Pelvic floor physiotherapy focuses on assessing and managing concerns related to the muscles that support the bladder, bowel, pelvic organs, and core. It may be considered for symptoms such as urinary leakage, pelvic heaviness, pain, weakness, or changes during pregnancy and after childbirth. Treatment is based on an individual assessment and may include education, exercises, movement guidance, and other physiotherapy techniques.
What Is Pelvic Floor Physiotherapy?
Pelvic floor physiotherapy is a specialised area of physiotherapy that assesses and treats the muscles, connective tissue, and nerves of the pelvic floor, the hammock of muscles spanning the base of the pelvis, between the pubic bone and tailbone. These muscles support the bladder, bowel, and uterus, control continence, contribute to core stability, and play a role in sexual function.
When they aren’t working well, are too weak, too tight, or poorly coordinated, the result can be leaking, urgency, heaviness or prolapse, pelvic or lower back pain, painful intercourse, or difficulty with bowel movements. A pelvic floor physiotherapist identifies which of these patterns is present and treats it with targeted exercise, manual therapy, biofeedback, breathing retraining, and practical changes to daily habits.
An important correction to a common assumption: not every pelvic floor problem is a weak pelvic floor. A significant proportion of the patients we see have an overactive pelvic floor, muscles held too tight, where more Kegels make symptoms worse. This is precisely why assessment matters before exercise.
Who Needs Pelvic Floor Physiotherapy?
During and After Pregnancy
Preparing the pelvic floor for labour and delivery, recovering from stretching, tearing, or episiotomy, addressing postnatal leaking, heaviness, or pain, and returning safely to exercise. Often treated alongside diastasis recti.
Women Who Haven’t Been Pregnant
Stress or urge incontinence, pelvic pain, painful intercourse, endometriosis-related pelvic pain, and pelvic floor dysfunction in athletes, especially runners, gymnasts, and CrossFit athletes, where high-impact loading and heavy lifting are common triggers.
Perimenopause and Menopause
Falling oestrogen affects pelvic floor tissue strength and elasticity, which is why leaking, urgency, and prolapse symptoms frequently appear or worsen in midlife. This is treatable, and it responds well.
Men
Pelvic floor physiotherapy is not only for women. Men are treated for post-prostatectomy incontinence, chronic pelvic pain syndrome, and bowel dysfunction.
After Pelvic or Abdominal Surgery
Rehabilitation following gynaecological, colorectal, or urological surgery, where scar tissue and altered muscle function need retraining.
What Conditions Does Pelvic Floor Physiotherapy Treat?
Bladder Conditions
Stress incontinence (leaking with coughing, sneezing, laughing, jumping), urge incontinence and overactive bladder, frequency, and incomplete emptying. Treatment retrains the muscles and the bladder’s habits together.
Pelvic Organ Prolapse
Bladder, uterine, or bowel prolapse causing heaviness, dragging, or a bulging sensation. Physiotherapy improves symptoms and supports in mild-to-moderate prolapse and is recommended first-line before surgical options.
Pelvic Pain and Sexual Function
Painful intercourse (dyspareunia), vaginismus, vulvodynia, coccyx pain, and chronic pelvic pain, usually involving an overactive pelvic floor that needs releasing, not strengthening.
Bowel Conditions
Constipation, straining, incomplete evacuation, and faecal urgency or incontinence, treated through coordination retraining and defecation mechanics.
Pregnancy and Postnatal
Birth preparation, perineal tear and episiotomy recovery, caesarean recovery, postnatal core and pelvic floor rehabilitation, and safe return to running and exercise.
What Happens at Your First Appointment
If you’ve hesitated to book because you’re unsure what an assessment involves, here is exactly what happens.
The Conversation
Your first appointment begins with a private discussion about your symptoms, medical and birth history where relevant, bladder and bowel habits, activity levels, and treatment goals. This helps your physiotherapist understand your concerns before moving on to the physical assessment.
The External Assessment
Your physiotherapist may assess your posture, breathing pattern, abdominal wall, hips, and lower back, as these areas can influence pelvic floor function. This part of the assessment is non-invasive.
The Internal Assessment
An internal vaginal or rectal examination may be recommended to assess pelvic floor muscle strength, tone, and coordination. It is optional, requires your explicit consent, and can be stopped at any time. Where an internal assessment is declined, external methods and biofeedback may be used instead. You may also request a female physiotherapist or bring a chaperone.
How Pelvic Floor Physiotherapy Treatment Works
Treatment depends on whether the pelvic floor muscles are weak, overactive, or not coordinating effectively with the rest of the body. Your programme may include the following approaches:
Muscle Retraining
Exercises focus on improving pelvic floor strength, relaxation, or coordination. Kegel exercises are not suitable for every condition, so technique and exercise selection are based on the assessment findings.
Manual Therapy
Hands-on techniques may be used to address tension or restricted movement in the pelvic floor and surrounding muscles where appropriate.
Breathing and Pressure Management
The pelvic floor works with the diaphragm, abdominal muscles, and trunk. Treatment may therefore include breathing strategies and guidance on managing pressure during lifting, exercise, coughing, or daily movement.
Bladder and Bowel Retraining
Education and gradual habit changes may be used to address concerns such as urgency, frequency, leakage, constipation, or straining.
Biofeedback
Biofeedback may help you understand when the pelvic floor muscles are contracting or relaxing, making it easier to practise the correct movement.
Return to Exercise and Daily Activity
Rehabilitation can progress towards activities such as running, lifting, and sport according to your symptoms, strength, and movement control.
At Orchard Health Clinic, your physiotherapists work alongside osteopaths and chiropractors under one roof, so the whole system is treated from one assessment rather than in fragments.
Orchard Health Clinic