Pelvic health

Clinics

Thursdays 9:30am -12:30pm at the Perinatal Pelvic Health Service.

Your appointment will be half an hour long, and you will either be assessed by the physiotherapist or the midwife, depending on what you have been referred for. They may treat you in the session, give advice, or provide you with exercises to complete at home. They will also advise you on any continued treatment.  

Location

Perinatal Pelvic Health Service
Cumberlege Centre, 3^rd Floor 
Hillingdon Main Building (not the Maternity Building) 

Telephone: 01895 542465 

Please note that all staff work part time and may not answer the call. Please use the voicemail service and someone will get back to you ASAP. 

Parking

Please park in the main car park (not maternity) and use the main entrance. Take a right at the information desk and take the stairs or lift to the third floor. 

Referrals

If you think you need a referral to the PPHS team, contact your Midwife, GP or email thh.perinatalpelvichealthservice@nhs.net. 

Antenatal  

• Previous 3rd/4th degree tear  
• Previous complex perineal trauma if symptomatic  
• Poor control and leaking wind or poo 
• Persistent perineal pain (pain in the area between your vagina and anus which began after your birth) 
• Painful sexual intercourse / internal examinations
• Vaginismus 

Postnatal   

• Wound breakdown   
• Wound haematoma   
• Perineal wound infection   
• 3^rd and 4^th degree tears  
• Postnatal dyspareunia (painful sex after birth) 
• Persistent perineal pain (after an episiotomy or tear during birth) 
• Postnatal faecal / flatus incontinence (leaking or difficulty controlling wind or poo) 
• Bladder retention (difficulty emptying you bladder fully) 

Facilities

• There are baby changing facilities on the Cumberledge Unit
• There is a water fountain available.

What is the pelvic floor?

The pelvic floor is a group of muscles and ligaments, which support the bladder, uterus (womb) and bowel. The openings from these organs, the urethra from the bladder, the vagina from the uterus and the anus from the bowel pass through the pelvic floor. The pelvic floor muscles attach to your pubic bone at the front and the tailbone at the back and form the base of your pelvis.

What do the pelvic floor muscles do?

When the pelvic floor is strong, it supports your pelvic organs to prevent problems such as: incontinence (the involuntary loss of urine or faeces), prolapse (lack of support) of the bladder, uterus and bowel. The pelvic floor muscles also help you to control bladder and bowel function, such as allowing you to ‘hold on’ until an appropriate time and place.

What causes pelvic floor muscle weakness?

Some of the common causes of pelvic floor muscle weakness are: pregnancy, childbirth – particularly following delivery of a large baby or prolonged pushing during delivery, being overweight, constipation (excessive straining to empty your bowel), persistent heavy lifting, excessive coughing, changes in hormonal levels at menopause, growing older.

How do I strengthen my pelvic floor muscles?

It is recommended that all women exercise their pelvic floor muscles everyday throughout life, to prevent weakness and improve strength. Exercising weak muscles regularly, over a period of time can strengthen them and make them work effectively again.

Imagine you are trying to stop yourself passing wind and then pull forward as though you are also trying to stop your flow of urine. This closes and draws up the back passage and vagina. By doing this, you should feel your pelvic floor muscles ‘lift up’ inside you and feel a definite ‘let go’ as the muscles relax.

• Hold for a few seconds then relax *
• Repeat several times *
• Follow by several short squeezes *

* discuss with your midwife or nurse how many of each

There is an online class —  Pelvic Health for Pregnant and Post Natal Women  — held every eight weeks by the North West London Maternity Team. The class aims to ensure that all users of midwifery services in NW London are provided with good access to education, support and information with regard to pelvic health, during and after pregnancy.

This is part of a series of education classes for pregnant and post natal women to support them with pelvic health. The class is run by a consultant obstetrician/gynaecologist, a specialist midwife and specialist physiotherapist.

The class will include:

• how to effectively do pelvic floor exercises
• practical tips to aid recovery post having your baby
• ... and much more.

The class is also interactive so you can ask the team questions you have.  Click here to reserve a spot.

What is the Anorectal Physiology Clinic?

This is a specialist clinic provided by doctors and physiotherapists who manage problems related to the pelvic floor -  the muscles within the pelvis. We specialise in the assessment of women who have had a third or fourth degree perineal tear as a result of childbirth, also known as an Obstetric Anal Sphincter Injury (OASI).

What is a third or fourth degree perineal tear/Obstetric Anal Sphincter Injury?

An OASI occurs when the tear during childbirth has also involved not just the skin around the vagina and the muscles surrounding it but  the anus (back passage). These types of tears are much less common (three out of 100 deliveries) but the muscles that are injured play an important role in controlling your bowel movements.

Women who sustain an OASI are more likely to suffer from faecal urgency (needing to rush to the bathroom to pass stool) and faecal incontinence (not being able to control the passage of stool) than women who do not sustain an OASI. 

For more information about these types of injuries, the Royal College of Obstetricians and Gynaecologists (RCOG) produce a leaflet which can be accessed via the following link:

Third and fourth degree tears

Why have I been asked to attend the Anorectal Physiology Clinic?

You have been invited to this clinic as you have either recently had a baby and sustained an OASI or you are currently pregnant and have sustained an OASI in a previous pregnancy. You could also have been referred to our clinic if another medical doctor or physiotherapist has asked us for an assessment due to ongoing problems you may have with controlling your bowels.

How should I prepare for my appointment?

There are no special preparations required. However, it would be helpful if you could empty your bowels and bladder before arrival. It is best to make arrangements for your baby or small children to be looked after on the day of your appointment as we are unable to care for them in our department.

On the day, please arrive at least 10 minutes before your scheduled appointment. If you are running late, please call and let us know at the earliest opportunity. We will do our best to accommodate you if you are late, but we may have to reschedule your appointment.

What happens during my scanning appointment?

If you agree to be examined, you will be asked to undress from the waist down (including your underwear) and lie on your back on the examination couch. A single use covering will be provided to you. The examinations include:

1. Examination of the perineum and vagina

This involves a visual examination of the pelvic floor. The medical professional will inspect your external genitalia (perineum) to ensure that the tear has fully healed from the outside. They may also examine you internally to check the vagina has healed. If you have any concerns about your healing, please let the doctor know.

2. Anal manometry testing

This test measures the strength of the muscles around the back passage. It involves inserting a tube into the back passage. This is usually done while you are lying on your left-hand side, so the team will ask you to turn over for this test.

The tube is sterile and inserted approximately 3-4cm into your back passage using lubrication. The medical professional will ask you to relax first and then to squeeze your back passage muscles against the tube and will take measurements (usually three measurements). This test lasts for up to a minute.

3. Endo-anal ultrasound scan

This test uses inaudible sound waves (ultrasound) to assess the structure of the back passage muscles (called the internal and external anal sphincters). It involves the gentle insertion of an ultrasound probe (about the thickness of your index finger) 3-4cm into the back passage.

The probe is lubricated and covered with a single-use probe cover. This test lasts for up to 60 seconds. We will record images of these muscles as they will be used as part of your medical records.

Once the investigations are complete and you are dressed, the medical professional will discuss the findings with you and make their recommendations for management. You will also be given the opportunity to ask any further questions you may have.

What are the benefits of attending this scan?

Attending this scanning provides you with an opportunity to speak with a specialist and address any concerns you may have regarding your perineal tear, pelvic floor and any symptoms you may have developed as a result of childbirth. Performing anal manometry and endo-anal ultrasound scans are the best ways of assessing the quality of the repair and how your bowel functions after a third or fourth degree perineal tear.

If you are being assessed during your pregnancy we can offer advice and make recommendations to you and your obstetric and midwifery teams based on our investigations. This will allow you to make the most informed decision on how you choose to deliver your baby. If you are having ongoing problems with your bowel function, we can give you advice on how to manage these symptoms as well as refer you to our team of specialised pelvic floor physiotherapists. 

What are the risks and side-effects of the investigations performed during scanning?

Ultrasound examination of the back passage and anal manometry testing are safe and pose no risk to you or your baby (if you are pregnant). The probe and the tube can be a little uncomfortable upon insertion, but every attempt will be made to minimise the discomfort caused to you. You can ask the doctor to stop the test at any time.

What are the alternatives to having this scan?

Attending the scan is not compulsory and if you decline the offer of an appointment we will continue to offer the best care we can without the scan. If you are pregnant with your second baby, we will have a mode of delivery conversation using your symptoms to best inform you.

If you have recently sustained an OASI and wish to be reviewed by a specialised pelvic floor physiotherapist, please contact your midwife or GP. If you are currently pregnant you can discuss your symptoms and options for birth with your obstetrician or midwife during your antenatal clinic appointments.

Helpful resources

RCOG perineal tears hub

rcog.org.uk/tears

Mothers with Anal Sphincter Injuries in Childbirth (MASIC)

masic.org.uk

Birth Trauma Association

birthtraumaassociation.org.uk