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Pelvic floor - advice from lead physiotherapist Jackie Montgomery

I was fortunate enough to recently meet Jackie Montgomery, the lead physiotherapist in obstetrics, gynaecology and pelvic floor services at the Queen Elizabeth University Hospital in Glasgow, when she spoke at one of the BMS seminars. Her talk was so inspirational, true to life and packed full with not only the most up to date medical information, but also good common sense, I thought it would be a good idea to ask her a few questions to help us all with our pelvic floors……

How long have you worked in the field of obstetrics and gynaecology Jackie ?

Hi Ruth and thank you for your feedback on my talk at the Stirling Study Day. I have been working in the field of Obstetrics, Gynaecology and Pelvic Floor Physiotherapy for just over 20 years now (surprisingly it doesn’t feel that long!) My job is Team Lead for a great team of physios who specialise in this area of work and we provide our services across Greater Glasgow and Clyde Health Board.

What age range do you mainly see with pelvic floor problems ?

Our patients range in age from 18 years to 90 years. Our Obstetric Service supports women before and after they have a baby and we provide physiotherapy input as a part of the antenatal education programme. In terms of pelvic floor problems, a large proportion of our patients are women within the 40 to 60 years age group and therefore may fall into the pre, peri or post menopausal range.

Would you say the whole topic of the pelvic floor needs to be demystified for many women - what they can’t see they don’t want to know about ?

One of the themes of my talk was "empowerment" and I am a strong believer in the power of education in all areas of life. As a physiotherapist specialising in this area I meet women who are referred to our service for help with a range of conditions including bladder and bowel incontinence and prolapse. One of the important aspects of my role is to help women understand the anatomy and function of the pelvic floor. I use a range of teaching aids to achieve this, including plastic models of the pelvis and the pelvic floor muscles, diagrams and leaflets. By helping women to understand this area of their bodies, it enables us to discuss reasons for their problems and the choice of conservative physiotherapy options available to them.

Do you get a large proportion of women coming with pelvic floor problems who have no idea how bad their symptoms are and who are just putting up with those symptoms ?

I think that some of the women referred to our service have been putting up with symptoms that they are unsure about and uncertain about the options available to them. In some cases it might be only when symptoms start to interfere with life in general that a woman decides to speak to her GP for advice. Adverts for products such as incontinence pads may mislead women to consider that their only option for urinary incontinence is to manage it rather than also seek help to improve or cure those symptoms.

Would you say it is never too early in life to start learning how to correctly do pelvic floors ?

The pelvic floor muscles are an important part of the overall function of the pelvic floor and like any muscle in the body, can become weak due to a variety of reasons. It is therefore good for women to know how to exercise these muscles correctly and to regularly carry out the exercises.

How often do you come across women who think they are beyond help and don’t realise that with correct training and a bit of effort from themselves they can still get their pelvic floors back !?

I regularly meet women referred by their consultants for a range of problems relating to their pelvic floor and some women are concerned that their age may be a barrier to learning the skills necessary to improve their pelvic floor muscles. We work with women of all ages to maximise their potential for recovery and improvement of their symptoms. Motivation is a key factor in achieving results from any rehabilitation programme and we work with each patient to set achievable goals. While this will in most cases include pelvic floor muscle exercise, there are a range of additional options for treatment including lifestyle modifications.

Do you think there needs to be a lot more education and information for women which is easily accessible on how to correctly do pelvic floor exercises?

I do agree that it would be very helpful if all women had easy access to information sources to help them make the best decisions regarding pelvic health, including how to correctly do pelvic floor exercise. It is also important to know if you are doing the pelvic floor muscle exercises incorrectly.

Do you agree it should be a priority in life to be able at any age to laugh, lift, sneeze and cough without leaking or as one of my friends aptly put it - having a wee scoosh!?

I would encourage women to seek help if they wish to explore the options for treatment of urinary leakage or any of the other common symptoms of pelvic floor dysfunction. They may decide to speak to their GP and ask about the availability of referral to a specialist physiotherapist for assessment and treatment.

What are the main aims of pelvic floor training?

The aims of pelvic floor training really depend on what has been identified as the main problem. However some general principles of muscle training apply to the pelvic floor as they would do for any other muscle in the body.

Initially it is of vital importance to ensure the correct muscle is being worked and if this is difficult for the woman due to a number of factors, the physiotherapist has a range of options that can be used to enhance muscle awareness.

When the correct technique has been identified it may be that strength is the main aim of muscle training together with enhancing muscle endurance i.e. the ability to maintain a contraction over time. It is also important for women to use the muscles in a specific way: an example of this would be teaching a woman to contract her pelvic floor immediately before she coughs, sneezes or laughs if she is experiencing episodes of urinary leakage associated with those activities.

Regular practice is also recommended and some women are making use of Pelvic Floor Muscle training Apps to remind them to do their exercises. It helps to get into the habit of linking doing the exercises with other activities (i.e. while brushing teeth, reading etc.)

Finally keep going - it takes time to strengthen any muscle and pelvic floor muscles are no different!

Thank you so much to Jackie for taking the time to answer the above questions, which I'm sure you will agree are extremely helpful and informative.


Bladder and bowel community :

Women's Health Concern :

Pelvic and Obstetric and Gynaecological Physiotherapy :

Elaine Miller : Humour and facts :

Any information is as accurate as possible at time of writing and is for information purposes only. The information and support that Let's Talk Menopause provides is for your own personal use. It is not intended to replace or substitute the judgement of any medical professional you may come in contact with. You should always seek advice from your healthcare professional regarding any medical condition.


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