Good pelvic health doesn’t tend to be on a woman’s mind until it’s gone.
Like back pain, when pelvic related problems strike they can be debilitating to everyday life and wellness.
With 14 years of experience as a doctor, I have witnessed first-hand the barriers to women seeking or obtaining help with problems in the pelvic region. These include fear, embarrassment, long waiting times to see specialists within the public system, costs of seeing specialists privately and sometimes women wrongly believing that symptoms are a normal part of pregnancy or menopause and that they have to put up with them. In this busy life we need to find time to make our health a priority and women are often pleasantly surprised to learn about the solutions.
Being a GP with a specialist interest in urogynaecology is very rewarding. I feel I can make a positive difference in a patient’s life when together we find health care solutions. Here are an example of some health issues that I diagnose and manage on a daily basis:
• Pelvic organ prolapse (dropping of the vaginal walls or uterus)
• Urinary Incontinence (urine leakage)
• Chronic pelvic pain (pain in the pelvis that has been present for 3+ months)
• Overactive pelvic floor (can lead to pelvic pain, pain with sex, urine leakage)
• Underactive pelvic floor (can contribute to urine leakage and prolapse)
• Overactive bladder (having to go to the toilet very frequently)
• Voiding dysfunction (problems with emptying the bladder or rectum)
What help is available to improving pelvic health?
While some of these health issues are not widely discussed and are considered taboo, they are common. I am currently treating 4-5 patients per day in relation to pelvic health. The majority of women range from 40-80 years, however, I see younger women during or post pregnancy as pelvic issues can arise at this time. I do also treat teenagers and women in their early 20s who may experience problems related to an overactive pelvic floor. It’s true that some women with anxiety can hold their tension in the pelvic floor and this may result in symptoms of an overactive pelvic floor as described above.
Examples of recent clients include a grandmother unable to undertake her passion of gardening due to a bothersome prolapse. This was simply resolved using a pessary ring, a silicone ring which provides support to the vaginal walls, without the need for surgery. She is back to gardening now! At the other age extreme, I recently treated a 24-year-old mother of two young children. I diagnosed her with chronic pelvic pain. She was struggling to work, look after her two young kids and on some days was even unable to walk. Her management included:
• General support
• Education around chronic pain and it’s management;
• Examination which lead to a diagnosis of over-active pelvic floor;
• Medication aimed at reducing pain and the impact of chronic pain in the longer term;
• Referral to and co-ordination of a multi-disciplinary team. (Robust evidence suggests that outcomes for women with chronic pelvic pain are better if a MDT approach is undertaken). The team involved:
• Gynecologist to rule out more sinister causes of pelvic pain.
• Urogynae physiotherapist.
• Psycholgist for support and with further education about limiting the longterm effects of chronic pain.
• Dietician to educate her about anti-inflammatory foods which may reduce pain.
Two months on she has a greater awareness of what is going on with her body and how she can manage it and subsequently cope with her day to day life. Despite us beginning to reduce her medication she now has at least half the pain she had just two months ago. A phenomenol result for her and the team!
Local expertise made easy
Having worked at the Royal Women’s Hospital Emergency Department and undertaken mentoring at Sunshine Hospital urogynae department, I have worked with doctors and allied health professionals who specialise in urogynecology. As a result of this experience, I can refer to some of Melbourne’s best specialists who have specific training and experience in the evaluation and treatment of conditions that affect the female pelvic organs, and the muscles and connective tissue that support the organs.
What is involved with a urogynae appointment at Women’s Health Hub ?
The medical treatment varies with each patient’s symptoms, concerns and beliefs. Medical health solutions range from bladder retraining or pelvic floor down-training advice, advice on healthy bowel care, pharmaceuticals; both oral and topical, fitting a pessary ring to referral to a urogynaecological physiotherapist or surgeon.
Our patients can also easily access specialists relevant to pelvic health such as an Obstetrician, Gynaecologist, Senior Pelvic Physiotherapist and Gynaecological Sonographer and Radiologist, Dietician and Psychologist reside in our specialist clinic in the same building.
Initially, the patient would require a 15-minute appointment that will be bulk billed. I will gain an understanding of the patient’s health concern’s and priorities. The second appointment is 30-minutes and will include a detailed history , examination and management plan ,(possibly including a pessary ring fitting). This will cost $150 with a rebate of $72.80 which leaves an out of pocket cost of $77.20.Subsequent visits for ongoing management of pelvic health issues and pessary care will be bulk-billed .
In addition, I have been practising as a GP within the western suburbs of Melbourne for six years and my additional specialist skills include:
• Mirena IUD insertion and removal
• Implanon insertion and removal
• Shared maternity care provision
• Management of unplanned pregnancy
Written by Vicki Ma (Accredited Practising Dietitian and Sports Dietitian) What you eat during pregnancy affects your developing baby.
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