Physios… Are we asking our female clients all the right questions?

When you assess a female client with lower back and/or hip pain, are you asking these questions?

• Have you ever been pregnant or given birth? Recent or otherwise.
• Do you ever leak urine with coughing, running, sneezing, laughing or lifting?
• Do you experience increased bladder urgency, or feel the need to urinate more than 8x/day?
• Do you have difficulty initiating your urine stream or do you have to strain to urinate?
• Do you ever experience pain with sexual activity, or does your lower back or hip pain worsen with sex?
• Do you struggle with constipation? (bowel movements <3x /week, needing to push/strain)
• Have you ever fallen on your tailbone or experience pain in your tailbone while sitting?
• Have you ever had abdominal or pelvic surgery? For example: hysterectomy, surgery to repair pelvic organ prolapse or to resolve incontinence

These questions may seem unrelated to your client’s current symptoms at first. However, the pelvic floor muscles are an integral part of the core. How do we assess core strength and function? How could we assess core strength/function even better? Don’t underestimate the power of your subjective assessment.

Let’s take the Pelvic Floor out of the realm of Women’s Health for a moment and put it back under the umbrella of orthopedic manual therapy.

You might not have the ability to assess the pelvic floor directly — but you can get a TON of information from the questions above. First start by asking them. Then, if your treatment plan involves some form of “core” strengthening or exercises, ask your client to let you know if they notice a change in their pelvic floor symptoms — for better or worse. Your exercises will have an impact on the pelvic floor whether you realize it or not.

Many of your female clients (male clients too!! – but let’s save that talk for another blog) — I would suspect way more than you realize — have symptoms of pelvic floor dysfunction in addition to their lower back or hip pain. But maybe their low back or hip pain is more important to them then their urinary incontinence at this moment in time. Or maybe they were told incontinence is normal after having a baby or reaching menopause. Or maybe they never thought to tell you…. or maybe you just never asked.

So when should you refer to a pelvic health physiotherapist? Two possible scenarios:

Scenario A: your client’s lower back and hip pain is resolved (good job!!), but their pelvic health issues are ongoing and now (because of your education) they have hope something can be done and have additional goals for physiotherapy.

Scenario B: your client’s hip or lower back pain is unchanged or not improving at the rate you would expect given your experience. When you ask, your client indicates their pelvic floor symptoms haven’t changed or have become more noticeable.

As physiotherapists, we have the opportunity to help people in many different and distinct ways. Our ability to form connections with our clients can help us to pick up on pelvic floor dysfunction more readily than many other health disciplines….

Let’s start by asking the right questions!