Pelvic Floor Physiotherapy

• Urinary incontinence 
• Bladder urgency 
• Pelvic floor pain 
• Pelvic organ prolapse
• Pain with intercourse 
• Bowel incontinence 
• Bowel urgency
• Constipation

As a woman, pelvic floor muscle physiotherapy can be a benefit for: pre or post natal conditions, chronic pain (vulvodynia, vaginismus, interstitial cystitis, endometriosis), menopausal conditions. 

A Women’s Health Physiotherapist uses specialist skills and potentially an internal assessment to assess the strength and tone of your pelvic floor. This helps determine a specialist programme to help strengthen or mobilise your muscles as needed, depending on your symptoms.

The specialist will first ask you some questions to take your history and understand more about your condition. This is essential to understand what to do during the session. They will assess your abdomen to check your breathing, your abdominal muscles activation, tightness, and specifically for post natal patients your abdominal separation. We will then check your pelvic floor strength and tone via a real time ultrasound and/or internal examination with your consent. After the assessment we will create a customised rehab program for you.

A Women’s Health Physiotherapist will assess the pelvic floor to determine the strength and the impact it may be having on the symptoms of the bladder. The patient would be advised what their long contraction is, how many seconds the long contraction can be held for and then how many times it can be repeated. These exercises would need to be repeated on a daily basis and the patient to come back for a review. Once the physiotherapist is happy with the progression of pelvic floor strength the exercises should become functional and incorporated into the patients exercise/ routine. 

The physiotherapist will determine the reason for your incontinence during the initial assessment with the ultrasound and with a rectal internal examination and will decide which exercises you will need to carry on and which manual techniques to use/stretches if there’s a tightness issue. Education will be given regarding diet, fluid intake and toilet habits.

The pelvic organs include the uterus, bowel and bladder. A prolapse is when the pelvic floor muscles and tissues become weaker and they can no longer hold your organs in place. 

The physiotherapist will assess the degree and kind of prolapse to then decide the right program from you. Depending on the degree the physiotherapy will choose exercises, will prescribe pessaries (support for the organs) or will send you to a uro/gynaecologist to eventually get surgery. 

The physiotherapist will ask you to perform a pelvic floor contraction and relaxation and then will test your muscles endurance asking for a long contraction (holding) as well. 

“ Imagine that you are trying to stop yourself from passing wind at the same time as trying to stop passing urine. You should feel a squeeze and lift inside your vagina. Do not hold your breath”

The physiotherapy after the initial consultation will decide how often they need to see you. This can vary from once a week to every other week at the beginning and then spread if progress is good and if you are diligent with your home exercise program.

A specific pelvic floor activation and contraction would be the best way to activate and strengthen the pelvic floor. 

Other exercises that help strengthen the pelvic floor are: 

• Squat 
• Bridge
• Bird Dog 
• Lunge 
• Single leg balance 

You should aim to complete your Pelvic floor exercises three times a day. There should be a mixture of both long and quick contractions. You need to determine yourself how long you can hold your contraction for and then how many times you can repeat this. This is different for everyone. 

Yes. After the initial assessment to determine the reason for the pain, the physiotherapist can help with breathing, stretches and exercises that can help with the pain brought on by intercourse. Advice and education are also given on different devices or equipment to help return to intercourse gradually.

Yes. After the initial assessment to determine the level of tightness and pain,, the physiotherapist can help with internal massage, breathing, stretches and exercises to help loosen up the involuntary tensing of your muscles. Advice and education can also be given on different devices or equipment to help improving your symptoms.

The initial appointment is 1 hour. The follow up can be half an hour or 1 hour depending on what you have to do with the physiotherapist (just exercise, just manual, or both).

The initial consultation of 1 hour is £155

A 1 hour follow up is £214

A 30min follow up is £107

You will need to clarify that with your insurance.

You should look for clarity, making sure they explain everything that is going to happen in the sessions and they explain the diagnosis to you. You should look for professionality and knowledge.

Yes. The pelvic floor has a major role in pregnancy, it supports your organs, prevents incontinence and helps turn the baby’s head in the correct position. Postpartum many things can happen to your pelvic floor both after a vaginal delivery and a c section one and pelvic floor exercises will help improve your symptoms.

If your physiotherapy decided to give you pelvic floor exercises to perform at home, these needs to be done daily and multiple times a day (4-5 times) in order to see an improvement, if you feel the need you can even use some biofeedback to help you understanding the correct movement and the physiotherapy will explain how to use it in the sessions.

Moreover you need to follow the advice of the physiotherapist regarding your habits, like for example how to avoid constipation, diet, fluid intake…

You can ask Google, ask your GP, or ask your gynaecologist.

Pelvic floor physiotherapy is normally not painful. It can be painful/uncomfortable during the internal examination (vaginal/rectal) when you suffer from acute pain syndromes or you are really tight but your physiotherapist will do everything possible to make you comfortable and will stop the internal examination at any point if you want to.