Pelvic Health: Ruth Schubert's Top Tips for Women

Meet Ruth Schubert, a pelvic health physiotherapist based in Byron Bay, NSW, who shares her expertise on maintaining pelvic floor health and managing menstrual discomfort.

Name: Ruth Schubert
Job: Pelvic health physiotherapist
Location: Byron Bay NSW

What inspired your career?

The first 10 years of my career was spent in sports medicine, working with football teams. Once I had my first daughter, I couldn’t believe the difference in the care birthing women received compared to the athletic population! My own pelvic health journey inspired my drive to create change and improve the outcomes of those with pelvic health concerns.

Why are people still embarrassed to talk about pelvic health?

This narrative is changing, with more awareness and incredible advocacy through social media platforms. However, there is a deeply personal and emotional impact of pelvic dysfunction that makes it hard to discuss. That’s why it is critical we continue to train trauma informed professionals who are caring and passionate about improving outcomes for those with pelvic problems.

Bust some of the common myths you hear from patients…

Pelvic floor problems can start at any time, and for many people, this is way before pregnancy and birth. For example, did you know nearly 30% of girls can have bladder leakage with exercise? Pelvic physios also treat bowel dysfunction and constipation which can start at any age.

One of the main focuses of my clinical and research work is in menstrual pain and endometriosis which can result in a pelvic region that is overly sensitive and tight.

Another myth is that you must have a vaginal exam when seeing a pelvic physio. We have so many options at our disposal (including abdominal and pelvic ultrasound) which can give us great insight without having to do an internal exam if this is a concern for you.

What are key signs someone should see a specialist?

1. Urinary or fecal incontinence (leaking).
2. Period pain, pain with intercourse, or pain using tampons.
3. Constipation or feelings of obstructed defecation.
4. Pelvic heaviness or dragging.
5. Pregnancy for birth preparation, and postnatally (anytime) for recovery and rehabilitation of the pelvic floor and abdominal wall.

How does the menstrual cycle affect pelvic floor function?

The hormonal changes we see throughout the cycle impacts the ligaments and muscles of the pelvic floor. A common symptom is that people may feel more symptomatic (e.g pelvic dragging or urinary leakage) as they lead into their period. Additionally significant menstrual pain and inflammation can increase the tension and sensitivity in the pelvic region leading to a cascade of other symptoms (e.g. bowel pain or pain with intercourse).

What about conditions like endometriosis or polycystic ovary syndrome (PCOS)?

Pain in the pelvis can increase the sensitivity of the nervous system and muscles leading to other pelvic problems (eg IBS, sexual pain etc). Endometriosis is linked with IBS, bladder pain, pain with intercourse and a whole host of other pelvic floor symptoms which are very treatable.

[When it comes to menstruation,] the muscles and the nervous system in the pelvis respond to the hormonal and inflammatory changes during our period and can increase menstrual pain, but also create other symptoms outlined above.

What are your top tips for pelvic floor health?

1. Work on having a set of pelvic floor muscles that are strong, coordinated, and able to relax when required.
2. Maintain excellent bowel habits and avoid constipation.
3. Maintain excellent bladder habits with appropriate (but not excessive) hydration, good bladder capacity and excellent urethral and pelvic floor muscle strength and coordination.
4. Don’t put up with pelvic floor symptoms and don’t guess what the appropriate rehabilitation should be. Have a thorough pelvic assessment so your rehabilitation can be tailored to your specific needs.

And your advice for period discomfort?

1. Self-management strategies for your worst days are important: heat, tens, massage - whatever works best for you.
2. Working on pelvic floor muscle relaxation and co-ordination, and internal pelvic floor massage/ stretches with your pelvic physio can help.
3. Periodising your period – managing your exercise load around your cycle can help you beat fatigue and improve pain symptoms when tailored appropriately. Try to avoid the all or nothing approach when it comes to exercise and pelvic pain.
4. Again, don’t guess! See a pelvic health professional so we can tailor your rehabilitation appropriately.

You can contact Ruth Schubert via her website or follow her on Instagram: @exhale_physiotherapy

Disclaimer: This blog is for information purposes and is not intended to be a substitute for professional medical advice and should not be relied on as health or personal advice.

With any persistent pain, especially period pain that is so bad that it interferes with your daily living, or stops you from going to school or work, it is important to consult a doctor to discuss treatment options.