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Incontinence and Bowel Management for Women, Men and Children.
Women’s Health Physiotherapist Brisbane, Australia.
Pelvic Floor Dysfunction Treatment.

Dementia – the Green Goblin

This week’s blog is a sad one. It’s talking about a problem which is likely to touch all our lives in some way. We will all know a family who has had to deal with the dementia diagnosis or will be right now in the thick of the dementia disruptor, with all the sadness and confusion that it not only brings to the sufferer, but also to the family and friends of the person with this awful disease. The figures for dementia are on the rise and the burden to the families and surrounding society can be huge.

My OT friend Anne, who gives me all the funny incontinence cards, also provides me with some amazing books to read and one which is very moving and poignant is called Green Vanilla Tea by Marie Williams. This book is an account of the personal journey of Marie Williams (a social worker by profession) whose husband had a diagnosis of dementia. It is particularly tragic because he was very young when he was diagnosed. They had two teenage children and the impact on all their lives is laid bare in the book.

Marie writes about dementia, calling it the Green Goblin, and her story, while tragic, gives an insight into the things we take so much for granted – things like language and communication, which slowly faded as her husband descended further into the grip of Alzheimers. Marie says:

The more I travelled in the company of this Green Goblin (talking about Alzheimers) the more I noticed the politics and power embedded in the ability to speak the way the various conversations shape our experiences, and the marginalisation of knowledge that is wordless. Oliver Sacks says our natural speech does not consist of words alone. Instead it consists of utterance- an uttering-forth of one’s whole meaning with one’s whole being- the understanding of which involves infinitely more than just word recognition. He goes onto say that language is immersed in tone and embedded in an expressiveness that transcends the verbal. He says it is deep, complex and subtle but perfectly preserved in people with aphasia (the total inability to speak). Not only is it preserved in people with aphasia he says it is ‘preternaturally enhanced’. (P135)

Today I have attended the first day of a 2 day workshop with Norman Doidge- the author of two brilliant books, which I would recommend to everyone to read. The Brain that Changes Itself and The Brain’s Way of Healing are brilliant reading about the plasticity of the brain and the ability of the brain to recover and compensate for significant losses and damage.

The final session today was on the very latest dementia research and best of all there is plenty of evidence stacking up on the preventative strategies that can be employed to prevent dementia and even make some reversing changes in early dementia.

All of these strategies need to be undertaken FOREVER! There will be a regression if you stop doing them. Social isolation not only worsens the progress of dementia, but makes it difficult for the sufferer to follow through with many of the strategies listed below. I am listing them early in this blog (below) so you can get started on a lifetime of dementia prevention, but will expand on all the research at a later time adding the exciting and compelling research that is going on in the dementia world to this blog at a later date.

In a nutshell what can you do to decrease the risk of dementia?

  • Correct cellular health of neurons and glia (address deficiencies Vit B12; treat infections; address teeth bacteria (floss teeth daily- teeth bacteria cross the blood brain barrier); Tested for heavy metals -lead, mercury, arsenic; pesticides; medications, drug abuse; food sensitivities- dairy, gluten (Good book Joe Bazzano The Toxin Solution)
  • Exercise – walk 3 kms a day 5 days a week (or cycle 16 kms, dance or other vigorous exercise)
  • Eat healthy -Mediteranean diet, 4 serves of fruit and vegetables, light on the dirty dozen ; eat organic watch hormones and pesticides.
  • Body mass index between 18-25%
  • Don’t smoke
  • Don’t drink too much(one glass wine per day
  • Sleep (good quality, enough)- a sleep study will tell you if you have sleep apnoea. Good sleep helps with elimination of waste build up in the brain.
  • DON’T HIT YOUR HEAD -avoid sports that cause minor repeated head injuries
  • Brain exercisesBrainHQ the most tested brain training by far; learn a new language; do something you are bad at- don’t keep doing things you are good at.
  • Control blood sugars
  • Importance of hormones (watch removal of hormone producing organ-ovary, thyroid
  • Eliminate foods that cause inflammation
  • Eliminate toxins
  • Be with people -beware social isolation. Loneliness magnified dementia and increased in those not married
  • Study all your life
  • Treat past traumas to decrease stress load

I will add the research which went across 30 years in two studies and other research by Dr Dale Bredesen at a later date, so I can get this blog out. Watch this space for the evidence to back up the above suggestions.

To finish though I want to include another quote from Marie Williams beautiful book for those people who have faced the difficult decision to place loved ones in care.

‘They showed me around and poured endless cups of tea but offered no pity. I was so relieved. Pity can be very isolating; there is nowhere to go from pity. One remains locked up in the sad story, alone. Pity has a way of creating and preserving hierarchical relationships between people that by their very structure assume the positions and abilities of the pitied are ‘less than’. It has nothing of the warmth and reciprocal human connection that comes with compassion. I told our story. The plight of a young family touched them and to my great relief they did not seem to think I was a bad person for considering placement. They held our story with a balance of authentic empathy and professional competence and they were kind- a tangible kindness that changes things and stays with you. (P158)’

And finally a statement with which I resonate with my blog writing. Marie’s great act of writing her story, may inspire others to agitate for more appropriate distribution of funds for research and programmes like the ones set out above. These interventions cause no harm and have research conducted over 30 years-so maybe instead of spending humungous amounts of money on more new drug trials, money could be allocated for centres of excellence with strategies for those with dementia.

 In “Picturing Human Right” a book by David Lloyd – he said stories, when voiced, become a political act. It doesn’t change the world, but storytelling changes people and people change the world. Telling this story is as much a political act as it is a story of love and hope. (P 236)

Further information can be gained from a programme on ABC 24 Sunday 10/12/17.


Disparity with rebates on different health professionals

I want to talk about fairness – or the lack of it.

My husband went to the dentist recently and had his six monthly check up. It took 30 minutes. He had an examination (it has a separate code), a clean (it has a separate code), a filling (it has a separate code) and the total of the bill was $298 and the rebate on that total was $259 therefore around $38 out of pocket (and the dentist very kindly accepted the rebate only for that). This cleaning of teeth and check up (and healthy rebate) with the dentist can happen twice a year. Pretty great!

Last year, I went to the podiatrist for a orthotic for my plantar fasciitis. The whole consultation took 20 minutes. I had an assessment (it had a separate code), a walk on the treadmill (it had a separate code), I had a cast made of each foot (pressed each foot into a foam box- it had a separate code) and then there was the making of the orthotic themselves (yep, separate code again). My total bill for this appointment was $715 and the rebate from the health fund was $400. Staggering amount of money for the pair of orthotics and 20 minutes but a very healthy rebate. This one consultation used up my complete podiatry allowance for the year.

When a patient comes to see a physiotherapist at our practice with pelvic floor dysfunction, we comprehensively assess the patient which most often includes amongst many other facets of an assessment, an internal examination because the pelvic floor muscles are situated on the inside of the pelvis (there is no separate code), there are measurements taken with a digital biofeedback device (no separate code), we comprehensively educate the patient about (for example) what is the normal bladder and bowel function (no separate code), and we comprehensively educate about how to treat what has gone wrong (no separate code). We regularly do a pre and post void residual measure with a real time ultrasound (no separate code). We regularly fit pessaries, a life-changing internal device for helping women with prolapse (again no separate code!)

The codes available to us at the rooms: Initial consultation 500, subsequent consultation 593 (or 505 depending on your health fund).

Nothing else.

When I see a new patient, especially if the patient has a pain condition, it takes a minimum of an hour and more often is 1.5 even 2 hours to help that patient. The charge for an initial consultation to see me is $195. The patient receives a rebate of $35. They are $160 out-of-pocket.

This is grossly unfair for the patient.

Should I charge less?

The overheads at our practice are huge. As I said, we fit pessaries (we have many different types of fitting kits for patients to try to a large stock of pessaries so patients can leave with their pessary) and we have a steriliser for these pessaries. We have two secretaries on most of the day. We give a 15 page handout to the patient to assist them with remembering all the information they have learnt; a copy of my book; a witches hat to allow the patient to do a bladder diary; plus if they have a pain condition they will get a specific pain handout and perhaps depending on the severity of their pain/anxiety also maybe get a 50 page booklet on managing pain and anxiety.

I could go on about the continuing education that my staff and I undertake each year. For example I am about to do a Norman Doidge 2 day workshop $760; an Explain Pain course (my 4th one- I do one every 3 years because they are so fantastic and the research is updating all the time) $1250 – it’s in Melbourne, so there’ll be airfares, accommodation etc; our CFA National Conference in Hobart – it’ll be around $700 plus airfares and accommodation to name just a few – last year I went to Florence for the International Continence Society 4 day conference. Was it amazing? Absolutely. Did it change and enhance my practise with patients? Absolutely. There are many, many others but I want to get to the point.

The point is that the Health Funds do not recognize the complexity of pelvic floor dysfunction and the time involved in seeing these patients.

The point is that the health funds do not value treatment of pelvic floor dysfunction the way they obviously value good healthy teeth or getting an orthotic for your foot.

What I can’t understand is they don’t see the health burden of pelvic floor dysfunction.

They don’t recognise the tremendous value in investing in preventative health measures like we offer patients.

If women can’t run or exercise properly because they leak urine or faeces or they have prolapse, then their cardiovascular health, their bone density and their general body strength will be compromised. It is a much bigger health issue. It affects Australia’s bottom (financial) line.

If women can’t have sex with their partners because they have vaginal pain, then their relationship is put under strain. The mental health of each partner may suffer. The relationship breaks down and then the children suffer. It becomes a much bigger health issue and it affects Australia’s bottom (financial) line.

If men leak urine or have pelvic pain and subsequent sexual dysfunction, it severely affects their mental health. It affects Australia’s bottom(financial) line.

As Professor Julius Sumner Miller used to say

Why is it so? 

Professor Julius Sumner Miller

Rant over………


Childbirth issues- Informed Consent, Forceps and Caesareans.

Amy being interviewed for ABC TV

There has been some heated debate recently about a headline grab that followed an interview of Amy Dawes, co-founder of The Australasian Birth Trauma Association (See link to the website here.) by ABC News. By her own admission, Amy is regretful that she answered yes when asked does she think that forceps should be banned? She herself has written that she was nervous and jumped in without necessarily thinking about the bigger world-stage picture. See below about why this is important. But this isn’t Amy’s fault and it isn’t the reporter’s fault. I think the fault lies with the lack of consideration given to women being able to deal with information, with facts, with evidence. And with our propensity to make childbirth mysterious and view it through rose-coloured glasses.

Amy is a mum (therefore a consumer- a non-medical person) who has suffered (for the rest of her life) a birth trauma to her pelvic floor muscles. Amy wasn’t informed during her pregnancy about the risks or the benefits of forceps. So when it came to making an informed decision during her prolonged labour, when the doctor said- the baby will come out with either forceps or a caesarean – because of her ignorance about the risks of forceps, whereas she was fully informed about what is involved with a Caesar and the risks of having a Caesarean section – for her it was a no-brainer.

Avoid the Caesar at all costs.

And what happened? Amy suffered a bilateral levator avulsion injury to her pelvic floor muscles from forceps. This happens around 40% of the time forceps are used. (It also happens in around 40% of women over the age of 35 when they are having their babies). These statistics surely warrant a mention during the 40 week pregnancy. If it was a hamstring tear or a biceps injury that happened 40% of the time when you undertook a certain activity, I am pretty sure we would be warned about it.

We live in a very regulated country – we have lots of rules and warnings in Australia. We can’t smoke on beaches (yay) or in restaurants (double yay), we have to wear seatbelts in cars because the evidence tells us that we sustain more significant injuries in big car crashes if we don’t wear our seatbelt. We have to swim between the flags so we don’t drown and can’t be served any more alcohol when we are already drunk (triple yay). The bar attendant and the establishment that it happened at are fined very substantially for doing so.

A clear assessment tool for assessing drunks (NZ) 

I included this because its such a clear infographic on assessing the state of sobriety

Rules for serving alcohol in Australia

And yet, many women do not hear anything about the risks of a vaginal delivery and the potential serious changes to the quality of their life if they sustain a serious injury with a vaginal delivery.

If we have any surgery, especially gynaecological repair surgery, we have to sign a consent form saying we understand what can go wrong during that operation. I have written a blog before though about the lack of insight we truly have about what we are signing for, when signing consent forms for operations. It’s a lot like when I sign forms for the bank – I don’t give them the consideration they deserve. Patients sign the consent form and then get surprised when they start to leak after an incontinence procedure (the consent form will say your stress incontinence will improve but you may get overactive bladder symptoms post-op and leak on hearing running water or putting your key in the door) or their prolapse repair surgery fails (even though the consent form may say if you have bilateral levator avulsion your risk of failure may be up to 80%). (NOTE: READ AND UNDERSTAND YOUR CONSENT FORM PROPERLY).

But when we have babies, there is still no informed consent form and yes I understand that many women are in no shape at the stage of needing forceps, to fully comprehend what the implications of a vacuum versus forceps versus a Caesarean section are. But sometime through that 40 week pregnancy, surely there can be a run through of what might happen, so the woman and her partner can appraise the risks and make a reasonable decision about what she would like to do should difficulties arise. That can always change at the last moment. But the story I hear every day from patients who have suffered a traumatic vaginal delivery is- ‘Why wasn’t I informed something like this could happen? I may well have still have chosen not to have a Caesar, but I would have made the decision based on the knowledge I had acquired through my pregnancy, from my obstetrician’. This information would have been unbiased, evidence-based information. The information is there – there are tools even to look at your risk dependent on certain factors such as your ethnicity, your height and weight, your age and other measurable factors (called UR-CHOICE).

One of my physio colleagues who attended the most recent Urogynaecological Society of Australasia (UGSA) reported there was a presentation entitled ‘Informed consent for vaginal birth’. This is a great thing (albeit weirdly late in the history of womankind and childbirth).

The discussion was that women should be fully informed regarding:

1. Risks of pregnancy eg. eclampsia/ premature birth etc

2. Risks post partum eg. haemorrhage/ infection,

3. Risks of delivery including elective C-section and repeat C-section

4. Risks of planned vaginal birth including risks of spontaneous delivery or foetal distress etc leading to instrumental delivery or emergency C-section.

5. Future risks from all methods of delivery is important to be known.

There was a consensus that vacuum should be used instead of forceps where possible.


Vacuum                                                    Forceps

Unfortunately there are some clinical situations where vacuum delivery is not suitable. There is concern that if the literature includes statements saying forceps should never be used, then women in low resource countries will suffer, as vacuum is not usually available there and an emergency C-section will occur which puts the women at risk of death. If a woman has obstructed labour and the baby is already dead, a vacuum cannot be used as the scalp of the baby comes off. Caesars can be dangerous in cases where the surgeon is inexperienced. Obstetric anal sphincter injuries  (OASIS) are also a risk factor with vaginal deliveries. Doctors who work around the world in low-income countries (where the majority of babies are born) report that there are definitely circumstances where forceps must be used.

Forceps are often used to assist in delivery of the baby’s head at time of Caesarean section. If registrars are not familiar forceps during a C-section, then more injuries may occur. That is what apparently happened with the vacuum in its early days – lots of injuries previously and now there are vacuum extraction training workshops. There can also be injuries from vacuums-fistulas from vacuum, injuries to the cervix and vagina with vacuum misapplied. Also the vacuum is contra-indicated with the delivery of premature babies. In many low-income overseas countries, forceps are also required because vacuums are too expensive.

It is risky if overseas doctors read articles like these on the internet (the one saying ban the forceps as a headline), and they then will not use forceps and don’t have vacuums and will do a Caesarean section – even for a baby who has died during delivery.  Many maternal injuries may result from a lack of use of forceps – Caesarean sections causing bladder injures, ureteric injuries, horrific uterine and cervical injuries (so much so that the women most likely will not be able to have any other children) – and she has only delivered a stillborn baby. But because the baby has died during the prolonged labour and has been there in the birth canal for 3-4 days, there is compression of the tissue and it becomes ischaemic and dies leaving a fistula. She will then leak urine +/- faeces uncontrollably through the vagina and be ostracised by her family and community…. but because of the C-section performed she will have an intact pelvic floor but no more children.

So obviously there is more to the story on the use of forceps.

My wish is there could there be a more moderate conversation about forceps because of their life-saving properties as you have read above. But there is no doubt that there is disparity between Australian states in the rates of use of forceps and the question is whether this relates to the health departments of the various State government dictating the % of each type of delivery because more Caesars cost more money.

Is it possible to have an informed debate without it becoming inflammatory and emotional?

I believe many women actually are more incensed about their lack of information prior to the delivery about what might happen. We are living in an information society – there is so much information available now via the internet, women are incredulous that they have never heard of prolapse or birth trauma before they have lived it! Where does that come from? Is that related to a suppression of negative talk about childbirth maybe from health professionals such as midwives and obstetricians – with good intentions- they don’t want women scared out of their wits before they have to deliver. I used to take ante-natal classes 20 years ago and I got scolded at the hospital for mentioning things like incontinence and prolapse to the women as it was considered too scary. And to be honest I didn’t even know about levator avulsion in those days (nobody did except a doctor in the US in 1938 who described levator avulsion in a medical text-book and it was never discussed again until many years later).

Should we still subscribe to the belief that women shouldn’t know about these things (such as levator avulsion and pelvic floor dysfunction) because it’s too scary for them? Shouldn’t they receive just as much information about what the different risks that are associated with childbirth as they do with any operation they are about to undergo? Are not women entitled to full disclosure?

Full disclosure can maybe only come with informed consent for women undergoing childbirth.

I look forward to the continuing conversations about this topic. And if you are reading this in another country or looking at the video links from the ABC story on forceps and childbirth, there is a place for forceps for sure.

And Amy Dawes is such an amazingly strong woman that following all the turbulence of this experience, Amy has gone on to co-found the Australasian Birth Trauma Association, a charity to give support to women whose birth experience was traumatic and from this many women have been helped by the information available on this website.
















Road Map to Women’s Health – The ABCD of Good Blood

Today’s blog is from a guest blogger Dr Lydia Pitcher. Lydia is a Haematologist/Oncologist with BloodCare and works at ICON Cancer Care, Noosa and SCHOC Buderim and we have had many discussions about the importance of basic blood care especially in Women’s Health and dementia assessment and management. Lydia continues to patiently answer all my questions. Here is Lydia’s blog.

A few weeks ago, I spoke to our local medical women’s group (QMWS) about my passion – The ABCD of Good Blood.  Here is an extract from that talk:

Sometimes I think we look after our cars better than we do our own bodies.

In the morning, when you turn on your car’s ignition, your dashboard automatically lights up – fuel gauge, speedometer, temperature gauge, oil gauge. There’s a light that alerts you to the fact that you don’t have your seat belt on, if the air bag is faulty, or if your battery is low. And when you petrol gauge falls to just above empty, there is an annoying beeping that makes sure you pull into the next petrol station.

As women, we wake up, look at ourselves in the mirror and comb our hair. If we are lucky we will notice some tell-tale signs – tiredness if some of our haematinics are low, pallor because of anaemia, or other significant warning signs of hair loss, mouth ulceration or excessive bleeding. But checking our basic nutrition – iron, vitamin B12, vitamin C and vitamin D – I call these the “pillars of good blood” – is a simple and easy (fasting) blood test.  Making sure you have adequate levels of these important vitamins, especially in women with the many additional stressors on their body including ovulation, menstruation, pregnancy and menopause can sometimes prevent years of struggling to cope whilst running on empty.

If you are well, and the tests are normal, this can be very reassuring. If you are about to have a significant strain on your body – pregnancy, surgery, physical exertion like a long trip, or a challenging situation like bereavement, work or relationship stress – I believe these tests are an essential part of healthcare. These essential nutrients should be robust, not just barely above the “normal” – preferably in the middle of the “reference range” – to make sure you are in the best physical and mental state to cope.

Likewise, I call our senior citizens “elite athletes” – still running in the marathon of life, but in doing so they often draw on reserves that have been stored in their youth. Tragically, a significant proportion of dementia is preventable – when due to depletion of the stores of vitamin B12 that is critical for neuro-cognitive functioning. Many of our elderly are tired, not because they are advanced in age, but because they are low in iron. They bruise easily not just because their skin is fragile, but they are so often vitamin C deficient. And how many of our elderly have had vitamin D deficiency and osteoporosis identified and treated before culminating in crippling spinal curvature or hip fracture?

Just like your car, that you service after 10,000km with a 50 point check list, we should be checking our bodies at middle age and in our elderly – for bone health, basic functioning of our vital organs, and the reserves of the essential “pillars of good blood”. We need to be doing the “wheel alignments” that will keep us happy and healthy into advanced age.

In the next few blogs I would like to talk more about what I call the “ABCD of good blood” – A for iron so important in preventing anaemia, B for vitamin B12, vitamin C and vitamin D. My thoughts are drawn from 20 years practice as a haematologist, with experience in children, adults and the elderly, in both my laboratory and clinical practice.


Dr Lydia Pitcher is a Haematologist/Oncologist with BloodCare and works at ICON Cancer Care, Noosa and SCHOC Buderim. The views in this article are her own, and are not a replacement for individual advice from your doctor.

Thank you Lydia. So important for good self-care and so easy to clarify your blood’s status. I am looking forward to the next blogs. (Just making an appointment for a tune-up at the doctors – and to all my physio colleagues out there who are constantly caring for patients and not so much for themselves, take heed also).


#IWD International Women’s Day Series: Mindfulness and exercise

Who does that to their employees? A few days before IWD say: “Can you write a paragraph on exercise for IWD?” To Megan, Jane, Alex, Marzena, Martine and Alison – I am sorry.

But the advantage of dropping this short writing task on them so suddenly is they just write from their heart and don’t overthink it. It just happens and that is sometimes more meaningful.

Today’s blog is from Martine and she is writing about Mindfulness.

Martine is a great advocate of mindfulness, teaching about it in the pain relaxation class (which used to be held on a Monday night) and using it every day in clinic with our patients who are suffering persistent pain.

Mindfulness is important in our increasingly mindless world. How easy is it to realise that a whole hour has slipped by due to swiping on Facebook or Instagram. Mindless activity. (Don’t get me wrong I do plenty of that.) Binge watching on Netflix – literally hours and hours slip by (come on Bob just one more episode….please). More mindless activity (yes we do plenty of that as well).

You see being mindful doesn’t always require a mat, mood lighting or soft music. It doesn’t always require an instructor to direct it. What it does require is for you to focus on your breathing, your thoughts, where you are and yourself. Being present. Using exercise as your vehicle for being mindful is so useful because you achieve two goals with the one activity. So here is Martine’s contribution on how exercise is her go-to mindfulness opportunity.

We have already read in the wonderful blogs written by my co-workers, about how exercise can be many things to many different people. Depending on the day and what I’m doing, for me exercise can be:

  • alone time
  • stress relief
  • self-care of my body
  • fresh air
  • exercise for my dog
  • expending some toddler energy
  • catching up with friends while we exercise together.

Martine having some mindful time with her kids

One of my favourite things about exercise is that it gives an opportunity for mindfulness. I find I can easily let my thoughts quiet, and focus on sensing what’s going on in my body, and in the world around me.

The feel of my feet hitting the ground, movement through my limbs, the sensation of the air on my skin. It is a wonderful way to calm and centre my mind into the present moment. Not everyone can find time or inclination to sit down and meditate each day, but exercise and movement can be an easy avenue to find a space for mindfulness in our busy lives.

The known benefits for mindfulness seem to be increasing everyday including:

  • reducing stress
  • increased immune response
  • improvement in pain levels or ability to cope with pain
  • improved coping skills
  • reduced aggression
  • improved work performance
  • mood elevation

All this just by moving mindfully- so it’s just another reason why I love exercise and I wouldn’t give it up for anything, nor would I ask anyone to give it up or want anyone else to give up exercise because of an injury, pain or pelvic floor dysfunction.


Thanks Martine. A brilliant succinct summary of mindfulness. As I said in the blog on yoga, I am finding yoga a great time for mindfulness. Being in the moment, feeling my gradual millimeter improvements in stretch-ability (no that isn’t a word), focusing on my breath and my increasing strength and achievement. Why don’t you think about incorporating some mindful exercise into every week and I will too, continuing to fulfil my 2018 New Years resolutions.

#IWD International Women’s Day Series: Yoga

Even though International Women’s Day (IWD) has come and gone, it doesn’t mean I am not going to finish posting all the blogs I had earmarked for this great day. Over the past few months, I have been busy helping to organise the 5th CFA State Conference called Women’s Health Through the Life Stages (Friday 9th March) at The Brisbane Convention Centre and a Diagnosing Birth Trauma workshop (Saturday 10th March) with Professor Peter Dietz at the Mater Hospital.

Hence the busyness prevented me from actually posting on IWD Thursday 8th March! Which is fine because we had lots to think about from the earlier great contributions from my staff (here), (here) and (here). The conferences were incredible and I know there are many more nurses, physios, fitpros, doctors and urogynaes who learnt so much from the presentations and this will inform their patient management behaviours in the future. We had a big section on Birth Trauma which was moving and enlightening and I will write a blog in the future on this.

Today’s contribution is from Marzena Skowronska, my new yoga instructor and she writes for us about what yoga has meant for her personally.

Marzena Skowronska our yoga teacher at Studio 194 Highgate Hill

“Yoga pose is not the goal.

Becoming flexible is not the goal.

Standing on your hands is not the goal.

The goal is to create space where you were once stuck.

To unveil the levels of protection around your heart.

To appreciate your body and become aware of the mind and the noise it creates.

To make peace with who you are.

The goal is to love, well… You.

Come to your yoga mat to feel; not to accomplish.

Shift your focus and your heart will grow💗    by Rachel Brathen

Child’s pose in our yoga class

Yoga came to my life during my first pregnancy and quickly became a passion assisting me not only on a physical level during two pregnancies and post-natally, but also on a deeper level, helping me to navigate with awareness in the myriad of roles I play as a modern woman (especially as a mother), and helping me to heal and grow.

What I really like about Yoga, is that it provides a platform of tangible practice on the mat, where we can learn how to be truly present and connect with ourselves, practise kindness towards ourselves (as often we are our own worst enemies judging, criticising and punishing ourselves), accept the limitation of our bodies, be content, do not judge, be grateful and love ourselves, so then we are able to extend it to others and incorporate in our everyday life off the mat.

What is more, through practising yoga I learnt and embodied self-love, self-compassion and became passionate about encouraging change, from a place of love and acceptance. I now support the notion that by healing myself, I heal and change the world. And because all that I see is a reflection of me, by working on myself, I mirror to others the healing they need. So by continuous work on myself through yoga, I am trying to do just that.

After only a few weeks of practising downdogs we are managing it so well as a group. 

Thanks Marzena.

One of my resolutions this year was to try to get to enjoy yoga and not find it as a reflection of how stiff, inflexible and rotund I was. Marzena has helped me to do this and I certainly enjoy the peace that I feel at the end of every session.


Yoga is held at Studio 194 on Tuesday and Wednesday at 6.15pm.  

#IWD International Women’s Day Exercise series: Return to exercise after babies

Today’s blog has been written by Alexandra Schafer – Alex – another one of my fabulous pelvic health physios and instructors at Studio194. She has shared her story about her post-natal rectus diastasis (abdominal muscle separation). As you know I have tasked all the girls with writing anything they like about exercise for International Women’s Day and sometimes when you give people free rein with a topic, you get plenty of (good) surprises. Over the years, so many of my patients have been surprised and even shocked that I have pelvic floor issues – they don’t realise many, many women’s health physios get into this area because of their own dysfunction! So here is Alex’s story – again a wonderful story of recovery and application of what we do every day to inspire anyone out there who maybe post natal and wondering – “Am I ever going to be ok again to exercise?”

Exercise is an important part of my life. My family and I hike a lot together, the boys play all sorts of sport, we go to the beach to swim and run around and I could keep going on and on about how important exercise is to me/us. 

When Sue asked me to write something for International Women’s day, I wanted to write about return to exercise after pregnancy and birth – which was actually a huge struggle for me! 

Before I got pregnant with my first son I was quite a gym junkie and did lots of running. I loved my exercise. During my first pregnancy, I was luckily able to continue my exercise regime with only a few changes which is probably why I recovered really well afterwards. During the second pregnancy however, I didn’t get to do much exercise at all, due to a lack of time and energy. After the birth of my second son I was told in hospital that I had an 8 cm large separation of my abdominal muscles. This came as a huge shock to me and got me worried about how I would recover and  would I be able to look after my very active toddler and a newborn baby. There was such a lack of support in my abdominal muscles that I could not even laugh without having to hug my belly.

Of course, I was trying to be a good patient and did my pelvic floor and deep abdominal exercises, which did help to decrease the enormous gap in my tummy muscles. But returning to the exercises I had previously loved was a whole different challenge. Every time I did do some weight lifting at the gym or tried to go for a run I felt really weak and I was too scared to continue for fear of risking a prolapse. So I avoided those kinds of exercises. It took me almost 2 years to find the confidence to again go for a run.

Initially it was surely a lack of strength and too much laxity, but the fear to do damage with exercises was a massive problem as time went on. Looking back I wish I could have found a place like Studio 194 where I am teaching classes, where I could have trusted that the exercises were pelvic floor friendly and safely progress me on to the exercises I did do before babies. At work every day we see women (after having babies but also during and after menopause or post-surgical) doing exactly this- struggling with a return to exercise – with the biggest barrier often being this fear factor!

Return to exercise is the goal for almost every woman. I am passionate about helping women as they struggle with any pelvic health problem and being able to offer to them advice and give them the confidence to return in a paced and graded way to exercise is fantastic. Pelvic floor issues can be so debilitating, embarrassing and longstanding. What I love about my job is that it is pretty amazing to see women progress in their exercise programs and feel confident in their bodies again. And it is not only the physical side of increasing strength, stamina and flexibility but also how exercise makes us all feel happy. 

In the clinic I am often asked: “Have I ignored the problem for too long? Is it too late to get better?” The answer is NO! It is never too late to get better and to return to exercise. Our bodies are made to move! If I have learnt one thing from my own post-natal experience, it is to never give up and stick to what you can do until you are strong enough to do what you love. For some women this might mean to use vaginal support pessaries or to have their running technique or exercise regime analysed in order to make changes that enhance their recovery.

Happy International Women’s Day everyone!

Thanks Alex- a fabulous story with a happy (exercise) ending. If Alex can put her hiking photo in, then I’m going to also.

Sue looking the part with her hiking sticks Mont Blanc 2017

You can have one-on-ones with Alex or attend her Mums and Bubs class or general Pilates classes at Studio 194.

#IWD International Women’s Day Exercise Series: Running

The next blog in my exercise series in the lead up to #IWD (International Women’s Day) on Thursday 8th March is on running and who better to write it than Jane Cannan, one of my fantastic physios, who herself is a (some would say) fanatical runner. A couple of years ago, Jane was all ears when I said I want to set up a proper running clinic to formalise the process of returning women to running. So many women have said to me over the years how much they miss their running- that it was critical for their mental health- but they were terrified to return to it after the birth of their children.

I too have been guilty of being reticent to allow them to go full hog at running, especially if they had prolapse (*)and it was a relief to have someone who not only loved their running, but became a running coach through Athletics Australia and passionately embraced the opportunity to set up the clinic. You can all read about the running clinic here – what is involved, how to book in, what are the steps before the actual running assessment, but what I wanted from Jane this time was a more emotional response to her running.

Because I’ve only used running as a way to get to a tennis ball on a tennis court – I’ve never particularly enjoyed it and that feeling only intensified after the birth of my three beautiful children (prolapse issues). But from the second I met Jane (after I recruited her through Facebook) I realised running was increasingly overtaking her life (did I just say that?) and she has become almost a professional at it.

Jane completing her first marathon

I’ve used this photo many times when writing about running and the pelvic floor and the running clinic- but I never tire of this incredible image. The absolute joy, relief and ecstatic wonderment expressed by Jane in this photo as she completed her first marathon is what every woman feels when she gets back to running after having been deprived of it for months/years/decades because of childbirth.

That’s what I thought Jane would write about when I asked her to write a paragraph about running from an emotional viewpoint. What I didn’t expect was hear her own pain story – one which has released a huge emotional response from Jane today as she recalled and wrote about her own experience of facing a future perhaps deprived of not just running but one filled with persistent pain. Read on and enjoy!

Running is something that I love to do and I know exactly why. Hands down, top of the list it that it helps me know and have confidence in my body. It makes me breathe and shake out tension and of course I love how it lets me have a social life in very comfortable active wear with zero concern about my appearance. I’m ecstatic that it’s also physical activity which I’m told is good for my heart, over the moon that it’s repeated weight bearing which is good for my bone density, thrilled that it helps my knee cartilage and vertebral disc health and I could have shouted from the roof tops when I learnt this year that research has shown it to boost my immune system by keeping my bone marrow healthy. But truth be told, for me it’s all about how it proves that my body can be trusted.

You see, despite running for as long as I can remember there was a time when I didn’t. As a young 25 year old PE teacher I hurt my back and it scared the pants off me. I was in a small country town away from my support network, and trying to prove my youth to the class, I hurt my back. Taken to the nearest town nearly 2 hours away I had an MRI and was told that my debilitating pain was coming from a disc in my back. The specialist told me that I should be very careful with my back in the future and that it would likely happen again at some stage. Running would be like asking for trouble sooner. So, as I lay frozen with pain, fear and grief for the loss of the person I thought I was for 10 days on the floor of a parent of a friends friend’s place, my brain, despite the 25 years of happy free movement before hand, convinced my body to be fragile. This was of course strongly reinforced upon return to work when the workplace assessment team put plans into place to limit all bending. I know everyone was trying to prevent more problems in the future, but the message I heard was: “Don’t bend, don’t let go of your core, you are fragile”! That message, which I now know to be incredibly misguided, sparked a thirst in me to find out more about the human body so here I am, 15 years later passionate about helping people trust their bodies.

Fear of movement is a terrible feeling. If you had told me 15 years ago that by the time I reached 40 I would have run 4 marathons, 1 ultra marathon and countless ½ marathons, 10k and 5km running events I would not have believed it possible especially not without the help of serious pain killers. It took a while, but with constant learning and some wise words and guidance from some incredible physios along the way, I am here, free to feel limitless.  My aim now is to keep movement part of my normal and running regularly is my favourite way to achieve this.

From my fingers to my toes I want my brain to always remember that movement is good and stiffness is not required here. Whichever activity your chose, do it with purpose and feel the wonder of your movement.

Now I have bolded that last sentence because that is the message I want all you incredible women reading this blog to have as your take home message. Thanks Jane for sharing an amazing story.

*Also remember that many times a pessary can be fitted to allow you to run and exercise freely without fear that everything will fall down.

Some of Jane’s run buddies (in uniform)

If you would like to be seen in the clinic specifically for running advice, please ring the rooms on ph: 3848 9601 and tell our secretaries that you would like to book in for the Clinic or pre-assessment, even if you are currently seeing myself or one of the other physios at the practice. Jane, Megan and Martine all conduct running clinics.  Appointments can be self-booked here, so that patients can directly choose a time to come along and be assessed by our physios. Alternatively, you can check in with our receptionists to be booked into a session.










#IWD International Women’s Day Exercise series: Pilates

Paul McCartney (circa 1969) and the Beatles on the cover of my Abbey Road album.

Paul McCartney at 75 years of age still beltin’ out a tune

Photo Courtesy of Marika Hart, Perth 2017

Start moving, keep moving, stay moving!

Make it your mantra for 2018. (Yes I know it’s March not January but who says there’s a rule about when you make your New Year’s resolutions?)

Evidence is strong that physical inactivity not only increases your risk of a cardiovascular event, increases your risk of osteoporosis and increases the chance of excessive weight gain (particularly around the middle leading to conditions such as metabolic syndrome), but can also significantly lower your emotional and mental health well-being.

But who needs evidence in the literature when you have photographic evidence of the amazing Paul McCartney pictured above. Here’s a man who has danced, jumped, strummed and swished his way around a stage for 60 years (including his gigs which started when he was just 15 when he met John Lennon at a church fete) and he looks (and sounds) absolutely amazing for any age – let alone 75. That’s all due to remaining physically active.

I really wish I could have my thirties and forties back again- not because I’m worried about which decade I’m heading towards (hurtling towards) but because I wish I could relive it – adding a lot more physical exercise. Those decades were wonderful as we were child-rearing, but I just didn’t place enough emphasis on exercise then. I was always trying to squeeze in work with a life which was crammed full of wonderful busyness with the kids and I didn’t think to prioritize my own exercise. (I wish I had known then what I know now – thank you internet).

When I turned 50 the kids were older and I started to walk more regularly and I became exquisitely aware as I approached menopause that changes were afoot! The feet became achey, the shoulders became ‘ouchy’ and the middle waist area became sloppy. Fortunately I increased the exercise (instead of sitting around more thinking rest would help the pain as many of us do) and suddenly the feet were pain-free, the shoulders got stronger (I had added some weights in at the gym) and the waist started to decrease a bit. (That’s not to say that I didn’t have two episodes of extreme foot pain with plantar fasciitis in the last decade which have resolved thankfully).

Proof that the answer to (almost) every question about your health is exercise!

So I have decided to ask each of my physios and Studio194 instructors to write a blog on some facet of exercise that is in their personal life or their working life. Today we start with Megan Bergman one of my pelvic health physios at my rooms and also one of my Pilates instructors. Megan’s blog on Pilates follows below.

Many people believe that doing Pilates is just about getting a stronger core, but it can give you so much more than that.

Movement is created first in the brain where the brain activates a specific pattern of nerve firing that co-ordinates the contraction and relaxation of the muscles required to execute the movement. Whilst doing this, the brain is also constantly monitoring the feedback from the muscles, joints and ligaments and other soft tissue to help ‘fine tune’ the movement. If you took a step and the muscles at the front of your thigh contracted too strongly and unchecked, your leg would swing forward into the air. If your lower leg muscles didn’t activate you’ll catch your toe on the ground.

Fortunately our brain is so clever that with practice repeated movements become more efficient, precise and easy. (Just like a baby learning to walk). So if we are to move well, the training must start in the brain. As Julie Wiebe PT writes “your brain is stronger than any of your muscles. It’s not if one particular muscle is strong or weak. It’s about brain work first, body work second.”

How does Pilates fit into this?

When doing our Pilates exercises you are often given a number of cues, such as when to breathe in or out, or when to lift your pelvic floor. Many people initially find this confusing, trying to move, and breathe and use good form, but there is a reason the exercise is taught in this way. Our aim is to train the timing, coordination and recruitment of the whole body to create beautiful movement. Beautiful movement is easy, flowing movement that uses only the necessary muscles, and doesn’t over-recruit unnecessary muscles. This can be a common problem for example in neck muscles in people who struggle with ongoing tightness or neck issues.

As already mentioned, it is the brain that sends the command to the muscles, and is responsible for coordinating the timing, sequence and force of each muscle’s activation. By tuning into the movement and how your body feels, we bring the brain’s attention to how it is moving and facilitate continuing improvement. With training and focus, we are training the brain to optimise each command. Yes, that’s right, training the brain. When looking at issues with the body, it is never just one muscle that is too strong, or too weak.  We’ve all tried endless stretching on tight muscles, and they just seem to tighten up again.We need to look at the brain’s strategy.Why is it tightening up that specific muscle? Why is the wrong strategy being utilised? 

So in the class you are prompted to breathe, activate the appropriate muscles and create movement. Similarly you are cued to check for unnecessary tightness or poor positioning. As I mentioned above this can be overwhelming so the goal is to start slowly. Focus on one thing, maybe the breathing in and out. As you get the hang of it you can incorporate more commands and more awareness.

Then to progress the movement, it becomes more complicated. We add another element, maybe some weight, or another limb moving. Our class participants move from learning how to effectively contract the pelvic floor in sitting, to contracting it while squatting, to contracting it while squatting with weight.  Our focus is on training how to exercise in a pelvic floor friendly manner.We need to make sure that the pelvic floor is lifting when the organs need support, and relaxing when it isn’t needed, so we always add an element of relaxing the pelvic floor, learning to switch it off. (You pelvic floor is not meant to work 24/7).

So when starting Pilates it may seem like a mental exercise at first.With good foundations, you can move onto many complex movements that challenge you, and make your body feel great.

Thanks Megan and I know my plan is to be stronger and fitter at 75 than I was at 35. Sir Paul McCartney you are inspirational.

#startmoving #keepmoving #staymoving 

Our Pilates classes: Megan takes our 6.30am Tuesday and Friday Pilates classes and conducts one-on-ones at Studio194 . Alexandra takes one-on-ones on Monday morning and Pilates on Tuesday 9.15am onwards; Martine takes a Pilates relaxation class on Monday night at 6.15pm) and Alison takes a Pilates Barre class on Friday at 9am. 

February: Bowel Awareness Month

While most people may think the most important date in February is Valentines Day (February 14th), February is actually Bowel Awareness Month and I have a wonderful story to relate to you about a fantastic screening programme that is here in Australia – that saves lives.  I had a patient the other day who reluctantly undertook his free bowel screening test which is available to everyone over the age of 50. I say reluctantly because being a male he couldn’t see the need (he did say to me the classic male thinking about health issues: “If it ain’t broke why fix it?”) but some clever nagging from his wife saw him submit it and sure enough it came back positive for blood. A colonoscopy was ordered and early stage bowel cancer was discovered. Because it was detected so early, the operation was not as extensive as it may have ended up being, had the test not been done and rather, frank blood in the toilet was the first sign.

Now that’s a good news story!

If you want to know more about bowel issues here is the link to the Bowel Cancer website to check out all the info on the screening test. Don’t be dismissive of the screening test when it arrives in the mail- it’s free and as my story demonstrates- it detects cancer and it saves lives.

Over the years I have counselled many family and friends about bowel issues – sometimes when they haven’t even asked a question. So it’s no wonder then for Xmas 2016 I received a book called “What’s Your Poo Telling You” ( I wrote a blog about that Bad Santa gift giving which was so much fun). For Xmas 2017 I received two desk calendars of the same name (What’s Your Poo Telling You) – who knew it was so great having a desk calendar to tell you what the date is? (Now all my charts have the correct date – not the one that’s sort of in the region). So obviously, my legacy to the world will be my comfort in chatting about all things bowels!

You know what? I’m very happy and comfortable with that legacy. Because bowels when they are acting up can cause all sorts of grief. And I am very happy to be the one who has an interest in what is wrong with your bowels. Constipation, IBS, loose stools giving urgency, gas control loss, faecal incontinence, obstructed defaecation, rectal prolapse, rectocoele, pain from fissures and haemorrhoids – all of these issues and many more can make women, men and children miserable and uncomfortable, sick and anxious, obsessed and worried. And many times the solutions are not complicated. Physios whose special interest is pelvic health can assess and treat these problems and in quite a quick turnaround, you are feeling more comfortable, are less anxious and more confident to get out of the house and face the world.

We are not going to make you feel uncomfortable; we will ask more detailed questions and want to know more rather than less; and we will not try to change the subject or brush over your bowel issues. Pelvic health physios love bowels because it is so damn rewarding when patients return to their next appointment and they are so happy with how things are travelling.

Got a bowel issue? Come and have a chat- you won’t be disappointed.

Sue Croft Physiotherapy, 7/47 Hampstead Road, Highgate Hill. Ph 07 38489601/ 0407659357.


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