Physiotherapy for pelvic health

Written by Oliver Atkinson on 23/2/2022

Physiotherapy traditionally helps assess and treat a range of conditions including:

• Musculoskeletal problems, such as back pain, reduced mobility in arms and legs, tennis elbow or carpal tunnel syndrome

• Sporting injuries and a return to activity

• Postural issues

• Breathing problems such as asthma and COPD.

Unknown to many it can also help with issues related to pelvic health, such as:

• Urinary incontinence

• Bladder and bowel dysfunction

• Pelvic floor weakness

• Pelvic pain and instability

• Pelvic prolapses

• Issues with intercourse

What does pelvic health physiotherapy involve?

Pelvic health physiotherapy involves assessing and treating a group of muscles that are involved with urinary, bowel and sexual function. These muscles are often referred to as your pelvic floor and more generally your core muscles. They are located around your spine, abdomen, diaphragm, pelvis, and genitals. The goal of pelvic health physiotherapy is to improve the function of these muscles through exercise, lifestyle modification, education, electrical stimulation, and manual therapy. 

Why would I need to see a Pelvic Health Physio?

Whilst women and older people tend to have a higher chance of suffering from Pelvic Floor symptoms, the truth is that anyone can have some form of pelvic floor dysfunction that can benefit from Physiotherapy.

Prenatal and Post-natal are some of the most common times when pelvic floor symptoms might arise. Through pregnancy and labour women’s bodies go through a lot of change and core muscles must stretch and lengthen in a short space of time. This can often lead to pain and weakness around the lower back, tailbone, pelvis, and hips. Along with pain individuals may also experience symptoms such as incontinence, prolapses, and pain with sexual intercourse. Assessment and a structured exercise program focussing on gradually building core muscle strength and control which over time and with supervised progression will improve these symptoms.

Menopause reduces a woman’s oestrogen levels significantly and oestrogen is important in maintaining optimal function in the pelvic floor region. Therefore, when going through menopause women are at higher risk of developing pelvic health concerns and may experience symptoms such as bulging, incontinence, overactive bladder, and pelvic pain. Pelvic Floor strengthening and control therefore plays an important role in improving these symptoms in combination with treatments from a doctor.

Men can also experience pelvic floor symptoms, the most common causes of pelvic floor dysfunction in men include chronic pelvic pain, chronic prostatitis, reduction in testosterone, and post-surgical, and post-prostatectomy. Common symptoms that men may be experiencing include the feeling of incomplete bladder or bowel emptying, constipation, slow/weak stream, incontinence, pelvic pain, back pain, and erectile dysfunction. Physiotherapy designed to specifically target the pelvic floor and core muscle groups, along with education and manual techniques can help restore control and function as well as improve testosterone production.

After undergoing surgery, specifically abdominal or pelvic surgery, it is also common to experience pelvic floor concerns. This may be due to the surgical procedure itself or due to prolonged catheterization. Commonly, post-surgery physiotherapy treatment will work towards decreasing pain, improving scar mobilisation, and restoring mobility and function through exercise and education.

What can I expect?

Your first session will be an assessment. Your physiotherapist will take a detailed history and gain an understanding of you, your signs and symptoms and the impact they are having on your life. This will be followed by an external assessment which commonly includes assessing posture, flexibility, stability, core control and strength around your lower back, hips, and pelvis. Afterwards, an external and internal assessment may be completed to assess the pelvic floor muscles. This may be done vaginally and/or rectally with women, and rectally with men. While an internal exam isn’t necessary for the assessment of every condition, should one be recommended, it would only ever be undertaken by a pelvic health specialist physiotherapist, who has done further training. If your physiotherapist does not perform this type of assessment and feels one is necessary, they can refer you to a colleague who can.

Following the assessment, the physiotherapist will talk you through their findings and give you a diagnosis. Based on this, an individualised treatment plan will be given to you. Treatment may include all or some of the following: education, exercises, electrical stimulation, and manual therapy.

During follow-up sessions, the physiotherapist will re-assess your symptoms and discuss them with you. They’ll use these reassessments to progress and adapt your treatment plan and ensure that the treatment is working.  Although recovery times vary drastically between conditions, generally you’d expect to see some sort of improvement after 6-8 weeks of physiotherapy intervention. If there has been no improvement, it may be that a further referral to a consultant for further tests is recommended at this point.