'Hidden' issue is brought out into the open; Health Reporter HELEN RAE discovers that a physiotherapist's trip to Canada will benefit many North women with pelvic floor problems.

AHEALTH specialist in the region used a trip to Canada to improve options for North East women.

Despite national awareness campaigns and an increasingly open attitude to "female" issues, many women still suffer pelvic floor dysfunctions in silence - unaware of the options available to them or too embarrassed to seek help and advice.

At South Tyneside NHS Foundation Trust, specialist physiotherapist Christine Burge has incorporated the good practice and products she discovered in Canada to improve the service offered to women in the region suffering from pelvic floor problems.

She said: "I trained initially as a general physiotherapist before specialising in women's health and have always been interested in ways to help improve the quality of life for our patients.

"I decided to apply to the Heyman Scholarship Fund, which is a travelling scholarship scheme for nurses and healthcare professionals in South Tyneside, and I was awarded the funds to spend time in Canada and met with expert Leslie Hanson.

"In both the US and Canada, there has been a far greater level of research into these problems.

"I spent two weeks in the pessary clinic at the Royal Alexandra Hospital in Edmonton, Alberta, where their approach to pelvic floor dysfunction and pelvic organ prolapse has been through the use of non-invasive treatment. For example, other options to relieve symptoms, which are vital when surgery isn't a viable option.

"Since my visit, we have introduced the use of silicone pessaries to help treat the symptoms caused by pelvic organ prolapse. They support the bladder neck from inside the vagina much in the same way an under-wire bra gives you support.

"In comparison to some traditionally-used materials, medical-grade silicone doesn''t carry odours, is non-allergenic and is softer and pliable, which makes it easier to use.

Pessaries can be used for women who would prefer nonsurgical treatment, or who are poor candidates for surgery, and those who still wish to have children.

"A lot of our patients simply want an answer to their problems - they don''t want it to stop them from doing the things in life they enjoy and they certainly want to be confident about the choices they make about their care.

"I think that a lot of people assume that the surgery may be the only way to improve their situation. There are situations where this is the case but, in some instances, non-invasive treatments are the answer. Increasingly, we have patients using silicone pessaries for prolapse who want to selfmanage their care.

"With proper guidance, a pessary can be self-inserted using the same technique you would if using a tampon."

In Canada, health experts recognise pelvic floor dysfunction as a hidden epidemic, and this is also the case in this country. Here in the UK, we are an ageing population and, in the next five to 10 years, it is estimated there will be a huge rise in the numbers of postmenopausal women, many of whom will need help, advice and treatment to alleviate problematic symptoms.

Ms Burge added: "Our urogynaecology service provides clinical assessment of women with urinary incontinence, vaginal prolapse and sexual dysfunction.

"At South Tyneside District Hospital, the team is headed by a consultant gynaecologist with a special interest in urogynaecology and includes nurses, a specialist physiotherapist and urogynae specialist nurse.

"We have an integrated continence care pathway that allows seamless movement by women across Primary Care to the hospital-based team.

"We also run a dedicated, 'one-stop' urodynamic clinic, where patients have an assessment, investigation and treatment all offered at the same time, because we want to limit the time patients have to spend in hospital.

"Between 400 and 500 women with suspected dysfunctions are referred to our team each year.

"We can also advise on pelvic floor, muscle reeducation and bladder retraining, as sometimes all it takes is a little re-education. Patients for whom pessaries are the most suitable form of treatment are managed in a dedicated pessary clinic.

"I really believe there is still much we can do to help women make an educated decision about their care, and there is a lot of work to be done to perhaps change some cultural perceptions and make sure women know all the options available to them."

Mrs GB, of South Tyneside, who has asked not to be named, is a housewife and carer.

In 2007, she attended the weekly gynaecology outpatient clinic at South Tyneside District Hospital, complaining of symptoms of a heavy feeling in the groin which got progressively worse and was particularly bad after standing or lifting, meaning she was unable to carry out even simple household tasks.

Prior to attending the clinic, the 57-year-old had undergone surgery for a prolapse when conservative management had failed to improve her condition some years previously. However, she unfortunately started to feel the symptoms of prolapse once again.

Mrs GB was reluctant to have any further surgery but wanted relief for her symptoms, which where affecting her quality of life. With advice and guidance from the urogynaecology team, she chose to trial a silicone pessary.

She responded well, was comfortable, felt supported and had significant relief from her symptoms.

During a check-up, she was offered the option of self-care, learning about how to make it more hygienic and reduce the risk of complications, and she agreed.

Following instruction, she removed her pessary without difficulty and, following instructions, learned the correct way to insert the pessary herself.

Today, Mrs GB self-cares for her pessary and returns to the clinic at six-monthly intervals for the first year, thereafter yearly intervals reducing her need for hospital attendance.

She said: "At first, the thought of self-care can be quite daunting, but the freedom, privacy and dignity of being able to take control of your own care, in your own home, and in your own time, is thoroughly worth it.

"I know that Christine Burge is on the end of the phone whenever I need her if I had a problem and it has been great to not have to make frequent appointments and trips to the hospital over the last few months.

"Women shouldn't feel they have to put up with these types of symptoms because help is out there. I really would recommend the use of a pessary, it's worth giving it a try."

Pelvic problems THERE are many symptoms of pelvic floor dysfunction including: Pelvic pain Pain with intercourse Vagina pain Pain between vagina and rectum Low back pain Urinary frequency and urgency Constipation Painful bowel movements Decreased urinary flow Exercise benefits In the UK, Pelvic Floor Dysfunction (PFD) undermines the quality of life of around one in three women.

It generally occurs in women following childbirth or postmenopause and later in life, problems include incontinence, sexual dysfunction and pelvic organ prolapse.

Pelvic organ prolapse occurs when the pelvic floor muscles become weak or damaged and can no longer support the pelvic organs.

The womb (uterus) falls into the vagina, the roof of the vagina sags and its floor bulges with the vagina itself potentially becoming wider.

While prolapse is not considered a life-threatening condition, it may cause a great deal of discomfort and distress.

Pelvic floor exercises or pelvic floor muscle training is one of the many ways of strengthening the pelvic floor supports. Experience shows even with verbal or written instructions, many women may not grasp how to do them properly. It is recommended that a physiotherapist, preferably one who has been trained in pelvic floor work, teaches women how to do these.

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HELPING HAND - Physiotherapist Christine Burge explains her procedures for helping women with often undiagnosed pelvic floor dysfunction