Pelvic Floor Physiotherapy: Purpose and Benefits

Pelvic floor physiotherapy is a specialised area of care that can help women and people experiencing bladder, bowel, prolapse, pelvic pain and sexual-health concerns. The pelvic floor is a group of muscles, nerves and connective tissues that supports the bladder, bowel and uterus, and plays an important role in continence, movement, sexual function and comfort.

When the pelvic floor is not functioning as well as it could, symptoms may include leaking urine when coughing, laughing or exercising, difficulty emptying the bladder or bowel, constipation and straining, a feeling of heaviness or bulging in the vagina, pelvic pain, or pain during sex. These symptoms are common, but they are not something you simply have to put up with.

Pelvic floor physiotherapy is not just about doing Kegels. Depending on your symptoms, treatment may focus on improving muscle strength and endurance, coordination, relaxation, movement, bladder and bowel habits, or a combination of these. This article outlines some of the ways pelvic floor physiotherapy may help.

1. Bladder leakage (urinary incontinence)

Pelvic floor muscle training is one of the most effective conservative treatments for urinary incontinence in women, particularly stress urinary incontinence and mixed urinary incontinence. Stress incontinence is leakage that occurs with activities such as coughing, sneezing, laughing, running or lifting. Mixed incontinence is a combination of stress leakage and urgency symptoms.

A large Cochrane review found that women with stress urinary incontinence who completed pelvic floor muscle training were more likely to report that their symptoms had improved or resolved than women who received no treatment or inactive treatment.[1] Treatment may also include bladder education, strategies for managing urgency, and a progressive exercise program tailored to your goals and daily life.

2. Pelvic organ prolapse

Pelvic organ prolapse occurs when the bladder, uterus or bowel moves downwards and creates a feeling of vaginal heaviness, pressure or bulging. Symptoms can vary widely. Some people notice a mild feeling of pressure at the end of the day, while others experience bladder or bowel changes that affect daily life.

Pelvic floor physiotherapy cannot promise to “fix” every prolapse. However, supervised pelvic floor muscle training can form part of a conservative management plan for some people with symptoms.[2] Treatment may include pelvic floor exercise, breathing and pressure-management strategies, and guidance around lifting, exercise and bowel habits. If specialist medical or surgical care is needed, pelvic floor physiotherapy can work alongside that care.

3. Pelvic pain and pain during sex

Pelvic pain can be influenced by a range of factors, including endometriosis, bladder and bowel conditions, nervous-system sensitisation, muscle tension and movement patterns. For some people, the pelvic floor muscles become overactive, tender or difficult to relax. This may contribute to pain with sitting, exercise, tampon use, vaginal examinations or sex.

Pelvic floor physiotherapy can be helpful when pelvic floor muscle tenderness or neuromuscular pain is contributing to symptoms. Treatment may include pain science education, breathing and nervous-system downregulation strategies, pelvic floor relaxation work, movement and exercise, and a gradual return to activities that have become difficult or painful. Chronic pelvic pain often benefits from a multidisciplinary approach, which may include support from a GP, gynaecologist, psychologist, pain specialist or sex therapist.[3]

4. Bowel symptoms and constipation

The pelvic floor needs to relax and coordinate effectively for bowel motions. Some people with constipation, straining or difficulty emptying their bowel have difficulty with this coordination. In these situations, simply doing more pelvic floor strengthening exercises is not always helpful.

Pelvic floor physiotherapy may include education about bowel positioning, breathing, pelvic floor relaxation and strategies to reduce straining. Persistent bowel symptoms should always be assessed properly, particularly if symptoms are new, severe or associated with bleeding, weight loss or significant pain.

5. Pregnancy and postnatal recovery

Pregnancy and birth can change how the pelvic floor feels and functions. Pelvic floor physiotherapy can help you understand these changes, assess symptoms such as leakage or heaviness, and build a realistic plan for returning to movement, exercise and daily activities.

Research suggests that structured pelvic floor muscle training started during pregnancy may reduce the chance of urinary leakage later in pregnancy and in the early postnatal period for some women.[4] The most appropriate plan will depend on your pregnancy, birth experience, recovery, symptoms and individual goals.

Why see a pelvic floor physiotherapist instead of just doing Kegels?

Kegels can be useful for some people, but they are not the right starting point for everyone. Some pelvic floors need strengthening; others need help with relaxation, coordination or learning how to respond to pressure during exercise and daily activities.

A pelvic floor physiotherapist can assess whether you are able to contract and relax the muscles effectively, check your technique, and create a program based on your symptoms and goals. Clinical guidelines recommend supervised pelvic floor muscle training be tailored to the individual, including their ability to contract and relax the pelvic floor.[2]

Getting the right support for you

Pelvic floor physiotherapy is not a one-size-fits-all solution. The best approach is an individualised plan based on your symptoms, health history, lifestyle and goals. Your appointment may include discussion, education, exercise prescription and practical strategies you can use at home. Telehealth can be a useful way to start the conversation and develop an initial plan, although some people may also benefit from an in-person assessment.

If pelvic floor symptoms are affecting your exercise, work, relationships or confidence, you do not need to manage them alone.

Learn more, follow us at @the_pelvichealthhub

Q&A

Question: Is pelvic floor physiotherapy only for urinary leakage?

Short answer: No. It can also help with bowel symptoms, constipation, prolapse symptoms, pelvic pain, pain during sex, and pregnancy or postnatal changes.

Question: Should everyone with pelvic floor symptoms start doing Kegels?

Short answer: Not always. Kegels can help some people. Others may need relaxation, coordination, breathing strategies, pressure management or changes to bowel and bladder habits. A pelvic floor physio can check what your pelvic floor needs and tailor a plan.

Question: Can pelvic floor physiotherapy cure prolapse?

Short answer: Pelvic floor physiotherapy cannot promise to fix every prolapse. Still, supervised pelvic floor muscle training, pressure-management strategies, lifting advice and bowel-habit support may be part of a care plan. It can also work alongside specialist medical or surgical care if needed.

Question: When should bowel symptoms be checked by a health professional?

Short answer: Persistent bowel symptoms should be checked properly, especially if they are new, severe or linked with bleeding, weight loss or significant pain. Pelvic floor physiotherapy may help with bowel positioning, breathing, pelvic floor relaxation and less straining when coordination is part of the problem.

Question: Can pelvic floor physiotherapy be started through telehealth?

Short answer: Yes. Telehealth can be a useful way to begin discussing symptoms, get education and build an initial plan. Some people may still benefit from an in-person assessment depending on their symptoms, goals and clinical needs.

References:

1      Dumoulin C, Cacciari LP, Hay-Smith EJC. Pelvic floor muscle training for urinary incontinence in women. Cochrane, 2018. https://www.cochrane.org/evidence/CD005654_pelvic-floor-muscle-training-urinary-incontinence-women

2      National Institute for Health and Care Excellence (NICE). Pelvic floor dysfunction: prevention and non-surgical management. NICE Guideline NG210. https://www.nice.org.uk/guidance/ng210/chapter/recommendations

3      Arnold MJ, Osgood M, Aust A. Chronic pelvic pain in women: ACOG updates recommendations. American Family Physician. 2021. https://www.aafp.org/pubs/afp/issues/2021/0201/p186.html

4      Woodley SJ, et al. Pelvic floor muscle training for prevention and treatment of urinary and faecal incontinence in antenatal and postnatal women. Cochrane Database of Systematic Reviews. 2020. https://doi.org/10.1002/14651858.CD007471.pub4