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

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).

Birth Trauma Week 2019

 

Every day, every week and every month of the year seem to be designated days, weeks and months recognizing associations, health messages and groups so that their special theme can be imparted, spruiked and disseminated. This past week – 7th to the 14th July – has been an important week as it is the one designated to NAIDOC Week and Birth Trauma Week. Both these issues are close to my heart and I would like to acknowledge each with a blog.

This week’s blog is recognizing Birth Trauma Week which was launched for the first time just last year. Birth Trauma Week recognizes the injuries women have sustained either physically or psychologically through childbirth regardless of the mode of delivery.

The Australasian Birth Trauma Association (ABTA) is an Australian not-for-profit organisation established in 2016 to support women and their families suffering from psychological and/or physical trauma from a difficult birth experience. Trauma means a wound, serious injury or damage but this damage can be physical or psychological (which can be deeply disturbing and distressing).(1)

The delivery of a baby can be a positive experience for many women, but for some it can be very negative experience, resulting in physical and/or psychological injuries (trauma). The psychological trauma may be the result of an extreme disconnect between a woman’s expectations of what would happen and the shock of what actually occurred. It may also relate to feelings of loss of control and a sense of not having a ‘voice’ in the face of authority, and unexplained interventions during the labour, as well as any physical damage that resulted. It is important to note that some women may have severe emotional distress after a traumatic birth, even though they did not have physical birth injuries. (1)

Amy Dawes (with her beautiful baby) who founded ABTA in 2016 with Prof H Peter Dietz

ABTA was established as a charity by Amy Dawes and Professor H Peter Dietz in 2016. Amy is a mother who suffered her own traumatic birth and is very open about the journey she has been on. You can read more about her story in this blog that I wrote a couple of years ago. There is a Governance Board for ABTA which overviews the organisation and they are running their first conference called Uniting Professionals in Birth Trauma Care this August (if you would like to attend this is the link to the conference details).

Amy’s dream of establishing this group revolved around ABTA being able to offer support to those who are affected by their childbirth experience. They aren’t trained clinicians or counselors, they are mothers who wish to help others and the members of the Facebook group include women, who have experienced mental health disorders, birth injuries such as a perineal tear or pelvic organ prolapse, industry representatives, and healthcare professionals such as pelvic health physiotherapists.

If you are having trouble recovering from your birth experience or adjusting to life with your birthing injuries, the Peer2Peer mentoring group that ABTA has may be a helpful support for you. The girls who have turned to ABTA for support often say: ‘You are not alone’. ABTA is there to offer support and advice to anyone who needs help coming to terms with a traumatic birth experience. This group is a safe space to ask questions without fear of judgment. (They do recommend that you talk to your GP, midwife or health visitor about how you feel).

Part of the problem about recovering from a traumatic birth is the assumption that if at the end, there is a healthy baby and a healthy mother (ie she is alive regardless of how battered or bruised she may be) then it’s been a good outcome. This is something like saying – If your plane gets hijacked on the way from London to Paris and it takes 15 hours of extreme anxiety and fear with a man who has a threatening weapon in his hand and you don’t know whether you are going to live or die, but you ultimately get to Paris safely…… then you have to completely disregard the things that happened on the plane and get on with life – no de-briefing, no psychological counselling for recovering and no understanding of your ordeal from friends or relatives.

But of course that wouldn’t happen.

Everyone would expect there would be time and counselling offered to each and every passenger and the world would be entirely sympathetic to what the travelers had just experienced.

And yet with childbirth it is different. There is an expectation that women demonstrate bravado and just get on with life as quickly as possible because hey – they are alive and baby is alive. But the women are in shock, they feel damaged (and in many cases they are very physically damaged, but somehow have to get on with looking after their new baby when they can barely sit, stand or walk!) It’s truly a wonder that recognition of birth trauma has taken so long to emerge as an issue. Birth trauma truly does impact on women and discounting it because for millennia women have just soldiered on, is disrespectful to women.

Awareness of birth trauma varies enormously with partners and extended family, health professionals and the general public often not getting it. The mother herself often can’t understand what she’s experiencing and when she goes to mother’s group or other friend’s places where there are women describing their happy birth outcomes and are already returning to the gym to exercise, it is often impossible for them to cope with these stories of joy and happiness.

Women can be very debilitated for month and even years if they do not address their feelings and thoughts, as well as getting appropriate post-natal assessment and treatment for their pelvic floor injuries from a pelvic health physiotherapist. What women have found from ABTA is common ground. Women with stories like theirs. They have found a support network and a non-judgmental shoulder to cry on.

But what is most important from this new Birth Trauma Week every July is the fact that the wider community may learn about the devastating consequences of a traumatic birth and be more understanding of why a woman or a family may be responding differently to societal expectations after the birth of their child and be more understanding and supportive of their needs and wants. Importantly health professionals will recognize the importance of referring the woman to the appropriate health provider – whether it be the pelvic health physio for complete assessment and treatment of her pelvic floor post-natally or the psychologist or psychiatrist to deal with the emotional and psychological impact of her birth story.

If you have pelvic health issues please seek help from your nearest pelvic health physiotherapist (google The Australian Physiotherapy Association Find a Physio) and they could then help you find a psychologist if you also need help with PTSD or PND. I have also included a chapter on Traumatic Childbirth in the new edition (Edition 3) of my book Pelvic Floor Essentials and post-partum recovery strategies are also covered extensively.

And finally on the last day of Birth Trauma Week and NAIDOC Week, I hope that we all take a moment to recognize that, whether you care about these two issues or not, there are some people who have enormous interest and invested their heart and soul into these topics and deserve our respect and goodwill. There are a lot of mothers out there who have suffered as a result of their births and there are many Indigenous Australians who deserve to have recognition within our Australian Constitution.

(1) https://www.birthtrauma.org.au/about-us/

 

The Sleep Apnoea and Dementia link: Get yourself checked pronto!

The sacrifices I make in the name of health prevention – plastering a photo of me in my pj’s ready for my sleep study on the internet!

It’s taken me over two years to write this blog on my own sleep apnoea diagnosis and subsequent treatment. I’ve been keen to do it but other blogs kept popping up and I just never got around to it. We know there is a strong link with nocturia and sleep apnoea, but at the gym today as I was watching the news, there was yet another headline about how sleep apnoea and dementia are linked and I was compelled to get off my butt and finally do it.

My story started when Bob (husband) decided to go to a sleep specialist a few months after we returned from our overseas trip in late in 2016. He had been struggling every night to stay awake much past 7pm and he felt like he had never got over his jet lag – and that was after 4 months. As I was sitting in with Bob at the respiratory physician’s appointment and she was asking him all the relevant questions, I had this overwhelming feeling that I should have been seeing her – not Bob!

Sleep apnoea, which means failure to breathe during sleep, can be obstructive or non-obstructive.

Non-obstructive or ‘central’ apnoea occurs when the brain fails to signal the breathing muscles that it’s time to get active.

In obstructive apnoea (also abbreviated to OSA standing for Obstructive Sleep Apnoea), breathing fails because of a relaxed airway that fails to open up despite the brain’s insistence. Eventually, sometimes after more than a minute without breathing, the brain sounds its alarms urgently enough to jolt the muscles of breathing back into action. Sometimes this wakes the sleeper, but more often the periods of apnoea and gasping serve only to rob sleep of its restful and restorative quality. A respiratory infection or excessive alcohol use can also interfere with breathing during sleep. Chronic and severe apnoea, however, is a prolonged, debilitating condition. (1)

After we sorted Bob (booked his sleep study) I chatted to the physician and she suggested that rather than coming to see her first, I just book straight in for a sleep study and after the study, come then to see her with the results. So Bob had his sleep study and got a clean bill of health and I went to Greenslopes Sleep Unit and they dressed me up (see photo at the top of the page) and I went back home to do my home sleep study. Like everyone, I naturally doubted I would sleep a wink trussed up as I was with the wiring and monitors, but it went swimmingly as I went to bed at 9.15pm and woke up at 6am having slept through the night without budging.

A week later I went to the doctor to read the results. It wasn’t pretty.

It had shown I had stopped breathing 27 times every hour; the longest pause in my breathing was 51 seconds and my oxygen saturation had dropped to 73% (it should be in the high 90’s). I was shocked to say the least. And so started the process of being assessed and fitted with a CPAP machine. CPAP stands for Continuous Positive Airways Pressure and is administered via a machine and a rather overwhelming mask and tubing – honestly my worst nightmare. More on that later. When working out mask types that are the most comfortable and give the best seal and pressures required to stop the sleep apnoeas, you have to go into hospital for the sleep study to trial their CPAP machine. I started with the nasal prong mask – and for me it was not good. It was quite uncomfortable. Then I moved onto the small half mask just over the nose, leaving the mouth free. My oxygen sats were much improved and the mask seal was good. The next step is to hire a CPAP machine for 4 weeks, returning weekly to assess the vital signs that these clever machines are able to report back to the team.

The first weeks were difficult because I suffer badly with claustrophobia. The first time I became aware of my ‘claustrophobia affliction’ was when I was about 19 and my mother paid for a single sleeper for my return train trip home from visiting my grandmother Dolly, who lived in Wollongong. The conductor diligently set up my bed at around 9 pm – but I lasted only half an hour before I called him again to return it to a seat. You see your face ends up about 6 inches away from the ceiling of the compartment and that freaked me out. This ‘claustrophobia affliction’ presented itself again on the first night we set up our campervan bed in Brighton on our first trip overseas together in 1984. Bob had taken quite a while to get it sorted (instructions were hard to come by) and again about 30 minutes after settling in, I literally jumped out of the bed and dived out of the van gasping for air. Again, my face 6 inches away from the roof was impossible for me to tolerate.

So you can understand that placing that mask over my head every night was my worst nightmare. I almost had to be asleep before I could tolerate it on – which is quite hard to master. Get the mask on and not fall asleep before that happened. By the end of week 2, I declared I just couldn’t do it. I had decided I was going to soldier on slowly destroying my brain cells without a CPAP machine.

And literally just then, the ABC News came on. Carrie Fisher, who played Princess Leia in the Star Wars series, had sadly died on a plane trip of sleep apnoea! I was shocked. I had never ever heard of sleep apnoea as a cause of death out loud on TV before. And just when I was being a complete idiot and denying the seriousness of my predicament, there it was – headline news.

I pulled up my Big Girl Pants and said get over your ‘Claustrophobia Affliction’ and make the bloody thing work – and I did and now my most favourite sleep companion (next to Bob) is my CPAP machine. From that moment it all went swimmingly. I suddenly had no trouble coping with it and my pressures, sats and mask fit were all stable and I proudly went back for my final visit to the team at CPAP Select at Greenslopes to buy my own machine. Luckily for me they had just had a brand new release of a Resmed Travel CPAP machine.

Resmed Travel Machine compared to the usual one

This machine is tiny compared to the one I thought I would have to buy and being much more portable than the big one I had been trialing would be great for our travels. It was a bit dearer at that time but I do believe they have come down in price these days. I am literally addicted to my machine now. I love it. I sleep completely through the night, never getting up anymore through the night and wake up refreshed and with clarity of thought (not that I really realized this until I had been using it for a few weeks). One night about a year ago we had a blackout and I literally thought I can’t go to sleep tonight until that power comes back on. I was scared to sleep flat without it.

It is very simple to set up and below is a You Tube video showing you how to use it.

So why as a Pelvic Health Physio do I think is it so important to get yourself checked?

The following is taken from an article by Park E et al (2015) Relationships between Nocturia, Obstructive Sleep Apnoea and Quality of Sleep.
As I mentioned earlier in this blog nocturia, the condition of waking up to urinate one or more times during the night, is common in adults, with a reported prevalence of 53%. However, the potential contribution that leads to sleep disturbance is less well acknowledged. Nocturia has been reported to be an independent predictor of self-reported insomnia with a 75% increased risk and of sleep quality reduction with a 71% increased risk.
Many causes of frequent nocturnal awakening to void have been described in the adult population.
These include:
  • decreased bladder capacity,
  • reduced glomerular filtration rate and nocturnal polyuria due to decreased arginine vasopressin,
  • incipient diabetes,
  • sleep-disordered breathing, such as, obstructive sleep apnoea (OSA),
  • congestive heart failure and/or diuretics use,
  • benign prostatic hypertrophy in men 
  • vaginal atrophy with consequent reduced sphincter control in women. 

Nocturia has been reported to be more severe in patients with OSA, and it is a well-researched end-organ symptom of OSA. It is found to be frequently associated with nocturia: 81% (17/21) women with OSA versus 40% (4/10) control women without OSA. The mechanism responsible for a higher prevalence of nocturia in OSA patients could be due to a reduced ability to concentrate urine during night sleep.

OSA is a condition characterized by repetitive episodes of complete or partial upper airway obstruction, which causes negative intra-thoracic pressure and consequently increases venous return to the heart. As a result, the right atrium and ventricle are distended, which receives wrong signaling of fluid overload, and the consequent release of brain-type atrial natriuretic peptide (ANP) from cardiac atria and ventricles. The secretion of anti-diuretic hormone (ADH), which is increased at night to promote the absorption of sodium and water from collecting tubules, is subsequently inhibited and this eventually leads to decreased urine concentration and consequent polyuria during night sleep.

In a study, diluted night-time urine was noted in 80% (16/21) of OSA patients, whereas it was noted in only 30% (3/10) of the control group. Numerous studies have reported reduction in nocturia after continuous positive airway pressure (CPAP) treatment in OSA patients, which supports the idea that OSA itself induces nocturia. However, despite the well-known pathophysiologic link between nocturia and OSA described above, the importance of nocturia has not been emphasized sufficiently in the context of screening for OSA. (The section in italics is taken directly from this article) (1)

But a second important reason is that people with sleep apnoea have been shown not only to have impaired memory and executive function, but also biomarker changes that are associated with Alzheimer’s disease. The results of several studies suggest that OSA might be a reversible cause of cognitive impairment and dementia, and that treatment of OSA, particularly in the early stages of AD, when patients are still largely independent, may decelerate dementia progression. (2) This particular article collected all available published clinical data and analyzed them through a quantitative meta-analytical approach. A quantitative meta-analysis suggests that the aggregate odds ratio for OSA in AD vs. healthy control was 5.05 and homogeneous. This reflects that patients with AD have a five times higher chance of presenting with OSA than cognitively non-impaired individuals of similar age. 

And this is why I personally feel getting a sleep study should be a routine consideration once women are post-menopausal, especially if they snore, if they suffer with nocturia and if they feel exhausted initially on waking. There is a validated questionnaire called TANGO which is an easy check list with questions to see which domains are affected.

I hope through my own personal journey of sleep apnoea, I have de-mystified getting a CPAP machine and encouraged a few of you, if not quite a lot of people, to have their sleep study and when the results are not good, take the next step of trialing a CPAP machine.

It is definitely worth looking after your brain.

Now my next goal. Get to bed before midnight more often! 

(1) Taken directly from: Park E et al (2015) Relationships between Nocturia, Obstructive Sleep Apnoea and Quality of Sleep, Sleep Medicine Research (SMR) 6(1): 28-34

(2)Emamian, F., Khazaie, H., Tahmasian, M., Leschziner, G. D., Morrell, M. J., Hsiung, G. Y., … Sepehry, A. A. (2016). The Association Between Obstructive Sleep Apnea and Alzheimer’s Disease: A Meta-Analysis Perspective. Frontiers in aging neuroscience8, 78. doi:10.3389/fnagi.2016.00078

 

Prolapse and Pessaries – all blogs in one area (well most of them)

Gathering similar blogs together under one banner helps when I am referring patients to particular topics for reference material. I did it a long time ago with the majority of my Pain Management blogs and recently did it with my Men’s Health blogs. 

So today I decided to group all my prolapse and pessary blogs together so they are quicker for patients to access.

Pelvic organ prolapse (POP) is common with up to 50% of women who have had a vaginal delivery having some form of prolapse, but only 15% are symptomatic 20 years later. If you become aware that you have prolapse there is so much you can do to increase your chances that the prolapse won’t progress to the point that you may be bothered by it and ultimately need surgery. Early intervention, such as is written about in the blogs below, can be helpful and allow you to continue to lead an active life with the types of exercise you want to do.

Learning how to correctly activate your pelvic floor muscles is the first step and seeing a Pelvic Health Physiotherapist can help de-mystify how to contract them. Many women have found out they have a levator avulsion injury and don’t really understand what are the implications of that. This blog describes what an avulsion injury is. 

However in recent times there has been increasing anxiety about the diagnosis of prolapse and I have written a blog about just this to try and help put things into perspective. When you are anxious, cortisol and adrenaline is coursing through your body all the time and this in fact may actually accentuate what you are feeling in your vagina – like with pain there can be a central sensitization effect with prolapse. So in your learning journey about your prolapse, reading this one about keeping your perspective about any diagnosis of prolapse is important.

This 2011 blog was the first one I posted highlighting research that showed that pelvic health physiotherapy should be the first line of treatment.

This next blog talks about not feeling that it’s essential to commit to surgery just because there is prolapse – that Grade 2 prolapse often doesn’t change much over the years and that it may be the new normal for a woman who has had a vaginal delivery.

This blog is the first in a series of five blogs designed to cover all possible facets of prolapse management. Step 1 Prolapse Management

This blog is Step 2 Find Yourself a Prolapse Mentor

This is Step 3 in the Prolapse series: Pelvic floor muscle training, bracing (the knack) and functional training

This is Step 4: Managing your bowels well 

And finally Step 5: Keep moving but keep your exercise friendly for the status of ‘your’ pelvic floor

This one is a good reminder about how to be mindful around the house with some of the chores we do if you have significant prolapse or especially are inn the early days post-op.

There are many blogs about pessaries in the over 300 blogs that I have written on pelvic floor dysfunction, but this one has a bit of the history of pessaries and how they can be a game-changer for a woman with prolapse.  

This blog has a wonderful story in it by Amy Dawes who has set up the Australasian Birth Trauma Association, a charity which is there to support women who have had a traumatic birth experience.

This pessary blog has more on the history of fitting pessaries in Australia.

Many women are keen to know if they can run with prolapse and many times you can, mostly if there is a pessary in to support the prolapse. But this needs to be assessed by a Pelvic Health Physio and recently some new guidelines have been released on the return to running post-partum which have been included in this blog.

So if you have prolapse (or think you may have prolapse) and want to understand more about what prolapse means, how to activate your pelvic floor muscles correctly and how to embark on a pelvic floor muscle strengthening programme then ring our practice at Highgate Hill, Brisbane on (07) 38489601 or mobile 0407659357 or email to admin@suecroftphysiotherapist.com.au and our secretaries can book you in with one of our talented physios seen below. You can also search the APA website for Find a Physio or the Continence Foundation of Australia register for the name of your nearest Pelvic Health Physiotherapist.

World Continence Awareness Week: Its all about the supervision of pelvic floor exercises!

If you follow my blog, you have heard the sad tale about me making the hard decision to close my pelvic floor inspired exercise studio (at Gladstone Road, Highgate Hill) at the end of 2018. This came about because in November 2017, there was a decree from the Australian Government that a number of complementary medicine categories would no longer be able to be covered by the Private Health Insurance companies. This is what the Government had decided as part of the linked advice above.

“Rules will be made to remove natural therapies from the definition of general treatment under section 121-10 of the Private Health Insurance Act 2007. Insurers will then not be able to offer benefits for these therapies as part of a complying health insurance policy.”

Three of these natural therapies included Pilates, Yoga and Tai Chi. There are many others but when I wrote the blog about this change, I was mostly addressing the restriction on Pilates. I wish to address this change again because I have just returned from a wonderfully inspiring weekend conference run by one of our leading Pelvic Health Educators, Taryn Hallum, updating the most recent research in all things Pelvic Health and some of the evidence has again got me all worked up about the changes implemented in just April 2019.

Jane Cannan, one of our Pelvic Health Physios

Pilates is one form of exercise. It is a name that the general public was familiar with and many physiotherapists had clinics with Pilates within the name of their practice, as they offered classes as an opportunity for patients to progress beyond just individual treatment. The word Pilates (named after Joseph Pilates who described the series of exercises) has a high recognition factor with the general public, who associate Pilates with strengthening exercises; understand that it helps with balance and coordination and that it is synonymous with perhaps posture, guided movements and set recognized exercises.

This dramatic decree from the government was quite incredible coming at a time when the slogan #exerciseismedicine was trending on Twitter and Instagram and that research was popping up everywhere saying exercise was the answer to most medical ailments!

And this dramatic decree was the nail in the coffin for my studio at Gladstone Road, Highgate Hill.

My studio was my dream – the opportunity to have a place where patients with pelvic floor ‘needs’ – maybe prolapse, urinary or faecal incontinence or pelvic pain – all things that can stop a conversation should one raise it over drinks at the bar in mixed company (in fact topics that are the focus of World Continence Awareness Week) could go and be supervised with their exercising and have their pelvic floor as the focus. The studio was definitely a wonderful add-on for our practice which is predominantly pelvic health-focused and one for which I had yearned for years.

I loved my studio. And that decree killed my dream. (Well until I created a small space at my rooms in Hampstead Road because my patients demanded we do something as they missed it so much.) The health funds would pay an amount towards the classes and this small subsidy would help the patients be able to afford to come regularly to the studio to exercise.

I really couldn’t understand the logic behind this decision.

Exercise is good for preventative health reasons. Bone density. Obesity. Diabetes. The Heart. The Lungs. The Brain. The Pelvic Floors (especially the pelvic floor). Really all the bits of our body are helped with exercise (but especially the pelvic floor and wait and see at the end of this blog about the evidence for supervision of pelvic floor muscle training in a class setting). Do government decision-makers not read Instagram or the Readers Digest? Of course the real medical literature is full of articles proclaiming the Wonder of Exercise, but I don’t expect public servants or the health department or the Health Minister to be all over research articles. But I would have thought some of them may have had a woman in their lives that loves their exercise. You see gyms, Pilates studios, yoga classes are all dominated by women. Women predominantly attend these health-promoting venues because they have read about the wondrous things that happen when you exercise.

Our yoga was loves at the studio

But what stirred up this hornet’s nest of annoyance again this weekend of learning and updating was the number of recent research papers that show that supervised training of the pelvic floor in classes and group sessions is better than assessing and teaching pelvic floor muscle training to a woman and then sending them home to do a home exercise programme. It appears that women need the supervision, the motivation, the inspiration, the dedication that a pelvic health physio supervised class gives them. Needless to say we will be looking at ways to increase the opportunity for women to attend more sessions in our Hampstead Road exercise space and ways to prompt them more in their home programme.

Now the good news is that very soon after the April introduction of this new decree – and after some dedicated lobbying from our professional organisation The Australian Physiotherapy Association– the Health Minister Greg Hunt reversed the decision as long as the P word is not mentioned – P doesn’t stand for preventative even though any exercise is preventative for so many things. P doesn’t stand for P*ssed off even though there’s a stack of physios, Pilates instructors and women who love their Pilates and have seen drastic declines in their numbers attending, who definitely are. P stands for Pilates – yes the actual word Pilates cannot be mentioned in any advertising, signage or handouts. And of course it must be a physio who is supervising the classes. There is unfortunately still one health fund who has refused to follow the decision of the health minister.

Enough whinging. Now the important message.

It’s World Continence Awareness Week. Ladies – do your pelvic floor exercises. Be motivated, be enthusiastic. Be regular in the initial phase and then integrate them into an exercise routine if you can. Make it count.

And what is your reward you ask?

Compared with no treatment or inactive control treatments, women with Stress Urinary Incontinence (SUI) who were in the Pelvic Floor Muscle Training (PFMT) groups were 6 times more likely to report being cured or improved. PFMT 72% Placebo/Control 11.4% (Doumoulin et al 2018)

The success rate for PFMT for SUI varies between 60-75% when performed in the outpatient setting under the supervision of a physiotherapist. (Fitz et al 2017).

In this World Continence Awareness Week, get yourself off to your nearest Pelvic Health Physio and be assessed and get in-training!

And below is our class space at Hampstead Rd with room for four people to the class. Ring (07) 38489601 if you want to try a one-on-one or group session.

 

Also for those ladies who used to come to dance, we are still doing dance every Thursday at 4pm at 194 Gladstone Road, Highgate Hill with Ash King. Again ring if you want to book in.

The thing I miss most about my little studio was it created a community – bureaucracy will never understand community though. 😦

The definition of Community: Our lovely dance ladies -we still congregate and chat, laugh and dance every Thursday at 4pm 

 

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