Women have long drawn a short straw when it comes to health. There’s a medical gender bias that focuses on men’s experiences and medical research is done on a male body.
Women have long been told that various under-researched conditions, from endometriosis to chronic pain, are either in their heads or there’s nothing that can be done about it. They just have to put up with it. For example, it was long believed that leakage was something that just happened after you have a baby. In reality, it’s a musculature problem that can be fixed with the right exercises.
Pelvic health is one area that has long been dismissed, but a strong core and pelvic floor – they’re the same muscle group – can help women with a range of issues from ab separation and urinary incontinence postpregnancy to prolapse and sexual function. A strong pelvic floor is important because it’s the muscle that holds up organs including the bladder, bowel and uterus. It wraps around the urethra, bowel and vagina, playing a vital role in preventing incontinence and improving sexual function.
According to the Hudson Institute of Medical Research, pelvic organ prolapse is “the most common medical condition you’ve never spoken about”. It affects 40 per cent of women and costs the Australian healthcare system $200m annually. Women’s health physiotherapist and founder of the Women’s Health Project in St Leonards, Brigitte Egan, says that even though pelvic floor dysfunction is common, it’s a taboo topic. “A big percentage of my clients are pre- and postnatal women; a big cohort have pain with sex. The other is around menopause, they find things like incontinence and prolapse symptoms start to get worse because of hormonal changes,” Egan says. She points out that it affects their quality of life.
“If women leak when they cough, sneeze, laugh or run, it can hold them back from exercise, which has a flow-on effect on their health,” she says. “For women who experience pain with inserting tampons and speculum exams, it’s harder for them to have a pap smear. “If more women understand they can see a women’s health physio for this, we can assess them, put a plan in place and help with their issues. “The first place to start is pelvic floor exercises and training the muscles in the right way. Maintaining good bowel habits is important, because constipation is detrimental for the pelvic floor and women who strain have more urinary incontinence. A healthy BMI puts less downward force on the pelvic floor and if you have a chronic cough, see your GP, because that adds extra pressure and can weaken the pelvic floor over time.”
Core Restore director Heather Foord founded her clinic because she saw a need after her children were born. As a former health journalist, she was amazed that she wasn’t prepared for what happened to her body postpartum. “Where was this education? Why has no one mentioned it to me? Anything related to a woman’s anatomy and reproductive system has always been shrouded in mystery, shame and stigma,” Foord says. “We know that shame thrives in isolation and darkness so I’m passionate about pelvic floor health and normalising issues such as incontinence and sexual dysfunction. If you bring it out into the open, you’re starving that shame and women will be more likely to reach out for help.”
Foord wanted to create a space for education, intervention and treatment. She did a health science degree and opened her first Core Restore clinic in 2022 in the Sutherland Shire. There are now four clinics, the most recent opening in Bondi. To strengthen the pelvic floor, Core Restore uses the non-invasive Emsella. Patients sit on a chair that uses electromagnetic currents to induce 11,200 supramaximal contractions of the pelvic floor – the equivalent of more than 11,000 Kegel exercises. It’s a workout for your pelvic floor and a stronger pelvic floor leads to fewer prolapse symptoms, better urinary control and less sexual dysfunction. “The clinic’s growth shows there’s a demand for it. I think it comes down to that removal of shame around the topic,” Foord says. “I do think we’re almost on the cusp of a tidal wave of not only funding from government but more funding from research.
“Pelvic floor health should be taught in high school with sex ed. During pregnancy we need to have open conversations about the pelvic floor and how to protect it and more from the government in terms of better postpartum care covered by Medicare. “We should consider our vagina like we consider our breasts and skin. We need to start checking our vaginal canal for bulging or lumps which could be a sign of prolapse, so if anything changes we can tell.” Women in Focus Physiotherapy founder Lyz Evans is an APA titled women’s health and continence physiotherapist with a master’s in pelvic health.
She created the Empowered Motherhood Program (EMP) to reach the women who couldn’t access her Bondi Junction clinic. The online platform provides the same evidence-based information and guided exercises that Evans offers in her clinical practice, but to a much wider audience. It was inspired by her patient, and now EMP co-founder, Kimberley Smith. As a former professional athlete, Smith couldn’t believe the disparity between the amount of care she received after a sporting injury compared to the little information available around rebuilding a body postpartum. Smith is now a pregnancy and postnatal exercise specialist. She and Evans launched the EMP during Covid with 40 videos. It has grown to more than 400 videos and specialised programs. “We started filming in 2018, through our own pregnancies and postnatal journeys, to be relatable. We weren’t quite ready to launch but wanted to help women in lockdown and we’ve continued to build on the program,” Evans says. “I was so sick of hearing people come in and say, ‘I wish I had of known’. We have the research, we have to get it out to more women.” More than 5000 women have been through the program, increasing their awareness of pelvic health.
“The pelvic floor is the foundation of your health and fitness. If you don’t have a well-functioning core and floor, the ongoing impacts to the body are significant and it’s not until women are in the thick of it, experiencing symptoms, that they realise the impact,” Evans says. “A lot of it can be prevented with early intervention. We are trying to provide women with the education and knowledge to prevent issues happening through birth.
“The health system is based on a reactive model of care – we provide treatment when broken. We need to change that dial so women are accessing care in a preventative way. If they are educated, know what to expect and what they can do for it, they can take the steps to get treatment.” Foord, Egan and Evans all point out that pelvic health isn’t government funded. And it should be, because women are missing out on vital care that could prevent long-term issues.
“Over time, the impact on the pelvic floor that happens in pregnancy and birth runs much further than the postnatal period. Peri and menopause issues come through as well when hormone and muscle mass drops,” Evans says. “The more we can do to prevent issues, the better for women later on in life. The time period between having a baby and perimenopause is a critical time to focus on pelvic health and rebuild that muscle bulk because it’s more challenging after menopause. “One of the leading causes of falls and admissions to nursing homes is incontinence, women racing to the toilet fall or it’s too hard to manage at home. “The run-on effect of poor pelvic health support carries on well beyond the pregnancy and postnatal years, the more we can do earlier is setting us up for life in our 70s 80s and 90s.”
Originally published in the Wentworth Courier. Full text available at: https://wentworthtodayspaper.dailytelegraph.com.au/html5/reader/production/default.aspx?pubname=&pubid=ca1f42cb-4d5f-4b02-aeb1-1145fe49b60b
