One small change: A physiotherapist on how to improve our health system

The one small change that I would like to see is the introduction of free pelvic floor muscle training exercise programmes into the public health care system. Pelvis floor muscle training is recommended as a first-line treatment for incontinence yet many men and women don’t know about it or can’t access this treatment easily in the public healthcare system.

Pregnancy, childbirth and menopause are the leading causes of incontinence for women. Prostate problems (eg benign prostate enlargement and prostate cancer) during the ageing process can also result in incontinence for men.

As many as one in three women and one in eight men suffer from incontinence in their lifetime yet many hide the problem rather than seek treatment for it. Instead, they suffer in silence, wearing incontinence pads and reducing their sexual and social activity and exercise levels as a result. It’s important to say that no amount of urinary leakage is normal in adults at any age.

If pelvic floor muscle training was easily accessible — and widely publicised — through the public health service, people would be less likely to hide their difficulties and seek treatment instead.

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Muscle training

While pelvic floor exercises might have been dismissed as ineffective in the past, new diagnostic approaches using ultrasound and MRI imaging have greatly improved the knowledge of pelvic physiotherapists who teach pelvic floor muscle training.

Research has found that two-thirds of women with bladder or bowel incontinence see improvements on completion of a series of pelvic floor exercises.

International healthcare guidelines state that it can take between three to six months to fully retrain the pelvis floor muscles and this retraining should be supervised by a specialist for between six to 12 weeks. Lifestyle changes such as reducing caffeine intake, losing weight and taking exercise can also help.

In France and Germany, new mothers are given 10 free sessions with a specialist pelvic floor physiotherapist. The sessions must be taken within three months of giving birth. We could start by offering this service to all new mothers which would make a huge difference to their quality of life following the birth of a baby.

• As our health system begins to return to normal activity levels following the Covid-19 pandemic, we would like to hear about one change you would like to see in our health system. It can be something simple that annoys you, day in, day out, that is easily fixed, or it can be a small change in practice or attitude that would make life easier for everyone. Email health@irishtimes.com with your suggestion or fill in the form below.