Women’s health is in major need of disruption. For too long women have suffered alone and in silence. Pelvic floor issues are normalised “because you’ve given birth, so what do you expect?” It’s time to break the taboos surrounding pelvic health so that we can enable women to access the high-quality healthcare that they deserve.
Pelvic issues like incontinence, prolapse, period pain and painful sex are common but they are not normal. Just because a woman menstruates does not mean that period pain is normal. Period pain could be a sign of endometriosis, which affects 10% of women, and has a ridiculously delayed diagnosis of seven to 10 years, leading to chronic pain and infertility.
If a woman is sexually active, it is not normal for her to have pain during intercourse. If a woman is pregnant, it does not mean that her back pain is normal. If a woman has given birth, it is not normal for her to have bladder leakage or pelvic organ prolapse. It’s high time we change the language dominating in women’s health.
When we tell a woman that her suffering is normal, we take away her right to receive treatment for her pain. We have a collective responsibility to give the woman the best possible chance to recover and live a healthier, pain-free life.
Pelvic organ prolapse and incontinence affects one in three women, which makes these issues common. What is normal is that two-thirds of women are not affected. Period pain is common and affects one in five girls and women. What is normal is the 80% of women who have pain-free periods. The sooner we reform this culture, the better access women will have to effective solutions.
When it comes to gynaecological issues, apart from doing nothing, the go-to treatment is typically surgery. Evidence-based alternatives such as pelvic floor physiotherapy are rarely provided. If a person was to have a shoulder surgery, they would be prescribed physiotherapy pre- and post-surgery yet pelvic floor issues are rarely afforded adjunct treatment options.
Pelvic physiotherapy is effective in managing pelvic organ prolapse, painful sex, back pain, endometriosis, and a number of women’s health issues. Research by the Australian Physiotherapy Association shows an 84% success rate in the treatment of incontinence. Unfortunately women continue to suffer, with incontinence in women being the largest factor for admittance into nursing homes.
Often women come out of endometriosis surgeries with the same amount of pain, and sometimes more pain. Prolapse surgeries have high recurrence rates, and some women are still incontinent after incontinence surgeries. The common thread is that women were not provided crucial pelvic floor education and rehabilitation.
These surgeries can also have debilitating side effects for women, as demonstrated by the recent vaginal mesh implants scandal. If these women had received physiotherapy before surgery, or better yet, immediately postpartum, many of them could have avoided surgery altogether. Importantly, women who have developed mesh complications may also benefit from pelvic floor physiotherapy.
Surgeries only provide one piece of the puzzle, with the pelvic floor component often overlooked. In women with conditions like endometriosis and vaginismus, the pelvic floor muscles become tight and unable to relax. Unless these muscles are released by a physiotherapist, a woman may continue to experience pain. In women with prolapse and incontinence, the pelvic floor muscles need to be strengthened, preferably before surgery is even recommended.
The World Health Organisation has outlined that there is a global maternal health crisis. In response, a working group of women’s health physiotherapists from four nations was set up with the aim of reducing the physical, psychological and social impact of pregnancy and birth-related injuries. We propose a proactive model to revolutionise postpartum care, similar to a successful model currently available to new mothers in France.
We believe that every woman has the right to receive a women’s health physiotherapy assessment at 20 weeks pregnant and at eight weeks postpartum. This allows for pelvic floor problems to be diagnosed early, for women to receive appropriate preventative advice, and for women to receive early access to evidence-based non-surgical solutions.
In March I conducted a poll surveying 800 women where I asked them if they would like to know about their individual risk factors for birth-related pelvic floor problems. 85% of women indicated they wanted to be informed before birth and only 2% indicated that being informed would scare them.
This poll clearly demonstrated that our failure to educate women prenatally of birth-related pelvic floor injury systematically strips them of their autonomy. This is further confirmed by the statement I hear most commonly by my clients: “Why didn’t anyone tell me this could happen?” Education is key to progress, especially in healthcare, and a woman has the right to be informed, so that she can prepare for her future.
- Heba Shaheed is a physiotherapist and women’s health advocate
