What is urogynecological physiotherapy and how does it help?
Urogynecological physiotherapy deals with intimate health at every stage of life. Patients are mainly women, but men should not be forgotten - they also need such care.
Patients most often come in with problems such as:
- incontinence of urine, gas, stool,
- organ prolapse,
- pain during intercourse,
- scar after cesarean section and episiotomy,
- preparation for pregnancy and childbirth,
- painful periods,
- endometriosis pain,
- separation of the rectus abdominis muscle,
- separation of the pubic symphysis during pregnancy,
- back and buttock pain during pregnancy,
- preparation for / care after gynecological or transabdominal surgery…
… and also for a safe return to physical activity after childbirth or surgery.
Why and why is it worth visiting a urogynecological physiotherapist?
It is worth going to a urogynecological physiotherapist for two main reasons: the first is prevention, the second – treatment.
When it comes to prevention, it is worth coming in the perinatal period (both during pregnancy and after childbirth), perimenopause (even if there are no symptoms of urinary incontinence or organ prolapse yet), but also in the case of performing intensive physical exercises.
More and more people come to the office before pregnancy, wanting to find out if the pelvic floor muscles (PFM) are working properly and what they can do at this stage. In such a visit, the basis is education of the patient about the anatomy and functioning of the PFM, as well as an explanation of prevention.
Risk factors such as constipation, urgency during urination or defecation, holding urine, smoking, strength sports and many others will have a negative impact on the pelvic floor. It is important that the patient receives knowledge and information that will support her, so that she can function and play sports in a healthy and safe way.
The second important reason for the visit is TREATMENT. Patients come to a urogynecological physiotherapist with a variety of problems. I would sum them up as everything we are embarrassed to ask a gynecologist about and what we think happens in old age, but in fact concerns people at every stage of life.
What should the average patient know? Is there any preparation needed for the visit?
A patient who comes to a urogynecological physiotherapist (who deals with intimate health) can expect intimate questions. It is definitely worth considering in advance what the main reason for the visit is and making a list of concerns.
I often get asked if it's okay to get tested during your period. The answer is: it depends. It depends on whether it doesn't bother the person being tested! Most therapists test during bleeding - I do too.
When a patient comes to see me, I try to create the most comfortable conditions for the examination. The patient has time and space to prepare for the examination, but also the opportunity to ask questions during and after the visit.
What is the first visit like?
The first visit is primarily a conversation, examination and planning of therapy. A good interview is essential. Questions often go beyond the scope of the reported problem. So if a patient comes to me with a long-term problem of pain during intercourse, I expand the interview with questions about the amount of stress, as well as anxiety and depression. I also use questionnaires that have been developed for patients with chronic pain. These are not diagnostic questionnaires, but screening ones. They allow me to find co-occurring causes of pain. Thanks to them, I know that I will be able to help the patient better if, in addition to my therapy, she meets with a psychologist or sexologist. This is a fairly new approach to the problem of pain. It is called the biopsychosocial model. It differs from the biomedical model, in which the cause of pain was sought exclusively in the tissue.
After the interview comes the examination. I do it to check how the pelvic floor is functioning. The examination can be direct, i.e. through the vagina (similar to a gynecological examination), or through the anus. In the event of a lack of consent, in the event of infection or for another reason, an indirect examination can be performed by placing a hand on the external parts of the perineum. Such an examination will be less accurate, but also very valuable. At the end there are recommendations and possible treatment planning, if necessary.
Is working with a given person always a series of meetings leading to learning about and solving the problem, or is it rather work in the office and "homework" assigned after the meeting?
The answer again is: it depends on the condition. Sometimes the visit is limited to instructions and recommendations with possible follow-up after a longer period of time. But it also happens that patients require longer care and several meetings to deal with the problem.
I always try to treat the patient as a partner in therapy, a person co-responsible for the process, which is why I usually give short exercises or recommendations to do. This also has an impact on the pace of change.
And do you only see women in your office, or can men also count on the help of a urogynecological physiotherapist? If they can, what are the most common problems they come in with?
Yes, men also come to the office – usually with urinary incontinence due to prostatectomy [partial or complete removal of the prostate gland – editor's note], but also with pain in the pelvic area, pain in the sacrum/coccyx, hemorrhoids. There are few physiotherapists who deal with men, and this group of people requires support just as much.
…and the children?
There are therapists who deal with children who require care for various reasons. In my work, I deal primarily with adults and refer children with problems to colleagues in the profession.
What is the current awareness of people in the field of urogynecological physiotherapy? Do they come to the office because they need it or are they referred by other specialists?
It varies greatly. It seems to me that the topic of urogynecological physiotherapy is becoming more popular every year. And that's good! You can find more and more substantive texts and help. The topics of intimate health have become less taboo.
Unfortunately, health education in our country is at a very low level, so during the visit I always try to tell a little about the function and tasks of the MDM and answer every question.
Currently, many people come forward on their own initiative. Because they learned from a friend, read, heard. It is also valuable that the group of specialists in other fields who trust us is growing.
Personally, I highly value the opportunity to exchange experiences between physiotherapists, doctors, midwives, psychologists. Thanks to such cooperation and mutual trust, the patient receives optimal help.
What is important when working with a patient?
Knowledge, experience, as well as attentiveness, empathy, listening. A sense of humor also helps a lot :)
Do you like your job?
Very much so. It has its ups and downs, but it brings a lot of satisfaction.
What is the most interesting case you have dealt with in your work?
It's hard to choose, but I might return to the topic of chronic pain again. In short... A patient came to me with pain during intercourse, which had been with her for a long time. In addition to my interview and examination, I used the aforementioned screening tests, which indicate the coexistence of other factors. It turned out that the patient also had anxiety problems and a lot of stress at work. In addition to office work and education in the neurophysiology of chronic pain and self-therapy, I also recommended that she consult a sexologist, who in turn suggested a consultation with a psychiatrist. The end of the story was very satisfying. No pain during intercourse, improved quality of life and self-esteem. The patient did a huge job. It should be mentioned that it was a longer process, based on the patient's commitment and mutual trust.
Are there any products on the market that may do more harm than good when it comes to the pelvic floor muscles or other areas of a urogynecological physiotherapist's practice?
I think that such a product is geisha balls, which are still recommended.
Geisha balls are theoretically designed to improve muscle tone. But what if the muscles are already too tense? There will be pain, numerous compensations (if the muscles are too weak), a feeling of discomfort, difficulties during intercourse, difficulties with urination or defecation.
Pelvic floor muscles need relaxation, not just tension. If you want to have good pelvic floor muscles, then exercise healthily. After all, in any other training there is time for both muscle tension and relaxation.
I often hear the claim that a visit to a urogynecological physiotherapist only makes sense for women after giving birth. What do you think about that?
The answer is partly above. “After giving birth” is not the only time a person should go for a visit. In my opinion, there is not enough talk about self-care in the context of physiotherapy. Education should start much earlier, in school, at home.
Most of us have probably heard as children: "before leaving the house, pee", and as we know, this is not a very healthy habit. Emptying and filling the bladder is its gymnastics and function. When we go to the toilet too often, this function is disturbed. There are many such habits and unfortunately they will also contribute to irregularities in the functioning of the MDM. It is therefore worth going to a physiotherapist for healthy habits: during pregnancy, after childbirth, during menopause or when a doubt or problem appears.
Thank you very much for this interview and for your comprehensive answers to all questions.
Mgr Agata Skoworodko:
I am a urogynecological physiotherapist. I deal professionally with intimate health at various stages of life. I specialize in physiotherapy for urinary incontinence, pelvic organ prolapse, pain of various origins in the pelvic area, and pain during intercourse. I also provide care to post-operative patients (early rehabilitation, wound protection instruction, scar work).
In my free time I like to run, ride a bike, ski, climb. Sport is also a very important element that I use in my work with patients when they want to return to physical activity.
I am a mother of two wonderful daughters, Marysia and Marta, who teach me something new every day.
Created at: 15/08/2022
Updated at: 15/08/2022
