What it is
The pelvic floor is a group of muscles, ligaments and fascia that closes the pelvis from below, like a hammock. It supports the bladder, uterus and rectum, helps control urine, wind and stools, takes part in sexual response, and works together with the diaphragm and abdominal muscles with every breath.
Pelvic physiotherapy is the branch of physiotherapy that assesses and treats these muscles. It is not just “doing Kegels”. A pelvic floor can be weak, but it can also be too tense, poorly coordinated or painful, and each needs a different treatment. That is why assessment always comes before exercise.
What happens in a session
The first appointment is the longest. We talk about your symptoms, but also about births, surgery, bladder and bowel habits, exercise, sleep and what matters to you.
We then observe how you sit, breathe and move. We assess the abdomen and, where relevant, any diastasis and scars. Looking at the perineum externally shows how the muscles contract and relax, for example when you cough.
An internal vaginal assessment is done with one gloved, lubricated finger. It is the most accurate way to understand the muscles’ strength, endurance, tone, coordination and any painful points, as well as how well the organs are supported. We explain everything first. It is always optional: it only goes ahead with your consent, you can stop at any moment and it can be left for another session. You are welcome to bring someone with you.
Treatment may include:
- Therapeutic exercise for strength, relaxation and coordination, built into breathing and everyday movement;
- Biofeedback, which shows muscle activity on a screen and helps you feel and control it;
- Manual therapy, external and internal, to release tension and painful points and to mobilise scars;
- Electrical stimulation, when indicated;
- Education: how the bladder works, toilet posture, hydration habits, managing abdominal pressure when lifting;
- Dilators and desensitisation techniques for pain during sex.
You always leave with a simple plan for home.
When it can help
International clinical guidelines recommend pelvic floor muscle training as first-line treatment for stress urinary incontinence. Pelvic physiotherapy can also help with urgency, mild to moderate prolapse, pain during sex, chronic pelvic pain, constipation, birth preparation and postnatal recovery. For women with endometriosis, it can help manage the associated muscle pain, alongside medical treatment.
What to expect and how many sessions
The number of sessions depends on the problem, your history and the work you do at home. Some women notice a difference within the first few weeks; others need longer. Muscles take time to change, as with any training. We reassess regularly and adjust the plan.
Frequently asked questions
Is the internal assessment compulsory?
No. It helps a great deal in guiding treatment, but it is always your choice. A lot of useful work can be done without it.
Can I come if I’m on my period?
Yes. If you would feel more comfortable, the internal assessment can wait for another session.
How soon after birth can I start?
A full assessment usually takes place after your six-week medical check. Before that, you can already learn how to breathe, move and protect your pelvic floor.
Do I need a medical diagnosis?
It isn’t required, but it helps to bring any scans and reports. If we notice any warning signs, we will refer you to a doctor.
When to see a doctor
See your doctor if you have blood in your urine or stools, bleeding after the menopause, fever with pelvic pain, sudden severe pain, loss of bowel control or are unable to pass urine.