Things I have learnt while being a Pelvic Health Physiotherapist.

Things I have learnt while being a Pelvic Health Physiotherapist


When I was younger working with people frequently wetting themselves is not something that I had ever envisioned for my future. In fact I was never interested in being a physiotherapist at all. I had always imagined myself as the successor to David Attenborough. Fast forward through a recession, a MSc. degree, junior rotations at the NHS’ largest trust, a year of travelling and I have found myself living in Wellington and speaking to women on a daily basis about their nether regions and fully immersing myself in the pelvic health world (there is an amazing amount of information available on twitter!)


So if you wouldn’t mind I would like to share some of the challenges I have learnt while being a Women’s Health Physiotherapist. If you are of a sensitive nature please bear in mind that I will be using the anatomical names for all the body parts that I regularly treat.




Challenge 1: Learning to say vagina without laughing.


I am one of those people with a very low giggle tolerance. I laugh at farts, toilet jokes you name it and sometimes trying to keep a serious face only makes it harder. So it has taken me a little while to see the vagina, urethra etc as just body parts. But that is all that they are. They have important functions, can be injured and require rehabilitation just like knees, hips and shoulders. Now I don’t blink an eye using words like anus and I encourage my patients to use the anatomical names rather than ‘down there” and ‘nether-regions” or the currently fashionable “vay-jay-jay”. There are some very imaginative ones such as “panty hamster” or “moose knuckle” but I would very much encourage women and their children to call it what it is.


Challenge 2:  Understanding the size of the problem.


It is estimated in NZ that 17-20% of women experience incontinence. As you will notice I have said incontinence, this is the same as ‘light-bladder-leakage” and any other term you have noticed in adverts that describe involuntary loss of urine. In Wellington that means that there are in the range of 8,000 women currently experiencing incontinence. If you are one of them, you are not alone, it is nothing to be ashamed of, but it is something that we can help you with. My mantra at the moment is ‘it is common, but not normal.”


For women who enjoy sport and being active the number with incontinence as you can imagine is higher.  A recent study in the US demonstrated that in a survey of 18-24 year old female semi-pro tri-athletes 37% reported urine incontinence and 24% reported anal incontinence (that’s 1 in 4!). None of the women surveyed had children so you can imagine with an injury to the pelvic floor muscles – the muscles around your vagina and anus – and high impact activity, you could end up with some serious problems.


This number is in addition to women experiencing overactive bladder (always looking for the loo), dyspareunia (pain with intercourse) and pelvic organ prolapse. If any of these problems are affecting you please stay off of Google (especially with prolapse) and seek some help with a professional, we are not as scary as some of the false information out there!


Challenge 3: Being completely non-judgmental and unshockable.


One of the biggest challenges and most important skills I have developed in this area is the understanding that there is a-lot that goes on behind closed doors. This includes working with current and past victims of family violence and sexual abuse. As a result I am pretty un-shockable and non-judgmental. If you have a question regarding sex, childbirth, incontinence (anal as well as urine) you can ask me. I cannot guarantee that I will have the answer but I will be able to find someone who might be able to help.


Challenge 4: The importance of being articulate.


Speaking to patients about the Pelvic Floor muscles is a challenge for a couple of reasons. Think about it, if I said to you do a contraction of your levators to approximately 1/3 of their range, you are going to find that very hard to do if I don’t explain it well. The first challenge is even though men can see the action of their pelvic floor, women can’t. They are directly underneath the head and even the most flexible of women would struggle to see them. Secondly I can’t demonstrate the exercises! Even the most liberal minded patients would object to me showing them how to do the lifts and it wouldn’t be much help for the male patients anyway. Thirdly women are not generally that comfortable with their genitals as their male counterparts are and as a result I have a developed a range of phrases and hand gestures to convey my meaning and I imagine to watch me in a consultation with no sound would be a treat!


I hope you have had a little chuckle at this blog post (especially at panty-hamster) and you would be a little more comfortable knowing that you can discuss the problems around your bladder and vagina. If you would like to know more you can follow me on Twitter @bigbluebucketnz and if you are affected by any of the problems highlighted please make an appointment with me Wellington Sports Medicine.


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