women's health and pelvic health physiotherapy

Women's Health and Pelvic Health is a very specific field of Physiotherapy. It requires additional training for those with a Physiotherapy qualification and allows practice in the field of Women specific conditions (pregnancy related concerns, post natal related concerns, continence, endometriosis, pelvic organ prolapse, perineal tears, mastitis and more).

There is also appreciation around Women specific life stages, such as the post partum period and menopause which can add a layer of complexity to what are normally standard injuries.

conditions treated by women's health and pelvic health physios

Pelvic Organ Prolapse (POP), including pessary fittings

Birth injuries

DRAM (abdominal separation)

Persistent Pelvic Pain e.g. endometriosis, PCOS, adenomyosis, pre and post pelvic surgery

Vaginismus, Dyspareunia, Vestibulodynia

Pelvic Floor Disorders

Pre and Post Surgery (endometriosis, hysterectomy, scopes etc)

Bladder concerns including:

Stress Urinary Incontinence (SUI)

Urge Urinary Incontinence (UUI)

Overactive Bladder (OAB)

Urgency, Frequency, and Dysuria

Pain disorders (interstitial cystitis, trigonitis)

Incomplete emptying

Bladder prolapse

Bowel concerns including:

Constipation

Incontinence (fecal or flatus)

Bowel prolapse

Fissures, haemorrhoid, and skin tag management

Obstetric Anal Sphincter Injury


ACC claims for pelvic health & "Maternal Birth injuries"

It is difficult to claim ACC for pelvic health physiotherapy. There needs to have been some form of external force that can be directly identified as causing the pelvic injury e.g. trauma sustained in a motorbike accident is considered external force, coughing causing a prolapse would be an internal force.

Birthing has historically been considered an internal force and as such has injuries sustained in childbirth were not covered by ACC, until now! As of October 2022 ACC has embraced Maternal Birth Injuries (MBI)! This is a major step towards getting early diagnosis and prevention in the field of womens health and we pelvic health physio's are so excited to have these injuries acknowledged by ACC, which has enabled more access to care for many women.

However....

Despite best intentions, ACC claims can only be submitted by clinics with a "Allied Health" contract. What this means is all physios on the alternate "Cost of Treatment" (COTr) contract cannot submit MBI claims to ACC. Unfortunately, this is a large number of Womens/Pelvic Health physios. The Allied Health Contract carries significant costs and requirements such as extensive audits. Many of us in this field are parents ourselves, working from smaller home clinics part time, and as such we cannot cover the cost of an Allied Health contract.

Stillwater Physio practices under the cost of treatments contract with ACC. And as such, at this point in time:

I cannot claim ACC for maternal birth injuries at this clinic

I do work under the Allied Health Contract in Newmarket and CAN claim birth injuries for you there, though you will find the ACC gap fee at that clinic is larger my private fee in Stillwater. I can keep fees down in Stillwater as I have minimised my overheads by practicing out of a home clinic. I have more equipment in Newmarket and work in a much larger team, so if you feel you would like to see me there please look me up at Auckland Physiotherapy, which is found on George Street.

My understanding is ACC is working on this unexpected legal glitch, and we hope all pelvic health physios will soon be able submit MBI claims, however it is expected this will take several years to achieve.

TRAINING IN PELVIC HEALTH

Women's Health and Pelvic Health Physiotherapy is a field in Physiotherapy which requires further training. The majority of training I have completed has been through  Tarryn Hallum's WHTA (Womens health Training Associates) courses for physiotherapists.

These include:

- Introduction to Women's health physiotherapy

- POP/SUI

- Chronic and Persistent Pelvic Pain

- OAB

- Anorectal Dysfunction

- Annual Research Updates

This field covers some very sensitive and private areas. To obtain information about your concern, many personal questions will be discussed and explored. Frequently a womens health consultation also requires a vaginal assessment, external and/or internal, though please note I don't tend to use a speculum. It is always up to you what you are willing to divulge. However, the more information I gain through these questions and assessment, the more tailored, streamlined and effective your treatment will be.

My questions are designed to get to the bottom of your concerns, and will rule in or out certain diagnoses or contributions to your presentation. They are thorough. Your history is as important as the physical assessment and frequently this discussion takes up the majority of our first appointment and contributes to more of my clinical reasoning then any other part of our session.

I am here to help you, and I understand this can be a very vulnerable space for many. I would like to reassure you that your privacy and confidentiality are important to me, and you will always be treated with respect. You are always welcome to bring a support person to your appointment, whether they are in the room with you or waiting near by. And your babies are always welcome!