Pelvic Floor and Women's Health Physiotherapy in Narellan

What a Pelvic Floor Physio Treats

Pelvic floor physiotherapy is a dedicated area of physiotherapy focused on the muscles at the base of your pelvis, the ones that control your bladder and bowel and support your pelvic organs. It is not something every physiotherapist practises. It requires postgraduate training in pelvic health, continence and women’s health on top of a physiotherapy degree.
We commonly treat:

Urinary incontinence, including leaking with coughing, sneezing, laughing, lifting or exercise
Urinary urgency and frequency, including needing to rush to the toilet or getting up overnight
Bowel symptoms, including constipation, straining and difficulty controlling wind
Pelvic organ prolapse, including heaviness, dragging or a bulging sensation
Persistent pelvic pain, including pain with intercourse and pain associated with endometriosis
Diastasis recti, the abdominal separation that can follow pregnancy
Pregnancy-related pain, including pelvic girdle pain and lower back pain
Postnatal recovery, including after both vaginal birth and caesarean
Returning to running, lifting and sport after having a baby or after surgery

We see women from Narellan, Camden, Oran Park, Smeaton Grange, Mount Annan, Gregory Hills and across the wider Macarthur and Campbelltown region.

Meet Your Women's Health Physiotherapists

Allison McMenemy is a Women’s and Pelvic Health Physiotherapist with a Bachelor of Science (Honours) in Physiotherapy from the University of Manchester. She has more than two decades of experience in musculoskeletal rehabilitation and has spent the last 14 years specialising exclusively in women’s health, across both maternity and rehabilitation settings. Her focus is pelvic floor dysfunction, pelvic pain, bladder and bowel dysfunction and pelvic organ prolapse, and she supports women right through the antenatal and postnatal periods. She is also a mother of four, which she will tell you informs the way she works.

Catherine Kokal is a Women’s Health and Musculoskeletal Physiotherapist and Exercise Physiologist, with a Master of Physiotherapy and a background in sport and exercise science. She is currently undertaking the Titling process to formally specialise in women’s health. Catherine treats prolapse, incontinence and bladder and bowel dysfunction, and has completed additional training in prolapse and pessaries, pelvic pain disorders and stress urinary incontinence. She has particular experience with endometriosis, vaginismus and coccydynia.

Between the two of them you can usually be seen quickly, and if you would prefer to see a particular physiotherapist, you can request her when you book.

Lisa Cornell is the Director of Bounce Back and is qualified as both a Physiotherapist and an Osteopath, which is an unusual combination and means she can draw on two different hands-on approaches within the same session. Alongside her women’s health work she has a particular interest in clinical pilates, which carries directly into pelvic floor and postnatal rehabilitation, as well as headaches and TMJ pain. She built the clinic around a team-based approach, so she is often the one who will bring in another practitioner if she thinks it will get you there faster.

What does a women’s health physio do?

A women’s health physio assesses how your pelvic floor and surrounding muscles are actually working, identifies what is driving your symptoms, and builds a treatment plan around that. Treatment usually combines hands-on techniques, specific retraining exercises and practical education about your bladder, bowel and daily habits.
We also treat all the usual aches and pains you would see any physiotherapist for, and we work with you through pregnancy and the postnatal period, treating pain as it comes up and helping you get back to the things you want to do.

Tight or Weak? Why Pelvic Floor Exercises Are Not Always the Answer

The standard advice for anything pelvic floor related is to do your Kegels. For a pelvic floor that is genuinely weak, that advice is correct.
But a lot of people have the opposite problem. Their pelvic floor is overactive: chronically tight, holding tension and unable to fully relax. If that is you, squeezing a muscle that is already refusing to let go will usually make your symptoms worse.

Here is what makes it confusing. Both problems can cause leaking. A tight muscle is a tired muscle, and a tired muscle cannot react quickly when you sneeze. So people who leak assume they are weak, squeeze harder, and get more symptomatic.

Signs of a Tight (Overactive) Pelvic Floor

Pelvic, tailbone or lower abdominal pain with no clear injury
Pain with intercourse, internal examinations or inserting a tampon
A slow or hesitant urine stream, or straining to start
Constipation, or never feeling like you have fully emptied
Symptoms that got worse after you started doing pelvic floor exercises

Signs of a Weak (Underactive) Pelvic Floor

Leaking with coughing, sneezing, laughing, lifting or impact
Heaviness, dragging or a bulging sensation
Difficulty controlling wind
Not being able to feel the muscles working when you try to squeeze

You cannot reliably tell which pattern you have from symptoms alone, and plenty of people have elements of both. That is the real argument for being assessed rather than following a video. If you have been doing pelvic floor exercises for months with no change, that is not a sign to try harder. It may be a sign you are doing the wrong exercise for your problem.

How do I know if I should see a women’s health physio?

If you answer yes to any of the following, it is worth having your pelvic floor assessed. You can book an appointment online, or if you would rather talk it through first, call us on (02) 4648 1669 and one of our women’s health physios will give you a ring back for a no-obligation chat about what you are experiencing.

Do you ever leak urine? (even a little bit)
Do you ever feel like you’re unable to completely empty your bladder when you go to the toilet?
Do you have moments of suddenly feeling like you’re busting to go and have to race to the toilet?
Do you ever feel a pressure or a heaviness in your pelvis?
Do you experience constipation?
Do you experience pain with intercourse?
Do you experience any low back or hip pain that keeps popping up or you can’t seem to shake?
Are you currently pregnant?
Have you recently had a baby?
Do you want to return to a certain activity after having a baby but aren’t sure how to go about it?
Have you been told that you have an abdominal separation?
Do you feel like your body is holding you back from doing something you want to do?
Have you heard people talk about the ‘pelvic floor’ or the ‘core’ and ‘pelvic floor exercises/kegels’ but you’re not 100% sure with what that all means, what those muscles are or how you should be using them?

We know that some of these things might feel a bit uncomfortable to talk about, but we assure you that all the things above are common things we see every day. We’re friendly and understanding and we really want to be able to help you put any concerns you have behind you!

Our women’s health treatment rooms are a space of no judgement where there’s no such thing as TMI!

What Happens at Your First Appointment

For a lot of people this is the barrier, so we will be direct about it.

Your first appointment starts with a conversation, and it takes up a good part of the session. Your physio will ask about your symptoms, your bladder and bowel habits, your pregnancy and birth history if relevant, your exercise and what you want to get back to. Nothing you say will be a surprise. This is what we do all day.

The physical assessment usually starts well away from your pelvis, looking at how you move, breathe and load through your hips and lower back, because pelvic floor problems very often involve everything around them.

Do I Have to Have an Internal Examination?

An internal vaginal examination is the most direct way to assess how your pelvic floor muscles contract and relax, so your physiotherapist may recommend one. It is entirely your choice. We will explain exactly what is involved, ask your permission before and during, and stop the moment you want to stop. You can decline, and you can change your mind partway through.

If you would rather not, there are alternatives. Real-time ultrasound lets us see your pelvic floor working through your abdomen with nothing internal at all. Plenty of women start there. Others prefer to wait until a later appointment once they feel more comfortable. All of that is completely reasonable and none of it will hold up your treatment.

What to Wear and What to Bring

Wear something comfortable you can move in. Bring any relevant scans, specialist letters or referrals. And if you have a baby, bring the baby. A pram in the room is completely normal here.

PREGNANT OR HAD YOUR BABY IN THE PAST 6 MONTHS? Pregnancy and the first months afterwards are when pelvic floor physiotherapy makes the most difference, and they are also when it is easiest to put off. If you are pregnant or you have had a baby in the past six months, book an assessment and we will build a plan around where you are: preparing for birth, recovering afterwards, or working out when it is safe to get back to running and the gym.

Referrals, Rebates and Funding

You do not need a GP referral to see a pelvic floor physio at Bounce Back. You can book directly.

A referral is only needed to access one of the funded pathways:

Private health insurance. Rebates apply depending on your level of extras cover. You pay in full at the clinic and claim your rebate directly through your fund
Medicare Chronic Disease Management plans. Your GP can prepare a plan covering a limited number of allied health visits per calendar year, shared across all disciplines
DVA. Covered with a referral
WorkCover. Accepted where the condition relates to an approved claim
NDIS. Available to self-managed and plan-managed participants where it is relevant to your plan

If cost is a concern, call us before you book. It is a completely normal question and it is better asked upfront.

FAQ

Do I need a referral to see a pelvic floor physio?

You do not need a referral to see a pelvic floor physio at Bounce Back, and you can book directly online or by phone. A referral is only required if you want to claim through a funded pathway such as a Medicare Chronic Disease Management plan, DVA or WorkCover. Private health insurance rebates do not require a GP referral.

Is an internal examination always required?

An internal examination is not always required, and it is always your choice. It is the most direct way to assess how your pelvic floor muscles contract and relax, so it may be recommended, but we will explain it fully and ask your consent before and during. If you prefer not to, real-time ultrasound can assess your pelvic floor through your abdomen instead.

How do I know if my pelvic floor is tight or weak?

You generally cannot tell whether your pelvic floor is tight or weak from symptoms alone, because both patterns can cause leaking. Tight pelvic floors more often produce pain, a slow urine stream and constipation, while weak pelvic floors more often produce leaking with impact and a feeling of heaviness. Many women have elements of both, which is why an assessment is the only reliable way to know which exercises will help you.

Can pelvic floor exercises make things worse?

Pelvic floor exercises can make things worse if your pelvic floor is already overactive and holding too much tension. Squeezing a muscle that cannot fully relax tends to increase pain, straining and urinary symptoms. If your symptoms got worse after you started doing Kegels, stop and get assessed rather than pushing harder.

Is it too late if I had my baby years ago?

It is not too late to see a women’s health physio years after having a baby, and many of the women we assess are well beyond the postnatal period. Pelvic floor muscles respond to correct training at any age and any stage, including after menopause. If you were never properly assessed after birth, that assessment is still worth doing.

Can I request a particular women's health physio?

You can request a particular women’s health physio when you book. We have three physiotherapists specialising in women’s and pelvic health, Allison, Lisa and Catherine, so if you would prefer to see one of them specifically, mention it when you book online or let our reception team know when you call.

Can I bring my baby to the appointment?

You can absolutely bring your baby to your appointment, and a pram in the treatment room is completely normal here. Many of the women we see are in the first months after birth, and childcare should never be the reason an assessment gets delayed.