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Pelvic Floor Physiotherapy: why it matters with Lesley Anne Noël

Hi Lesley, thank you for taking a bit of time to have a chat with me today! To start off, would you mind telling me a bit about yourself and what you do? Hi! I am a French-Filipino physiotherapist or physical therapist working in Paris, France, where I have a practice specializing in Women's Health - pelvic floor physiotherapy especially. I have a multicultural background, having some experience in the Philippines, Singapore, and the United States.

How did you come to be in this career, what has been your journey to this point? When I gave birth to my son, I was in the Philippines, where pelvic floor physiotherapy does not exist. I have not had the privilege of having pelvic floor PT sessions. It was only when I started my practice in France that I learned about this specialty. I found this to be very interesting and I figured that if I train myself in this specialty, I could help a lot of women suffering from pelvic floor problems. I imagined the number of women in the world who didn't receive this type of care, just like me! So in a way, I felt lucky to have experienced this and I wanted to share this chance to as many women as possible by practicing in this field. So I started training myself and this is where I got to where I am now.

What is your overall goal in the work you do? My goal overall is to educate and promote awareness about our bodies, help people achieve optimum function despite any kind of dysfunction and empower them and maximize movement potential in any kind of dysfunction.

How does access to pelvic floor rehabilitation differ in France compared with other countries? France is very good with pelvic floor rehabilitation. Every woman gets a prescription to go see a physiotherapist for pelvic floor muscle training after delivery. Even outside of the postpartum phase, you can go see any doctor and get a prescription if you want. A lot of physiotherapists are specialized in this specialty and I find that we are very thorough with it. That means that when you see your PT, you just don't get a list of home exercises to do and then get a check-up in a few weeks. It means you come in for at least 10 sessions, work closely with your PT for maybe once or twice a week until your treatment goals are reached. I think it helps a lot that this is all reimbursed by the state. It is also a very common thing for women to talk about rééducation périnéale. We also get prescriptions for abdominal muscle rehabilitation for diastasis recti abdominis after delivery. I feel very lucky to be French and have this kind of access to care.

Does everyone who has had a vaginal birth need some degree of pelvic floor rehabilitation? Definitely. Vaginal birth is a traumatic event to the pelvic floor, so it is necessary to have a thorough pelvic floor evaluation after birth. Depending on the findings, some women would need a few sessions to learn as much as there is to know about good habits and pelvic floor muscle training, and some women may have to undergo longer sessions to rehabilitate a weak pelvic floor.

Do people who have had a c-section need pelvic floor rehabilitation? Yes! I get a lot of prescriptions for pelvic floor PT after a C-section. The weight of the baby during pregnancy is a factor to consider and some women might already have an existing pelvic floor dysfunction even before getting pregnant. Also, sometimes women still push before a C-section is decided, which could lead to weakness or dysfunction.

So many women suffer from bladder leakage after giving birth, do you believe this is an accepted part of life postpartum? As a physiotherapist, I strongly believe that bladder leakage should not be an accepted part of life postpartum. I do not believe in telling women to just wear a pad and deal with it. This is where physiotherapy plays an important role. Every woman should know that there is hope if they have pelvic floor symptoms.

Do men suffer from pelvic floor issues and can they be rehabilitated? Yes! Although less talked about, men do suffer from pelvic floor issues. Prostate surgery is one of the major causes of urinary incontinence in men. Aside from that, they could also suffer from urinary frequency, urgency, hesitancy, straining, among other issues.

Do you think there is sufficient education about the function of the pelvic floor? If not, what would you like to see change? I think that there is insufficient education about the pelvic floor. Even in France, where pelvic floor PT is quite common, women only learn about it after they give birth, when they start their pelvic floor sessions. This should be a standard part of education from our younger years. There is also a need to raise awareness about the importance of the pelvic floor muscles and stop ignoring it or keep treating it as a taboo.

If you had one wish for every person who gives birth, what would it be? My wish would be for pelvic floor physiotherapy to be accessible to every woman in the world not only after giving birth, but through every stage of a woman's life.

You can read more about pelvic floor rehab and contact Lesley via her website

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