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-  WOMENS HEALTH  -

 

ABSOLUTE PHYSIO has a special interest in Womens Health.

We all want to be in good health and achieving this is a challenge enough. Add to this the complexity of the female form and it is a rollercoaster journey to achieving a balance and  equilibrium. Fortunately, Womens Health Medicine is one of the most rapidly advancing areas and today we have more answers and explanations.  And most importantly we have treatment choices rather than the former acceptance of just living with it.


Menstrual Problems 
Menorrhagia (heavy periods)
Dysmenorrhoea (painful periods)
Abnormal uterine bleeding       
Oligomenorrhoea (irregular or infrequent periods)
Amenorrhoea (absent periods)        
PMS (premenstrual syndrome)
Headaches and migraines
Menopause
Hot Flushes  
Sleep disturbances   
Urinary incontinence   
Cystitis  
Dizziness and palpitations   
Headaches   
Fatigue  
Mood changes
Infertility
Unexplained Primary or Secondary  
Irregular ovulation  
High FSH  
Luteal Phase Defect
Assistance during IVF, GIFT etc  
Male infertility
Gynaecological Problems
PCOS (polycystic ovarian syndrome)
Endometriosis
PID (pelvic inflammatory disorder)
Thrush infections and Vaginitis

Pregnancy    
SIJ (sacroiliac joint) dysfunction     
Low back pain and Sciatica   
Carpal tunnel symptoms  
Morning sickness    
Heartburn

Urinary tract infections and Cystitis

Pelvic Floor Dysfunction

Urinary and Stress Incontinence




Acupuncture – the physiological mechanisms

The ovary is a highly vascularised organ and maintenance of a high blood flow is necessary for normal ovulatory function. Sympathetic nerves appear to be distinctly involved in the control of ovulation. These factors are important in conditions like PCOS and Infertility. Recent research has shown that treatment with electro-acupuncture (EA) of low frequency is successful with inducing regular ovulation in women with PCOS anovulation. Other studies have shown that EA is effective in improving ovarian blood flow as a reflex via the ovarian sympathetic nerves.

With unexplained infertility it has been found that these women often present with a high uterine artery blood flow impedance. Numerous studies have found that EA can reduce this impedance thus improving uterine blood flow and increasing endometrial thickening and receptivity. It is suggested that this effect of acupuncture is due to a central inhibition of the sympathetic activity.  In many ACT (assisted conception therapy) clinics it is becoming practice that patients receive EA in preparation for  their treatment or during the treatment cycle.

Research  has shown that Acupuncture can increase blood flow to the brain and specifically the hypothalamus. The hypothalamus plays a crucial role in hormone control, autonomic response and neuro-chemical production which are all important in menstrual disruption and chronic problems. The hypothalamus controls the hypothalamic-pituitary-adrenal (HPA) and hypothalamic-pituitary-ovarian (HPO) axes and hence the influence of Acupuncture via the hypothalamus  can affect both these systems.

Stress is known to adversely affect the immune and endocrine systems and disrupt menstrual regularity.  Stress increases the activity of the HPA axis, adrenalin levels increase which inhibits the utilisation of progesterone, one of the key hormones in reproductive function. If the adrenals are overworked, blood flow is diverted from the uterus and ovaries.

Acupuncture can normalise the HPO axis through the release of endogenous opiods and other peptides in the central and peripheral nervous systems. An imbalance in the pituitary function may prevent a woman from producing the hormones responsible for a normal, ovulating menstrual cycle. The resulting impact can be a factor in infertility.

Acupuncture stimulates the release of beta endorphins from the hypothalamus,  anterior pituitary and the ovaries . Because of this impact on beta endorphin levels, which affects GnRH secretion and the menstrual cycle in turn, it is logical to hypothesize that acupuncture may influence ovulation and fertility.

There is a growing scientific evidence base supporting the use of acupuncture for the treatment of womens health problems and many women are turning to acupuncture as a stand-alone treatment or in conjunction with western medicine management. Acupuncture is a safe intervention and can have short and long term benefits.



Pelvic Floor Dysfunction

The Pelvic Floor is has a number of extremely important functions that are often poorly understood. It is in layman’s terms, the layer of muscles that run from the pubic bone interiorly to the coccyx posterior that support the pelvic organs.

It has important roles in:

  • maintaining urinary and faecal continence
  • inhibiting the bladder
  • increasing intra abdominal pressure when lifting heavy objects or coughing and sneezing
  • it helps to support the lower spine as it is part of the limbo pelvic musculature
  • it is integral in sexual response.

A number of factors can cause weakness or dysfunction in these muscles which can lead to problems in any of the areas above including low back pain, stress incontinence, urinary frequency and sexual dysfunction.

Physiotherapy can assist in retraining these muscles through learning how to relax/contract the pelvic floor, strengthening and using the knowledge to improve quality of life whether  the problem be incontinence, frequency, low back pain, or sexual response. Pelvic floor weakness is not only an issue in women, but also in men, particularly after prostate cancer treatment.

A very useful tool in the re-education of the Pelvic Floor is the Biofeedback Device. This machine can indicate accurately changes in muscle strength and tone and is visually mediated.

The strength of the pelvic floor is measured using a comfortable probe and can be seen in the form of a bar graph. This enables the client to contract and relax the pelvic floor effectively as they can see changes on a graph and also objectively measure improvements in the strength of the pelvic floor over a treatment period.

Neuromuscular Stimulation can also be administered to strengthen via the same probe in conjunction with the biofeedback. The client can work with the stems to further increase the strength of a pelvic floor contraction if the weakness is profound.



Urinary Stress Incontinence

This is an involuntary loss of urine with an increase in intra abdominal pressure (e.g. laughing, coughing, sneezing, running, and jumping).

Far too many women see this as an inevitable part of getting older or childbirth and accept is as something they have to live with. This is not the case! Continence can almost always be improved if not cured with pelvic floor retraining.

It is caused by a weakness in the pelvic floor musculature, and sometimes can be the result of prolapse of the bladder, the uterus or the rectum. Childbirth, a hysterectomy, menopause, or pelvic floor inhibition or weakness can all be contributing factors.

Physiotherapy for stress incontinence involves and assessment of the pelvic floor function, and then appropriate retraining depending on the level of weakness.

The client is taught where the pelvic floor is and how to contract and relax it. An exercise programme is then followed with or without neuromuscular stimulation, and the Biofeedback gives additional encouragement and information to the client.



Urge Incontinence

This is the inability to stop the muscle around the bladder from contracting leading to an involuntary loss of urine. It is also associated with the feeling of urgency to find a toilet despite the bladder not being full. People complain of having to go to the toilet more than 7 times a day, waking more than once during the night, and occasionally bed wetting.

There is a direct link between nerves supplying the detrusor muscle (the muscle around the bladder which is responsible for bladder emptying) and the pelvic floor muscles. In many cases, strengthening the pelvic floor inhibits the detrusor muscle and diminishes the urge to empty the bladder. The physiotherapist would again do a thorough assessment of the problem, design a programme and often retraining the pelvic floor and bladder is very successful in urgency issues.



 
UTI and Cystitis

Bladder infections, particularly recurrent ones can be a major cause of urge incontinence. Bladder retraining and pelvic floor re education can be part of the medical management of UTI’s . Interstitial Cystitis can be a long term effect and this painful condition would be diagnosed with a cystoscopy performed by a Urologist/Gynaecologist. Physiotherapy in conjunction with treatment from a Uro/Gynae can help in pain control and bladder retraining.



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