Why Aren't I Being Listened to?

Interview with Amy Steventon, Advanced Practice Urogynaecology

If you have felt dismissed when discussing your bladder, bowel or pelvic health, know that your experience matters. You deserve to be listened to and validated by family, friends and health professionals.

If you feel that you are not being listened to, you are not alone. The 2023 Victorian women’s health survey (bit.ly/vwhs2023) found that 1 in 10 women felt dismissed by their health care provider, one-third of the women surveyed reported insensitive and disrespectful interactions with medical professionals, and only 54% reported receiving the care they needed.

Talking about bladder and bowel control, or pelvic health, isn't always easy, but taking that first step can be incredibly empowering. While it can take time to find the right support, help is out there.

It is important to remember that although incontinence is common, it is not something you have to live with and should not be ignored. No matter your age or stage of life, in most cases, incontinence symptoms can be improved, better managed, or even cured.

We talk to Amy Steventon, a pelvic health physiotherapist (physio) at Jean Hailes clinic and Her Care in Melbourne, for tips on how to be heard.

Amy Steventon, Advanced Practice Urogynaecology Listened to?

Q: What is the most common problem for patiens requesting tests for further investigation into their bladder, bowel or pelvic pain?

A: People presenting with pelvic pain have often consulted many practitioners over many years to get a diagnosis for their pain, on average it takes 7 years for a diagnosis of conditions such as endometriosis.

This will hopefully improve with the recent increase in awareness of this condition and other pelvic pain conditions. In comparison, bladder and bowel concerns seem to be more readily diagnosed and referred to specialists.

Q: What advice do you have for someone who feels they have been brushed off or not taken seriously by a health professional

A: It is important to find someone you feel comfortable talking to about your incontinence or pelvic pain concerns. This may involve discussing intimate issues, as we often see concurrent sexual dysfunction when people present with incontinence or pelvic pain issues.

One doesn’t necessarily cause the other, but they can often exist together. If you feel your health concerns have not been met, or perhaps your health care provider isn’t the right person.

 Find a pelvic health physio // CFA Physiotherapy Group cfaphysios.com.au // Australian Physiotherapy Association choose.physio/find-a-physio under ‘Refine your search’ select ‘Special interest area: Women’s, Men’s and Pelvic Health’.

 "If you have your period on the day of your pelvic health physio appointment, you can still go for your consultation or treatment."

 to speak to, it may be helpful to seek out a specialist who has an interest in bladder, bowel or pelvic health
 and is comfortable and knowledgeable discussing it.

 The National Continence Helpline (1800 33 00 66 Mon Fri 8am-8pm AEST) can provide an empathetic and supportive environment to discuss your incontinence via their free telehealth service run by nurse continence specialists. They can also find local health professionals with a special interest in bladder and bowel continence health, such as pelvic floor physiotherapists, to refer you to.

 To see a pelvic health physiotherapist you don't need a referral from your doctor. You can just book an appointment yourself. However, if eligible you can get a Chronic Condition Management Plan from your GP and get a rebate from Medicare to cover some of the cost.

 Q: What happens when you visit a pelvic health physiotherapist?

 A: During your first appointment your physiotherapist will take a medical history and ask questions such as:

• What are your symptoms?    
• What would you like to be able to do that you cannotdo now?    
• How are your bladder and bowel working?    
• Any pelvic organ prolapse symptoms such as a dragging or heaviness in the vagina or rectum?    
• Any concerns you have with sexual intercourse, such as pain or incontinence (leaking wee or poo)?    
• What does your day-to-day life look like in terms of work, family, hobbies, sleep, stress, and other lifestyle factors that may be affecting your symptoms?
               

Physical examination

Consultations may involve an internal pelvic floor examination if you and your physio think it will assist your treatment. This will be discussed in detail with you and  will only proceed with your informed consent. If there is anything that may make this examination difficult for you, it is important that you discuss this with your physio before your examination so you can make a plan together that makes you feel comfortable and safe.

    
 Other examination options can be used if you would prefer. Some physio clinics use an ultrasound to look at the pelvic floor muscles from the outside. Sometimes this is done with a probe on your lower stomach and other times the probe may be placed on the outside of your body on the small flat surface between the vagina (or scrotum) and anus.
     

Treatment plan

Your physio will discuss with you whether the physical activity and exercise you have been doing is appropriate for you and suggest changes if needed.

Together you will discuss the goals you would like to work towards and make a treatment plan. Your physio will design a home exercise program that is specific to your needs and fits easily into your day. It will usually include lots of education so you understand your symptoms and how you can work towards making changes and managing symptoms yourself. They will discuss anatomy and how the relevant areas of your body work, such as the pelvic floor muscles, bladder, bowel or other areas that relate to your issue.

 If persistent pain is a concern of yours, your physio will teach you about pain, how it occurs and how you can help yourself manage it. You will usually be given exercises that will help your pelvic floor and other muscles, and suggestions on changes to day-to-day lifestyle factors to help with your symptoms. If your pelvic floor muscles are working too hard, your physio may teach you helpful ways to breathe, and strategies to relax these muscles specifically, and also relax you generally. Your physio might suggest using equipment such as biofeedback, muscle stimulation, or pelvic floor trainers to help you improve how your pelvic floor muscles are working.