After treatment

Finding a lymphoedema or pelvic health physio

Your GP will write the referral. They just need a name — and there are national registers that exist to give you one.

Two referrals matter more than any other after breast cancer treatment, and both are hard to arrange for the same reason: the credential is specific, and your GP almost certainly does not have a name to hand.

That is not a failure on their part. There is no reason a general practitioner would know which local physiotherapist holds lymphoedema accreditation. There are national registers for exactly this, and if you arrive with a name, your GP can write the referral to that person.

Why the credential matters

Anyone can say they treat the pelvic floor. Anyone can offer lymphatic massage. Neither statement means the person has trained in it.

Bring the name. Your GP writes the letter. That is the whole trick.

Lymphoedema: the national register

The National Lymphoedema Practitioners Register is the only recognised register of Accredited Lymphoedema Practitioners in Australia and New Zealand. It is administered by the Australasian Lymphology Association, the peak body for lymphoedema in both countries.

Accreditation is not a self-declaration. It requires a relevant health qualification, registration or professional body membership, completion of recognised lymphoedema training, current professional indemnity insurance, and ongoing lymphoedema-specific professional development. Only accredited practitioners appear on the register.

Search the National Lymphoedema Practitioners Register

The ALA suggests starting with a search radius of at least 20 km, and expanding to 100 km for outer metropolitan, regional and rural areas. There are filters for specific body areas, specialist services, home visits, and DVA and NDIS eligibility.

The term to give your GP is ALA Accredited Lymphoedema Practitioner.

Pelvic health: two registers, use both

Continence Health Australia — formerly the Continence Foundation of Australia — runs a national service directory covering pelvic floor physiotherapists, nurse continence specialists, public clinics and private practices.

Search the Continence Health Australia directory

Their physiotherapy group directory is the more specific of the two. Every physiotherapist listed has completed at least a postgraduate certificate in continence and women’s health or pelvic floor physiotherapy, and listings show individual qualifications and the conditions each practitioner treats — including oncology.

Search the CHA physiotherapy directory

The Australian Physiotherapy Association also runs a consumer search at choose.physio. The credential to look for is APA Titled Women’s, Men’s and Pelvic Health Physiotherapist. Titling is awarded by the APA and requires postgraduate qualification — it is the difference between a physiotherapist who has trained in this and one with a general interest.

If you would rather talk to a person than search a database, the National Continence Helpline is 1800 33 00 66. It is free, staffed by continence nurse specialists, and they will point you to services in your area.

What to hand your GP

Two lines, with a name and a practice address under each:

• Referral for assessment by an ALA Accredited Lymphoedema Practitioner, following axillary node removal.
• Referral for assessment by an APA Titled Pelvic Health Physiotherapist, for stress urinary incontinence — noting post-partum history and treatment-induced menopause if relevant.

Ask at the same appointment whether a chronic disease management plan applies to you. In Australia these can subsidise a limited number of allied health visits per calendar year, and the eligibility rules and item numbers are your GP’s call, not something to argue from a website.

What to ask when you ring the clinic

• Is the practitioner on the National Lymphoedema Practitioners Register, or APA titled in pelvic health? Ask directly. A good clinic answers immediately.
• Do they treat post-cancer patients specifically?
• For lymphoedema: do they do circumference or bioimpedance measurement, and garment fitting?
• For pelvic health: do they assess before prescribing exercises? This is the important one. A large proportion of women cannot perform a correct pelvic floor contraction from written instructions, and for anyone whose pelvic floor is already overactive, more squeezing makes things worse.
• Cost per session, and whether a care plan is accepted.

Public options

Most major cancer centres and many public hospitals run lymphoedema services, and public pelvic health physiotherapy exists in most states. Waiting lists vary, and eligibility is often tied to having been treated within that health service. If you were treated at a public hospital, ask your treating team what their own service offers before looking privately — it is a question worth asking at every follow-up appointment you still have.

One thing worth saying plainly

Leaking when you skip, jump or cough is common after babies, more common after treatment-induced menopause, and very treatable. It is also the single most common reason women quietly stop exercising and never say why.

It is a reason to change how you move while you get it assessed. It is never a reason to stop moving.