my services
Chronic Pelvic Pain
Chronic Pelvic Pain is a complex condition of pain which has been present for more than six months in duration. Pain can be felt within the pelvic floor muscles, at the entrance to the vagina, in the rectum, penis, testicles, pelvis or low abdomen. The cause of Chronic Pelvic Pain is not always known but the following conditions can lead to chronic pain:
- Pudendal Neuralgia: Nerve compression of the pudendal nerve causing pain especially when sitting
- Vulvodynia: Persistent unexplained pain in and on the vulva where tests have shown nothing to be wrong
- Vaginismus: Involuntary tightening of the pelvic floor muscles causing pain when inserting a tampon or pain with, or an inability to have penetrative sex.
- Interstitial Cystitis /Painful Bladder Syndrome: Pain in the bladder, vagina, urethra or abdomen and symptoms can also include urgency and frequent need to pass urine and can be due to chronic infections which may or may no longer be present.
- Post-Surgery Pain: Vaginal tissue can be painful following any pelvic floor/gynaecological surgery which can also lead to pain with penetrative sex.
In response to these symptoms the pelvic floor muscles and abdomen can become tense. This tension becomes part of the problem further feeding into the holding patterns and pain cycle within Chronic Pelvic Pain. The pelvic floor is susceptible to holding tension for many other reasons such as childbirth, history of constipation or bowel disorders, history of urinary tract infection, poor posture and emotional holding due to stress or anxiety. Some people may not have experienced any of these but still suffer with symptoms because of general tightness in the pelvic floor just like we can experience tightness in other muscles in our body. Strengthening the pelvic floor when it is already tense or tight will be counterproductive and can actually increase symptoms which is why finding ways to relax the pelvic floor is vital with such symptoms.
Pelvic floor manual therapy is a hands-on mobilising technique to diagnose and treat soft tissues which can help to decrease pain in the pelvic floor, increase range of movement and function and reduce tissue inflammation. I am passionate about using this therapy within a holistic approach to treating Chronic Pelvic Pain and work closely with my patients to find the best road to recovery. Other modalities include breathing work, relaxation strategies, graded exposure, strengthening exercises, diet and fluid advice and advice on stress and anxiety management to improve quality of life. I firmly believe that physiotherapy treatment should NEVER be painful and all treatment sessions are conducted in a sensitive and calming manner. It is also important to note that a multidisciplinary team approach is often needed with chronic pain conditions and I have excellent connections with both Consultant pain specialists and Clinical Psychologists in the area.
Menopause Assessment
I offer a holistic and individualised physiotherapy approach to support women through the perimenopause and menopause.
The Menopause Assessment is a comprehensive pelvic health assessment for any woman who is perimenopausal or postmenopausal. Whether you are experiencing symptoms or just thinking about the future and want to do what you can to prevent symptoms, then you can benefit from this specialist one hour session.
All too often, niggling problems, such as urgency to pee, leakage of urine, feelings of a prolapse, constipation or painful sex are just put down to something to put up with as you get older. This is absolutely not the case. These symptoms are common, but not normal, and bladder and bowel problems can be helped and sex should not be painful.
The session will include a detailed discussion of your medical history, your bladder, bowel, and sexual function along with any menopause symptoms you are experiencing. It will also involve an internal, vaginal assessment to determine how well your pelvic floor muscles are functioning, allowing an accurate and personalised exercise programme to be prescribed for you.
You will leave the session with a better understanding of your own pelvic floor and how you can improve it to support you through the rest of your life, along with specific advice for any problems you may be experiencing. This assessment can be booked as a one-off assessment, however follow up sessions are available for those who require extra support to help them reach their goals.
Endometriosis
Physiotherapy probably isn’t the first thing you think of when seeking help for endometriosis, however, even though physiotherapy cannot change the condition, it can offer so much to help the pain associated with it.
Endometriosis is where endometrial tissue is located outside the uterus which thickens, breaks down and bleeds each month. This blood cannot exit the body and becomes trapped. Cysts can form along with scar tissue and adhesions, causing irritation to the surrounding tissues and hence pain. It is not only the body that needs help with Endometriosis but also the mind which is why Pelvic Health Physiotherapy addresses the connection between mind and body with a holistic approach consisting of both education and hands-on treatment. If you are struggling with any of the following symptoms then I can help you:
- Pelvic and abdominal pain
- Constipation
- Bladder symptoms – frequency, urgency, pain on urination
- Fatigue
- Stress/ anxiety
- Painful sex
- Low back pain
Bladder Dysfunction
Approximately 1 in 3 women in the UK suffer with urinary incontinence. The Department of Health and the National Institute of Clinical Excellence (NICE) recommend that conservative treatment in the form of supervised pelvic floor muscle training and bladder training should be the first line of treatment offered.
- Stress Urinary incontinence: Loss of urine due to exertion such as coughing, sneezing, laughing, jumping or running.
- Urge Incontinence: Leakage of urine due to not being able to hold on when needing to pee.
- Urgency: A sudden and intense need to pee and can be related to triggers such as arriving home or seeing the toilet.
- Frequency: The need to pee too often (more than 8 times in 24 hours).
- Nocturia: Getting up during the night to pee.
- Hesitancy: Difficulty or slow to start the flow.
- Incomplete Emptying: Bladder not emptying fully.
Pelvic floor muscles can be damaged or weakened by pregnancy and childbirth, pelvic or abdominal surgery and the ageing process. It is important to restore normal function to the pelvic floor muscles by assessing and formulating a specific strengthening programme of exercise or relaxation strategies alongside management advice, bladder training and fluid/ dietary advice. Pelvic floor muscle training is effective for both urinary and faecal incontinence in both men and women.
Pelvic Organ Prolapse
Pelvic Organ Prolapse occurs when the pelvic floor muscles and ligaments are stretched and weakened and are unable to support the uterus (womb), the bladder or bowel which can bulge against the vaginal walls. Weakness can occur from pregnancy and childbirth, constipation and straining, frequent heavy lifting, obesity or through the menopause and ageing process. It is frequently described as a dragging sensation or pressure within the vagina, a feeling of a bulge or something coming down and can be associated with lower back pain/discomfort, bladder problems and difficulty emptying the bowel.
Pelvic Health Physiotherapy is able to treat mild to moderate prolapse with specifically tailored exercises to strengthen and/or relax the pelvic floor, enabling the pelvic floor muscles to regain function and support to alleviate the associated symptoms. Management advice on daily living, fluid and diet, bladder and bowel health and the psychological impact this diagnosis can have also play a critical role in treatment.
A prolapse diagnosis for many women unfortunately leads to a life of fear and avoidance. Amanda works with you to lift this fear, tailoring your goals with a management plan to get you back to the life you want to lead.
Pregnancy/Postnatal
Pelvic Girdle Pain (PGP)
PGP in pregnancy (previously called Symphysis Pubis Dysfunction, or SPD) is a very common complaint which the NHS suggests can affect 1 in 5 women during pregnancy. Pain can be felt anywhere around the pelvic joints at the back or front of the pelvis and symptoms can vary in intensity from person to person. Physiotherapy can significantly help you to manage the pain and prevent deterioration. A thorough assessment will lead to an individualised treatment plan which may include exercise, posture advice, manual treatment techniques and the use of support belts if required. Getting diagnosed early can help keep pain to a minimum and allow improved function throughout your pregnancy.
Diastasis Recti Abdominis
Diastasis Recti Abdominis is a thinning and widening of the Linea alba (the connective tissue in the middle of the abdomen). All pregnant women will experience a degree of this by the end of their pregnancy as the abdominal muscles have to stretch to accommodate the growing baby and this should, therefore, be considered completely normal. Some women experience a noticeable bulge which may be seen especially when getting out of the bath or getting out of bed. Although this is a natural separation and not a split or torn muscle and has no serious consequences, physiotherapy can help to restore the abdominal strength and function. Treatment can occur both during pregnancy and after your baby is born and consists of an assessment and management plan individualised to your needs and goals.
New Mum Assessment
After delivery your body can often feel different and you may have concerns or questions that you would like answered. Whether you have had a vaginal delivery, forceps, ventouse or caesarean section the New Mum Assessment can help you to understand your post baby body and aid your recovery. I am passionate, not only about helping to alleviate problems when they arise, but also about the importance of health prevention. Whether you are experiencing problems or would just like reassurance and the knowledge of how to prevent problems in the future then the New Mum Assessment session is for you.
This one-hour assessment covers the following areas:
- General advice regarding your type of delivery
- Pelvic floor muscle assessment and advice on re-education
- Abdominal check for Diastasis Rectus Abdominis
- Exercise: A bespoke return to exercise plan will be made for you
This assessment can be booked as a one-off, however follow up sessions are available for those who require extra support to help them reach their goals. You are more than welcome to bring your baby with you to this session.
Bowel Dysfunction
I focus on a holistic approach to bowel problems and will not only assess your pelvic floor muscles, working with you to tailor a specific exercise programme, but will also offer advice and management on diet, lifestyle and correct toilet habits. It is estimated that between 1-10% of adults are affected by faecal incontinence. The problems can be caused by weak pelvic floor muscles following pregnancy/childbirth, the menopause, the ageing process or long-term straining to open the bowel. Poor diet and fluid intake can also play a part in an unhappy bowel.
Pelvic Health Physiotherapy can help with the following types of bowel dysfunction:
- Faecal/ Flatus Incontinence: Leakage from the back passage of faeces or wind.
- Faecal Urgency: The need to empty the bowel suddenly.
- Anismus: Also known as dyssynergic defaecation is a condition which makes it difficult to empty your bowel. It is a type of pelvic floor dysfunction where the pelvic floor doesn’t relax when you try to empty your bowel.
- Proctalgia Fugax/Levator Ani Syndrome: Conditions that causes sudden, severe anal pain usually due to spasm in the pelvic floor.
- Anal Fissures/ Haemorrhoids (Piles): Pain from these can cause a secondary problem of pelvic floor tension
- Prolapse
- Constipation
- Incomplete Bowel Emptying
Men's Health
I can help you with a range of pelvic health issues which can appear at any age:
- Chronic Pelvic Pain: Often called Chronic Pelvic Pain Syndrome (CPPS), CPPS is more prevalent in younger men between the ages of 25-50 affecting between 2-16% of the male population. CPPS can significantly impact quality of life due to the range of symptoms that can occur such as pain in the penis, testicles, pain when sitting and pain with sexual function. I understand how difficult these topics can be to talk about and will work with you in a sensitive manner, allowing you to feel at ease to openly discuss not only the physical symptoms you may have but also how your problems are affecting your quality of life. Although this can sometimes be difficult to discuss it is a vital part in ensuring the right treatment and management for you. It is important to note that a multidisciplinary team approach is often needed with chronic pain conditions and I have excellent connections with both Consultant pain specialists and Clinical Psychologists in the area.
- Prostate Surgery: If you have been diagnosed with prostate cancer and are awaiting surgery then it’s not too early to have an assessment. I recommend being seen before surgery (if possible) so as to assess your muscle function and teach correct exercises to enhance your recovery after. Pelvic floor muscle strengthening before surgery has been shown to significantly improve post-prostatectomy urinary incontinence, post micturition dribble (dribbling urine after peeing) and erectile dysfunction (Goonewardene SS, Gillatt D, Persad R 2018). You will have a full pelvic floor assessment to determine how well your pelvic floor muscles are functioning, allowing an accurate and personalised exercise programme to be prescribed for you. You would then have further sessions post-surgery to progress your rehabilitation. If you are unable to be seen before surgery then starting physiotherapy as soon as you are able after your surgery is an important part in your recovery.
- Urgency (sudden need to pee)
- Urge/ Stress Incontinence (bladder leakage after urgency or when you cough, sneeze or with exertion)
- Difficulty Emptying/ Slow Flow
- Urinary Frequency
- Erectile Dysfunction
Bladder symptoms in men are relatively common, with evidence showing more than 30% of men over 65 having issues (NICE updated 2015). There are a variety of possible causes such as age-related changes, infection, inflammation, muscle dysfunction or changes in the prostate gland which enlarges with increasing age. Pelvic Health Physiotherapy can address the symptoms that occur and give you the help you need to regain control of your bladder.