Pelvic health physiotherapy

Pelvic health physiotherapy treats the muscles, nerves and connective tissue of the pelvic floor. In practice that means the problems most women are told to accept: leaking when you cough, sneeze, laugh or run, needing the toilet urgently or often, a heaviness or dragging sensation, pain during sex, and a pelvic floor that has never felt the same since a baby.

Leaking urine when you cough, sneeze, laugh or run is common, but it is not a normal part of being a woman or of getting older, and supervised pelvic floor muscle training improves or resolves it for many women who complete a full programme.

What does the evidence actually say

NICE recommends supervised pelvic floor muscle training, carried out over a period of at least three months, as the first line treatment for stress urinary incontinence and mixed urinary incontinence in women. It is also a recognised first line treatment for the symptoms of pelvic organ prolapse. That means physiotherapy is not the alternative you try before the real treatment. It is the recommended starting point, ahead of surgery.

The important word in that recommendation is ‘supervised’. The single most common reason women believe pelvic floor exercises have failed them is that nobody ever checked whether they were doing them correctly, and a substantial proportion of women contract the wrong muscles when first asked to. An assessment establishes what your pelvic floor is actually doing before anything is prescribed, and what type of exercise may be indicated.

What happens at the first appointment

We talk first. About the symptoms, about how long they have been there, about what they are stopping you doing, and about your history including births, surgery and anything currently being investigated. Then we assess.

An internal examination is usually the most accurate way to assess pelvic floor strength, endurance and coordination, and it is the part people worry about beforehand. We explain exactly what it involves before anything happens, it is entirely your decision, and there is a great deal we can assess and treat without one. Nothing happens that you have not agreed to.

You leave with an explanation of what we found and a specific programme, usually with a review appointment to progress it.

How long does it take to work

Most pelvic floor programmes need three months to give a fair account of themselves, which is why NICE specifies that period. Many women notice a change earlier than that, and the programme continues to build afterwards.

Is it too late for me

Probably not. Muscle responds to training whenever the training starts. We treat women of all ages and circumstances, and it is never too late to feel the benefits.

When physiotherapy is not the whole answer

Some symptoms need a gynaecology or urology opinion alongside physiotherapy, and a few need one instead of it. If that applies to you we will say so at the assessment. We would rather tell you that at the first appointment than sell you a course of treatment that was never going to be enough.