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Adenomyosis written by Claire De Vos (Physiotherapist)

What is Adenomyosis?

Adenomyosis is a condition that affects up to 1 in 10 women yet is rarely spoken about. It occurs when cells similar to those that line the uterus (womb) grow into the muscle wall of the uterus. The extra tissue can cause the uterus to enlarge and with each menstrual cycle it thickens, breaks down and bleeds which can lead to cramping, pain, and heavy periods. Adenomyosis most commonly occurs in women aged 35-50 years who have had children, although it can occur in young women and teenagers as well. The cause of adenomyosis is largely unknown, although it is believed that childbirth or previous surgeries can increase the risk of developing it.

Uterus model showing Adenomyosis

Adenomyosis differs from endometriosis (another common pelvic pain condition), although many women have both adenomyosis and endometriosis. Endometriosis occurs where cells similar to those that line the uterus grow on other parts of the body, commonly the fallopian tubes, ovaries, bladder and bowel

Adenomyosis Symptoms

Diagram showing a healthy and a uterus with Adenomyosis

Adenomyosis can vary greatly from woman to woman. For some women, symptoms can be severe and extremely debilitating. However, up to 30% of women with adenomyosis experience no symptoms at all. The correlation between the severity of symptoms and the amount of adenomyosis is also poor so it is difficult to predict who will experience symptoms.

Symptoms of adenomyosis can vary between women but may include:

  • Heavy, painful periods
  • Menstrual cramping
  • Pain in lower limb and lumbar spine
  • Pressure in pelvis and/or bloating
  • Chronic pelvic pain
  • Pain with sexual intercourse

How is it diagnosed?

Adenomyosis can be difficult to diagnose. If a medical practitioner suspects you have adenomyosis they will likely refer you for a transvaginal (internal) pelvic ultrasound.
MRI is also a useful tool for diagnosing adenomyosis and is non-invasive.

How is it treated?

There are medical, surgical, and conservative management strategies. Although the only definitive cure is hysterectomy, there are many lifestyle and medical interventions that can decrease pain and improve quality of life.

Conservative management

Uterine model Adenomyosis

The good news is physiotherapy can help! Physiotherapy management may include lifestyle modification advice and pain management strategies including heat, ice, pacing and gentle movement. Physiotherapy management may also include; soft tissue release, pelvic floor muscle down-training, biofeedback, and retraining good bladder and bowel habits. Your pelvic health physiotherapist will conduct a comprehensive assessment and work together with you to identify your goals and create a tailored management plan.

Exercise is an important part of managing any persistent pain condition and working with an exercise physiologist who specialises in managing pelvic pain conditions is a great way to incorporate regular movement and activity into your daily routine.

Medical Management:

  • Pain management and analgesia
  • Hormonal therapies. These may be either oral medications or an intrauterine device can help such as the Mirena.

Surgical Management:

  • Laparoscopy
  • High intensity ultrasound
  • uterine artery embolization
  • Endometrial ablation

If you experience any of the above symptoms, get in touch today to discuss the role of Pelvic Floor Physiotherapy and Exercise Physiology.


Book an appointment today for your assessment!

Blog by Claire De Vos (Physiotherapist)

Continence and Women’s Health Physiotherapy Services by Claire De Vos (Physiotherapist)

Total Physiocare is now offering Continence and Women’s Health Physiotherapy Services!

Women’s health physiotherapists are highly trained and skilled in assessing, diagnosing and managing a variety of health concerns that may affect women throughout their lives. Such conditions may include; incontinence and bladder dysfunction, pelvic organ prolapse, sexual pain or dysfunction, chronic pelvic pain, lactation issues, as well as musculoskeletal aches and pains associated with pregnancy and menopause.

Our Women’s Health Physiotherapist Claire explains a little more about common conditions she treats below:

Bladder Dysfunction:

Bladder dysfunction refers to difficulty with the storage or emptying of the bladder. Common forms of bladder dysfunction include:

  • Stress urinary incontinence: leaking on exertion e.g. cough, sneeze, laugh, jump, run
  • Urge urinary incontinence: leaking on the way to the toilet
  • Mixed Urinary Incontinence: both stress and urge urinary incontinence
  • Urinary Urgency: experience of a sudden, non-deferrable urge to empty your bladder. May be accompanied by urge incontinence and/or urinary frequency (see below).
  • Urinary Frequency: Emptying your bladder frequently (more than 6x per day, or more than 2x overnight)
  • Difficulty or pain emptying your bladder/feeling of incomplete emptying.

Physiotherapy is considered by the International Continence Society to be a first-line treatment of these conditions. Treatment may include: pelvic floor muscle training, bladder training and bladder calming techniques.


Pelvic Organ Prolapse:

Pelvic organ prolapse is extremely common, occurring in 1 in 3 women (a very similar rate to incontinence). It often occurs as a result of pregnancy/childbirth and may worsen during menopause. Pelvic organ prolapse occurs where there is increased laxity in the vaginal wall, resulting in descent of one or more pelvic organs (bladder, bowel, uterus or cervix) into the vagina.

Symptoms may include:

  • Heaviness or dragging within the vagina, particularly after long periods on your feet, lifting or at the end of the day
  • Some women may feel low back pain

Physiotherapy management often includes pelvic floor muscle training as well as education about strategies to reduce the symptoms of prolapse. Your physiotherapist will work closely with your GP/specialist to help you manage your prolapse and achieve your goals.


Chronic Pelvic Pain:

Chronic pelvic pain can have a significant impact on a woman’s quality of life. It may be associated with other conditions including endometriosis, painful periods and IBS.

Women with chronic pelvic pain may experience associated heavy periods, experience pain/difficulty with insertion or removal of tampons and often experience discomfort during intercourse.

Physiotherapy treatment will often involve pelvic floor muscle down-training, mindfulness, relaxation strategies and stretches. Your physiotherapist will work with you and your healthcare team (which may include GP, specialist and psychologist) to help to decrease your discomfort and get back to activities.


Pelvic Girdle Pain:

Pelvic Girdle Pain (PGP) occurs frequently during pregnancy, with approximately 50% of women experiencing some degree of PGP during their pregnancy.

PGP refers to pain felt either over the joint between the sacrum (lower spine) and pelvis on either one or both sides of the body. It may also radiate into the sides of the hips or be felt over the pubic symphysis (the bone at the front of your pelvis).

PGP usually resolves once you have delivered your baby but in the meantime physiotherapy can help you manage you symptoms and keep active for the remainder of your pregnancy.



Mastitis, which often occurs as a result of blocked milk ducts results in inflammation of the breast tissue. This can result in redness, engorgement and pain for the breastfeeding mother. Fortunately, therapeutic ultrasound administered by a physiotherapist is effective at relieving the inflammation of mastitis and enhancing your recovery.


Abdominal Separation:

During pregnancy your tummy muscles stretch to accommodate your growing baby. After delivery you may have been told you have an abdominal separation or “DRAM” which is where these stretched muscles are taking a little more time to come back together.

There are certain exercises you should avoid if you have an abdominal muscle separation, particularly crunches.

Your physiotherapist can assess your tummy muscles (usually around 6 weeks post-natal) and advise you on the best exercises to manage your separation.


Post-Natal Check:

Congratulations on the arrival of your new baby! Growing and delivering a baby, as well as taking care of a new born can be both physically and emotionally draining.

One of the best ways to help manage this is by getting regular exercise. However, we recommend a post-natal check (usually around 6 week’s post-partum) so that your physiotherapist can guide you on an appropriate return to exercise plan.

It is common to experience pelvic floor dysfunction and abdominal separation (see above) following the delivery of your baby and it is important to have these issues assessed and addressed before returning to high level exercise.


Book an appointment today for your assessment!

Blog by Claire De Vos (Physiotherapist)

Exercise After Birth – Blog by Emily Shortal (Physiotherapist)

Returning to Exercise After Birth

We all know the importance of exercise after having a baby, but there are many misconceptions about how and when you should start. With today’s world of social media and celebrity mums who seem to bounce back to their pre-baby shape within weeks, there can be a lot of pressure on new mums to get back onto the fitness wagon. And while we don’t want you to forget to look after yourself as well as your new baby, there needs to be a safe and gradual return to exercising.

The First 6 Weeks:

Pelvic Floor Exercises
You can recommence your pelvic floor exercises a couple days after giving birth. It it common that initially after a vaginal birth, contracting your pelvic floor will feel different than before. This will improve as you practise. Focus on the ‘squeeze and lift’ technique, completing both short and long (10 second) holds. Ensure you aren’t holding your breath or squeezing your buttocks/thighs.

Transverse Abdominis (tummy) Exercises
During pregnancy, the connective tissue of the abdominal muscles stretch to allow the baby to grow. To assist with the recovery of a DRAM (diastasis of recti abdominis muscles), you can commence static activation exercises. This involves gently drawing the lower portion of your abdomen inwards (towards your spine). Avoid bracing or sucking in your stomach, or holding your breath. Try first lying on your back, then kneeling on all fours. Aim to build up to 10 second holds without compromising your technique.



Walking is a simple and great exercise which you can return to in the early stages after giving birth. It’s low impact, an opportunity to get outdoors and help your baby fall asleep. Start off gently and listen to your body. If you feel tired, don’t overdo it. Aim to gradually build up the duration by 10 minutes each week.

After 6 Weeks:

Once you have had your 6 week obstetrician check up and ensured you are healing well, you may commence other forms of cardiovascular exercise such as swimming and cycling. These are great low impact options. You may also recommence gentle strength training. Clinical pilates is a great way to safely rebuild your core strength under the supervision of a Physiotherapist.
Remember- not all ‘core’ exercises you have done in the past are appropriate to return to yet. Avoid stomach crunching style exercises, or doming of the abdominals. At this stage, it is best to seek advice from your Physiotherapist for a suitable program and monitoring of your abdominal separation.

Running and High Impact Exercise

At the very earliest, you should not consider returning to running or high impact sport until 12 weeks after giving birth. This is to allow time for your pelvic floor muscles to recover from the pregnancy and labour. And if you’re thinking: “but I had a Caesarian”, remember that your pelvic floor muscles still had to support the extra weight of a growing baby for 9 months, so don’t think that you’re off the hook.

A quick test you can do at home to see if you are ready for returning to high impact exercise is:
Repeat 10 star jumps with a cough on each jump and with a fairly full bladder. You should not leak when doing this.

At Total Physiocare, we can help you return safely to exercise after having your bub. We conduct both 1:1 and group pilates sessions at our Kew, Heidelberg, Footscray and Reservoir clinics.

Book an appointment today for your assessment!

Blog by Emily Shortal

Do you have issues with incontinence?

Women’s Health and Incontinence Physiotherapy

Women’s health and incontinence physiotherapy is a specialty of physiotherapy that focuses on incontinence and conditions specific to women in particular. Services range from antenatal/post-natal education and exercise, as well as musculoskeletal treatment for particular conditions such as prolapse. Pelvic floor muscle weakness in particular has been linked to many women’s health conditions.

What is the Pelvic Floor?

The pelvic floor refers to the group of muscles that support the pelvic organs (the bowel, bladder and uterus). They stretch from the front of your pubic bone to the back of your tailbone.

From Continence Foundation Australia

The pelvic floor has three main functions:

  1. Support the pelvic organs

Pelvic muscle damage or weakness can lead to the pelvic organs being poorly supported. In severe cases, prolapse can occur, where the pelvic organ slips further down than it is meant to be, sometimes even external to the body.

  1. Allowing proper continence of the bowel and bladder

In order to allow proper continence, the pelvic floor muscles must be able to contract and relax appropriately. If these muscles are unable to relax, bowel and bladder incontinence may result. Alternatively, if these muscles are too active, constipation and painful urination can occur.

  1. Working with the other ‘core’ muscles to stabilise the spine

As well as supporting the pelvic organs, the pelvic floor forms the base of the core, while the diaphragm forms the roof and the deep spinal/abdominal muscles form the walls. For our core stability to be most effective, these muscle groups need to work effectively together. Dysfunction with the pelvic floor muscles lead to decreased core stability, which can lead to back pain and injury.

Why are Pelvic Floor exercises important?

Pelvic floor exercises are crucial to strengthening the pelvic floor muscles and limiting the conditions associated with weak pelvic floor muscles. Urinary incontinence occurs in over one third of women and up to 13% of men. Pelvic floor muscle training has been shown to eliminate completely or reduce episodes of urinary incontinence. Pelvic floor exercises can also reduce prolapse symptoms and limit the development of associated conditions. Finally, we rely on our core stability every day during activities such as walking, lifting objects – in fact, even while you are sitting down reading this article! Any imbalance in our core muscles can have widespread effects throughout the body, so it is vital to make sure your pelvic floor is working properly.

What are the symptoms of Pelvic Floor dysfunction?

There are many symptoms of pelvic floor dysfunction. Common symptoms include:

  • Leaking small amounts of urine when coughing, sneezing, laughing or running
  • A frequent need to urinate
  • Feeling of incomplete emptying with urinating or with bowel movements
  • Constipation, straining, pain with bowel movements
  • Unexplained backache
  • Pain for women during intercourse
  • Reduced sensation in the vagina

How does Pelvic Floor dysfunction affect men?

Men experience similar symptoms of pelvic floor dysfunction, such as stress incontinence, constipation, backache and incomplete bladder emptying. Men are commonly affected by pelvic floor dysfunction after prostate surgery and abdominal surgery. Following prostate surgery in particular, men can experience bladder issues for 6-12 months afterwards. It is particularly important for men undergoing prostate surgery to commence pelvic floor muscle training exercises. Pelvic floor muscle training can speed up the recovery process and reduce symptoms of incontinence.

From Continence Foundation Australia

How can I strengthen my Pelvic Floor muscles?

There are many different exercises available for men and women to strengthen their pelvic floor, depending on what the underlying issue is – be it core weakness, incontinence or even prolapse. For further information, book in to see our Continence and Women’s Health Physiotherapist today for a full assessment and tailored exercise program.

Men’s & Women’s Health and Continence Physiotherapy assessments are available at our Footscray, Camberwell and Heidelberg clinics.

Where can I find further information?

Further information can be found from the following websites:

The Continence Foundation of Australia

Pelvic Floor – Better Health Channel

Pelvic Floor – Information for Men

Pelvic Floor First

This post was compiled by our Physiotherapist Simone