gyn physiotherapist referal

Well Tullyleaf, you know what it happening, and that is what is important! These doctors do give away their folly when they deny the reality that a woman is experiencing, then deny that a prolapse is a prolapse.

These sorts of events do shake our confidence in doctors for very valid reasons, and you may never take a doctor's word for anything, ever again. However, it is important to regard this as a reminder that doctor doesn't *always* know best, though sometimes they do, and that it is important to recognise that they are human, and that we need to get several medical opinions to gain a better understanding of anything that goes wrong with our bodies if there is any hint of a reflection of a concealed scalpel in the room, because scalpels indicate permanent changes, and there is always a risk with a one way door.

Whomever you finally select to treat you for any condition has to have your confidence, and that has to be earned.

You can try out a physio without too much risk, as long as you monitor progress carefully. I wouldn't assume anything bad or anything good about the physio treatment until you have the treatment. Once you know what she wants you to do you are free to participate or not. I have had helpful and unhelpful physio, sometimes from the same practitioner. The electrical stimulation therapy, quite scary in 1982, was helpful, but the pelvic floor exercise regime they had initially given me, failed dismally because my pelvic nerves had gone to sleep and needed waking up. Once my nerves woke up the PF exercises worked better, but I recognise now that my tucked and zipped posture was sabotaging my PF all along. There is no way of telling until you try, and inform yourself as widely as you can, so you are in a position to understand what is happening in your body.

I now believe that over-emphasising the pelvic floor is a mistake because the abdominal and pelvic cavities are one unit bounded by the respiratory diaphragm at the top; the abdominal groups at the front, sides, and under belly; the lower spine and its related muscles at the back; and underneath the sacrum and spine, and inside the pelvic cavity, the PF muscles form a multi-directional stabilising system which is designed to let things out of the body, a big role indeed knowing what to retain and what to let out.

To single out the pelvic floor muscles as 'The Key' is a very short-sighted approach, which will not firm up the vaginal walls, but will lift the bottom of the cavity, making them floppier!

It is only by winding up all the muscles I have described, and others too, and stretching them out until they are in slight tension (working) that the posture will shift to bring them all into proper alignment. In proper alignment they can maintain their own strength with day to day activity, and shift the pelvic organs forward, so they are sitting on the pubic bones, instead of being supported over the vagina, where they will always be prone to falling down the plughole once a bit of intraabdominal pressure is exerted, ie breathing, walking or any movement. Intraabdominal forces are inevitable. That is why the pelvic region has a spot on the lower abdominal wall which has only ligamentous support from side to side, no muscle tissue (This is part of the tranverse abdominus muscle). The only way to pull in the lower abdomen is by shortening the vertical rectus abdominus muscles.

Aha! But what about the transverse abdomninus, you say? The lower part of the transverse abdominus muscle is anchored on both sides into the inguinal ligament, which is a stringlike ligament that runs from the bottom of each pelvic wing in a more or less straight line to the front point of the pubic bone on each side. It is like a bow string. Straight, but flexible. The muscle tissue in that part of the TA stops just below the top of the inguinal ligament, and melds into the ligamentous band below it. It is not possible to tighten the lower part of the TA, because there is no muscle tissue to tighten! It just sits there like an almost inflexible hammock as a little pouch for the bladder and uterus to rest in, forward of the pubic bones, and largely out of the way of intraabdominal forces and gravity which will simply push them harder into the hammock, *not* down the vagina!

There is nothing wrong with having pelvic floor muscles that obey your every order, but they are no more important than every other muscle that bound the abdominal cavity, and enables us to maintain tall, feminine posture. With tall, feminine posture the PF muscles take care of themselves.

Without tall, feminine WW posture you can have quite ordinary (read 'not exercised/damaged') PF muscles and still retain your pelvic organs inside your body (see pp 28 and 29 of STWW to see how).

The PF muscles have a major role in stabilising the *back* wall of the pelvic cavity, and allowing and controlling urination and bowel emptying. And they are a great sex toy! *But* they are diagonal, and the slope is forwards at up to 45 degrees. They are *not* a shelf underneath the pelvic organs. If they must be described as a shelf it is a very slopey shelf. Anything you put on a slopey shelf like that will slip straight forward onto the pubic bones. Well, fancy that! It was designed that way! Clever Creator, eh?

Hope this will help you clarify why you are going to physio. Good luck!

BTW, there is not a single research paper that I can find that shows that PF muscle exercises (Kegals) will help anything but the slightest prolapse. If you can find one, please tell all of us. Not being spiteful or smartarse here. There simply is no evidence. But you might get more than Kegals. Here's hoping.

Cheers

Louise