Urogynaecological physiotherapy for female urinary incontinence. Episode 94

Kamila Grabek
I think this should be a subject that should definitely be talked about more. Precisely because more and more women and men are experiencing it.

Monika Rachtan
Does it happen to you that girls come up to you and say You know, you saved my sex?

Kamila Grabek
Urinary incontinence is not only related to this menopausal or perimenopausal period, but can also result from our bad habits.

Monika Rachtan
Who thinks about how he pees. Like.

Kamila Grabek
And they for I don't know, 8, 10 or 12 hours even sometimes when they are working, they just won't go to the toilet.

Monika Rachtan
Hi Monika Rachtan. I welcome you very warmly to the fourth season of the programme. First of all, the patient. As you can see we have a new set-up in the studio and a new spring energy. And today we are going to talk about a difficult problem, because it turns out that more than 30 per cent of women struggle with incontinence. Not only is it a stigmatising problem, but it also affects mental health. This is what I will be talking about today with my guest Kamila Grabek. A very warm welcome to you. Hello, Kamila, you are a physiotherapist. Such a complicated name, but we will explain in a moment what it means exactly. Tell me, when women, girls come to you, because the problem also affects young girls, how do they talk about their problem, does naming it, using the word incontinence in general go down their throat so easily, or is it for them though? Do you know that you feel such an embarrassing problem?

Kamila Grabek
I would say it is getting easier at the moment. It is less and less of a taboo subject and more and more women are actually coming to my practice with this problem. However, I think it is still associated with the menopause, with old age, so to speak, while in fact more and more young women also have problems with incontinence and I think that we really have nothing to be ashamed of on this subject. I think this should be a subject that should definitely be talked about more. Precisely because more and more women and men are experiencing it.

Monika Rachtan
And what was the age of the youngest girl who came to your practice? Do you remember?

Kamila Grabek
I think about 20 years, because we have to remember that incontinence is not only related to this menopausal period or the perimenopausal period, but it can also be due to our abnormal habits or some past surgeries in the pelvic area. Thus.

Monika Rachtan
Well, exactly, and in such young girls in the menopause? I think we know what factors can cause incontinence, and if we don't, we'll discuss them right away. In young girls, on the other hand, I wonder what can happen that causes incontinence to occur. I am thinking of a girl who has not given birth, who has not undergone any gynaecological surgery. Why all of a sudden such a problem?

Kamila Grabek
First and foremost, incontinence. Most people also associate it with muscle weakness. And here I would say that this is not entirely true, because incontinence alone tells us absolutely nothing about the pelvis. Well. We do not know whether the patient has muscles that are too relaxed or just too tight. If I were to divide women into these two groups, I would say, of course, that older women tend to have more weakness in these muscles, while young women tend to have overly tight muscles.

Monika Rachtan
And these excessive muscle tensions can cause incontinence.

Kamila Grabek
As much as possible. Such patients report not only incontinence, but also, for example, painful gynaecological examination, painful intercourse, some problems with the application of tampons or menstrual cups. These are most often.

Monika Rachtan
And you also said that, there are certain habits that can make incontinence a problem. What are those habits?

Kamila Grabek
Exactly. For example, our peeing in the Malysz position, i.e. hanging over the toilet.

Monika Rachtan
Well, how do I do that when I'm in a shopping mall?

Kamila Grabek
That's right. It's actually best to have some disinfectant with you, wipes and those toilets just cleaned, covered with paper and still sit down. Because our pelvic floors are the muscles that line our pelvis from below. They will be responsible for continence, of course, but also for sexual function. They will be responsible for holding the internal organs in place in the pelvis and will also be responsible for holding our body in space, i.e. such deep stabilisation. Therefore, as we hover over this toilet, there is no way that these muscles will not be tense in some way. They will want to tense up precisely to protect us and to be able to maintain this position over the toilet. On the other hand, we should always be completely relaxed down there when we do the toilet, so this contradicts us a little here. Well, on the one hand, for Mixi, or peeing, we need to relax, on the other hand, by assuming this hanging position, we are not able to relax these muscles completely. This can also result in abnormal emptying of the bladder, sometimes a backlog of urine and therefore, for example, recurrent infections.

Kamila Grabek
So it's very important to sit down.

Monika Rachtan
If you found our conversation interesting and are looking for more valuable content, subscribe to us on YouTube and Spotify. Monika Rachtan I invite you! Because I thought to myself, when I was looking for Malysz once a month at the mall, well, that's still slack. But if, for example, someone uses the toilet at work, it's a toilet that's accessible to a lot of people. then there are girls who do pee like four times a day or five times a day and then the likelihood of this problem happening is much higher. And I also think that in general, you know, who thinks about how they pee? Well we kind of don't think about it, we just do it reflexively. We used to be told by our mum not to sit on the toilet in public. So we remember that and we don't sit down either. You know, there's not always paper in the toilet, we don't always have that disinfectant with us to do it, so it can be difficult. But on the other hand, I think that, however, when we pack our lipstick in our handbag and when we pack some of the other things that we take to work, well, taking that disinfectant and wipes is not some terrible effort.

Monika Rachtan
You can leave it in the desk and just.

Kamila Grabek
Exactly.

Monika Rachtan
We have it in stock.

Kamila Grabek
Exactly. When you mentioned the mother, I thought of an abnormal habit, that is, the habit of peeing in reserve, because very often this habit is caught in childhood, when our parents force us to go to the toilet even when we don't want to. The bladder has a certain capacity and this capacity is more or less between 400 and 700 millilitres. At the moment when we want to go to the toilet the bladder is theoretically about two-thirds full, so every time we go to the toilet we should pass about 250 to 300 ml of urine and this is like a normal value. However, sometimes it is so, that at the moment when we go to the toilet as a backup, you can say that our bladder starts to get smaller, so it will call us to the toilet more and more often. Because that's how I always describe it to patients very much.

Monika Rachtan
Please, as vividly as possible.

Kamila Grabek
That's right, which means we imagine a balloon. Here this part is our bladder. This funnel from the balloon is our urethra. The moment this bladder sends us a signal that we want to go to the toilet. The muscle that is on the bladder starts to contract and so the pressure builds up. It wants us. When we feel a push, we want to go to the toilet and we go to the toilet. We relax our pelvic floor, which is that sphincter on the urethra. And that urine is pushed out slowly as if from the bladder. This is the normal situation. On the other hand, the moment we go into the toilet to spare, without this feeling of pushing and without this increase in pressure, it is very possible that we will have to force this urine out. That is, we will be creating a very high pressure in the abdominal cavity, which will push the organs down. That is, firstly. Secondly, due to the fact that we will not stimulate this bladder to fully stretch, it will be the case that after some time.

Monika Rachtan
He will forget to stretch, he will forget. How to do it.

Kamila Grabek
We can say this, it will no longer be able to stretch to the value it had before. As a result, it will start to call us to that toilet more and more often again and then we may find that we feel a very, very big push and we go to that toilet and we do literally a few drops. And I have patients like that too, and there are actually quite a few of them.

Monika Rachtan
Well, yes, because there are often situations like this. We're somewhere on a journey, we've got a toilet, we say okay, I'm going to pee so we don't have to stop later. Well, and it turns out to be bad. And tell me, and for example, can this kind of overloading of this bladder, that is holding urine for too long, walking with a full bladder also be unhealthy?

Kamila Grabek
It can be unhealthy because then the other way round we can over-stretch the bladder and so, for example, we don't feel like going to the toilet even though it is completely full. Such a backlog of urine can also, of course, give rise to problems with infection. And this is such a first problem to pay attention to. Very often this problem arises in patients who just have this fear of going to public toilets, either because the toilets just seem unclean to them, or because some people have something that they are afraid to do. The moment someone next to them hears yes, That is, when I have such patients who are afraid to use the toilet because they think that when they urinate, it is so loud that everyone hears, everyone judges and they for 8, 10 or 12 hours even sometimes when they are working, they just won't go to the toilet.

Monika Rachtan
I mean, you know, peeing is still normal. It's worse with pooping, well it's actually a bit of a problem when you're at the mall, you go and oh. Well, sort of, but peeing, well I think it's such a normal thing. Everyone pees, no one poops. So it's like.

Kamila Grabek
But you'd be surprised how many women really struggle to get off normally in the workplace or just in the mall. Because of what someone next to them might hear.

Monika Rachtan
I have this patent that if I'm in the toilet and there's actually someone next to me and, you know, I've got this problem that I'm blocked by something, I take the paper and roll it up like this? And then if you put one that's a bit soaking wet then when you pee you can't hear it. So girls if you don't know how to do it then really this way works. But I also remember a situation like this. My aunty is in general sorry aunty if you're listening to this but I don't like your name, that my aunty was ashamed to pee in the house. I mean she said she lived in a block of flats and there were loud risers and she said you could hear your upstairs neighbour peeing terribly, so she didn't want to do that to her neighbours. And also that's what I learnt from her with the paper she would put paper under every time so you couldn't hear her peeing.

Kamila Grabek
This is clever.

Monika Rachtan
Yes, this is very clever. So girls, if you are really very ashamed, we have just the cure for your problem. You will already be peeing in public.

Kamila Grabek
Well, I'll be honest, I didn't know that patent. So.

Monika Rachtan
You will pass on to your patients.

Kamila Grabek
Communicate to patients. Need to remember.

Monika Rachtan
And tell me if such frequent intimate infections Well because we also struggle with it and it's actually a big problem in women. The cause or underwear, or some girls for example after intercourse, very often have a problem with such infections. Can they also influence us to have this incontinence problem in a while if we have several of these infections a month?

Kamila Grabek
Absolutely. If these infections are recurrent, constantly irritate the bladder, well then, of course, in the case of incontinence we always have to exclude this infection. So if the patient says that, in addition to frequent urination, she also has some itching, burning, well then it is all the more reason for us to send her for additional tests to a urologist, for a urine culture, to check that everything is ok there.

Monika Rachtan
Tell me, when an incontinence problem arises, is it such common sense, common sense behaviour to go to a primary care doctor, to go to a urologist just to rule out any diseases. But should you go to a physiotherapist first and work out the problem a bit? With someone like you? And then a decision is made as to whether a doctor is necessary.

Kamila Grabek
I will say this I think you can go to a urologist in parallel to rule out all sorts of infections. Do an abdominal ultrasound, see the bladder bird, see if there is nothing there. Well, because some types of incontinence may also be due to some kind of obstruction. Urinary incontinence can be the result of an obstruction created by some cancerous tumour, for example. So this, of course, is also worth ruling out. Especially if we have such a family history that there is some kind of tumour occurrence or We have never been to a urologist either, because I have patients who even avoid gynaecologists by a wide margin and just.

Monika Rachtan
Which is no good.

Kamila Grabek
Exactly and simply somewhere this research is being overlooked. Just like that. This prophylaxis is not really there, it doesn't exist, so it's worth going to the doctors as much as possible. To gynaecologists, too, because, as we were discussing backstage, there is such a thing as latent incontinence. This is incontinence arising from, for example, lowering of the organs and pressure on the urethra. Yes? That is, there is pressure occurring. Therefore, for example, in specific changes of position, this urethra suddenly opens up, a few drops can fall out like this. And here, too, as if if the patient has not been to the gynaecologist for a long time, and I have such patients who admit to me that they have not been 20 or 30 years.

Monika Rachtan
The last time they saw a gynaecologist was when they had their babies.

Kamila Grabek
Exactly. Well for me it was a shock. At first in the office, but there are really a lot of such patients too. However, I always encourage these examinations. Well, because we also need to see, for example, if there is a reduction in the organs. Yes? I am, of course, able to examine this as far as possible and during the cough test, when I examine internally, I hold my finger in the vagina. I ask the patient to cough. Sometimes you can actually feel the lowering. Yes. You can feel something that shouldn't be there. On the other hand, I refer anyway to the gynaecologist, so that he also tells me what this lowering looks like according to him. What exactly is lowered there. The gynaecologist also examines with a speculum and can immediately carry out an ultrasound cytology if such examinations have not been carried out for a long time. I also really value this cooperation. However, you can also go straight away to me, that is to say to a urogynaecological physiotherapist, to have your pelvic floor checked because, despite the fact that gynaecology is developing rapidly in Poland, I think that still not many people know about it and not many people pay attention to their pelvic floor at all.

Monika Rachtan
And it's very important to consult and also catch the problem at the earliest possible stage of development. Because you said about this latent incontinence. So what? I urinate, but I don't see it because I don't fully understand it.

Kamila Grabek
It is the case that very often, when it comes to latent incontinence, we have a lowering of the organs. Therefore, sometimes patients are referred for surgery and after the operation, the moment the surgeon raises all these organs to their anatomical, normal position, we may find that we come out of the operation and suddenly the incontinence that was not there starts.

Monika Rachtan
And what have they done to me right?

Kamila Grabek
Exactly. Or which was very sporadic. So somewhere in some specific cases the patient didn't care, well, because it happened to her there three times in six months, yes? Well, who would care about that. But then she comes back from such an operation. And there she is. She's also a bit frightened, because she thinks that maybe something has been damaged, something has happened. And very often patients are referred for urogynaecological rehabilitation before various types of surgery in the pelvic area.

Monika Rachtan
That is, to see what will happen after the operation, that is.

Kamila Grabek
Exactly how does it all work, how do these pelvic floor muscles behave, does the patient know how to tighten them, does she know how to tighten them? How many times does she tighten them? Yes, Well that is also important, does the patient tense twice and then not have the strength to do anything afterwards. Is he able to do a full series of 10 12 repetitions and then still be able to hold those muscles in that contraction? Yes. Some patients have that they are able to do those quick repetitions. But when we get to these held tensions, she can feel that the contraction is letting go despite her will. That is, she wants to maintain, but these muscles just let go.

Monika Rachtan
Should we? When we sit and talk to each other, are you tensing your pelvic floor muscles and exercising here or there.

Kamila Grabek
Well, precisely not. Not exactly and not completely either. I recommend this to patients because first of all, it is always a good idea to check what state these pelvic floor muscles of ours are in, because, as I said, these incontinences are not only due to their weakness, but can also be due to excessive tension.

Monika Rachtan
That is, you also have to learn to relax those muscles sometimes after such a visit.

Kamila Grabek
Yes, as much as possible. Such a normal, well-functioning muscle is a muscle that tenses up, but it's also a muscle that can let go of that tension. And I always explain this to patients using the example of the biceps, because it seems to me that it's very illustrative, that if we have this biceps loose, as we do now. Then we are able to perform a full contraction, yes? On the other hand, if this muscle is a bit tight, we are neither able to fully relax it, nor is this contraction somehow satisfactory for us, because this range of movement is just tiny. So, for example, if we have a problem with an excessively tense pelvic floor, we usually first try to relax it a little and tonify the tension, and only then try to bring out the full contraction. And to teach the patient how to work with the pelvic floor at home. Because it's important that later on this rehabilitation is also transferred to the home field, right?

Monika Rachtan
Kamila tell me if you could list the kind of key symptoms that should worry any woman of any age, be she a 20 year old, a 40 year old or a 70 year old Ten year old, and which should make her go specifically to a urological physiotherapist.

Kamila Grabek
It is definitely incontinence. And here I immediately point out that even letting go of a few drops and only in specific situations is also incontinence. That is to say, women also associate it somehow so drastically. If I have incontinence, I should, I don't know, be wearing pads or nappies. Yeah? And that's just kind of like incontinence according to some people. On the other hand, the moment we leak even a few drops during coughing, laughing, sneezing, some physical activity, we should do that too.

Monika Rachtan
So is this the first symptom? Another.

Kamila Grabek
Another is, for example, painful intercourse, a painful gynaecological examination or some problems with the application of tampons or cups. Another thing is the feeling of filling up the pelvis with some kind of ball that shouldn't be there, because this can indicate either vascular problems, such as passive pelvic congestion and some kind of internal varicose veins, but it can also indicate, for example, a lowering of the organs, So this is also important to pay attention to such symptoms. Certainly painful periods, which used to be considered our beauty. Exactly. This is also not physiology. Of course, menstruation can be felt by us. We may feel that more tense lower abdomen, some mild cramps, well, but menstruation should in no way impede our daily life and functioning. And there are some women who have to give up work, school or a favourite activity for the first three days of their period. So if something like this happens, a gynaecologist and a urogynaecological physiotherapist should be consulted.

Monika Rachtan
Well, yes, pain during menstruation is not a physiological phenomenon And it's worth reminding girls of this too, because we seem to have been told for years that periods just have to hurt, And it turns out that there are many causes that can cause painful periods. And these causes can be treated, alleviated, as if that's all there is to do. So it's worth it, it really is. If you have such a problem that it just hurts you terribly during your period, or even just hurts, then you need to consult. And that gynaecologist, uro physiotherapist are really good specialists who can help you in such a situation, so keep that in mind. Let's go back to the visit to your surgery. What does a physiotherapy examination look like?

Kamila Grabek
A lot of people get unnecessarily stressed, and I think that an examination with a urogynaecological physiotherapist is nevertheless a bit more pleasant than with a gynaecologist.

Monika Rachtan
Of course, this can always be considered in terms of enjoyment, but well, let's assume.

Kamila Grabek
But for some patients, somehow these gynaecologists are indeed very bad. Perhaps they have just come across the wrong specialists and that's that. On the other hand, I know that many girls are frightened by the speculum, which is what the gynaecologist inserts into the vagina and expands there to see for themselves.

Monika Rachtan
Do you have a speculum too?

Kamila Grabek
What it all looks like. Exactly, I do not usually use, I do not use. Sometimes it is used when the organs are lowered, but as I say, I always just refer then to the gynaecologist, so that he can look at it with an expert eye. So the visit, like any visit, always starts with an interview. The questions vary. If you are coming in with incontinence, these questions will not only be incontinence. Of course we go through sexual function, through just micturition defecation, i.e. pee and poo. I need to know what your habits are, how you work, whether you have a sedentary job or some physical work. Yes. Do you train anything? I have women who are not professional athletes. Yes. Or they lift weights professionally, so in that case, it's worth taking care of that pelvic floor as well. However, after such a comprehensive interview, it should take us about 15 to 20 minutes. We move on to such a general examination of the body.

Monika Rachtan
And tell me, and are there any professions in particular that stand out, that get to you most often?

Kamila Grabek
Hmm interesting question. You know I've never really thought about it. There are certainly a lot of people who are sedentary and who have little physical activity. I think I have more patients in my practice who don't have that physical activity than I do.

Monika Rachtan
So physical activity is not only about a beautiful figure, it's not only about fitness, it's also like one of the protective factors against incontinence. Well, yes.

Kamila Grabek
As much as possible, because these are muscles like any other and they just need that work throughout the day. In the same way that we won't build nice big glutes by sitting on them.

Monika Rachtan
That really disappointed me.

Kamila Grabek
So does the pelvic floor. Don't get stronger from sitting so we need to move, we need to give it movement and as much general movement as possible. Yes? So here I also warn that walking is not physical activity, it is some kind of our basic activity that everyone should provide for themselves. However, when I ask patients about physical activity, I always ask about any organised training, or whether they do anything at home in addition to this spontaneous movement, which is walking, whether they train with weights, whether they stretch, whether they do fitness training; it is also important for this movement to be general and not to focus on just one thing, but to include every aspect of movement.

Monika Rachtan
And you were still talking about sport. Well that's exactly right. You've got some sort of sport that when you hear a patient come in and say they're doing this sport, you say ok, I already know there's going to be a problem there or rather not.

Kamila Grabek
Sometimes they are indeed women who lift heavy weights. And here I mean such really heavy weights, because I have women who come and tell me they lift 200kg on a barbell. So yes professionally, so it's a big strain on the musculoskeletal system in general, on the muscles, so also of course on the pelvic floor muscles. But it's not a rule because some people lift 200kg each and their pelvic floor looks great.

Monika Rachtan
But it is such an extreme in these physical activities. It is also something that can be dangerous and we must remember to do it under medical supervision. Okay, but let's go back to the surgery. Right.

Kamila Grabek
Exactly, then. Okay, let's get on with this main study of mine. It mainly takes place in the supine position. The patient gets a gynaecological skirt from me, if that feels better. And I simply finger test, which means I apply a finger to the vagina, of course in a glove with gel. And I examine myself one by one all the muscles at the entrance to the vagina. Then I go deeper, examine deeply, check how the urethra behaves, how the ligaments are all around. I check myself generally the whole pelvis, so also the sacrum and I look at the mobility in the hip joints. I look at the diaphragm, which is how a woman breathes, whether she can take a breath into her lower ribs, what moves when she breathes. Because it's also very interesting that a lot of us have different breathing patterns and they can also affect both the function of the pelvic DNA and different kinds of overload in the body, so that's also very important. Whereas in the pelvic floor itself, of course, as I mentioned, I ask for a cough to see how these muscles behave when we cough, whether they are just cushioning the cough for us, because during any increase in pressure our pelvic floor should tighten up.

Kamila Grabek
That is, it should just try to close that urethra. Sometimes it is simply not there. And then we know that this is probably the main cause of this incontinence, this failure of the muscular apparatus. However, I also check at the very end how the patient tenses these muscles, that is, I ask for a couple of quick tensions, then I ask for a sustained tension, I check how much the patient can withstand in this tension, whether she is able to perform any tension at all, or not, for example, during this exercise, because women also tend to push instead of tensing these muscles. It is also very possible that this is simply due to some kind of habit, simply a great weakening of these muscles, or perhaps just a lack of feeling for this body. Well, again, people who don't move much won't have such a good feeling of the body as people who train and have probably felt their pelvic floor somewhere before. So I check the tension of those muscles for myself. Sometimes, but not always. If the patient wants, we can use such a device for electro-stimulation, for biofeedback, that is, then.

Monika Rachtan
What does it consist of?

Kamila Grabek
That's right. We apply the electrodes vaginally. I select these electrodes in the surgery, because there are various electrodes and we select them according to our needs. There are electrodes which, for example, can read the voltage and muscle activation. On the one hand, and on the other hand, there are electrodes that simply take the pelvic floor. So more generally in their charts, which they then show us and we also carry out a whole protocol like this. It's called the glial protocol. And it basically consists of practically the same thing that I do with my own finger. That is, first there are quick contractions, then there is a sustained contraction, right? And here we are able to check ourselves as objectively as possible. Yes? Well, because the apparatus shows us on the monitor how these muscles are flexing, how strong they are, whether the contraction has really been held, whether, for example, it starts to relax and then the patient tries to flex again, relaxes again, flexes again? Yes. So it's already such a very accurate diagnosis. And on this device we can also carry out the therapy right away, because we can use electrotherapy, which means we simply stimulate the muscles with electrical therapy.

Kamila Grabek
It is not electrical impulses, it is not electric shocks. Calm.

Monika Rachtan
I just wanted to ask if it hurts.

Kamila Grabek
It is not painful. I mean we certainly don't turn it up so that it's painful in any way. But no, it is not a current of some high frequency. Frequency. Pulses. Yes, it's all already set up for ourselves under what comes out in the examination.

Monika Rachtan
Okay, that's one treatment option. And if not these electroshock treatments? No, no. What you said about, then, like afterwards, with what? What am I going to leave you with?

Kamila Grabek
In fact, also with exercises that we can of course do ourselves at home, that is, we do the tensions, the relaxations respectively. I, of course, write down how many times a day it should be, what should these tensions look like? How can we check that we are doing them well at home? Because this is also a common concern of patients. The easiest way is simply to use your own finger, So somewhere, if the pelvic floor is very weak, we always start with lying down positions. Yes. So, lying on her back, the patient puts some quilts or pillows behind her, leans back, bends her legs so that everything around her abdomen and pelvis relaxes here. She applies her finger to her vagina and on this finger she should feel that the muscles tighten, but also pull the finger inwards. And this is then the correct pelvic floor tension. In general, without the finger, the patient should also feel that when she tightens her pelvic floor, it not only tightens, but also lifts upwards, as if pulling towards her head.

Monika Rachtan
So pleasant this physiotherapy. Generally speaking, you can do that here. You can have a nice time with each other. And tell me, can I come and practice with you? You know, for example, I don't feel confident. I don't know if I'm doing it right and, let's say, I come to you three times, we practise together and then I go home and I do it on my own.

Kamila Grabek
Yes, absolutely. I usually explain to my patients that if we have a problem with the pelvic floor, first of all, it is not enough to do the exercises for a week and then we are perfect. This time is a little longer; we should give ourselves at least two or three months, in most cases even more, to really get the whole therapy over with. I think that 2 or 3 months are the first results. Because it's just like any other training, and just like any other training, the pelvic floor will require this increase in stimulus. So, of course, we start in the supine position, but then we try to transfer this movement to sitting. That is, we already have the strain on the organs, the force of gravity. This will already be more difficult for our pelvic floor. Then, while standing, we can try to transfer this tension into specific exercises, so that the patient can, for example, perform this tension during a squat or during a jump.

Kamila Grabek
Of course, it is also not the case that later on these muscles should always be tensed in the same way during the squat, because these muscles should work automatically. So if rehabilitation is carried out from start to finish, the result is that we don't have the symptoms we had. Well, and the pelvic floor is already working automatically, just like really every other muscle in our body. So.

Monika Rachtan
OK, you've convinced me. Where do you accept? In Lodz.

Kamila Grabek
In Łódź Yes.

Monika Rachtan
Good. Then I'm at your place. We'll check in and practice. Does it happen to you that girls come to you and say You know, you saved my sex, well because.

Kamila Grabek
So.

Monika Rachtan
There is a serious problem.

Kamila Grabek
Yes? I have a lot of female patients who have problems with painful intercourse, but there are also some who don't get satisfaction from intercourse. And this is where I think that, surprisingly for some, physiotherapy can also have an effect.

Monika Rachtan
Well, yes, because if something hurts you, it can be pleasant for you. Totally I can't imagine that and it also somehow spoils the relationship in the relationship. Because on the one hand the man is trying, he seems to be doing everything right, and the girl either doesn't want to, or it's just an ordeal for her. And then when she frees herself from that problem, well wow, she lives again.

Kamila Grabek
On the other hand, this very lack of sexual satisfaction does not always go hand in hand with pain either. Sometimes there are patients who seem to have no pain in sex, while they have no orgasms whatsoever so they are unable to achieve them with a partner on their own. And here it is also worth seeing how this pelvic floor works.

Monika Rachtan
So there's a lot of these life issues that can be saved in your practice. And I also think that sort of getting rid of the incontinence problem, which let's say sort of is a hassle because of the service, but also we just feel all the time that when we know that we don't have, that we have incontinence, well we look back all the time and we wonder if people are running away from us because we smell, right? Well there's a certain smell that comes up and it's kind of hard to fool reality that it's not there. And I think that's also a mega problem that makes girls inclined to look for the cause and deal with it though.

Kamila Grabek
Yes, yes, exactly. However, when such symptoms also appear, well, it means that probably this incontinence is already quite considerable. And here I would also say straight away that I would recommend a consultation for all girls who are in the perinatal period, even before pregnancy. Before at least before the birth. And if they haven't managed before the birth, then after the birth always.

Monika Rachtan
Ok, well that's when we set up certain things for ourselves before birth too. We learn how to handle our pelvic floor. It's well known that childbirth is a big strain, and girls also often have some kind of trauma that they went through childbirth, that incontinence has just occurred. And so they come in the first few months after having a baby. And you can see that this postnatal depression is caused not by the fact that there is a baby in the world, not by the fact that suddenly responsibilities have arrived, but something terrible incontinence has just appeared.

Kamila Grabek
Yes, some are very nailed down by this because, for example, they had previously led some very active sporting lifestyle and suddenly they are left with it after they are switched off because they are worried about this incontinence, sometimes also faecal incontinence. I had such a patient who came to me just after giving birth. She had been very active the whole pregnancy, exercising, doing weight-bearing exercises. And she came back to me with incontinence, but also faecal incontinence. And here, of course, all the tests started, because we also have to check if there is any damage there. So there has to be an ultrasound, there has to be a transanal ultrasound in this case, yes? And this is where the rectal examination comes in. This is also the case for me. So I need to have a rectal examination after all, because that is also where we have our pelvic floor muscles and that is also where it is sometimes useful to check how they are behaving.

Monika Rachtan
Have you been able to help this patient?

Kamila Grabek
Yes. It turned out that the damage wasn't there. It was just caused by such a lot of tissue stretching during the birth and she just needed a bit of time, a bit of exercise, a bit of care to get back to that state, let's say fairly pre-pregnancy. And that went fairly quickly for us. But here the girls also have to remember that everyone will regenerate differently after this birth and they have to remember that these six weeks, which is so conventional, let's say the postpartum six weeks, is really very conventional and such a real postpartum regeneration is at least a year after the birth, and very often we go into labour and after six weeks we would already like to, I don't know, climb in the Alps.

Monika Rachtan
Mountains move.

Kamila Grabek
Move mountains. We just don't know what, and we need some of that time.

Monika Rachtan
So it's worth giving yourself that time. Kamila I was browsing through your Instagram and I saw that you also deal with guys and we have another 40 minutes to talk about that because unfortunately the airtime is chasing us, so today we dealt with girls. But would you agree to tell us about men next time? I think it's an interesting topic. Girls, we have different problems and some of them are embarrassing, some of them affect our quality of life, but remember that many of these problems can be solved with a physiotherapist, with different specialists. It doesn't always have to end in painful operations, painful treatments and it's just worth taking care of your health and going for a consultation. And specialists such as Kamila Grabek, who was my guest today, but above all your guest, can help you. So welcome to Kamila, to Lodz.

Kamila Grabek
I am happy to help.

Monika Rachtan
And I thank you very much for our time together today. This was the programme. First of all, the Patient. My name is Monika Rachtan and I invite you to follow me, but also Kamila, on social media. See you there.