Why You Should Consider Central Mechanisms When Treating Endometriosis

Recently, there has been an explosion of research into endometriosis associated pain and the influence of central mechanisms in the pain experience. Endometriosis-associated pain syndrome (EAP) is defined as “chronic or recurrent pelvic pain in patients with laparoscopically confirmed endometriosis”, and the term is used when the symptoms persist despite adequate endometriosis treatment.

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POP and Exercise – Are We Too Cautious With Our Advice?

Traditionally, high impact exercise (including heavy weight lifting and running) has been discouraged in women with pelvic organ prolapse (POP). There is little research to support this, however, expert opinion hypothesised that high impact exercise results in significant increases in intra-abdominal pressure (IAP). This pressure may contribute to worsening POP symptoms by weakening the pelvic...

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Adverse Childhood Experiences: Implications For Adult Health

Did you know that adverse experiences in childhood can have a big impact on health later in life? A landmark study in 1998 known as the ACE (Adverse Childhood Experiences) study followed over 17,000 participants, investigating the impact of emotional and physical trauma in childhood on physical and psychological health later in life. The results were overwhelmingly clear that childhood abuse and...

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Impact of Gestational Diabetes on the Pelvic Floor Muscles

Gestational diabetes (GDM) is associated with increased incidence of pelvic floor dysfunction and urinary incontinence, both during pregnancy and post-natally. An interesting study was published late 2020 on this topic, exploring the effect of GDM on the pelvic floor muscles. 110 pregnant women with and without GDM were assessed with 3D ultrasound at 24-28 weeks and 34-38 weeks gestation, and...

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Treating Incontinence, Empowering Women

Urinary incontinence (UI) is a significant problem for Australian women. Affecting 1 in 3 women of all ages, this is an issue that needs to be taken seriously. When a woman is not able to control her bladder, it can affect her life profoundly. Women will often stop exercising, withdraw from intimacy, have reduced self-esteem, and avoid engaging in things they enjoy. Shockingly, a large population...

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Stress, Anxiety & Pelvic Pain: A Challenging Combination

We have noticed a recent dramatic increase in pelvic pain presentations that appear to be triggered by higher levels of stress and anxiety during the COVID-19 pandemic. When a patient presents with chronic pain, it is no longer acceptable to view them through a narrow lens. More and more research now supports what we have long known, that chronic pain is driven by a sensitised nervous system....

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Conservative Management of Prolapse

For women with pelvic organ prolapse, the lifestyle changes associated with being at home during COVID-19 are having a big impact on their symptoms. Women are home with their kids more, and doing heavier house and garden work. As the gyms and pools are closed, many have also turned to running or high impact online exercise programs, all of which are contributing. Given the strong evidence base...

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FODMAPs: The Latest In Health And The Irritable Bowel

Irritable bowel syndrome (IBS) is the most common gastrointestinal disorder. Symptoms of bloating, abdominal pain and diarrhoea or constipation (or alternating) are frequent. These impact daily life, mental wellbeing, increase absenteeism from work/school and affect social activities.

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Exercise: A Vital Part Of Cancer Management

Exercise is a vital part of cancer management. The benefits are not only physical. Exercise can improve mood, symptoms of depression, and also have an impact on the body’s immune system and chances of overall survival. The benefits of exercise in cancer are so widely supported that it is now recommended by the Clinical Oncology Society of Australia that exercise be a part of everyone’s cancer...

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Explaining Pain Doesn’t Have To Be Painful

The research is now undeniable - educating a patient about the science of pain is an essential component of chronic pain care. But what is the best way to do this? Shan recently presented a workshop on this exact topic with Dr Patricia Neumann, fellow Specialist Women’s, Men’s...

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Let's Talk Sex

Life is complicated. Sex is complicated. Sex is profoundly influenced by everything that’s happening in our lives, and sex reciprocally influences what is happening in our lives. They are not separable. Many of the ideas that we develop about sexuality and our bodies begin with familial and socio-cultural beliefs, and the sex education we receive at school. Most of us went into puberty education...

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New ‘Magic Pill’ For Treating Erectile Dysfunction

Erectile dysfunction affects up to 1 in 2 men. Current typical treatment options include medication and lifestyle modification. A systematic review published this year has found a new “wonder drug” for erectile dysfunction and premature ejaculation. This magic pill has no side effects, is affordable, and is easy to administer. And you will never guess what it is….. Pelvic Floor Exercises!

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Is A Tight Pelvic Floor A Strong Pelvic Floor?

“Isn’t it good for my pelvic floor to be tight? Isn’t a tight pelvic floor a strong pelvic floor?” These are two questions we are often asked, and the answer to both is NO! More and more commonly we are diagnosing pelvic floor muscle overactivity as a contributing factor to bladder and bowel dysfunction, pelvic pain and dyspareunia. Shan and Leonie attended a workshop at the International...

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How to Improve Life After Gynae Cancer

Gynaecological cancer is the third most commonly diagnosed cancer among women. Thankfully the survival rates are increasing, but, as a consequence, many women are now having to live with the adverse effects of treatment. These often include bothersome bladder, bowel and sexual dysfunction. Research and awareness in this area is improving, with Associate Professor Helena Frawley from Monash...

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Case Study: LUTS following TURP

Anthony was referred to WMHP with incontinence and painful voiding 3 months after a transurethral resection of the prostate (TURP). This case study explores the complex and diverse aetiology of lower urinary tract symptoms (LUTS) and highlights the contribution of increased tension in pelvic floor muscles.

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Endometriosis, No More Suffering In Silence

Endometriosis, a disease affecting 1 in 10 Australian women, is rarely spoken about but can have devastating effects on many aspects of a woman’s life. Thankfully, this should change, with the release of a National Action Plan (NAP) for Endometriosis, delivered by Health Minister Greg Hunt last year.

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Fluid Intake And OAB: Less Is More!

Many health professionals endorse drinking 2 litres of water each day, despite a lack of scientific evidence to support this1. In patients with overactive bladder (OAB), excessive fluid intake is known to exacerbate urinary frequency and urgency. A new systematic review has just been published, investigating fluid intake and OAB, and the results are fascinating.

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New Research On Vulvodynia Management

Vulvodynia affects 10-20% of women, and its prevalence is on the rise. It affects women across the lifespan, and its pathophysiology is still poorly understood. Associate Professor Melanie Morin, Canadian researcher and Pelvic Floor Physiotherapist, recently presented an update on Provoked Vestibulodynia (PVD) at the International Continence Society 2018 in Philadelphia. Her fascinating...

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Case Study: Faecal Incontinence

Jill was referred by a Urologist to WMHP for management of Urgency Urinary Incontinence, but during subjective assessment disclosed that Faecal Incontinence was actually her most bothersome symptom. This case study highlights the absolutely devastating effect Faecal Incontinence can have on a person’s quality of life, and how a structured treatment program can cure this highly bothersome...

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International Continence Society 2018 - Key Highlights

Leonie Yeap, Clinical Manager at WMHP, and I were fortunate enough to travel to Philadelphia, USA to attend the 48th annual meeting of the International Continence Society held in August. The meeting, attended by around 1500 delegates from across the globe, is a forum for researchers, clinicians and students to explore the latest research on urinary and faecal incontinence and pelvic floor...

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Better Bowels With Rectal Balloon Biofeedback

Rectal balloon therapy is emerging as an exciting biofeedback tool to effectively treat a variety of benign anorectal disorders. Wald and co-authors recently published the American College of Gastroenterology Clinical Guideline: Management of Benign Anorectal Disorders1, and strongly recommended the use of biofeedback with rectal balloon therapy for treatment of defecatory disorders, chronic...

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Case Study: Post Prostatectomy Incontinence

Fred was referred to WMHP with significant incontinence after surgical treatment for prostate cancer. This case study is a fascinating example of the complexity and diverse etiological factors which can contribute to post-prostatectomy incontinence, and explores Fred’s journey on the road to recovery of continence.

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Prolapse: Treat Early For Best Results

Pelvic Organ Prolapse (POP) affects HALF of all parous women, however it is still surrounded by taboo. At the recent 26th National Conference on Incontinence, Professor Suzanne Hagen, Scottish Pelvic Floor research guru and international keynote, presented her soon-to-be-published Cochrane systematic review on conservative management of prolapse.

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Incontinence: Worse Than Death!

In a recent study, 55% of people considered having bladder and bowel incontinence to be 'worse than death'. Being incontinent was rated higher than 'relying on a breathing machine to live' (50%), 'being bed-bound' (45%), and 'being confused all the time' (40%). This result is staggering, and highlights the stigmatisation of incontinence. Professor Adrian Wagg, Canadian Geriatrician, shared this...

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Does Cranberry Work For Preventing UTI?

Urinary tract infections (UTIs) are incredibly common, affecting 1 in 2 women and 1 in 20 men in their lifetime. Twenty to thirty percent of women who contract a UTI will experience recurrence. A common treatment for recurrent UTIs is low dose antibiotic prophylaxis, however such treatment programs can lead to antibiotic resistance. The increase in antibiotic resistance has re-ignited interest...

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Highlights from the Post Prostatectomy Incontinence Masterclass

A Post Prostatectomy Incontinence Masterclass at the Asia-Pacific Prostate Cancer Conference 2017 was convened by Shan Morrison and Rachel Heerey. The masterclass brought together experts in urology, pelvic floor physiotherapy, nursing, and psychology. We were very lucky to have such an expert faculty presenting on the day, including surgeons Mr Daniel Moon, Mr Peter Sutherland and Mr Homi...

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Case Study: Increased Tension In The Pelvic Floor Muscles

Sonya was referred to WMHP for obstructed defecation and pain with bowel emptying. However, following a thorough biopsychosocial assessment, it emerged that Sonya’s main concern was dyspareunia. This case study explores the complex inter-relationships of bladder, bowel, and sexual function, and highlights the sequela of increased tension in the pelvic floor muscles (previously termed an “...

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CPPS: The ‘Black Hole’ Of Men’s Health

Chronic Pelvic Pain Syndrome (CPPS) is only recently being recognised as the “black hole” of men’s health. It’s not well understood by health professionals and has a huge impact on men’s physical, emotional and social health and wellbeing. A holistic management approach is needed to address the complex influences of psycho-social factors as well as the biological ones.

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Case Study: Provoked Vulvodynia

Provoked vulvodynia is one of the many chronic pelvic pain syndromes we see presenting in women. This complex and multifactorial condition has a significant impact on every aspect of the lives of these women who are often young. There is increasing evidence supporting a multi-disciplinary, biopsychosocial approach. This case study illustrates Physiotherapy best practice.

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Hot Off The Press: The ICI Book

The recently published and highly anticipated 6th edition of the ‘International Consultation on Incontinence’ book highlights the very strong evidence base supporting pelvic floor muscle training as an effective treatment for many bladder and bowel disorders. Pelvic floor muscle training is Grade A recommended treatment for female urinary incontinence and pelvic organ prolapse.

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10 Tips For Managing IC / PBS From Professor Curtis Nickel

Interstitial cystitis / painful bladder syndrome (IC/PBS) is a complex condition, and often difficult to treat. Professor Curtis Nickel, urologist and pelvic pain guru from Canada, was a key note speaker at the recent USANZ conference, and shared ‘10 Tips For Managing IC/PBS’. His overwhelming message, loud and clear, was that IC/PBS is a multi-factorial condition, and a multidisciplinary...

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Exciting New Resource For Nocturia Management

Dr Wendy Bower, physiotherapist and researcher at Royal Melbourne Hospital, is leading a research team in Australia, Europe and Asia, investigating nocturia, its multifactorial aetiology, and how to most effectively treat it. They have developed a new screening tool TANGO, which aids the user in targeting the aetiology of nocturia and guiding individualised treatment.

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The Importance Of Pain Science Education

Chronic pain is a huge health problem, and is expected to cost the western world as much as diabetes and cancer combined.  Dr David Butler and Professor Lorimer Moseley have pioneered the understanding and treatment of chronic pain internationally and, luckily for us, they live right here in Australia and work at the University of South Australia.  Their latest research tells us that...

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The Evolution Of Bladder Diaries

I recently received an email from a referring GP asking for a copy of our bladder diary. This request made me think about the importance of bladder diaries because patients are typically very poor historians regarding their bladder function. Often their subjective history will be quite different from what is actually happening!  Bladder diaries are an extremely useful diagnostic tool and...

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Patient Adherence: The Key To Success

Patient motivation and adherence is the most important predictor of treatment success.  The International Continence Society (ICS) acknowledges the importance of this and recently invited an expert panel to review the literature in this area and provide recommendations for research and clinical practice.

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When Patients Don't Listen

A 2010 Harvard Medical School study showed that about 20 percent of first-time prescriptions are never filled. This means that 1 in 5 patients don’t follow their doctor's recommendations. This was reinforced recently when we received some feedback from a patient who had been struggling with bladder symptoms for two years. She was seeing both a urologist and gynaecologist and had been referred to...

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A Small Muscle With Big Impact

When I first graduated from Physio I never imagined I would spend my career rehabilitating one small internal muscle and that it could be so interesting and rewarding! Pelvic floor disorders can impact social and physical activities, intimate relationships and workforce participation, leaving sufferers isolated, embarrassed and lacking confidence. Together we can help them.

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