What to expect when seeing a Continence Physiotherapist

Continence physios develop tailored programs that help rectify continence issues. To make the most of your first appointment, be prepared and know what to expect.

 

What is a Continence Physio?
A Continence Physio is a fully qualified physiotherapist who has done additional training to specialise in continence and women’s health. This requires further study of physical conditions that relate to the pelvis, bowel, bladder, reproductive organs, lower back and pelvic floor muscle.

The pelvic floor muscle plays a critical role in bowel and bladder control. It’s a sling of muscles that attach to the pubic bone at the front and tail bone at the back and is clenched to stop the passing of wind, urine or faeces. It also plays a role in supporting the pelvic organs.

Without exercise, the muscle can become weak over time. Other factors can also contribute, including pregnancy, childbirth, being overweight or having a chronic cough.

A Continence Physio can assess the pelvic floor’s level of function, any degree of pelvic organ prolapse and develop a program of exercises to meet your needs.
Do you need a doctor’s referral to see a Continence Physiotherapist?

It depends on the clinic or individual physio. While many prefer a referral, some will accept new clients without one. Although it’s not always essential, a referral from your GP may make you eligible for a Medicare or private health insurance rebate, so it’s worth enquiring.

Seeing your doctor first will rule out other common causes of incontinence, such as an infection (typically a UTI) or a side-effect of regular medication.

They’ll also be able to check for less common, but more serious causes like bladder cancer.

The doctor will be able to assess if the issue is physical, and therefore suitable to be treated by a physiotherapist

So, although you may not always need a referral to see a continence physio, there are many good reasons why you should see your doctor first.

 

Preparing for your appointment
Once you’ve made an appointment, some physiotherapists will send out an information pack which might also contain a questionnaire to be completed and returned in advance. This is to provide them with necessary background information as well as to prompt them to ask more about particular issues.

If this information isn’t requested in advance, you will be asked similar questions and the answers noted during your initial appointment.

It’s often hard to recall the specifics of symptoms when we’re put on the spot. That’s why some physios will also request that you keep a bladder diary for two or three consecutive days in the lead up to your appointment. This is a record across the day of:

 

 

 

You can read more about keeping a bladder diary here, including a couple of helpful templates. 

Even if you’ve not been asked to keep a diary before your appointment, doing so will ensure the information you provide is accurate.

 

Other questions to expect
Although this list isn’t exhaustive, as the saying goes, forewarned is forearmed. Knowing what type of questions you could be asked will give you time to think about your answer. For some questions, there’s also a brief explanation of why it’s relevant to incontinence.

• How long have you been experiencing symptoms?
• Do you think your incontinence is getting better, worse or has stayed about the same?
• Have you tried anything to remedy your incontinence? Has anything you’ve attempted helped?
• Have you been pregnant? Did you carry to full terms and what kind of birth did you have? Did you have a long or short labour? How big was your baby? Did you have an episiotomy? How was your recovery? The same questions will be asked for subsequent pregnancies
• Do you have any difficulty or pain during sex? (This can a sign of a prolapse – when one or more pelvic organs have dropped out of place. You can read about the symptoms and treatments for vaginal prolapse here)
• Have you had any treatment for a prolapse? Do you have a heavy or dragging sensation in your vagina? Have you noticed any bulging inside your vagina or rectum? (These are symptoms of prolapse.)
• Have you had any pelvic surgery?
• Do you suffer from persistent constipation? (This question is important because straining on the toilet puts excessive pressure on the pelvic floor and can contribute to its weakening)
• Do you smoke? (Like constipation, a chronic cough applies repeated pressure the pelvic floor muscle)
• Your height and weight. (This can be used to calculate your BMI as carrying excess weight can weaken the pelvic floor)
• Your usual physical activity. (The jarring of high impact sports like running, tennis and netball can have a detrimental effect on your pelvic floor’s strength. Similarly, too little activity can contribute to constipation and weight gain.)
• What you do for work and leisure and how your incontinence is impacting your life?

What to expect at your first appointment
Your initial appointment will probably be an hour-long, with subsequent ones being 30 – 45 minutes. In addition to gathering background information, a physical examination is likely.

The physio will check the skin around the genital area for any signs of irritation, damage and infection. They’ll also ask you to squeeze your pelvic floor muscle to observe the external signs of strength and effectiveness. (You can do this by imagining you’re trying not to pass wind, urine or faeces.)

They will also insert a lubricated, gloved finger into the vagina and ask you to squeeze and relax your pelvic floor to determine how strong or weak it is. If you’re suffering from faecal incontinence, the same examination may be performed in the anus.

Some physios use ultrasound on the lower abdomen or perineum (the area between the vagina and anus) to get a clearer image of what’s happening when you clench and release the pelvic floor.

Your standing posture, gait (the way you walk) and usually sitting position might also be evaluated.

 

 

 

 

The thought of this type of intimate questioning and examination can make some people feel very uncomfortable – even putting some off seeking the help they need. However, like many things in life, the reality isn’t nearly as bad as you might imagine.

Keep in mind that this is what Continence Physios do every day and that they have gone through this process with scores of people before you. They’re incredibly professional, understanding and very good at making people feel at ease.

While some aspects may feel confronting, such as asking about your weight or sex life, there is no judgement, so answer honestly. And the physical examination is really no different from seeing the gynaecologist.

Continence Physios will not make you feel inadequate or ashamed - their sole goal is to determine how to improve your bladder and bowel control.

 

Prepare your questions
Meeting with a Continence Physiotherapist is also your opportunity to ask questions. It’s easy to forget what you wanted to know, so write down your questions as you think of them and take the notes to your appointment.

Here are a few ideas to get you started:

• How has my pelvic floor become weak?
• In addition to exercises, what lifestyle changes could improve my continence?
• How long will it be before I notice an improvement?
• Can my incontinence be completely fixed?
• What other treatments are available and what are the benefits and risks of each?
• I’m concerned my incontinence is interfering with intimacy – is something you can advise me about?
• How can I manage while the treatment or exercises are taking effect?

You can read more on overcoming embarrassment and preparation in this article: Questions for the Doctor

 

Managing Incontinence
Ask your Continence Physio about managing leaks so you can confidently get on with everyday life. Most will recommend purpose-made liners, pads or pants.

Unlike period pads, TENA products have been made to handle the thin, fast flow of urine, locking it away to keep the skin’s surface dry and preventing odours from developing. They’re all soft, breathable, comfortable and discreet under everyday clothing.

For small leaks, TENA Liners are ideal for everyday use. If you need more absorbency, there’s an extensive range of TENA Pads from ultra-thins through to TENA Maxi Night that give you the confidence to sleep through the night.

If you have a special occasion or are travelling, TENA Pants look and feel like regular underwear, but with the security of high absorbency.

Finding the right product to suit your needs is essential in managing. Try TENA’s Product Finder Tool. This online program steps you through a short series of questions, then suggests products that may be suitable. You can even order free samples. If they don’t turn out to be just right, jump back online and try some others.

 

 

Sources:
https://www.laughwithoutleaking.com.au/blogs/news/pelvic-health-continence-physio
https://jeanhailes.org.au/news/what-happens-when-you-see-a-pelvic-floor-physiotherapist-or-endocrinologist
https://www.apexphysio.com.au/womens-health-continence-physiotherapist

 

Asaleo Care makes no warranties or representations regarding the completeness or accuracy of the information. This information should be used only as a guide and should not be relied upon as a substitute for professional, medical or other health professional advice.