An urgent (bladder) matter

Do you have a problem with your bladder and feel you need to speak to someone about it? To talk about bladder issues is a big deal for many people because it feels very private. But, did you know that 1 in 3 women in Australia have a bladder control problem? Yes, it really is THAT common. This month’s blog aims to release the fear of speaking out about a condition known as bladder urgency, and to show you that help is at hand.

woman with bladder urgency

What is bladder urgency?

Bladder urgency is a sudden, desperate and uncomfortable need to empty your bladder. Imagine walking down the street doing your weekly window shopping and instantly feeling like you have to wee. At this point it’s a frantic scramble to try and find the nearest toilet to avoid having an accident there and then. The feeling can be described as a “busting need to go to the toilet”. This can occur several times a day, and if it does, this need to urinate over and over is known as frequency.

Types of bladder urgency

There are two types of bladder urgency:

  • Dry urgency: You have the sudden urge to urinate and are able to reach the toilet without leaking any urine
  • Wet urgency: You have the sudden urge to urinate and leak urine on the way to, or as you reach the toilet

Dry urgency will commonly go undiagnosed because women who experience it think it is their normal bladder habit, and do not seek the help of a professional. It is those women who have accidents before reaching the toilet (a distressing and often embarrassing experience) who tend to speak up and ask for help.

Causes of bladder urgency

There are many causes of bladder urgency, including:

  • An overactive bladder that contracts when it should not
  • Overactive, weak, or damaged pelvic floor muscles
  • An overly sensitive nervous system (triggered by stress, anxiety, poor sleep and even winter chills)
  • Constipation
  • Low oestrogen levels (commonly associated with breast feeding and menopause)
  • Poor toileting habits
  • Trained family habits extending through generations

A common picture we see in clinic is that of someone experiencing urgency due to an over-sensitive nervous system. A normal bladder can store anywhere between 500-700mls of urine before the brain tells you to go for a wee. In a normal setting, this occurs without the sudden, urgent feeling. With an over-sensitive nervous system, only small amounts of urine collected stimulate nerve endings in the bladder wall, sending messages to the brain to tell the woman to find a toilet… and quick. The bladder (said to be overactive) is unable to fill to its normal levels, and many people will start to develop a pattern of lots of toilet visits, combined with only eliminating small amounts of wee each time. Unfortunately for many women, this can run through the day and night, leading to disturbed sleep patterns, which increases stress and anxiety levels.

Now throw COVID-19 into the equation. The current pandemic is creating a lot of added stress and anxiety for many of us. Here at Physiotherapy for Women, our therapists have noticed a marked increase in cases of bladder urgency presenting to the clinic over the last four months. The pandemic has forced many of us to work from home, providing the convenience of a comfortable toilet nearby whenever needed, leading to poor bladder habits. As you can see, there are many factors at play here with lots to consider for the therapist and patient when implementing treatment.

Treatment

Assessment and treatment of every woman’s bladder issue requires a Physiotherapist who has completed the required post-graduate training in women’s health. The aim is to help each woman develop her own skills in reducing the bladder urge, frequency of urination, and any leakage she may experience. Everyone’s circumstances are different and requires a unique approach for the individual. We have treated many women with bladder control conditions, meaning we know how to work with you to find out what works for you.

Treatment techniques may include:

  • Release of overactive pelvic floor muscles
  • Strengthening and re-training of weak or damaged pelvic floor muscles
  • Stress management
  • Advice on training your bladder habits

Do not let your bladder be the boss of your life. We encourage you to speak up now and side-step the negativity surrounding bladder problems. Call us on 08 8443 3355 to get help from our experienced, highly trained Physiotherapists.

Core topic: The thorax

Hello ladies and welcome to another installment of our health blog. This month we are focusing on the trunk, specifically the mid-back region of the trunk known as the ‘thorax’. This is one of the most commonly treated areas of the body in our clinic. It is central to many disorders we see on a daily basis, including neck, shoulder and low back complaints.

Anatomy

The trunk or ‘torso’ is the central core of the human body, out of which comes our arms, legs and neck. The torso can be broken down into three parts: the thorax, the abdomen and the pelvic bowl. The thorax, being the top part of the torso, is separated from the abdomen (the lower part) by a big muscle known as the diaphragm. Above the diaphragm sits the lungs and heart which are surrounded by our protective rib cage. The rib cage is made up of 12 pairs of ribs that (for the most part) attach at the back to the ‘thoracic’  vertebrae in the spine, and at the front to our chest bone (aka the ‘sternum’). It is an intricate part of the body which is made up of lots of joints, ligaments and muscles that all function together to allow us to move and breathe efficiently.

An analogy

woman being massaged helping her thorax and mid-back pain

The thorax, being a large part of our core, plays a pivotal role in the transfer of loads or forces that act on the body when we move. Our body is a unit, so it makes sense that a problem in one area can affect another area distant from that part. The mid-back has close connections to the neck, shoulder, low back and pelvis. If we have pain or are not moving well in the mid-back, then this can lead to problems in all the other areas (and vice versa). We liken the thorax to a train station. The trains coming into the thorax are the various loads or forces that are transferring from other parts of the body. Choo-choo!

A good example here would be if the muscles that span and stabilise the thorax are too tight, too weak, or simply activate at the wrong time in an attempt to handle one of the trains (forces) transferring through the region, the station becomes loud (ouch!) and over-excited. What results is pain and poor movement patterns.

A stiff rib or spinal joint may be able to cope with the loads temporarily, but eventually derailment occurs, and chaos ensues. The same can be said for joints at the other end of the spectrum. An overly flexible joint will struggle to deal with load just as much as an overly stiff joint does. Again, poor movement and pain occur.

The emotion of it all

Treating a person in pain is a complex thing. Yes we have to take into account how someone is moving and what they do daily to increase load on their body, but there is commonly an underlying emotional aspect to a person’s pain that we also need to break into with our treatment. Many women we treat do not realise the effect that stress has on their bodies. Pent up energy from everyday life stresses and difficult work and social aspects, gets stored and held in the thorax region of the body. Common areas we treat here include the tops of the shoulders, ribs and diaphragm. Muscles become tight, joints become stiff, and unless we can help to restore balance to this busy area of the body, the cycle continues with poor movement and painful episodes. When the trains aren’t running on time, it can get a bit much!

Problems in this region can also lead to poor breathing mechanics which can lead to a variety of issues including lack of energy, fatigue, and poor muscle function. A release of the diaphragm muscle under the rib cage can be helpful in releasing the tension and emotion held within us.

Treatment

Every woman we see in clinic requires a specific treatment plan, based on their presentation and needs. Pregnant, young, old, active or sedentary… We listen carefully to every woman who comes through our door before carrying out a thorough examination. Our findings will then help formulate a unique treatment plan which we discuss with each patient in depth before commencing treatment.

For complaints in the thorax, whether it be an angry over-worked muscle, a stiff spinal joint, or a sprained rib joint, we use a combination of:

  • Hands-on techniques to relieve tight muscles and stiff joints
  • Exercise prescription to increase strength and flexibility, and improve movement patterns
  • Postural advice / exercises
  • Stress management techniques to increase a patient’s awareness of their emotional state

Next steps

If you are struggling with mid-back, rib or pain elsewhere in the thorax, please call us today on 08 8443 3355. We’ll focus the spotlight on your busy train station and get things running smoothly and on time in no time at all.

Injury blog: Gluteal tendinopathy

Do you have pain on the outside of your hip area? If so, this blog will be worth a read. This month we are looking at a common issue we see in clinic involving a group of muscles known as the gluteal muscles. These muscles are prone to developing sore tender spots in them, but we are going to focus more on the tendons of these muscles… Specifically on an injury known as ‘tendinopathy’.

Your glute anatomy

The gluteal muscles are found in the hip and buttock region of the body and consist of three muscles altogether. These are:

  • Gluteus Maximus: A large buttock muscle which helps to move the hip backwards and rotate it outwards.
  • Gluteus Medius: A fan-shaped muscle found on the side of the hip between the pelvis and the hard bony ball you can feel a short way down your upper leg on the outside. This muscle helps to move the hip out sideways, as well as rotate the hip and stabilise the pelvis when we walk or run.
  • Gluteus Minimus: Another fan shaped muscle which sits deep to the gluteus medius muscle and performs a similar role.

The tendons of the gluteus medius and minimus muscles, where they attach into the thighbone, are commonly exposed to high amounts of compression and loading, which over time leave them open to injury. We will be talking about the medius and minimus muscles here.

What is tendinopathy?

Tendinopathy is the name we give to an injured tendon, whereby the tendon has undergone physical change, due to excessive loads acting on them when we move incorrectly over a long period of time. An example involving the gluteal muscles is where imbalances in the relationship between the pelvis and thighbone (i.e. from weakness of the gluteal muscles) result in the hip moving in an abnormal and inefficient way. Over time this places excessive strain on the gluteal tendons as the hip moves when we walk or run.

Initially the tendons and other tissues around them respond by becoming thicker, due to chemical changes that are occurring inside the tendon. A thicker tendon is able to cope more with the compression it is under, but there is a downside. During the thickening process, the tendon fibres also become disorganised or deranged, leaving the tendon less able to cope with the force a muscle exerts on it when it contracts or ‘pulls’ on it. As the process continues the tendon becomes more and more degenerated and eventually the tendon is no longer able to adapt to the excessive forces acting on it and a tear can occur. A tear can be the result of an untreated tendinopathy.

Who does it affect?

In the active population, gluteal tendinopathy is commonly seen in athletes, like runners. It is also commonly seen in people who are inactive where the effect of de-conditioning leads to weakness and changes in the way we move. So, you are not safe from this injury even if you don’t regularly exert yourself!

Signs and symptoms

The main symptom is pain on the outside of the hip that comes on without any real obvious ‘injury’ or event. This pain then worsens over time and is usually brought on by weight bearing activities like walking, running and climbing stairs. As with many tendon injuries, you may feel pain at the beginning of an activity, with a lessening of pain as the activity progresses, and then a worsening of pain again after you finish. A common symptom of gluteal tendinopathy is pain experienced at nighttime when lying on the injured side. You may also feel pain that radiates down the thigh to the knee.

Treatment

The good news is if you seek treatment early in the injury process, you can avoid long term complications like tears, which are notoriously much harder to treat. Our advice to you is come and see us as soon as possible after you start to feel pain.

We are extremely well versed in treating gluteal tendon injuries and can get to work immediately. There is a good chance weakness in your gluteal muscles will have been a factor in the development of the injury, as well as a disengagement of the way the trunk, pelvis and legs act together as a unit. Strengthening exercises which focus on building muscle mass, as well as specific exercises to gradually re-load and strengthen the tendon to its full capacity will be key to your recovery. We will also have to re-train your movement patterns to ensure any abnormal movements are corrected. That way we can be sure when you return to your full training schedule, or whatever activity you want, we won’t be seeing you back for the same problem two months down the line.

We may use any number of treatment techniques to help you back to full fitness. These may include massage, joint mobilisation, dry needling and shockwave therapy. So, if you have hip pain, come and see us today – we can help.

Wrist and thumb pain after pregnancy?

young mother holding newborn babyIt has been a long journey and you’ve been through a lot over the last 10 months. You’re already exhausted and you’ve only just started your life with a new addition to the family. Life doesn’t get much busier than this, right?! How frustrating then that you’re having to battle through this new period with a sore wrist and thumb. If it’s any consolation, you’re not alone. One study from 2017 reported over 50% of women experienced wrist pain following delivery of their baby, and over 80% of those still had pain two months on. Read on to find out why.

The most common cause of wrist and thumb pain after pregnancy is a condition called De Quervain’s Tenosynovitis. That’s a bit of a mouthful so let us explain simply. There are a few different tendons which run from muscles in the forearm along the thumb side of the wrist, which act to move the thumb away from the hand when the palm is held out flat. The tendons are covered in a thin ‘sheath’ of tissue which provides important lubrication to allow for smooth movement. On their journey from the forearm, the tendons and their sheaths have to pass through a little tunnel, made up of bone and soft tissue. In De Quervain’s, the tendons and/or sheaths become thickened and this leads to problems with movement through the tunnel.

It is thought that new mums are at higher risk of developing this condition due to the repetitive nature of lifting and holding their baby. These movements put the hand, thumb and wrist into a compromised position and increases strain through those tissues. It has also been suggested that increased fluid retention and hormonal changes following pregnancy could also be involved in the development of this condition.

Another common cause of wrist and hand pain following pregnancy is Carpal Tunnel Syndrome. This condition involves the pinching of a nerve as it passes through the wrist. This is different from De Quervain’s in that a patient will experience pins and needles and/or numbness in the hand as well as wrist pain—a blog topic for another month!

Signs and symptoms

If you develop this condition you can expect the following:

  • Pain and/or swelling around the base of the thumb, and thumb side of the wrist
  • Pain increased by thumb and wrist movements
  • Pain associated with gripping, lifting and twisting objects
  • Popping/clicking with wrist movements (in severe cases)

If you are reading this and alarm bells are already ringing, then you may want to consider giving us a call to book an appointment. We can help you with this problem so read on to see what treatment we offer.

Treatment

As this is a busy time of your life, our aim will be to get you out of pain and functioning as soon as possible. After all, you have a little one to prioritise now and it’s not like you can just stop parenting to allow your body to heal. Fortunately, you don’t have to. Our treatment for De Quervain’s may include any or all of the below options:

  • Rest and splinting: In the initial stages, you may need to alter how much you do with your wrist and thumb. Getting some extra help around the house from friends and family may help to take the load off. Using feeding pillows to support the baby during meal times is another way to reduce your ‘holding’ time. Wearing a splint or brace can help to reduce aggravating movements in key areas of the wrist whilst still allowing you to move and perform your everyday We may fit you with one of these if we think it is necessary.
  • Massage and joint mobilisation: To release tight muscles and restore range of motion to the hand, wrist and forearm joints.
  • Taping: To support the wrist or aid with drainage of the wrist area back up the limb towards the heart.
  • Stretching: To combat any tightness of the hand and forearm muscles. You’ll also need to do some of these at home.
  • Graded strengthening exercises: Evidence is pointing more towards gradual loading exercises to rehabilitate the tendon and restore full movement and strength to the tissues.

Other treatment options include therapeutic ultrasound and corticosteroid injections for pain relief. For severe or persistent cases that don’t respond to a more conservative approach, a surgical opinion may be required. We will always work hard to ensure you don’t reach that point because the recovery is always longer and it means a time period where your function will be much reduced, which is always difficult when you have a little one.

Our advice to you is to not let it get to that in the first place. No matter how trivial you think it is, if you start to feel pain in your wrist in the early days of motherhood, please get in touch with us here at Physiotherapy for Women. We can put all of the above in place straight away to avoid your pain getting out of control. That means more time for you and your baby. What could be more important at this time?

See you next month!

How important are you to yourself?

Hello readers! We trust everyone had a superb festive season. Now that the fun and frolics are over for another year, it’s back to the routine of everyday life… This may mean many of life’s stresses that disappeared temporarily during the Christmas carnage will rear their head again. This can be a bit of a shock to the system and before you know it, you’re immersed in work, family, keeping your home clean and slaving over the hob. But what about you? Where do YOU fit in to all of this? It’s easy to get caught up in life and forget about number one. Here at Physiotherapy for Women, we always ask the question ‘How important are you to yourself?’. Let’s discuss why this is important and what you can do to ensure you make 2020 more about you.

note with positive care messageSelf-care is a vital part of life. We know it’s a bit of a cliché, but if you don’t look after yourself first, how can you look after others, or work, or do anything? You’d be surprised how little time many of our patients spend looking after themselves. It often takes being in pain for someone to realise that something has to give, and change is needed. It’s also regularly the case that someone is stressed, exhausted and moving poorly (and not enough too!), which all play a role in why they have pain. And this is where we ask the questions about self-awareness and attitudes towards themselves.

Let’s give you an example… A working mum comes to us for help with neck and shoulder pain. She has two children, one at school, one at daycare, and her and her partner work a job each. The week is full of running around organising the kid’s drop-offs and pick-ups, working, cooking, cleaning and washing. Weekends are full of kids sports and visiting relatives. Sound familiar? Where is the time for anything else? For many it’s a source of stress in itself. Being time poor is a huge factor in why people fail to look after themselves and end up in pain (and stay there). For this working mum, her pain is now affecting her ability to ‘do’ life. The really hard thing is, something has to give if the cycle is to be broken and for her pain to become a thing of the past. She needs to prioritise self-care and learn that it is OK to spend time on herself. It is pivotal that she does, so she can get back on track ‘doing’ life.

As her physiotherapist, our primary goal is to get her out of pain. Our second goal is to keep her out of pain. And this is where advice on lifestyle, exercise and moving well (and often) comes into play. One of the hardest jobs we have as a physio is educating people on how to change their lives, so they can work towards preventing injury rather than waiting for it to happen and then seeking help. In the case of the working mum, it involves helping her change her attitude towards self-care to ensure she is running at 100%, so she can give everything she needs to her family and work. Some of the topics we might discuss with her and suggest changes to may include:

  • Exercise — a must for all humans. Our important bodily functions rely on us moving regularly. Try taking a walk in the evening once the kids are in bed (get your partner/family member/friend to watch over them). It will allow you to unwind from the days’ events whilst giving your body some valuable movement. Alternatively, reserve one evening in the week or weekend to attend a yoga or pilates class. Or think about what you can do at home (incidental exercise while doing mundane tasks, or a nightly 20 minutes of exercise in the lounge room or on the deck!)
  • Diet — a sticking point for time-poor people, but eating a diet rich in fruits, vegetables and other nutritious foods will keep your energy levels pumping and ready for everything. Diets high in fast or nutrient poor food will leave you sluggish and tired. Try packing your own healthy lunch and snacks, when you pack your child’s lunchbox!
  • Meditation or mindfulness — a great way to have you time. It only requires 10-15 minutes a day and is a fantastic way to unwind and clear the mind. It takes practice but can be very beneficial to easing stress. We can advise on where to get started.
  • Keep a gratitude diary — every morning when you wake up, immediately write down 5 things you are grateful for. While you can pop it in the ‘notes’ section on your phone, try opting for a pad and paper on your bedside table. It helps give you focus on what’s important to you. This is great motivation for keeping yourself healthy, happy and grateful.

There are many other areas we may discuss with you. We won’t pretend it’s easy to make these changes, but we are here to help guide you through all of it one bit at a time. Our main message here is that whilst we appreciate you have many responsibilities and important things in your life, we would like you to make YOU a high priority. Yes, this is us telling you to read that book, take that bath and take up that hobby you’ve always wanted to! Be important to yourself and make 2020 a year for self-care.