January 17, 2024

Physio after OASI: speaking with ‘The Mothership Physio’

We’ve sat down with the wonderful Emma and Claire, both women’s health physiotherapists and founders of ‘The Mothership Physio’, to talk about the benefits of Physiotherapy after a birth injury, including women who have suffered an Obstetric Anal Sphincter Injury (OASI).

Do you think there is currently the right access to treatment for women who have suffered a birth injury or a traumatic birth?

We seem to be doing a real disservice to women that suffer from a birth injury, or traumatic birth. There is a real lack of understanding, and lack of services including timely and sufficient specialist pelvic health physiotherapy. There are not enough pelvic health physiotherapists in the NHS, and without specialist training standard physiotherapists do not have the skills and knowledge to help women with birth injuries.

Is there evidence to show pelvic floor exercises can help regain better sphincter control in women you have suffered an Obstetric Anal Sphincter Injury (OASI) and might be suffering from faecal incontinence?

Yes, the evidence does suggest that pelvic floor exercises can help regain better sphincter control in women suffering from faecal incontinence.

The anatomy and function of the pelvic floor highlights how integral it is to the anal sphincter structure and function. The pelvic floor is not just one muscle but a complex set of muscles some of which blend and function to support the workings of the sphincter for faecal continence.

However, pelvic floor exercises are only one aspect of treatment. Women need to be assessed individually to check their pelvic floor strength and function as well as the strength of other muscles that support the pelvis. This assessment must take into account a multitude of factors such as a mother’s symptoms, healing or scarring, posture, breathing mechanics and who they are as a person and what they want to achieve as they move forward.

This approach needs to happen with empathy, and potentially alongside trauma counseling, as long-term stress will affect the nervous system and will also affect the pelvic floor. This is the way to help regain better sphincter control, and there are not many studies that have looked at a combined approach.

What support can women’s health physiotherapists provide to those suffering from an OASI and potentially suffering from faecal incontinence?

Pelvic health physiostherpists understand the challenges of living with anal incontinence, and will problem solve with you to help manage your bowels, and any other associated symptoms, (heaviness, pain with intercourse, urine leakage, etc).

Treatment will vary depending on a mother’s specific symptoms. It might involve hands on treatment to the pelvic floor muscles, mobility & breathing exercises, scar management techniques and advice on how best to defecate, and once the pelvic floor muscles have been assessed, either strengthening exercises if the pelvic floor is weak or downtraining if the muscle is affected by scaring or spasm.

As physiotherapists, we consider the person as a whole and often it’s a team approach with dietitians and psychology getting involved too. Importantly, we consider how the pelvic floor is coping with the demands of ‘mum life’ which is often very loaded and upright.

There will be a need to strengthen the whole body postpartum so that the individual affected can return to a gym class or sport with confidence.

Sadly, this final part of rehab is often overlooked by the NHS due to time and budget constraints. That’s why Emma and I created The Mothership Physio online postnatal programme.

This is a safe, physio-led, online postnatal exercise and education programme for new mums or those heading towards perimenopause. We offer a mix of achievable 15-minute core, cardio, pilates and well-being workouts designed to return you to whatever it is you love doing, and feeling like yourself again.

We provide safe modifications, step-by-step guidance and education on your body throughout the programme including a monthly live ‘clinic call’. So mums feel confident, in control and empowered throughout their postpartum fitness journey.

With an OASI injury requiring surgical repair, what problems can the remaining scar tissue cause and how can that be managed?

Scar tissue within or adjacent to the pelvic floor and anal sphincter can impair their function. It may result in a loss of control over urination or bowel movements, or pain during intercourse.

Scar tissue is heavy for the muscle to work around. Often the side of the pelvic floor muscle that has scar tissue within it responds sluggishly or doesn’t lift up as much as the other side that is free of scar tissue. If there is a scar in the anal sphincter that may lose some of its ability to tighten.

It takes two years for a scar to mature and then it is thought that our bodies remodel scar tissue constantly. Sometimes during menopause, the drop in oestrogen levels can cause more scar tissue formation. This can lead to a new onset of symptoms or an increase in symptoms.

Pelvic health physiotherapy aims to make the scar more flexible by manipulating the scar tissue with movement and massage. The aim is the more scar tissue is moved and massaged, the softer and more similar to the tissue around it, it becomes. This reduces tightness and tension from any adhesions.

A physiotherapist (with your permission) may complete internal and external vaginal or anal massage on the scar. The aim is to glide and move the scar and associated tissue in lots of directions. This can be uncomfortable at times because of the lack of blood flow to the area, but the physio will work with you to ensure it’s within your comfort zone, and you also might be taught how to do the massage yourself between sessions.

Specific strength and mobility exercises are prescribed to help all the surrounding ligaments and muscles of the pelvic floor and pelvis to work optimally alongside the body as a whole.

What are the common misconceptions or myths with women’s health physiotherapy?

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