Category: Gynaecology


Why Is The Pelvic Floor So Important?

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I’m sure you’ve heard of the pelvic floor. If you’ve had children, you were probably told, in passing, to ‘do your pelvic floor exercises’, maybe without any other instruction or explanation. It’s not just after babies that the pelvic floor is important, however.  Women, and men, can experience pelvic floor issues at any stage in life and it can have a wide range of implications. So let’s look into it a bit further and see why the pelvic floor is so important.

What is it?

The pelvic floor is a group of muscles and connective tissue that attaches to the bottom of your pelvis, like a sling between your legs.  This sling supports your pelvic organs, including your bladder, uterus and rectum. 

The pelvic floor is part of the core muscle system, working closely with your transverse abdominus, multifidus and diaphragm to support your trunk.  This is your ‘core’ and contributes to back stability, postural strength and function.  

What problems can it cause?

Common problems arising from pelvic floor dysfunction are:

  • Stress urinary incontinence – this is the name for leaking pee when you cough or sneeze and is often the reason that mums don’t go trampolining!  The pelvic floor can also be a factor in overactive bladder and urge urinary incontinence.

 

  • Pelvic organ prolapse – this is when your pelvic organs are not supported fully and drop down into your vagina, and can sometimes protrude.  Women typically notice a heaviness in their pelvis on weight bearing activities and may notice a bulge from their vagina. 

 

  • Sexual dysfunction – this could range from an inability to orgasm to discomfort during penetration to not being able to have sex due to pain.

 

  • Pelvic pain syndromes – conditions such are vulvodynia, vaginismus and Bladder Pain Syndrome (interstitial cystitis) often have involvement of the pelvic floor muscle complex, which can contribute to pain and dysfunction.  

 

  • Back pain – core weakness is a common factor in chronic or recurrent back pain. Working on core activation and strength have been shown to help reduce the severity of chronic back pain and reduce the incidence of episodes. 

why the pelvic floor is so important

  • Diastasis rectus abdominus – this is the separation of abdominal msucles, usually due to pregnancy.  The pelvic floor is part of the core, and together they work to support your trunk.  The balance between your core muscles and external abdominals is what helps to improve this issue. 

What can go wrong?

The pelvic floor is a complex system of muscles.  Any muscle in your body needs strength to contract, flexibility to function and the ability to fully relax.  The pelvic floor needs to be able to balance its power and contractibility, with its relaxation and length in order to function comfortably and effectively.  

This muscle system can be weak or inactive.  This could be due to pregnancy, exercise, occupation, weight, age, the list goes on.  If the muscles are weak they will not be able to counteract downward forces through your trunk.  This may lead to bladder or bowel leaking, pelvic organ prolapse or sexual dysfunction (for example, inability to orgasm).  Weakness in the core muscle system can cause or be a factor in lower back pain and perpetuate diastasis rectus abdominus. 

The pelvic floor can also be overactive or shortened. This can be due to overtraining, stress or anxiety, infection, or as part of a trauma response.  Tension in these muscles can cause pain related to urination, sex, or defecation; even sitting down or wearing tight trousers can be problematic for some people. It can contribute to urinary retention or incontinence, overactive bladder, or bladder pain syndrome. Tension or pain in your pelvic floor can also influence the surrounding structures and can be felt in or contribute to hip leg or back pain. 

On examination, it is very routine to find that the pelvic floor muscles are both overactive and weak at the same time. If someone perceives a pelvic floor problem, for example a bit of leaking, the common advice is to ‘do your kegels’. Kegels are essentially strengthening exercises.  The problem with this arises when people don’t know if their pelvic floor is actually weak, how to do an effective pelvic floor contraction and how to relax the muscles in between.  The muscles need strength, but even more important is range (i.e. the ability to fully relax and then fully contract).  Without working on the length and full relaxation in your pelvic floor, you will never get an optimal contraction. 

What to do about it?

The research says that 65% of people who think that they’re doing their pelvic floor exercises correctly are in fact doing it incorrectly.   This may be due to an ineffective contraction (reduced fibre activation or reduced range for example) or it could be that they are working to bear down with their pelvic floor muscles, which is the opposite to what we want to achieve and can make problems worse. 

The only way to find out if you are contracting your pelvic floor correctly is to have an internal vaginal assessment with a specialist Pelvic Health Physiotherapist.  A vaginal assessment is very routine for those of us in the trade.  A pelvic floor examination involves feeling the muscles just on the inside of your vagina – feeling them contract, relax and what happens during a cough.  This should be entirely comfortable and pain-free.  We would also assess for signs of prolapse, in lying but also in standing if necessary.  

NICE Guidelines (NICE 2022) recommend supervised pelvic floor retraining as a first-line treatment for stress or mixed incontinence and for pelvic organ prolapse.  This means assessment and treatment with a specialist Pelvic Health Physiotherapist. 

If pain is your issue, please don’t be put off by talk of internal examinations.  They can be very helpful in diagnosis and treatment but are not imperative.  Pelvic pain issues are very complex and lots of progress can be made ‘hands off’.  It might be something to discuss and revisit during a subsequent appointment.  You are always welcome to say no at any point.

In a nutshell, we all have pelvic floors, and they can impact every aspect of life.  If you think you might have an issue with your pelvic floor, or would just like to check, do something about it and see a Pelvic Health Physio!

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The 5 Gynaecological Cancers you need to be aware of…

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Awareness of the 5 gynaecological cancers is very low despite 21,000 women receiving a diagnosis each year. As with many cancers, early diagnosis is key so it is important women are aware of the signs and symptoms to look out for and to know what’s normal for them.

At The Surrey Park Clinic we offer Well Woman checksCervical Screening and Ovarian Cancer screening. You can find out more about these tests by following the links and you can book these on-line or by calling 01483 454 016. As September is Gynae Cancer Awareness Month, we are offering 10% off our Well Woman and Ovarian Cancer Screening checks for bookings made in September.

Ovarian Cancer

Otherwise known as the silent killer, ovarian cancer is sadly often diagnosed at a late stage which is why awareness of symptoms is critical to ensure this cancer is caught early.

Ovarian cancer affects around 7,500 women a year. It is the abnormal growth and division of cells in the ovary and the tumour can spread to other areas of the abdomen. Recent research has highlighted that ovarian cancer is likely to start in the fallopian tubes.

Symptoms of ovarian cancer:

The main symptoms of ovarian cancer are fairly vague and non-specific but do watch out for:

  • Struggling to eat and feeling full more quickly
  • Abdominal bloating
  • Abdominal or pelvic pain felt over a period of time
  • A change in bladder habits
  • Post menopausal bleeding

If you have any of these symptoms, please do see your GP or book into to see our consultant gynaecologist. At The Surrey Park Clinic, we offer ovarian cancer screening. Our Consultant Gynaecologist will discuss your medical history, conduct a trans-vaginal scan to assess the ovaries and also do CA125, CEA, Ca19-9 blood tests.

Who is at risk?

  • Women with a family history of Ovarian cancer and or related cancers such as breast, bowel and endometrial cancer
  • Women with an inherited BRCA gene mutation
  • As there is increasing awareness of Ovarian cancer, many women simply wish to have the reassurance of having their ovaries checked, especially if they have a friend who has developed the disease

More information on Ovarian Cancer:

Vulval Cancer

Vulval Cancer fortunately is quite a rare cancer and tends to affect women over 65 years. In order to be vigilant, it is important to know what your vulva “normally” looks like. We advise using a mirror to get to know the appearance of your vulva and check this on a regular basis to see if there are any changes.

Symptoms of Cancer of the Vulva:

  • a persistent itch in the vulva
  • pain, soreness or tenderness in the vulva
  • raised and thickened patches of skin that can be red, white or dark
  • a lump or wart-like growth on the vulva
  • bleeding from the vulva or blood-stained vaginal discharge between periods
  • an open sore in the vulva
  • a burning pain when peeing
  • a mole on the vulva that changes shape or colour

What Causes Vulval Cancer?

The exact cause of vulval cancer is unclear, but the following factors may increase your risk of developing the condition:

  • increasing age
  • vulval intraepithelial neoplasia (VIN) – where the cells in the vulva are abnormal and at risk of turning cancerous
  • persistent infection with certain versions of the human papillomavirus (HPV)
  • skin conditions affecting the vulva, such as lichen sclerosus
  • smoking

Our Consultant Gynaecologist, Mr Jay Chatterjee, gives an overview of Vulval Cancer:

 

Womb/Uterine Cancer

This is the most common gynaecological cancer which affects a woman’s reproductive system. It tends to be more common amongst post-menopausal women.

Symptoms of womb cancer:

  • any abnormal bleeding during your usual cycle
  • any bleeding post menopause

What causes womb cancer?

It is not always clear why womb cancer occurs but there are factors which may increase your risk of developing it. If you have high levels of oestrogen in your body you may have a higher risk. Obesity can create higher levels of oestrogen and there may also be a slight higher risk from long term use of tamoxifen.

Our Consultant Gynaecologist, Mr Jay Chatterjee, shares an overview of womb cancer:

 

Cervical Cancer

What is Cervical Cancer?

Cervical cancer is one of the few cancers that is highly preventable. This is because dangerous pre-cancerous cell changes can be picked up in a Cervical screening, and any abnormal cells can be removed before they develop into cervical cancer.

Cervical cancer is the second most common cancer in women under 35 years and causes approximately 1,000 deaths per year in the UK. Most cervical cancers are caused by the Human Papilloma Virus (HPV).

What Are The Symptoms of Cervical Cancer?

Symptoms include:

  • Vaginal bleeding between periods
  • Bleeding during or after sexual intercourse
  • Bleeding at any time if you are past Menopause
  • Vaginal discharge that smells unpleasant
  • Discomfort or pain during sexual intercourse

How do I Reduce my risk of Cervical Cancer?

Ensuring you are up to date with your Cervical screening appointments are the best way to reduce your risk of Cervical cancer. Research suggests that Cervical screenings (smear test and HPV testing) save around 1,000 lives every year. At The Surrey Park Clinic we offer a cervical screening service – find out more here.

HPV vaccines are also now available. Human papillomavirus vaccines are vaccines that prevent infection by certain types of human papillomavirus. Available HPV vaccines protect against either two, four, or nine types of HPV. All HPV vaccines protect against at least HPV types 16 and 18, which cause the greatest risk of cervical cancer.

 

Mr Jay Chatterjee gives an overview of Cervical Cancer:

 

Vaginal Cancer

Vaginal cancer is a rare cancer affecting the vagina, the tube leading from the cervix (neck of the womb) to the vulva.

What are the symptoms of vaginal cancer?

  • vaginal bleeding after the menopause
  • bleeding after sex or pain during sex
  • smelly or bloodstained vaginal discharge
  • bleeding between periods
  • a lump or mass in or at the entrance to the vagina
  • an itch in your vagina that will not go away
  • pain when peeing, or needing to pee a lot

Vaginal cancer is very rare for women under 40 but if you are experiencing symptoms, please do seek medical advice as early diagnosis is key.