8 Reasons you may need pelvic health physiotherapy

It is likely that if you have a sore knee, back or shoulder you would probably consider seeing a physiotherapist.  I wonder how many people’s first thought when they start developing vaginal prolapse symptoms or start leaking when exercising actually is to seek help from a physiotherapist?  I would suspect not many, I have had many a bewildered patient in my clinic who have been “sent to physio” by their consultant or GP but have no idea how a physio is going to help. 

When I started my physiotherapy degree, I had no idea that physios could fix pelvic floors and I find now that even experienced physiotherapists don’t have much of an idea what goes on in a pelvic health physiotherapy clinic! 

Pelvic health physiotherapy is an area which has some robust evidence behind it and it stated in many guidelines as first line treatment for a variety of pelvic conditions.  I’m on a mission to educate and spread the word that there is hope and there is successful treatment out there for conditions that can affect lives in all sorts of ways – emotionally, physically, socially and financially.  Read on for the top 8 reasons to see a pelvic health physio …..

*Please note, this blog is a two-part series. I have talked about 4 conditions in part 1, and will continue with another 4 conditions in part 2!!*  

1)     “Bladder weakness”

Are you leaking urine? Are you constantly searching for toilets? Are you waking up multiple times to go for a wee?

Urinary incontinence is defined as “the complaint of any involuntary leakage of urine” (International Continence Society).

The main types of urinary incontinence are :

  • “stress incontinence” which is leaking on effort or exertion – commonly when coughing, sneezing or during impact exercise such as star jumps, running, trampolining etc 

  • “urge urinary incontinence” which is leakage alongside urgency (a sudden compelling desire to urinate – in other words “OMG I need a toilet NOW”)

  • “mixed urinary incontinence” is when you have stress incontinence and urge incontinence symptoms

  • “Overactive Bladder” is an umbrella term for urgency (OMG I need a toilet NOW) with or without leakage and usually with frequency (going to toilet more often than you would consider as normal) and nocturia (going to the toilet multiple times in the night-time).

Guidelines recommend pelvic floor muscle training, supervised by a professional, as FIRST-LINE treatment for women with stress incontinence or mixed incontinence.  Bladder training is recommended as first line treatment for urgency or mixed incontinence.  (NICE guidelines, 2013)

Physiotherapy is highly successful as a treatment for women with bladder problems, for around 85% of women their symptoms will improve or resolve with physiotherapy.  Treatment is not just about pelvic floor exercises, so if you have already tried pelvic floor exercises it does not mean physiotherapy will not work for you!


2)     Vaginal Prolapse

Vaginal prolapse or “Pelvic Organ Prolapse” is when one or more of the pelvic organs (bladder, bowel, womb) descend and bulge in to the vagina. 

Symptoms can include a sensation of heaviness in the pelvis and/or vagina, sensation of a bulge in the vagina, seeing or feeling a bulge in the vagina, difficulty fully emptying the bowels, difficulty having a wee or fully emptying the bladder.  Often symptoms worsen as the day goes on, after being on your feet a lot, after exercising or when you need to open your bowels. 

Most mild-moderate prolapses will benefit from physiotherapy to improve the pelvic floor support under and around the prolapse and also to improve the strength and coordination of other important muscles, to reduce the load/pressures going through the pelvic floor and prolapse. Physiotherapy will usually have a great impact on the symptoms you are suffering with and aims to prevent the prolapse from worsening with time. 

Again, it isn’t all about the pelvic floor, we will also assess your external muscles and posture, your lifting techniques, how you are exercising and your bladder and bowel habits.   This will all determine your individual plan of treatment that best suits you, your symptoms and your lifestyle. 


3)     Painful Intercourse (dyspareunia)

Many women experience pain during or after sex, either in the vagina or deeper in the pelvis.  Reasons why vary, many conditions can contribute to and/or cause painful sex.  These include infections such as thrush, the menopause, allergies, endometriosis, fibroids, constipation and pelvic floor muscle dysfunction.  It is important you see a GP or go to a sexual health clinic as a first port of call to rule out causes such as infection. 

Often women have a combination of different psychological and physical factors which are causing painful sex. For this reason, I often recommend patients also see a psychosexual therapist alongside physiotherapy to address psychological, relationship and emotional factors. 

Pelvic floor dysfunction is a big reason for painful intercourse, specialist pelvic health physiotherapy is therefore an effective form of treatment for dyspareunia. Usually the pelvic floor muscles are “overactive” or overworking or tight, pelvic health physiotherapists use a variety of treatment methods to help you release these muscles and then start coordinating them in the correct way.  Treatments include education, desensitisation, massage, retraining muscle function with relaxation techniques, using the breath, awareness training, visualisation, body scanning and contract-relax work and increasing elasticity of skin/scar tissue.  We may also use adjuncts such as biofeedback with EMG and dilators or pelvic floor wands. 


4)     Pelvic Girdle Pain related to pregnancy

Are you suffering from Pelvic Girdle Pain (PGP) in pregnancy? Or still suffering with PGP despite having had your baby weeks, months or years ago?

Physiotherapy can have an integral role to play in the treatment and management of all pelvic pain conditions. 

PGP is pain in the pelvis which is related to pregnancy, symptoms usually start during pregnancy but for some women symptoms start shortly after delivery

It’s a condition that affects up to 1 in 5 pregnant women, in varying degrees of severity

PGP is common, but should not be considered as "normal"

Physiotherapists are specialised in the assessment and treatment of altered pelvic mechanics, muscle imbalances and postural problems.  Therefore, the background causes of PGP can be identified and then addressed through manual therapy, exercises and advice.


Soon to come …. Part 2 where I will discuss another 4 reasons to see a pelvic health physiotherapist (hint….chronic pelvic pain, faecal urgency/incontinence, constipation and tummy muscle separation) Watch this space!!!

Lee Philpotts