Hi Junior_physio,

Firstly, i can appreciate your willingness to learn and help but this sort of things is a subcpeciality area - i don't think it can be fairly taught over the internet within a few posts. People complete masters degrees to become proficient in this area.

Having said that, From the extremely limited amount of information we have and not ever having seen the patient move or have an objective examination (i am putting the disclaimer in deliberately!), it sounds like she has excessive pressure - the urge to go when there is no urine there, the fact that she is prolapsing, the fact that she does not have incontinence all point to increased abdominal pressure (in my opinion). Again, i don't see these people unless a women's health physio has been involved.

Perhaps a better question to ask is how did i learn to treat people with excessive muscle activation and increased abdominal pressure? I simply took a few courses. If you have ever been on a course, the material they cover on them can't just be covered in a few posts here. There is observation (which i have alluded to but difficult to teach you) of their control strategies, movement patterns/muscle coordination, passive structure testing, etc etc that goes into it.

As for coughing and sneezing - does this cause problems? If not, then why teach a strategy for it?

Ask her if it feels differently when she exercises like goes for a run or fast walk. If she feels a little better, then i would almost certainly bet she has excessive activation of her obliques - during exercise, they will probably act phasically like they should and so relax a little when they are supposed to. This might decrease the pressure temporarily and ease the symptoms. The worst is probably when she is standing still.

Anyway, i still recommend that she see a specialist in this area - it is only fair to her and to you. I would ask if i could go along as well to learn more. If you are interested in the area, i would take more courses or at least buy a book about it. I think the statistics are 1/3 of all women post-menopause have some issue with pelvic floor etc. It won't be like you are wasting your money!

Good luck.