Pelvic health physiotherapy

Specialist pelvic health physiotherapists use a broad range of treatments to help you achieve your goals. Pelvic health physiotherapy is much more than just pelvic floor exercises. The treatments recommended will depend on your symptoms and goals but may include: 

• Exercises to improve strength, endurance and coordination of the pelvic floor muscles 
• Exercises, stretches, manual therapy and other techniques to help relax an overactive or tense pelvic floor muscle 
• Advice and education about lifestyle choices to help improve bladder and bowel function e.g. advice on management of
• constipation, advice on drinking habits to improve bladder function 
• Advice and education to help you understand persistent pelvic pain and techniques to help you improve this 
• Exercises to improve core strength following pregnancy, childbirth, injury or pelvic surgery 
• Guidance on returning to physical activity following pregnancy, childbirth or pelvic surgery. 
• Scar massage to abdominal scars following pelvic surgery and caesarean section or perineal scars following childbirth 

Advice about appropriate use of adjuncts to facilitate rehabilitation – this includes a huge variety of adjuncts such as electrical stimulation of the pelvic floor muscle, biofeedback to improve pelvic floor muscle function, use of continence devices, use of dilators to help with pain during vaginal penetration.

The use of adjuncts will depend on the nature of your symptoms and any relevant medical conditions you have but many people with pelvic health conditions do not require any adjuncts at all. 

We understand that talking about intimate pelvic health issues can be daunting or even seem embarrassing, but our team will do everything they can to make you feel at ease.

Your initial assessment will be conducted in a private room and our physiotherapists will offer you the opportunity to have a chaperone if you wish.

As members the Health Care and Professions Council (HCPC), our physiotherapists have a professional and legal responsibility to protect the confidentiality of patients.

Your physiotherapist will begin by taking a detailed account of your medical history. They will want to know more about the nature of your symptoms and how they impact you.

They will often ask about your pelvic functions (your bladder, bowel and sexual functions), as well as any other medical concerns you might have. This is to ensure they take a holistic approach to your care, which considers many individualised factors in your treatment plan.

This conversation is followed by a physical examination. Depending on your symptoms, this could be to look at movements of your body, including your back, hips, and pelvis, as well as testing different muscle groups. This helps them to understand the movement of your body and whether this could be contributing to your pelvic problems.

Your physiotherapist may recommend an internal examination of the pelvic floor muscles. Whether or not this is recommended is dependent on the symptoms that you are seeking help with and any other medical conditions that you have. An internal examination involves the physiotherapist placing a gloved finger in the opening of the vagina or the anus (back passage) to assess the pelvic floor muscles.

The precise nature of the examination recommended will depend on the type of symptoms you have. If either of the internal examinations are recommended, your physiotherapist will discuss this in detail with you before asking for your consent to the examination and it is, of course, your choice as to whether you go ahead with an internal examination.

It is important to note that if you decide not to have an internal examination this does not mean that you will not be offered treatment.  Once the assessment has been completed your physiotherapist will discuss the findings with you and work with you to develop an individual treatment program to enable you to meet your personal goals. This may sometimes involve referring you on to another clinician for further advice or assessment.

The exercises you will be assigned depend on your condition and related symptoms.

Pelvic floor dysfunction caused by hypotonicity (weak pelvic floor muscles) require pelvic floor strengthening exercises, known as Kegel exercises. Your physiotherapist will guide you through these.

Hypertonic muscles (tight muscles) require relaxing exercises called reverse Kegels or down-training.

If your pelvic floor muscles are tight and weak (which is possible), any tension is treated before weakness. After your muscles have reached a normal resting tone and are able to relax fully, their strength is reassessed and strengthening exercises are prescribed, if appropriate.

Regular home exercises can also be supported by breathing or core strengthening exercises.

It is important to remember that exercises can be both internal and external. Your physiotherapist will ensure you understand how to carry out each exercise (whichever type), in a relaxed and efficient manner.

When you choose to go private for physiotherapy with Circle Health Group, you can expect:

• Flexible appointment times and locations to fit your routine
• Freedom to choose your hospital and physiotherapist
• Specialist physiotherapy equipment and imaging facilities at your fingertips
• Specialist advice and exercises to follow in sessions and at home
• Tailored services (your physiotherapist will build your programme around your needs)

If you want to know more physiotherapy and find out if it's the right treatment for you, call a member of our team directly.

Content reviewed by Circle in-house team in December 2023. Next review due December 2026.

• Pelvic heath, Obstetric and Gynaecology Physiotherapy (POGP)