General Women’s Health
- All Treatments
- Vesical and Rectal Troubles
- Pelvic Pain
- Abdominal Weakness
- Swollen Legs / Cellulitis
Events in woman life as pregnancy and menopause but also disease (thyroid, cancer…) combine with an active life (impact sport and hyper pressure sport) and certain habits (smoking, alcohol consumption…) lead to body modification and urinary issues such as:
- Stress urinary incontinence: 30% to 50% of women suffer from this condition. Risk increase with number of pregnancy and age. It is characterized by urine leakage (not preceded by urgency) occurring when sneezing, laughing, coughing, and lifting or during physical activities (running, jumping…). In extreme cases, even walking can trigger it. This type of incontinence is due to a brutal abdominal pressure increase causing leaking through either hypermobility of the urethral canal (urinary canal) or sphincter failure (weakness of muscles blocking the urethra).
- Urgency micturition is a sudden irrepressible urge to urinate
- Urinary incontinence by urgency is an involuntary urine leakage preceded by compelling urge to urinate, leading sometimes to complete urination. This type of incontinence is caused by an involuntary contraction of the bladder and it is not link to physical activity. It is named instable bladder or hyperactive bladder. It can appear in certain situation associated with reflex micturition such as incontrollable laugh, fear, orgasm…
- Mixte urinary incontinence is a combination of two above dysfunctions
- Dysuria with post-micturition residue: Dysuria is characterized by a difficulty to empty the bladder, with or without associated pain. This dysfunction is commonly overlooked because painless and with a progressive apparition. Dysuria is often associated with urine leakage when standing up afterwards.
Anal leakage: Anal continence is a complex mechanism: As we eat, food is digested by our stomach then by our intestine to reach the last part named rectum. Two sphincters close the rectum: an internal one with an involuntary control and an external one with a voluntary control.
As the stools arrive in the rectum, it distends the wall which is supposed to trigger the need to go to the loo. When it is not possible to go, a voluntary contraction, of the external sphincter and of another pelvis muscle named pubo rectal muscle, diminishes the need.
After a while, the internal sphincter also contract but involuntary, allowing us not be forced to voluntary contract the external sphincter all the time without having to rush to the loo.
When the external sphincter or other pelvis muscles are teared, the voluntary contraction is not possible anymore. Consequently, the time between the stools entering the rectum and having to exit is drastically shortened, we speak of anal incontinence.
Rectum works as a tank collecting stool allowing a delayed elimination. However, if the rectal compliance is reduced, this tank is smaller and can’t conserve the stools compiling to eliminate them more frequently. On the opposite, if the rectal compliance is increased or if the rectal sensibility is impaired, stools will accumulate leading to anal incontinence by overflow.
Rectum static dysfunctions are often the source of anal incontinence. For exteriorised prolapse (in very long labour or following use of forceps) anal incontinence is also frequent.
A prolapse is is a condition where organs fall down or slip out of place.
Types of prolapse
If it affects the front of your vagina, it is an anterior prolapse (cystocele). The bladder bulges into the front wall of the vagina
If it affects the top or your vagina, it is a prolapse of uterus or of cervix (hysterocele).
And if it affects the back part of your vagina, its a posterior prolapse (rectocele or enterocoele). The bowel bulges forward into the back wall of the vagina.
Sometimes you can have more than one prolapse. For instance, you can have a cystocele and a rectocele.
To know how severe your prolapse is , a number system is used, ranging from one to four, with four indicating a severe prolapse.
What are the symptoms ?
- Sensation of a bulge or something coming down or out of the vagina, which sometimes needs to be pushed back
- Problems passing urine – such as slow stream, a feeling of not emptying the bladder fully, needing to urinate more often and leaking a small amount of urine when you cough, sneeze or exercise
- Discomfort during sex
- Some women don’t have any symptoms..
What are causes ?
Prolapse is caused by weakening of tissues that support the pelvic organs. Although there’s rarely a single cause, the risk of developing pelvic organ prolapse can be increased by:
- your age – prolapse is more common as you get older
- childbirth, particularly if you had a long or difficult labour, or gave birth to multiple babies or a large baby – up to half of all women who have had children are affected by some degree of prolapse
- changes caused by the menopause – such as weakening of tissue and low levels of the hormone oestrogen
- being overweight, obese or having large fibroids (non-cancerous tumours in or around the womb) or pelvic cysts – which creates extra pressure in the pelvic area
- previous pelvic surgery – such as a hysterectomy or bladder repair
- repeated heavy lifting and manual work
- long-term coughing or sneezing – for example, if you smoke, have a lung condition or allergy
- excessive straining when going to the toilet because of long-term constipation
How is prolapse treated ? What to do to prevent it ?
What are these pain?
They are due to a muscular dysfunction caused by muscular hypertonia (hypertonic pelvic floor)
- Dyspareunia: a pain of variable intensity felt during sexual intercourse by a man or a woman.
- Vulvar Syndrome: a vulvar discomfort lasting for more than 3 month for no apparent reason.
- Vaginismus: prolong or recurrent muscular contraction of pelvic floor muscles around vaginal opening. This involuntary and incontrollable reflex prevents any desired vaginal penetration, even a finger or a tampon when the vaginismus is total. In other case, it can be partial or situational when it appear only in certain situation (e.g. sexual intercourse)
- Vestibulitis Syndrome: pain touching the vestibule (membrane between the small lips localised around the vaginal opening). These pains are often describe as aa burn sensation or even a tear/stabbing sensation during a pressure (vaginal penetration, tampon insertion, gynaecological exam, riding a bike…) on the vulva or at the vaginal entrance
- Pudendal Neuralgia: neuropathic pain (intense, burning or electrical pain) in between genital organ and anus
- Interstitial Cystitis/Painful Bladder Syndrome: often unknown and misdiagnosed concerning bladder, pelvic area and surrounding pelvic region. Bladder wall is normally covered of a protective layer preventing direct contact between urine and bladder tissues. In Interstitial Cystitis, this layer is too thin. Consequently, urine acidity creates a burning sensation in the vesical and pelvic region. Patients may experience mild discomfort, pressure, tenderness or intense pain in the bladder and pelvic area. Symptoms also include urgent need to urinate, a frequent need to urinate or a combination of all the above. Pain may change in intensity as the bladder fills with urine or as it empties. Women’s symptoms often get worse during menstruation. They may sometimes experience pain during vaginal intercourse
- Irritable bowel syndrome (IBS): common trouble of digestive system causing abdominal pain, constipation, diarrhea , or both alternatively
- Ano-rectal pain, often link to difficulty to eliminate stools, require bowel habits and postural education
- Sacral, coccyx (tailbone) and thoraco-lombar-abdominal-pelvi-perineum pains result from postural and biomechanical change occurring over the pregnancy: shoulder inside, increased lordosis (lower back arch backward), abdomen shift forward, hips in external rotation (feet outside like a cowboy)
- Pain related to pudendal nerve: it is characterized by a perineal pain often on one side, similar as a burning sensation with sometimes pain inside the anus. These symptoms are aggravated in sitting position and relived in standing/lying position. It can also be associated to a pain around vaginal orifice
- Pain due to episiotomy scar or suture break, increased in sitting position and during sexual intercourse
- Pain at external anal sphincter level, due to injury, tear, large episiotomy. It presents as an intense and punctual pain trigger by bowel movement and sometimes in sitting position
- Abdominal pain: C-section scar are one of the cause but rectus addomini diastasis lead to dysfunction of abdominal muscles and may result in pain while performing simple movement and task of life.
What are the causes?
- Local fracture or adjacent perineal tissue
- Sprain and dislocation
- Extreme sport (by creating muscles spasms predisposing to these pains)
- Haemorrhoidal ablation, abnormal cracks, ulcer, urethral surgery
- Labour with or without complication
- Sexual traumatism: sexual abuse leading to defense reaction and closing of perineal muscles
- Psychosomatic aspect: general tension of the body resulting from life stress as obviously an impact on all the muscles including perineal muscles
Your abdominal muscles were stretch and sometimes injured to provide space to your baby. This is the cause of diastasis (a gap in your belly) and often of transverse muscle weakness.
Your hormones also play a big part in abdominal and pelvis muscles relaxations to help the birth of your baby. If you gave birth through a C-section, adhesions due to the scare are another cause of lack of control and weakness of the transverse muscle.
Consequently, you need to regain good sensations and control of your transverse muscles. They are essential, working as a belt around your abdomen holding your organ and limiting pressure on your pelvis floor when you cough, sneeze, laugh or run. If this pressure is not limited it leads to incontinence and prolapses.
Do not hesitate to have a look to our blog; there are articles on abdominal anatomy and related dysfunction to help you understand these problems.
Abdominal rehabilitation can start few days after you gave birth. This rehabilitation is divided on different steps dependant of your weakness.
Beginning of rehabilitation:
The aim is to gently mobilise your abdominal transverse muscle to regain awareness of your body thanks to a breathing approach. LEARN TO EXHALE AND ENGAGE PELVIS MUSCLE PERFORMING AN EFFORT.
Our woman health physiotherapist will offer to apply a K-Taping to enhance the speed of closure of the post-natal diastasis .
At the same time, the Abdominal Rehabilitation will start using the The ABDO-MG® (Abdominaux Méthode Guillarme) approach: It is a functional rehabilitation method respecting abdominal physiology. It associates control exhalation through a special device with an abdominal stimulation triggered thanks to this exhalation. Integration of control exhalation in the abdominal rehabilitation guarantee a safe approach allowing an early start, even just few days after you gave birth or you had a surgery.
Abdo-MG aims at recovering functional abdominal muscles enhancing breathing and integrating good habits in you daily life.
When the gap in rectus abdomini (diastasis) is closed, it will be possible to start a specific rehabilitation for your transverse muscle.
It is FORBIDDEN, even more after giving birth but also true for any woman, to do hyper pressure abdominal exercises (crunches, sit ups…). Indeed, these types of exercises create a strong push towards the floor. The increase pressure in the abdomen prevents to engage pelvis muscle letting visceral organ to drop (internal link to “mauvais abdo”).
Therefore, our women health physiotherapist will teach you a HYPOPRESSIVE GYMNASTIQUE preventing the push toward the floor to protect your pelvis muscles and avoid incontinence and prolapses.
Before to start any rehabilitation, it is essential to evaluate the stage of your post-partum (how you recover from the pregnancy) by examining both your pelvic bones/joints and pelvis muscles. For this purpose, our women health physiotherapist always begins with a thorough case history followed by a general examination. Then, a specific examination of your C-section scars (internally and externally) if there is one and of your abdomen will be performed. Abdominal exam include but not only: muscle tension evaluation, diastasis measurement, transverse muscle function when coughing…
Thanks (not really) to your hormones, , diameter of you veins increase.
The combination of different elements prevents the blood to come back normally from your lower limbs to your legs, creating sensation of heavy legs, welling and varices.
On a long term, it also causes cellulite.
What is Cellulitis ?
Cellulitis is an accumulation of adipose tissues (fat cells) underneath the skin which herniate through the connective tissues. It gives an orange peel or dimpling aspect. It is commonly localized on the back or side of the thighs, but it can also appear above the knee or inside the thigh.
Cellulite has multifactorial causes which are not all known or well understood. The main ones are female hormones, genetic, lack of physical activity and diet.
Deep fat cells can be eliminated with a liposuction or disappear with sport but adipose cells underneath the skin remain. All women have adipose cells and it is impossible to make it disappear. However, the orange peel and dimpling aspect can be reduced and it is possible to give a smoother aspect to the skin.
Often, the lack of activity and water retention associated with cellulite is the main cause of the non-aesthetical aspect of skin which is easily reduced by an association of drainage techniques and palper rouler.