October 8, 2018

pelvic floor exercise latest news from ICS Philadelphia

I recently attended a conference in Philadelphia and participated in Kari Bo’s pelvic floor exercise group and attended other workshops where Kari was speaking and available to answer questions. Kari Bo is a highly regarded researcher who has provided so much quality evidence about pelvic floor exercise over the years. She has published research which tells us that we should do 3 sets of 8 to 12 maximum voluntary contractions each day to strengthen muscles. She tells us that when we do those best effort contractions of the muscles, it doesn’t matter too much about breathing pattern. But, if you can only tighten your pelvic floor by doing an huge intake of breath, then it is highly likely that you are not targeting the pelvic floor to gain a “maximum voluntary contraction” for training purposes. In every day life, you also need to be able to do a pelvic floor […]
October 8, 2018

pregnancy related pelvic girdle pain (PRPGP)

pregnancy related pelvic girdle pain is the name given to pain in the area of the pelvis which starts during pregnancy and usually goes as soon as the baby is born. it can be as little as a pinching sensation as you turn over in bed or get out of a chair, to a more debilitating pain which stops you walking and being able to be active through your pregnancy. The pain typically, is felt in any of these areas: the pubic bone at the front of your pelvis, the scar-iliac joints on the right or left at the back of your pelvis (the sacro-iliac joints are the joints below the dimples to right and left of the back of your pelvis), and may include your low back. Sometimes too the pain goes down the outside of the hips and makes lying on your side uncomfortable. The pain may also […]
July 16, 2018

Male pelvic pain

Pelvic floor muscles can be the source of pelvic pain problems. Since men have pelvic floor muscles, these muscles can be the reason why you are suffering from pain in the pelvic area. Typically, pain will be described in different parts of the pelvis: penis, testicles, area between anus and testicles, anus, groins. The pain may be aching, stabbing, tense, tight or any number of different descriptions. The problem may also cause urinary frequency and irritation making you feel like going to the toilet. We tend to call this pain “chronic pelvic pain syndrome”. Chronic refers to pain that has been present for several months and won’t go away. If the pain was managed well in the first place, it wouldn’t need to become “chronic”. We sadly see some men who have been suffering for years without knowing where to turn. It is important to see a Doctor who will […]
March 20, 2018

Consult Cee Heron for your child’s bladder or bowel control problem

This years Cee has been working at Monash Health’s Paediatric (children’s) Continence Clinic. This is a multidisciplinary clinic which offers help for a variety of conditions ranging from day time wetting (accidents) and bedwetting to constipation and faecal incontinence in children aged from 4-6 up to 16 years of age. Most children gain day time bladder control and bowel control by the age of 4. Night time bladder control often develops a little after a child has gained control by day. Timeframe for bladder and bowel control often varies from child to child. But it is important to know when you should seek help: there is a lot we can do to solve problems! You should seek help if: 1. Your child still has bladder control problems by day or bedwetting after the age of 6-7. 2. Your child still has soiling accidents (inappropriate loss of poo) after the age […]
March 20, 2018

hip tendinopathy

Caroline attended a course run by Alison Grimaldi in Sydney at the end of last year updating on current assessment and management approach to tendinopathy. This included tendinopathy at side of hip (gluteal tendinopathy), back of hip (hamstring tendinopathy) front of hip (iliopsoas tendinopathy) and inside hip/groin (adductor tendinopathy). This was a great course that helped us revise the basic anatomy, pathology, assessment and management of common hip tendon problems. (and ALL Physios should be constantly updating on the basics). As “Pelvic” Physios, we tend to see people whose musculoskeletal problems are complex and may have been present for several months or years. This tends to mean that an original injury is now triggering secondary issues. Often pain is present in multiple muscles, tendons and joints. So we will follow all the testing for different structures and start to note all the areas showing problems and discuss how we might […]
December 3, 2017

Cee now available for consultation at Pinnacle Physiotherapy

Cee has recently started working at Pinnacle Physiotherapy and will be available for consultations on Mondays, Wednesday afternoons and Friday mornings.
December 3, 2017

Lower Anterior Resection Syndrome – workshop attended

At the recent Continence Foundation Conference, i attended a workshop on the subject of Lower Anterior Resection Syndrome (LARS). This syndrome occurs in those who have had the lower part of their bowel removed in order to get rid of bowel cancer in this lower part of the bowel. During the surgery, the lower part of the bowel (called the colon) is removed and with it the upper part of the rectum. The syndrome is characterised by frequent passage of loose stool, difficulty controlling the bowel and often sense of incomplete emptying. It can be very distressing to have overcome cancer and yet to be left with a problem which causes huge embarrassment and loss of quality of life. There is a lot we can do to help those with the problem to understand why the problems occur and how to manage them.
December 3, 2017

Cee and Caroline attended Continence Foundation Conference in Sydney

Continence Foundation Australia Conference 2017- hear from Cee who presented at the conference: I had an opportunity to attend Continence Foundation National Conference 2 weeks ago in Sydney. It was a great conference, gathering many health professionals including Gynaecologists, Urologists, Continence and Women’s/Men’s Health Physiotherapists and Continence Nurses both nationally and internationally to share their knowledge in order to optimise our service delivery to our patients. I also presented my Masters research project and was proud to give my input and to share with others, the role of Physiotherapists in managing continence conditions. It was a great couple of days. I hope to be able to do more research and have many more opportunities to present like this in the future.
October 25, 2017

pelvic pain workshop

I recently attended a 2 day workshop run by a group called “Pelvic Pain Victoria”. It brought together health professionals across the spectrum to discuss best team management of pelvic pain in its many presentations. We had Doctors, both G.Ps and Specialists (Urologists, Pain Specialists, Gynaecologists, Urogynaecologists, Gastroenterologists), Psychologists, Pain Scientists and Physiotherapists all gathered together to hear what each group is trying to do to help manage pain. The main messages are: Pain is real. Pain is never “just in your head”. Pain is there when it first starts for a good reason: it is there to protect us and allow us to stop, heal and get better. Sometimes the process of healing doesn’t run to plan and nerves start, lets say, to get used to sending messages of pain and they start to send more messages making us feel that the pain is there all the time or […]
September 17, 2017

Chronic Pelvic Pain and Dry Needling.

I have taken time this year to update Dry Needling general skills in order to be able to attend the long awaited “Dry Needling for Pelvic Pain” course at the end of June this year. We all do a lot of professional development, but every now and then we do a course that really transforms our practice and enables us to offer something really exciting for management of a particular condition. And so this was such a course. Dr Jan Dammerholt, a highly regarded Physiotherapist and Dry Needling educator and practitioner, came over from America to give us insight into safe techniques for treating Pelvic Pain and Pelvic Floor problems, using Dry Needling techniques. Dry Needling may not be for everyone, and for those that do not like the idea of treatment needles, then all the muscles can be treated with manual therapy techniques. However for those who are keen […]
September 17, 2017

Professional development update

Cee recently attended a one day Physiotherapy “masterclass” for current evidence in Physiotherapy after Prostate surgery. This was followed by an Ultrasound workshop. See the blog about transperineal ultrasound.
September 17, 2017

Transperineal ultrasound, a tool to help you to exercise your pelvic floor correctly.

Transperineal ultrasound assessment- A visual tool to help train your pelvic floor! Transperineal ultrasound provides a visual image of your pelvic floor working in a real time. Note that ultrasound can be done across the lower abdomen or from the perineum. Pelvic floor Phyisotherapists are trained to image the pelvic floor via the perineum. As Physiotherapists, we use an ultrasound to assess your pelvic floor muscle function. Transperineal ultrasound has been shown to be an effective tool in measuring pelvic floor muscle function. Many people who need to train their pelvic floor often find it difficult to activate correctly. Lots of people do not know what the correct contractions feel like. So, with transperineal ultrasound, you can see your pelvic floor working when you are contracting it right! With this visual feedback, many people will find it easier to train their pelvic floor. This results in them achieving their rehab […]
August 28, 2017

Is incontinence, prolapse and sexual dysfunction a normal process of ageing? Cee Heron (Tangyotkajohn)’s research tells us that women over 55 should get help for pelvic floor problems

Is incontinence, prolapse and sexual dysfunction a normal process of aging? In June, I had an opportunity to present my research project at the World Confederation for Physical Therapy Asia Western Pacific Region Conference in Bangkok. My research project was on help seeking behaviour in women over 55 years old with pelvic floor dysfunction living independently in Australia. Pelvic floor dysfunction is a broad term encompassing bladder, bowel and sexual dysfunction as well as prolapse. It is a large problem affecting many aging women in Australia and has a significant cost to society. Despite many successful treatments being available not many women seek help for their condition. According to my research, many Australian women over 55 years believe that pelvic floor dysfunction is a normal part of ageing; they indicated that they were self-managing their problems. But that is not the case! I can let you know now that pelvic […]
August 28, 2017

Cee Tangyotkajohn changes her name to Heron

Cee got married last year and from now will be known as Cee Heron. But just so her fans can find her, we will use Tangyotkajohn in brackets to make sure that for the foreseeable future, there is no confusion!!
July 18, 2017


PESSARY FITTING FOR PELVIC ORGAN PROLAPSE This is a new service that i have been offering this year.  I completed courses to learn how to fit pessaries some time ago.  It took me some time to finally organise things to be able to offer the service.  So i am really pleased that i can offer ring pessary fitting  now. We aim to be able to help women of any age who might have prolapse but do not want to have surgery.  Many young women do have some prolapse after giving birth but are certainly too young for surgery and may well be going on to have more children so surgery is not an option.  A ring pessary is easy to insert and can be used on and off to enable women to feel comfortable.  Women can  exercise pelvic floor effectively once the prolapse is reduced with the ring pessary.   […]
July 18, 2017


USANEE (CEE) TANGYOTKAJOHN PRESENTED HER MASTERS THESES AT CONFERENCE IN THAILAND. Well done to Cee who recently travelled to Thailand to present at a Physiotherapy conference.  It takes a lot of commitment to put yourself forward to speak in front of an auditorium of fellow Physiotherapists.  Great work!  Lets hope this is the start of more research to come from Cee.
July 18, 2017


NEW STAFF MEMBERS USANEE TANGYOTKAJOHN AND CANDICE GRAETZ START WORKING WITH PENINSULA PELVIC FLOOR PHYSIOTHERAPY Really excited to have 2 great new Physios working for us: Usanee (Cee) Tangyotkajohn has started working for Peninsula Pelvic Floor Physiotherapy at TSIC in Frankston.  She is available on Friday afternoons.  Cee has been gaining experience with the Continence Team at Monash Health and also privately in Frankston before starting with us this year.  She completed a Masters in Continence, Women’s and Men’s Health Physiotherapy from Curtin University so is highly qualified to treat all aspects of Women’s and Men’s Health Physiotherapy. Candice Graetz completed her Post Graduate training in Pelvic Floor Physiotherapy at Melbourne University and is available for consultations at Peninsula Pelvic Floor Physiotherapy at Pinnacle, Dromana.  Candice also does general musculoskeletal Physio and Pilates at Pinnacle .  So for those wanting to start Pilates but feeling unsure about pelvic floor and […]
July 18, 2017


MOTIVATION FOR PELVIC FLOOR EXERCISE I meet so many people that struggle to do pelvic floor exercise. Many feel defeated by the relentless need to  be exercising these muscles several times a day. Here are some ideas for making pelvic floor exercise part of your day.  After all,   we all have to wash ourselves, feed ourselves and do basic household tasks every day.  If pelvic floor exercise becomes part of routine tasks, then pelvic floor exercise will be routine too! So, work pelvic floor exercise in with regular routine tasks. Kitchen tasks – unpacking the dishwasher, as you reach down and reach up to put away tighten pelvic floor and “core”. As you fill the kettle with water, engage pelvic floor and core to resist the slight weight of a full kettle of water. As you wait for a kettle to boil, or stir something on the cooktop, or wait […]
July 18, 2017


PHYSIOTHERAPY FOR CONSTIPATION There are many causes of Constipation.  Problems anywhere in the Gastrointestinal Tract can cause constipation.  The Gastrointestinal Tract refers to the whole system or “pathway” from mouth to anus.  The food is put in at the mouth, the food is processed in the stomach and small intestine.  Waste becomes formed in the large intestine (colon) and waste (poo or “faeces”) is shunted to the rectum.  The rectum is like a waiting room..messages go to the brain to say that something is waiting, we get the urge to empty the bowel, can hold on until we find a suitable place to get rid of the waste (“defecation”).  Muscles of the pelvic floor control the exit at the anus.  We also have a band of muscle called the “anal sphincter” which helps to give us control and prevent us having accidents or losing control before we get to the […]
July 18, 2017


MENOPAUSE AND PELVIC FLOOR So i attended the course and its been a few weeks since.  It takes a while to see how a course will inform practice.  I have used what i learnt to empathise greatly with clients who really are having to   “cope” with Menopause symptoms.  The fact is that Menopause will start to occur for most women, anywhere from 45 to 55 years old.  Some women will go into “early” Menopause before the magic 45 year start.  Many will notice signs somewhere within the usual 45 to 55 year time frame.  So lets face it, there’s a  big difference between 45 and 55 years old.  I notice that women who are experiencing symptoms before 50 seem to feel that they are a bit young, and those after 50 are accepting or wondering when on earth Menopause will happen because they really are fed up with periods! […]

Transperineal ultrasound assessment- A visual tool to help train your pelvic floor
Transperineal ultrasound provides a picture of your pelvic floor muscles as they are actually  working.  The Ultrasound can be done across the lower tummy or from the perineum (the area in men and women between bladder exit and back passage).  Pelvic floor Physiotherapists are trained to image the pelvic floor via the perineum.  This approach gives you detailed information about your muscle function.

NOTE,  IT HAS BEEN SHOWN THAT 60% OF PEOPLE WHO JUST READ INFORMATION FROM A LEAFLET ABOUT HOW TO CONTRACT THEIR PELVIC FLOOR WILL GET IT WRONG. So, ultrasound feedback is a fantastic, non-invasive tool to help you get it right.
There is a lot of focus in life about how men and women need to strengthen their pelvic floor muscles to help with bladder and bowel control.  But  pelvic floor muscles  also need to be able to relax properly.

We see many people for help with pelvic pain problems.  Many of these people will need to relax their pelvic floor before they can strengthen.  We call this  condition where muscles are too tight “overactive pelvic floor”. Overactive pelvic floor  can lead to pain around the vaginal, clitoral area or back passage in women, or testicles,  penis and back passage in men. Pain may also be felt in the broader abdominal/tummy areas and pelvis.  Transperineal ultrasound can also assist us in treating these conditions.
In summary, Transperineal ultrasound is suitable for:
• Before and after prostatectomy
• Pelvic pain: some people may not be able to tolerate an internal examination.
• Difficulty with emptying your bladder or bowel
• People who do not want an internal examination