view to die for and reasonably priced food.

After descending many stairs we strolled through the Old Town and enjoyed the bustle of markets and outdoor bands playing. We visited the Mirabella Gardens, Mozartsteg (Mozart’s Bridge) and the steps near the nunnery (Benedikten Frauenstift Nonnberg) – all scenes where Maria (Julie Andrews) and the children sang Do Rae Me.

Mirabella Gardens

The next morning was the Panorama Tour and our guide Bridget was bright, energetic and informative as we drove around to the different sites as seen in the movie. The corny part of this four-hour bus tour (which I was totally looking forward to) was the sing-a-long. It made me realize how much I say la-la-la-la when singing along watching the movie (this was actually a big disappointment to Bob-I think he thought I would totally be singing from the rafters of the bus and knowing all the words). But I would suggest to improve the tour, they hand out printed word sheets, or have it on the TV screens that are fitted in the buses – or BYO word sheets so you can get maximum serotonin rush!

Bridget – our hostess from the Sound of Music tour

The following day we picked up our hire car to head off to our next destination, Werfen, which is about 35 mins out of Salzburg. On the way we had planned to visit Eagle’s Nest Berchtesgaden, Germany – Hitler’s holiday home. The Kehlsteinhaus is a Third Reich-era building erected atop the summit of the Kehlstein, a rocky outcrop that rises above the Obersalzburg near the town of Berchtesgaden. It was used exclusively by members of the Nazi Party for Government and social meetings, but now is a restaurant and amazing scenic point for tourists.

We were chuffed when negotiated the German road signs and found it, found a carpark, worked out the automated parking payment machine and headed for the buses to take us up the very windy road to the top. As we approached the buses though, everyone was strangely walking away from the bus terminus with disappointed looks on their faces.  We soon found out that the lift at Eagles Nest had broken down and so there would be no Eagle’s Nest today. ☹ This lift is apparently a spectacle – the interior has polished solid brass and circular Venetian mirrors and rises 131 metres.

So we pushed on to find the final scene of the Sound of Music (which appears in hindsight to be on someone’s private property – oops) and the scene of the picnic with Maria and the children with the magnificent alps in the background.

The final scene as Maria and the Captain lead the family to safety The picnic scene from The Sound of Music

Finally we went to another of the special sights of the Salzburg region – the Eis Cave – but decided against actually going inside as it was late in the day and we had limited time (for the cost of the experience), but rather just walked up to the refuge and had a hot chocolate and sausage with bread.

 

The path leading into the Eis Cave and the Refuge just below it.

Standard fare around Germany and Austria is sausages, bratwurst, leberkase and frankfurters – a #meatloversparadise.

Meat is a mainstay of most menus in Austria and Germany- even the soup has a rissole parked in it

On Saturday, we had some time to kill prior to picking up our children (due to their delayed flight) and detoured to The Golling Falls, which should definitely make it to your must-see places around Salzburg. It is very close to Salzburg and takes quite a short time to get around and the Falls are spectacular.

 

Golling Falls

Once we had successfully met up with the kids at Salzburg airport we headed to Five Fingers, a spectacular viewing platform overlooking The Alps and the iconic village of Hallstatt, the Hallstatersee lake and the inner Salzkammergut region. You catch a gondola up to the top (32 euros per adult) and then walk along the top of the mountain to the platforms. They have different ‘thrill’ levels – for example one made of glass and another with a hole in it allowing you to unnervingly see the incredible drop below.

The scenery here was stunning and so worth the expense of the gondola. We then drove onto Hallstatt and parked the car in the designated car park (14 euros per day) as Hallstatt is a car-less village. The village is beautiful with flower window boxes everywhere and quaint houses perched on the Lake Hallstatt.

The iconic photo spot for Hallstatt and the dream spot for some drinks and later dinner 

The last adventure in the Salzburg region was catching the cog rail train up to the top of Schafbergbahn. The view was again spectacular but this is an expensive trip (42 euros per adult). The train trip takes 35 minutes to get to the top but the views are again spectacular – like many spots in this region.

Cog rail train   View from the top

Some things to remember when travelling:

  • Don’t give a cash/ travel card number to a car hire company because they take a bond deposit -in our case 1200 euros – which actually comes off your cash card (potentially leaving you penniless in an expensive part of the world….) yes it could take up to 30 days to get the euros returned which will be well and truly after we are back at work. Thank you Hertz 😦
  • When hiring a car, totally get the guy to explain what you are signing (which is written in German) because it can become very expensive when you realize it includes an 80 Euro fuel package. Fortunately I was able to rectify this situation (the diesel actually only cost 35 euro) but it took too many phone calls when you are on holidays.
  • The exchange rate at present is appalling so travel to Europe is crazy expensive but shopping at Spa Grocery stores is very reasonable and you can get made up rolls for hiking and drinks are very cheap there. You don’t have to eat out every meal – going to their ready-prepared food section can save many euros.
  • The best bar in the world  Lucky Bob – it was Father’s Day in Hallstatt and he got to spend it with Sophie and Mike – Katie rang in from Australia

Beware: A serious amount of ‘Mountain Spam’ is coming

Summer landscape of the Odle Mountains in the Dolomites taken from above Seceda at the end of the Fermeda chairlift 

(Photo by Bernado Ricci Armani)

I always feel a little guilty when we head off for another holiday overseas, but on the eve of our 2019 trip, I want to justify why in recent years we are heading OS so many times.

Our first trip was in 1984 and we had no holidays for 3 years to save up and go to the UK and Europe for 9 weeks.

It was glorious.

It was expansive to see the rest of the world and experience different cultures and it certainly whetted our appetite for travel. But that appetite had to be suppressed for 27 years, because that’s how long it took for the next opportunity to leave the children alone (safely) arose. Whilst we had an absolutely amazing trip that visit in 2011, as the plane landed after a 24 hour flight home, I turned to Bob and said- I can’t do that again! That plane flight absolutely wiped us both out and yep I decided that was the last holiday OS.

Ravello, Amalfi Coast 2011

But there’s nothing like a slide night of photos of the Amalfi Coast and Positano to re-consider such a rash statement and revisiting The Continent became a high priority again. Three years later we had another trip planned and booked and we excitedly jumped on the plane and headed on that long 24 hour plane flight. It took 3 years to save for the trip and that was in the days when our Aussie dollar actually had a bit of credibility.

Then in 2016 the first of our children went to London to work (as they do) and in 2018 another one went off on his Great London Adventure. So since then we have headed off to London/Europe every year to holiday and give the children a hug or seven. As much as we love their desire to travel the world and experience working overseas, we miss their company and look forward to some short catch-ups.

The downhill slide of the Aussie dollar has definitely hurt each year so why do we do it? It seems an such extravagant thing to do, and I am sure people think we are greedy (for life experiences), but I have relatives and friends for whom life has suddenly and unexpectedly been changed dramatically by ill-health and as such their ‘life bucket list’ has been decimated. And it is for that reason that we go despite it being a financial impost and probably not the best thing for our retirement.

Who knows what life has to throw up in the future and what I don’t want to do is wait until I’ve retired, because at the moment, physically I can manage it, whereas in the future we may not.

The last couple of trips have been to London, but this year we decided (we couldn’t stand another wet, cold busy city trip) to go to some beautiful European Alps and see if the kinder could join us – and like the Hills sang to Maria in the Sound of Music, the kids are rendezvousing with us in Salzburg to Climb Every Mountain we can find.

The reality is I am very excited about this trip – there are many gondolas to ride up and many mountains to walk across and down so there will be lots of mountain spam coming in the next few weeks. I’ll apologize up front now, but I do hope I am providing a community service with lots of homuncular refreshment to help flush out those naturally occurring chemicals of dopamine and serotonin (sometimes called the happy hormones) and make you feel good even if you can’t actually be there…….and remember we waited 27 years and work pretty hard all year to achieve this goal. And what is our goal?

To stop buying things and start buying life experiences. Life is really very short.

The Matterhorn in Summer (I shall be replacing all these shots with my own very soon)

Photo by Vaclav Bacovsky

See you soon Sophie, Jimmy and Mick xx

PS Big congrats to Sophie and Jimmy who got engaged on the magical Mont Blanc Trail walk – slightly more romantic than our telephone booth – hey Bob Croft? But it was a little Supermanish….

Secret Whispers

 

Half the problem with pelvic health dysfunction is that people become secretive about it and don’t disclose it to their partner, their best friend and strangely not even their doctor. Yes that’s right – 65% of women and 30% of men sitting in a GP waiting room report some type of urinary incontinence, yet only 31% of these people report having sought help from a health professional. (1) There is shame attached to urinary and faecal incontinence and so for this reason women and men struggle on alone, going to Coles to purchase pads to hide their condition and feel isolated and fearful about the future – their ageing future and what does it hold for them?

So how do most patients make their way to see a pelvic health physio?

Referrals from GPs?  Yes some do and thanks to the wonderful work of the Continence Foundation of Australia, the peak body for Continence Promotion in Australia, the GPs (and all health professionals) have at their disposal, wonderful printed resources in English and many other languages to give handouts to patients about pelvic floor dysfunction and its management. Pelvic health physios (actually all physios) are first contact practitioners and as such patients don’t require a medical referral to see them – you can just walk in off the street.

The Commonwealth Government also has a Medicare programme called an Enhanced Primary Care Plan which recognizes urinary incontinence as one of the chronic conditions that can be included in a plan. This entitles the patient to $53.80 rebate on their consultation cost for up to 5 visits which helps defray the cost of a consultation with a pelvic health physiotherapist if you don’t have private health cover. Make sure you check with your GP to see if you are eligible for a plan.

Referrals from urogynaes/gynaes? Definitely! The recent release of the Australian Commission on Safety and Quality in Health Care document emphasizes the importance of first-line conservative management of stress incontinence and prolapse conditions for women (meaning pelvic floor muscle training PFMT, the knack – engaging the pelvic floor muscles prior to increases in intra-abdominal pressure, lifestyle advice such as defaecation dynamics and the use of a pessary where possible). So don’t be surprised when you consult with a surgeon and the first thing they do is refer you to a pelvic health physiotherapist.

But many patients come via secret whispers or the ‘ripple effect’. One friend seeks help, gets cured (up to 85% achieve this) and finds life much more fun without urinary incontinence; and tells another friend who gets a pessary fitted and is able to exercise with gay abandon; and she tells her Aunty (who has frequency) and after only a few visits, can suddenly go to the theatre after all, because she isn’t terrified of being trapped in the middle seat in the Dress Circle with a busting bladder; and Aunty’s neighbour is incredulous and immediately rings for an appointment next week.

Things are definitely improving regarding the secrecy surrounding pelvic floor dysfunction, but there’s still a long way to go and I am thankful for the way women can share their successes with their tribe, so others may seek help for this lonely condition.

Because pelvic floor dysfunction can make you lonely.

It stops you going on bus trips with PROBUS or your Rotary club. It makes you think twice about going on the bush walk arranged by your friends. It insidiously causes you to refuse an invitation to learn Salsa dancing. It can make you feel trapped inside your own home.

Don’t be trapped by your pelvic floor dysfunction. Treatment strategies are often ridiculously simple, common sense behaviours; changes in long-held beliefs and habits and simply finding the seemingly elusive pelvic floor muscles and learning how to activate and strengthen them.

I hope this helps you realize your potential with your own pelvic floor (and bladder and bowel) by encouraging you to seek out a pelvic health physiotherapist. If you live in Brisbane, give my secretaries a ring on (07) 38489601 or (text) 0407659357 and make an appointment to see Megan, Jane, Martine, Alexandra or myself and start living a full life again.

 

Living life to the fullest

  1. (Byles & Chiarelli, 2003: Help seeking for urinary incontinence: a survey of those attending GP waiting rooms, Australian and New Zealand Continence Journal).
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