Continence Physiotherapy Network of WA

Other Bladder/Vaginal Symptoms

  • Sensory Symptoms
  • Voiding Symptoms
  • Other Urinary Incontinence
  • Pelvic Organ Prolapse
  • Vaginal Pain

Sensory Symptoms:

  • Increased, reduced or absent bladder sensation with filling.

  • Extended periods of time without an urge to void.

  • Leaking without a desire to void.

  • Insensible loss.

  • Intense, sudden urge to void with insufficient time to reach the toilet.

  • Bladder pain.

Contributing Factors:

  • Neurological disease.

  • Peripheral nerve dysfunction.

  • Chronic pain.

  • Side effects of medications (including natural remedies).

  • Prior bladder injury or trauma.

  • Repeatedly holding on with large bladder volumes.

Assessment and Management:

  • In the absence of pathology, refer to Continence and Women's Health Physiotherapist or Continence Nurse.

  • Physiotherapy assessment may include a detailed history, bladder diary and screening of post void residual.

  • Physiotherapy management includes education about maintaining normal void volumes, healthy bladder/bowel habits, pain management and education about sensitising factors, normalising pelvic floor muscle function.

Red Flags:

Further investigation or referral to specialist is indicated when incontinence is associated with, or accompanied by:

  • Persistent or recurring urinary tract infections.

  • Dysuria, persisting bladder or urethral pain.

  • Haematuria, glycosuria or persistent proteinuria.

  • Inability to empty bladder or straining to empty.

  • Post void residual volume >200ml.

  • Nocturnal enuresis.

  • Rectal bleeding or unexplained vaginal bleeding.

  • Recent sudden alteration of bowel habits with no obvious explanation.

  • Persistent vulvo-vaginal itching area or undiagnosed vulval or rectal dermatological conditions.

  • Pelvic organ prolapse (POP) past introitus causing difficulty emptying bladder.

  • Pelvic masses, unexplained weight loss or unremitting night pain.

  • Suspected neurological disease e.g. MS, Parkinson's disease, stroke, dementia or spinal cord symptoms, such as muscle weakness/wasting, altered reflexes, altered sensation (generally and saddle region), inability to empty bladder, loss of sensation when voiding.

 

 

Voiding symptoms:

  • Hesitancy, slow or intermittent stream.

  • Straining to void.

  • Sense of incomplete emptying or needing to immediately re-void.

Contributing Factors:

  • Reduced fluid intake.

  • Inadequate voiding volumes.

  • Pelvic organ prolapse or obstructed outlet.

  • Pelvic floor muscle dysynergia.

  • Suboptimal voiding mechanics.

Assessment and Management:

  • In the absence of pathology, refer to Continence and Women's Health Physiotherapist or Continence Nurse.

  • Physiotherapy assessment may include: a detailed history, uroflowmetry where available, screening for post void residual, bladder diary, pelvic floor muscle assessment.

  • Physiotherapy management includes instruction in voiding techniques, healthy bladder and bowel habits, management of pelvic floor muscle dysfunction.

  • Continence nurse may  teach clean intermittent self-catheterisation where required.

Red Flags:

Further investigation or referral to specialist is indicated when incontinence is associated with, or accompanied by:

  • Persistent or recurring urinary tract infections.

  • Dysuria, persisting bladder or urethral pain.

  • Haematuria, glycosuria or persistent proteinuria.

  • Inability to empty bladder or straining to empty.

  • Post void residual volume >200ml.

  • Nocturnal enuresis.

  • Rectal bleeding or unexplained vaginal bleeding.

  • Recent sudden alteration of bowel habits with no obvious explanation,

  • Persistent vulvo-vaginal itching area or undiagnosed vulval or rectal dermatological conditions.

  • Pelvic organ prolapse (POP) past introitus causing difficulty emptying bladder.

  • Pelvic masses, unexplained weight loss or unremitting night pain.

  • Suspected neurological disease e.g. MS, Parkinson's disease, stroke, dementia or spinal cord symptoms, such as muscle weakness/wasting, altered reflexes, altered sensation (generally and saddle region), inability to empty bladder, loss of sensation when voiding.

 

Other Urinary Incontinence Symptoms:

  • Continuous urinary incontinence.

  • Insensible urinary incontinence.

  • Coital incontinence.

  • Post-micturition dribble. 

Contributing Factors:

  • Constipation.

  • Sphincter insufficiency.

  • Poor voiding dynamics.

  • Poor bladder habits.

  • Pelvic floor muscle weakness.

Assessment and Management:

  • In the absence of pathology, refer to Continence and Women's Health Physiotherapist or Continence Nurse.

  • Physiotherapy assessment may include a detailed history, vaginal examination and pelvic floor muscle assessment.

  • Physiotherapy management includes education about contributing lifestyle factors, optimising bladder and bowel function including voiding and defecation dynamics.  Pelvic floor muscle rehabilitation may be included in the management.

Red Flags:

Further investigation or referral to specialist is indicated when incontinence is associated with, or accompanied by:

  • Persistent or recurring urinary tract infections.

  • Dysuria, persisting bladder or urethral pain.

  • Haematuria, glycosuria or persistent proteinuria.

  • Inability to empty bladder or straining to empty.

  • Post void residual volume >200ml.

  • Nocturnal enuresis.

  • Rectal bleeding or unexplained vaginal bleeding.

  • Recent sudden alteration of bowel habits with no obvious explanation.

  • Persistent vulvo-vaginal itching area or undiagnosed vulval or rectal dermatological conditions.

  • Pelvic organ prolapse (POP) past introitus causing difficulty emptying bladder.

  • Pelvic masses, unexplained weight loss or unremitting night pain.

  • Suspected neurological disease e.g. MS, Parkinson's disease, stroke, dementia or spinal cord symptoms, such as muscle weakness/wasting, altered reflexes, altered sensation (generally and saddle region), inability to empty bladder, loss of sensation when voiding.

  • Suspected urogenital fistulae.

Sypmtoms of Pelvic Organ Prolapse (POP):

  • POP is the herniation of pelvic organs through the urogenital diaphragm into the vagina or beyond.

  • Feeling of a bulge or heaviness in the genital area.

  • Urinary and/or faecal incontinence.

  • Difficulties passing urine or stool.

  • Pelvic pain and sexual dysfunction.

Contributing factors:

  • Repetitive coughing or sneezing.

  • Obesity/Increased BMI.

  • Defaecation dysfunction.

  • Hormonal status.

  • Excessive loading with lifting or exercise.

Assessment and management:

  • In the absence of pathology, refer to a Continence and Women's Health Physiotherapist.

  • Physiotherapy assessment will include a detailed history, vaginal examination and pelvic floor muscle assessment.

  • Physiotherapy management of contributing lifestyle factors, optimisation of bowel function (reducing constipation), and pelvic floor muscle rehabilitation. A vaginal pessary may be recommended to assist return to more active lifestyle.

Red Flags:

Further investigation or referral to specialist is indicated when incontinence is associated with, or accompanied by:

  • Persistent or recurring urinary tract infections.

  • Dysuria, persisting bladder or urethral pain.

  • Haematuria, glycosuria or persistent proteinuria.

  • Inability to empty bladder or straining to empty.

  • Post void residual volume >200ml.

  • Nocturnal enuresis.

  • Rectal bleeding or unexplained vaginal bleeding.

  • Recent sudden alteration of bowel habits with no obvious explanation.

  • Persistent vulvo-vaginal itching area or undiagnosed vulval or rectal dermatological conditions.

  • POP past introitus causing difficulty emptying bladder.

  • Pelvic masses, unexplained weight loss or unremitting night pain.

  • Suspected neurological disease e.g. MS, Parkinson's disease, stroke, dementia or spinal cord symptoms, such as muscle weakness/wasting, altered reflexes, altered sensation (generally and saddle region), inability to empty bladder, loss of sensation when voiding.

 

 

 

 

Symptoms of Vaginal Pain (including Vulvodynia):

  • Pain on vaginal examination or PAP smear (women of any age).

  • Pain inserting or removing tampons.

  • Superficial or deep pain of the vulva or vagina with sexual intercourse.

  • Primary vaginal pain (no previous sexual experience that was pain free) or secondary vaginal pain (prior experience of pain-free intercourse).

  • Vulval or vaginal pain provoked by specific activities, clothing, soaps or other topical applications (vaginal pain can also be non-provoked).

Contributing Factors:

  • Increased pelvic floor muscle tension.

  • Prior obstetric injury or perineal repair/scar tissue.

  • Peripheral tissue sensitivity.

  • Dermal conditions: Candidiasis, Atrophic Vaginosis, Bacterial Vaginosis, Fungal infections, Lichen's Sclerosis, or other.

  • Centrally driven pain: Chronic pain, specific pain event, increased stress levels, emotional/psychological event or trauma.

Assessment and Management:

  • In the absence of pathology, refer to a Continence and Women's Health Physiotherapist.

  • Physiotherapy assessment is likely to include: a detailed history; vulval/vaginal examination; pelvic floor muscle assessment; abdominal and pelvic muscle assessment.

  • Physiotherapy management may include: education about persistent pain; pain management strategies; stress management; paced exercise; pelvic floor muscle rehabilitation; education about sexual function; devices such as dilators to assist graduated exposure to intercourse/having a vaginal examination.

  • If vaginal pain is longstanding, management often requires a multidisciplinary approach.

Red Flags:

Further investigation or referral to specialist is indicated when incontinence is associated with, or accompanied by:

  • Persistent or recurring urinary tract infections.

  • Dysuria, persisting bladder or urethral pain.

  • Haematuria, glycosuria or persistent proteinuria.

  • Inability to empty bladder or straining to empty.

  • Post void residual volume >200ml.

  • Nocturnal enuresis.

  • Rectal bleeding or unexplained vaginal bleeding.

  • Recent sudden alteration of bowel habits with no obvious explanation.

  • Persistent vulvo-vaginal itching area or undiagnosed vulval or rectal dermatological conditions.

  • Pelvic organ prolapse (POP) past introitus causing difficulty emptying bladder.

  • Pelvic masses, unexplained weight loss or unremitting night pain.

  • Suspected neurological disease e.g. MS, Parkinson's disease, stroke, dementia or spinal cord symptoms, such as muscle weakness/wasting, altered reflexes, altered sensation (generally and saddle region), inability to empty bladder, loss of sensation when voiding.