Holisitic hopes

Helen Mooney meets some physios who believe that women’s health and MSK specialists should collaborate more closely.

There are about 700 registered women’s health physiotherapists in the UK. A number work in the NHS, however many work in private practice. Given that women make up half of the population, and that thousands of women at any one time are in need of treatment from a women’s health physiotherapist, it does not take a mathematician to work out that the ratio of specialist physiotherapist to female patient is far too low.
The Pelvic, Obstetric, and Gynaecological Physiotherapy Association (POGP) is associated with the Chartered Society of Physiotherapy and its vice-chair Katie Mann explains that the role and skills of women’s health physiotherapists are often multi-faceted, spanning obstetrics, gynaecology, continence and sexual health.
That said, the most common conditions treated by women’s health physiotherapists are the conditions of prolapse and incontinence associated with a weak pelvic floor – something that’s mainly in found in women who have had children and in older women. Indeed, in the UK it is estimated that 50 per cent of parous women experience some degree of prolapse and that 10 to 20 per cent seek medical care.  

Shining a spotlight

In November the POGP, formerly the Association of Chartered Physiotherapists in Women’s Health will gather for its annual conference in Liverpool. This precedes the two-day European Congress of the European Region of the World Confederation for Physical Therapy. Much of what the POGP and its members are seeking to do is shine the spotlight on the role of physiotherapy in helping to treat both women’s and men’s health in a holistic way. 

Questions to ask

Ms Mann believes that when it comes to pelvic floor and incontinence treatment, musculoskeletal (MSK) physiotherapists need to become better informed about the questions they can be asking of their patients, the non-invasive treatment they can provide, and the possibility of referring on to specialist physiotherapists. Holding a rare band 8A post, the pelvic floor and women’s health specialist physiotherapist is based at Southport and Ormskirk Hospital NHS Trust.
‘Where I work my MSK physiotherapist colleagues see me as an MSK physiotherapist who treats the pelvic floor, in the trust we all work together but I know in many hospitals this is not the case because women’s health physiotherapists are often working in maternity and will have no day-to-day contact with their MSK colleagues.’

Holistic health

Kate Lough, a pelvic floor function specialist physiotherapist who will be speaking at this year’s POGP conference on the role of the physiotherapist in a psychosexual consultation, believes that physiotherapy should be focused ‘very much around holistic health – the body carries its ills’. 
Ms Lough, who is currently researching a PhD at Glasgow Caledonian University into the use of pessaries for prolapse, thinks that it is easy for MSK physiotherapists to be able to learn the skills needed to ask their patients about the ‘meatier problems’ they are having with their bowels, bladders and sex. She says this means they will then have the full patient information and can refer on to specialists. 
She admits, however, that this can be difficult in an NHS setting because physiotherapists do not have access to a private environment when they are treating patients.

Know your limitations

Becky Aston, a women’s health physiotherapist who works in private practice, agrees. ‘As physiotherapists we all need to be aware of our own limitations. We are also there as a health advocate. Whether people see us for shoulder pain, knee pain or something else the technique and skills needed are the same, if you are not looking at the whole person you are not treating them in a holistic way.
‘One women in three has a pelvic problem and some sort of incontinence.  We need to get away from this concept of physiotherapists being pigeonholed as treating specific problems, we have to treat the whole patient holistically.’

Pelvic floor examination

She says that, while the majority of physiotherapists seeing patients now in the NHS are MSK physiotherapists, all physiotherapists cannot be expected to be trained in or want to examine the pelvic floor. 
‘They need to be able either to refer or to acquire the skills they need,’ she says. However, she admits that to do this, physiotherapists must also have access to the right courses, training and support.
Yvonne Coldron, a women’s health specialist who works in private practice at North Downs Hospital in Caterham, Surrey, believes that physiotherapists must be trained in women’s health at undergraduate level. ‘There is an issue in undergraduate physiotherapy training where this is seen as an extra and it should be integral, if that were the case all physios would then have had training in women’s health, and it would raise awareness.’ 

Undergraduate training

Amanda Savage, a pelvic floor physiotherapist who works in private practice at South Cambridge Physiotherapy, is disillusioned by the lack of training for undergraduates. ‘When I was training I did a two-week placement as part of a women’s health rotation. Before that I did not even know about it. I think it is such a shame because of cut backs that this has been lost and we are losing the chance of training people to become women’s health physios because they are just not being exposed to it.’
Ms Lough says that while she thinks that the specialism is a postgraduate skill she questions why ‘the whole range of women and men’s health conditions, many of which are terribly common, are not taught and made aware to undergraduates’.
Coupled with the belief that there needs to be much greater awareness of the role of women’s health physiotherapists among the physiotherapy profession as a whole, there is also much anxiety about what the future holds. With the NHS facing arguably the most tumultuous period in its 68-year history it is perhaps inevitable that the role of the specialist physiotherapist will be further reduced.

Not a sexy topic

Ms Aston says that already the lack of women’s health physiotherapists in the NHS means that many patients have often seen a plethora of specialists before they find someone that can help. ‘There is a good service for obstetric patients in pregnancy and back-pain in the NHS but I have heard that these appointments and services are also being cut back,’ she warns.
‘It is more of a struggle to find incontinence and prolapse specialists … I think that in the NHS incontinence is not a very sexy topic, but people underestimate how much incontinence impacts on quality of life. The problem is also that a lot of rheumatologists, gynaecologists and neurologists don’t understand what physios do … we need to get these specialists understanding what we can do and referring to us.’
Ms Coldron agrees and adds that specialist women’s health physiotherapists need to work on educating fund holders of their existence as well. Last year, the Scottish government promised investment into specialist physiotherapy services for incontinence following a campaign for an increase in services led by CSP Scotland.

Need to convince CCGs

Ms Lough warns that across the border in England this is not the case, rather the opposite, and that when a women’s health post becomes vacant it is often down-banded, split or simply got rid of entirely. 
And Ms Mann thinks more needs to be done to convince clinical commissioning groups (CCGs) to invest in specialist women’s health physiotherapists. 
‘The problem is that politically, clinical commissioning groups only have a limited budget and certain areas have to have direct funding and we are not one of them.’ fl 

The Pelvic, Obstetric, and Gynaecological Physiotherapy Association

  • POGP has more than 700 members and associates and is a professional network affiliated to the Chartered Society of Physiotherapy.
  • The Obstetric Association of Chartered Physiotherapists was formed in 1948 by members of the Chartered Society of Physiotherapy interested in obstetrics. It was one of the earliest clinical interest groups to be formed.  In 1976, gynaecology was added to the specialty and the group became known as the Association of Chartered Physiotherapists in Obstetrics and Gynaecology. 
  • In 1994 the Association was re-named the Association of Chartered Physiotherapists in Women’s Health
  • In 2014 the Association changed its name again to the Pelvic Obstetric and Gynaecological Physiotherapy Association and currently has a UK membership of at least 700 members and associates. It is also a founder member of the International Organization of Physical Therapists in Women’s Health. 

More information 

Helen Mooney

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