Gynaecological problems 

There are many gynaecological problems that do not necessitate surgery and can be treated conservatively with Physiotherapy. Women are often not aware of this and become fearful of seeing someone about it as they think the only option is surgery. 

Pelvic organ prolapse 

There are several areas that can prolapse apart from just the womb. About 50% of women who have had children will develop some form of pelvic organ prolapse in their lifetime. The treatment of these can be Conservative, Physiotherapy, Mechanical, Pessaries, or Surgical, depending on the symptoms.  
 
Conservative treatment is possible both with minor and more severe prolapses. Pelvic floor muscle exercises are a key component of treatment. By strengthening the pelvic floor muscles this can help to re-establish good enough support to reduce the prolapse. 
 
If you are destined to have surgery it is still prudent to have some Physiotherapy input first. If the pelvic floor muscles are very weak then the surgery is less likely to be as successful. The stronger the muscles are then the better the post-surgical outcome will be. Itis for this reason that many Consultants will refer their patients to us pre surgery for pelvic floor muscle rehabilitation. 

cystocele 

This is where the bladder bulges into the front wall of the vagina. This occurs because of weakening of the muscles and connective tissue between the bladder and the vaginal wall. Some people may not have any symptoms at all from a cystocele but others may be symptomatic. 
 
Causes can include: 
Childbirth 
Chronic cough 
Being overweight 
Genetic influence 
Surgery 
 
Symptoms can include: 
Difficulty urinating 
Increased frequency of urination 
Urgency 
Bladder leakage 
 

rectocele 

Also known as a posterior vaginal wall prolapse results when the rectum bulges into the back wall of the vagina.  
 
Common causes are: 
Childbirth 
Constipation 
Chronic cough 
Being overweight 
Genetic influence 
Surgery 
 
Symptoms can include: 
Sense of pressure within the vagina 
Difficulty opening the bowels 
Pain on opening the bowels 
Constipation 
A feeling of not fully emptying the bowels 

uterine prolapse 

The uterus, or womb, is normally held in place by a series of ligamnets and muscles. treatment can be conservative or surgical, depending on the symptoms. 
 
Common causes are: 
Pregnancy 
Childbirth 
Heavy lifting 
Chronic cough 
Being overweight 
Genetic influence 
 
Treatment:  
Conservative - Physiotherapy - muscle strengthening 
Mechanical - Pessaries, usually fitted by your GP, or Consultant 
Surgical - Hysterectomy or a uterine repair 
 

Rehabilitation after gynaecological surgery 

Some patients will be referred to us for treatment prior to their surgery for strengthening exercises for the pelvic floor muscles. At this point we will also go through with the patient exactly what will be expected of them from a physiotherapy point of view after their operation. If you know that you are going to have gynae surgery then pre-habilitation is most useful. 
 
After surgery we will look at how you are progressing, and how you are doing with your exercises. We can use real-time ultrasound to assess the pelvic floor muscles activity and function and to give you feedback with how you are progressing. 
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