Featured: Charlotte Church with Oxford Physiotherapy Clinic

“I got into pelvic health after my rotations. It took two years, before I started because it's a post-graduate rotation. Once I started, I never left,” Charlotte said.

“I worked for the NHS, leading the team at the Royal Free in London. It has one of the largest pelvic floor physiotherapy teams in the United Kingdom. Due to the commute, I decided to put it to one side for a bit and enjoy being a mummy, and that’s when I realized there was nothing for women regionally so I set up a practice with a friend."

Charlotte continued, "It is gratifying to help people feel comfortable enough to talk about these things, and help them".

"There is something about putting people at ease talking about "embarrassing things" - Charlotte Church.

Listening to Charlotte speak, I find it ironic that we women go through pregnancy, and labor but still feel uncomfortable talking about our pelvic health. Up until a few years ago, I didn't know the specialty existed so I took some time to ask Charlotte some more questions. This is what she had to say ...

Is Pelvic Health Physiotherapy only for women who have just had a baby?

No, it’s for all ages - I even see children with late bed-wetting and giggling incontinence.

However, our most frequented patients are post-natal or menopausal women.

In the United Kingdom, we see women for an initial assessment around the same time as their 6-8 week GP check. Often the GP doesn’t have the time or sometimes the skill set to assess the pelvic floor or abdominals; they certainly do not have the training to treat them. We also treat women who gave birth years ago that may still have a tummy gap or related pelvic floor issues. Some of our patients may never have been pregnant but are still struggling with pelvic floor dysfunction.

| Pelvic floor dysfunction can happen to anyone, not just pregnant women.

If someone is pregnant, when should they see a Women's Health Physiotherapist?
Go see a women’s health physiotherapist if:

• you’ve never heard of pelvic floor exercises, or you are unsure about what they might be.
• you have pelvic girdle pain or lower back pain.
• If you have a history of pelvic girdle pain, see a physiotherapist before you get pregnant, or in early pregnancy, this can get on top of the condition early in the hope to prevent symptoms from occurring.

I’ve heard the phrase Mummy MOT? What is it, and can you talk through the process?

It is a post-natal review carried out by a physiotherapist, and it is completely up to you what is reviewed and examined. The most common things that will be examined are the tummy muscles and pelvic floor. The physiotherapist will examine to see if your muscles are still separated, and how big the gap between your muscles are.

| 1/3 of women will still have a tummy gap at eight weeks post-birth.

A tummy gap may cause instability around the pelvis or poor core strength leading to women developing pelvic or back pain.

Often, you’ll have your pelvic floor reviewed because:

• you have a specific symptom,
• you’re keen to run or exercise, and want to get back to a certain level safely without putting yourself at risk of further weakening your pelvic floor, or
• you want to get stronger.

To have your pelvic floor reviewed there is a vaginal examination with a single-gloved finger where the physiotherapist will ask you to do a couple of things including a cough, and a pelvic floor squeeze so they can feel what the muscles are like and how they are recovering.

If symptoms are more to do with bowel or coccyx pain, then the physiotherapist may need to do a rectal examination. But often they will get more information from the vaginal examination. This would all be discussed with you in advance before proceeding with anything.

You don’t have to have a vaginal examination, the physiotherapist can do a visual check and look at how you squeeze but it is not as accurate.

For any back or pelvic problems, you will have a muscular-skeletal assessment as well.

Based on their findings, they will provide you with exercises, and explain what you need to do.

At the end of your post-natal review, you should be leaving with an idea of:

• What your tummy muscles are like,
• How well your pelvic floor is functioning/recovering, and
• Exercise advice and progression so you can exercise safely and feel confident with your postnatal exercise routine.

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Our readership is international, how could they go about finding professional help?

In the United States, you’ll look for a physical therapist and you'll need a referral so talk to your insurance company.

In Europe, it will depend on the country. For example, in France, any woman who has delivered a baby gets a prescription for ten physical therapy sessions, and other countries may offer this too. Speak to your GP or midwife for more country specific information.

Here in the United Kingdom, you can refer yourself through the NHS. Ask your midwife or GP for more information if you're not familiar with the process. You can also seek private care from qualified professionals like myself. There is a directory of qualified professionals on our clinical interest group website Physiotherapists | POGP (thepogp.co.uk)

How often should I see a pelvic health physiotherapist?

Most good pelvic health physiotherapists won’t need to see you often. After your initial examination, and pending your technique, the physiotherapist should only need to see you two more times over six months. If they are not happy with your technique then you may need to see them a little more often.

| It is not a big, never-ending financial commitment.

Self-Check V Professional help

If you feel comfortable, you can check yourself. Take a clean finger, place it in your vagina, and activate your pelvic floor to see if you can feel a tightening.

If you are able to, use a mirror, you should see things moving away from you. It is like a flower closing, not everything opening up and baring down.

The other thing you can do is get a pelvic floor educating stick, which is a probe with a long stick. They are about £12 and can be purchased online.

Start as you want to finish.

The best most accurate way is to seek professional help where an expert can give you feedback. They can tell you how strong your muscle is, analyze your technique, and give you a home program that is individualized for you and should help you recover faster.

A professional can also advise you on what type of general exercise you should be doing.

| Depending on your pelvic floor strength, for example, weight training may not be a good idea as this could cause a prolapse. The physiotherapist can work with you to build the strength back up so you can get back to this safely.

How do I know if I'm doing a pelvic floor exercise (PFE) correctly?

When you think about Pelvic Floor Exercises, tighten your back passage as if you are trying to stop yourself from passing wind, and then at the same time tighten your front passage as if you are stopping yourself from passing urine and lift.

Imagine you are sitting on a tissue and trying to lift it out of the box. It is important to do the back and then the front.

Occasionally it is okay, but as a rule, don’t try to stop your urine (quick flow) because this might cause a Urinary Tract infection (UTI).

Next month, Charlotte will join us for Part TWO of this series where she answers more questions including some questions asked by our Instagram followers.

A special thank you to Charlotte Church from Oxford Physiotherapy Clinic for sharing her time and expertise with us. You can find her on Instagram @clinicoxfordphysiotherapy