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Abstract painting of a womans hips in blue and floral Dreamstime
Health and beauty
March 2023
Reading time 4 Minutes

Here's everything you need to know about your pelvic floor

When it comes to pelvic floor physiotherapy, I suspect I am not in the minority when I say I had never heard of it. I've had physiotherapy to cure a frozen shoulder and to ease sciatica but I was, until recently, clueless about physiotherapy for your pelvic floor.

I admit this to Roseanna Grace, a Clinical Specialist Pelvic Floor Physiotherapist, when I meet her at her clinic on Holly Avenue in Jesmond. She doesn’t seem surprised. ‘Even at university, where I studied physio, we were supposed to be experts on every muscle; we were supposed to know all the thirty-odd muscles in your hand; all the origins, all the attachments, and know their function. Not one lecture on anything in the pelvic floor! It’s the same at medical school. It remains a taboo, and this is why you hear patients say, “I saw the GP, but I was a bit dismissed”.’

It was this lack of information that initially put Roseanna off the idea of ever specialising in the pelvic floor. ‘I think we all go in wanting to be sports physios, and when you’re allocated your special placement, women’s health just isn’t top of the list because we have no theory or understanding of the caseload,’ she laughs. She hoped her work placement would be in sport physio, and if not, in one of the more common neuro-children’s placements, burns and plastics or physio for learning difficulties. When offered pelvic floor, she begged to not do it. ‘I really didn’t want to do it, but luckily I ended up loving it,’ she says.

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Roseanna loved it because she was immediately able to see the difference she was making to people’s, predominantly women’s, lives. She explains that typically a physio will have a situation where a patient keeps returning with the same issue as they aren’t completing the exercises they’ve been given to remedy the problem. This is not the case with the patients she treats in pelvic health.

‘You are meeting women whose quality of life is affected, whether that is their mood, periods, stress incontinence, prolapse or painful sex. And, naturally, they are very receptive, they do what they need to do because they don’t want to have these problems. I could see I was making a difference and I loved that.’

Roseanna Grace

Once Roseanna had finished her training she was stuck in a catch 22 situation as regionally there were very few jobs, and as a recent graduate she needed experience to apply for a job – but in order to get experience she needed to be in a job. Ultimately, she decided to invest in herself and her future and complete several courses in London at her own expense. ‘That’s why people just don’t do it,’ she says. ‘You have to put so much money into extra courses, because you haven’t been taught it as an undergraduate.’ You also need the expert support and guidance of an experienced and dedicated NHS team around you to cement that learning. Without such support, which Roseanna was lucky to receive early in her career, her knowledge base and approach would not be what it is now.

Lucky for the North East that she did take it upon herself to specialise, as the statistics are rather concerning. Gateshead has one, hospital-based, pelvic floor physio who works part-time. North Tees and Hartlepool have never had a pelvic floor physio, which may arguably contribute towards gynaecological surgeries which could be avoided. Durham Hospital has two part time NHS pelvic floor physios. Newcastle, which has a bigger centre, has five part time pelvic floor physios. As I’m listening to these statistics with my eyes widening, Roseanna nods in agreement. ‘That’s why these problems get worse and worse, because the referral waits are massive.’

So now I know why I’ve never heard of pelvic floor physiotherapy, and I’m becoming outraged that my ignorance is linked to the fact that ‘women’s issues’ are still seen as taboo. These issues are as wide ranging as painful sex, pelvic girdle pains, heavy periods, prolapse, incontinence, bladder urgency, bladder frequency, IBS, faecal incontinence and constipation.

It seems fortuitous, therefore, that Roseanna has set up not one but two clinics, but I wonder what inspired her to do so and how she had the confidence, especially at such a young age, to make the leap. ‘Good question!’ Roseanna immediately responds. ‘I’m not a business person. I don’t think any healthcare professional ethically gets into it for that as there’s not that much money in healthcare.’ She goes on to explain that ultimately it was a negative experience within one of her NHS posts where, she feels, her passion and enthusiasm were misinterpreted as overstepping, that led to her decision to set up her own practice.

With ties to the region (her mother is from Chester-le-Street, Roseanna studied at Northumbria University and her other half is from Sunderland) she decided to set up her first clinic on Clayton Road in Jesmond.

An initial consultation ranges from £65 to £89 depending on which physiotherapist you see (Roseanna has trained two physiotherapists who also work with her at both sites). This is then followed six to eight weeks later by a follow-up consultation. I appreciate we are facing a cost-of-living crisis, and I would never wish to suggest that £65 is nothing, but were we to reflect, some of us would have to admit to paying that amount regularly to get our hair done or for a special night out.

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An initial one hour and 15-minute full screening consultation would, regardless of the issue, include pelvic floor, bladder, bowel, gynae, sexual function, diet and menopause. As Roseanna points out, some of these areas may not seem to be an issue currently but need to be included in order to identify any risk factors or elements which could be contributing to symptom presentation (for example, constipation can be a big cause of bladder leakage).

The first 30–40 minutes would include gathering information to help guide an assessment and then conclude with a highly recommended but optional examination to assess your pelvic floor. The rest of the appointment would look to educate and inform the patient and to jointly set goals: whether that be dietary changes, increasing fibre intake, seeking to lessen stress levels or even the amount of caffeine consumed each day and a personalised and individualised exercise plan.

‘It is also worth considering that we would think nothing of having a regular check-up at the dentist to prevent future problems. It would be sensible, surely, to do the same with our pelvic floor health’

It is also worth considering that we would think nothing of having a regular check-up at the dentist to prevent future problems. It would be sensible, surely, to do the same with our pelvic floor health. Roseanna agrees that it makes sense to have a check-up pre-pregnancy and pre-gynae surgery to strengthen everything and help with post-op recovery. She also recommends having a check-up approaching menopause, and before any changes in workout routines – be that skipping, weight training or trying HIIT exercises for the first time. As anyone who went from couch potato to full Joe Wicks during lockdown knows, such exertion can have quite unpleasant repercussions!

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And let’s face it, as women we are often great at looking after everyone else in our lives, sometimes at the expense of looking after ourselves. Added to this, the fact that so many women’s issues still remain taboo, and with the lack of funding and resources in this area, there is little wonder that serious health issues can go overlooked or ignored for years.

If you have read to the end of this article, please hear my call to arms. If you have a concern about your pelvic health, please speak up. If you feel you are not being heard, if you can, please self-fund your treatment. If you feel you are being fobbed off with – ‘it’s probably thrush’; ‘your only choice is a hysterectomy’; ‘there’s nothing to be done’, please seek another opinion. Seek Roseanna Grace’s opinion. Then, share your story with a woman who may benefit from the breaking of some taboos. Thank you.
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