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Q&A on women's health physiotherapy with senior physiotherapist Dr Rachel Bromley - ANSWERS BACK

(80 Posts)
HeatherMumsnet (MNHQ) Mon 11-Nov-13 11:45:24

Were running a Q&A on Womens Health Physiotherapy with Nuffield Health. Their senior Womens Health Physiotherapists will answer all your questions on musculoskeletal problems and issues with the bladder or pelvic floor. These might be antenatal or postnatal problems associated with pregnancy or childbirth, or gynaecological problems.

Dr Rachel Bromley is a senior physiotherapist. She qualified as a physiotherapist in 1992 and has been specialising in continence and womens health since 2005. She has recently completed a Masters Degree in Continence and Womens Health at Bradford University. Rachel is the clinical lead physiotherapist for Womens Health within Nuffield Health and as such teaches and mentors other physiotherapists within the company who have an interest in womens health and continence. Dr Bromley has had additional specialist training in the assessment and treatment of a variety of womens health conditions, including urinary stress incontinence, urgency, symptoms of prolapse, voiding dysfunction, pelvic girdle pain and other pregnancy related conditions.

Laura Haworth qualified from Cardiff University in 2004 with a BSc in Physiotherapy. She has worked in Australia and New Zealand. Back in the UK, Laura joined Pilates Art and completed her equipment and mat-based Pilates training through the APPI Institute. She worked in their Hampstead clinic for eighteen months and became part of the womens health special interest group, working towards developing a private womens health service. Laura joined Nuffield Health in 2011. Since January, she has been based at the Nuffield Health Wharf Medical Centre in Canary Wharf where she has been assisting in the development of the womens health service.

Post your questions to the experts before 18 November and well upload the answers to this thread on 27 November.

This Q&A is sponsored by Nuffield Health

PavlovtheCat Fri 15-Nov-13 10:44:38

I have had a microdiscectomy for an L5/S1 prolapse. I also have a slightly out of line vertebrae of the same area, probably the reason for the prolapse. I have had returning symptoms since the surgery in June of this year and have been told it may have re-prolapsed, awaiting MRI. Also told it could be nerve damage/scar tissue build up.

I saw a Nuffield Physiotherapist for three sessions while waiting forever for my NHS referral post surgery (still waiting) who have me some exercises in quite a tough regime to do to build core stability. I have worked to this, before return of leg pain. GP told me to stop. Physio had said here would be some residual pain and to work through it.

There is conflicting advice now and I don't know whether to proceed with exercise.

What is your view on continuing exercise with leg pain (sciatica) while the diagnosis is unclear (ie, it might be a re-prolapse, might be internal scarring, might be nerve damage from prior to surgery unlikely). And, can a nuffield physiotherapist give muscle massage to address back pain and muscle spasm while there is leg pain? Would this be beneficial?

cantreachmytoes Fri 15-Nov-13 17:29:06

I gave birth in France. I had access to pelvic floor and abdominal (abs are only done when PF is ok) physio from midwife and physio.

1. In France we're commonly told that the "reeducation" prevents prolapse and incontinence later in life. Do you believe this to be true?

2. If yes to the above, do you think it would save the NHS in the long run if all postpartum women were offered 12 sessions of PF then 12 sessions of abs as standard (more when needed).

3. Do you think that midwives should also be able to be trained in pelvic floor "reeducation" in the UK?

Meringue33 Fri 15-Nov-13 19:13:33

I have pain in my SP and a split rictus. I gave birth ten months ago. What exercises including abs exercises are safe to do?

Mumzy Fri 15-Nov-13 20:59:31

I have a degenerative disc condition and this has been getting worse with each of my 3 pregnancies. I've been told by my consultant to improve my core stability with regular Pilates sessions swimming. Are these the best ways to help my lower back pain

principalitygirl Fri 15-Nov-13 23:13:16

I gave birth 14 months ago. Had v v long labour ending in forceps delivery with epic. Had slight bum continence issues for a few months after but saw women's health physio and exercises they gave helped.
BUT I have two ongoing issues:
1) my pelvic floor / vaginal muscles are nothing like they were before and I can really tell the difference when it comes to sex. It all still feels bigger / looser down there and my orgasms are only about a third of their previous intensity at best. sad Can I ever get them back like they were before and if so, how? I've bought a Pelvic Toner recently but I've only used it a couple of times.
2) Pre-pregnancy I was a size 10-12 and always had a small waist. After I gave birth I
had a 2.5 finger width gap between my ab muscles. I'm back in my pre-pregnancy clothes and just a couple of pounds above my pre-baby weight still. But I look about four or five months pregnant! I've been trying to get back to fitness and been doing cardio and pilates regularly. But my tummy is hardly changing. I had a session with a personal trainer v recently and my tummy gap is still 2 fingers width. Physio advised no crunches initially but is that still the advice over a year later? I've also read on some postnatal fitness sites that the plank is bad if you have separated abs as the gravity pulls everything into the gap making it worse but all the trainers and fitness instructors I've asked say it's the best way to get flat abs... I'm confused! How can I get a flatter tummy? What exercises are best and what should I avoid completely. I'm embarrassed to wear lots of my clothes cos I look like a slim pregnant person! I'm worried I need a tummy tuck. I've looked into the Tuppler Technique - is it recommended?

principalitygirl Fri 15-Nov-13 23:13:55

epi not epic!

Queenmarigold Sat 16-Nov-13 19:28:00

I had an induction at 37 weeks with twins, one ventouse one forceps. Both good size babies, over 6.5lbs each. I have several issues:
1- sex is very painful, whatever position. Any penetration is excruciating.
2- episiotomy scar is painful. This is separate to the other pain and hurts during non sexual movement eg squatting.
3- loss of bladder sensation. My need to pee is not normal. I have small pelvic floor problems and can't run or do strenuous exercise without leaking urine.

What do I do?
I do my pf exercises and have been referred for ob-gyn appt for the sexual pain. Is there anything else? Babies now 10months old. I'm sick of it.

LovesBeingHereAgain Sat 16-Nov-13 23:12:16

I have a rectocele, I'd like to do some exercise but too much activity sets off my back pain and soreness, what would you recommend?

Saxie Sun 17-Nov-13 07:12:40

I would like to second the request for a 10/12 set of physio sessions on the NHS after giving birth. I feel that the French system is much more supportive to mothers and presumably gets them back on their feet much quicker. It probably helps prevent a mass of Drs appointments.

If men gave birth the facilities provided would be 5* and make it a much better experience.

mrscog Sun 17-Nov-13 09:25:02

I had a ventouse delivery and a 2nd degree tear, I was very incontinent for the first few days but then it all got much better by 6weeks post partum and now DS is nearly 2 I have absolutely no coughing/sneezing issues at all - just one tiny issue left and it's this - first thing in the morning after my wee I find that after when I'm washing hands in warm water I always leak a bit more! It seems completely related to the warm water. Is there any explanation for this? I have a strong PF now, but I don't even get any warning - it dribbles out when I start washing. It's not a huge issue but one that intrigues me all the same!

Brittapie Sun 17-Nov-13 12:22:08

Yesterday was my DD2's (my last baby) 4th birthday. I also had to stop mid dance in the evening (I do proper partner swing dancing, so I wasn't just randomly bouncing about) because the SPD pain was so bad.

I found that dangling one leg off a step, sort of hooking my foot under the step and pulling hard eased it a bit, but the only thing that allowed me to not be in awful pain was a lot of painkillers, which then meant I couldn't dance because I was too doped up.

Are there any other quick fixes that I can do to help when it gets bad? I have long term exercises, but I need things to do when I have got all dressed up, paid £13.50 to get in, there is a live band and a lovely slippy floor and I have a great lead to dance with. Then one movement, that usually would be fine, makes my pelvis go "crunch" and I have to stop. Because that is mega frustrating.

pinkoneblueone Sun 17-Nov-13 18:33:39

Please can I have some advice? My children are 9 and almost 5 I have trouble pooing and actually over eat so that I can go otherwise I get consytipated I eat lots of fruit and veg daily more than the 5 a day recommendation. I did none of the exercises recommended after pregnancy and have a fair amount of loose skin I have lost a lot 5 stone since january with change of diet and exercise and I was wondering if there are any exercises you would recommend to help me go to the toilet and get rid of the loose skin

missorinoco Sun 17-Nov-13 19:36:23

Hi. Great choice of Q&A MN, thanks.

I have had three children, and had stress incontinence during pregnancy with the second and third. Prolonged pushing at 6 cm in the first, and then ventouse with a small tear with 2rd and 3rd. Did all my pelvic floor exercises for about 6 weeks post partum, then forgot. I do them occasionally, and found a great thread on here with some tips.

Anyway, my previously pre pregnancies cast iron bladder,is now average, which is ok, but I have stress incontinence mainly with sneezing or coughing, even if I have nearly empty bladder. It was also a problem if I ran, although this seems to have improved.

What can I do to improve this? I do occasional pelvic floor exercises, the symptoms resolve, usually as the virus does, and then I am ok til next time. If I do sustained exercises will this improve, or is it something I have to live with. If so, will exercises stop if worsening over time?

And, sorry, lots of questions - how often and for how long do I need to the exercises for. Because I don't notice a tangible improvement I don't have a feel for what if any benefit my pelvic floor is deriving from the exercises.


fannyfireworks Sun 17-Nov-13 20:04:32

Hi smile I had a missed miscarriage 2 years ago (& had a d&c after). My periods have been regular (28-31 days) since but lighter & shorter, they last about 2 days sometimes just over. I am quite overweight so i would expect them to b heavier & longer. I'd like to try for a baby in the next few years - I am 30.

Should I be concerned?

Thank you

BlondieTinsellyMinx Sun 17-Nov-13 22:15:23

Another separation of the tummy muscles sufferer here, I also have ongoing pain in one hip.

Which exercises are best to try and get my abs back (I have lost all my baby weight but still have a bump!), I have had differing advice from fitness instructors and NHS physios? ... and tbh so far nothing has worked. DD is now nearly 4 and I'd like my figure back!

strongandlong Mon 18-Nov-13 18:57:43

Like Clearlymoo, I have pain when standing up, having been sitting down. I've dealt with it mainly by avoiding sitting down (have switched to a standing desk). It would nice to be able to stand up without wincing! What can I do?

Background: My youngest dd is 4 and I still have pgp during my period, although its not a problem the rest of the time. Am fit and active in general, do quite a lot of strength training. Sometimes have probs with tight hip flexors.

cleanandclothed Mon 18-Nov-13 21:16:53

Is trampolining good or bad for pelvic floor muscles? I love it and don't want to give up but have had 2 3rd degree tears and don't want continence issues later on.

PacificDogwood Mon 18-Nov-13 21:19:38

Yes, my question is about high impact exercise as well:
If I take up running, is that likely to make things worse? Or better as I hope to improve core strength and lose a bit of weight? confused

And what about pelvic floor supports? Are they any good, which one would you recommend and should I wear one only when exercising or all the time?

Wolfiefan Mon 18-Nov-13 21:24:38

I had SPD with my first pg. Back pain with my second. First delivery was water birth but I was left with separated stomach muscles that didn't knit (why is this not checked after birth?). My second birth was very very rapid. I was also asked to move from an ante natal bed to a delivery bed. I now have back and hip issues. Could rapid delivery and shifting in labour contribute to this?
(Bizarrely my mum had rapid deliveries and was also asked to scoot over to another bed at the point of pushing. She has had to have a hip replacement.)

jonicomelately Mon 18-Nov-13 23:12:48

How the hell do I improve my posture? I am very badly designed with a small back and large chest. Unless you are built like this it's impossible to know how hard it is not to lean forward so sayi g keep your shoulders back won't help. Are there any garments I could use! I buy good bras too so please don't say that either. I am thinking the only solution is a breast reduction.

LatinForTelly Mon 18-Nov-13 23:29:37

Hi, marking my place, and am interested in the answers to Pacific's running and pelvic floor support questions.

My stomach muscles split when I had my first child. Is it ok to exercise them? I seem to have got the impression, perhaps wrongly, that I had to go very easy on them.

Thanks for the Q&A, MN.

LetsFaceTheMusicAndDance Tue 19-Nov-13 08:55:57

I hope I'm not too late to post.

I had a sub-total abdominal hysterectomy 6 weeks ago. I've been doing my pelvic floor exercises regularly (thanks Gussigrips). How do I know if I'm doing them correctly?

Also, before the op, I had no idea that I was putting myself at greater risk of prolapse and I do want to get back to lifting, running on a treadmill (at 1% incline for lower impact). What should I do to enable this? Should I try to swap the treadmill for a cross-trainer?

1 more question. How do I start sorting my abs out? After having a huge fibroid (5 months 'gestation' size) for 20 years, they need work!

Thank you.

HeatherMumsnet (MNHQ) Tue 19-Nov-13 11:01:35

The Q&A is now closed. We will send a selection of questions over to the physiotherapists and post their answers to this thread on 27 November.

principalitygirl Mon 25-Nov-13 20:31:52

Have the replies been published somewhere but I've missed them please?

SuiGeneris Mon 25-Nov-13 20:34:28

Yes, a link would be good, please.

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