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🫀 Women's Health Guide · Updated March 2026

Pelvic Floor Physiotherapy:
What It Is & Who Needs It

An accessible guide to pelvic floor dysfunction, how physiotherapy assesses and treats it, and why it is relevant far beyond the postnatal period. Written by Dr. Dharam Pandey, integrating 25+ years of clinical experience.

⏱️ 12 min read 👩‍⚕️ Dr. Dharam Pandey, PhD 📋 Evidence-based
📖 Read Full Guide 💬 Ask a Specialist
📊 Pelvic Health by the Numbers
1 in 3
Women experience pelvic floor dysfunction
50%
Of women over 50 have some form of prolapse
80%
Improve with physiotherapy
25%
Of young athletes have urinary incontinence

"It's not just about postpartum — pelvic health matters at every life stage."

40+Years research in women's health
15+Specialist physiotherapists
95%Patient satisfaction
All agesFrom teens to seniors
📋 In this guide
1. What is the Pelvic Floor? 2. Who Needs Pelvic Floor PT? 3. Common Conditions 4. What to Expect: Assessment 5. Treatment Approaches 6. Essential Exercises 7. Pelvic Health Across Life 8. Myths & Facts 9. FAQs
Foundation

What is the Pelvic Floor?

The pelvic floor is a hammock-like group of muscles, ligaments, and connective tissue that supports the bladder, uterus, and rectum.

🔍 Key Functions

🫂
Support
Holds pelvic organs in place
🚽
Sphincter
Controls bladder and bowel
❤️
Sexual
Enhances sensation and function
🫁
Stability
Works with core muscles
🔄
Pump
Aids venous return
🤰
Birth
Supports during pregnancy
🧠 The Core Connection

The pelvic floor works as a team with your deep abdominal muscles (transversus abdominis), diaphragm, and multifidus. This is your "core" — they activate together to provide stability.

💡 How they work together:

When you breathe in, the diaphragm descends and the pelvic floor gently lengthens. When you breathe out, both contract. This coordinated action is essential for continence and core stability.

👩‍⚕️ Dr. Pandey's Note:

"The pelvic floor is often called the 'floor' of the core, but it's more like a trampoline — flexible yet supportive, responding to pressure and demand."

Beyond Postpartum

Who Needs Pelvic Floor Physiotherapy?

Pelvic floor dysfunction affects women at ALL life stages — not just after childbirth.

🤰
Pregnancy
Prepares pelvic floor for birth, reduces back pain, teaches proper pushing techniques.
2nd & 3rd trimester
👶
Postnatal
Healing after birth, addressing incontinence, prolapse, diastasis recti, returning to exercise safely.
6 weeks postpartum +
🏃‍♀️
Athletes
High-impact sports increase pressure. Many young athletes experience leakage but don't report it.
Runners, gymnasts, CrossFit
👵
Perimenopause/Menopause
Oestrogen decline affects tissue health, increasing risk of prolapse, urgency, recurrent UTIs.
40s, 50s, 60s+
🔪
Pre/Post Surgery
Preparation for hysterectomy, prolapse surgery, or cancer treatment improves outcomes.
Gynaecological surgery
🚽
Chronic Constipation
Straining damages pelvic floor. Physiotherapy teaches proper defecation mechanics.
All ages
🌟 Key Message

Pelvic floor physiotherapy isn't just for new mothers. If you have ANY pelvic health concern at ANY age, help is available. You don't have to "just live with it."

What We Treat

Common Pelvic Floor Conditions

Pelvic floor dysfunction falls into two categories: too tight or too loose. Both cause symptoms.

🔴 Overactive Pelvic Floor

Muscles that are too tight, unable to relax. Common in athletes, stressed individuals, and after certain injuries.

  • Painful intercourse (dyspareunia)
  • Chronic pelvic pain
  • Vaginismus
  • Urinary urgency/frequency
  • Constipation (difficulty relaxing to pass stool)
  • Tailbone pain
🔵 Underactive Pelvic Floor

Muscles that are weak, unable to provide support. Common after childbirth, menopause, or surgery.

  • Stress urinary incontinence (leak with cough/sneeze)
  • Urge incontinence (sudden strong urge)
  • Pelvic organ prolapse (bulge sensation)
  • Faecal incontinence
  • Reduced sexual sensation
  • Lack of support during activity

*Some people have mixed presentations — both overactive and underactive features.

What to Expect

Your First Assessment

Many women feel nervous about pelvic floor assessment. Here's exactly what happens — so you know what to expect.

1
Detailed History
Your physiotherapist will ask about symptoms, bladder/bowel habits, childbirth history, surgeries, and what bothers you most. This guides the entire assessment.
2
Posture & Movement
We assess your breathing, core activation, posture, and how you move. The pelvic floor doesn't work alone — we need to see the whole picture.
3
Internal Examination
With your consent, a gentle internal exam (vaginal or rectal) assesses muscle strength, tone, coordination, and ability to contract and relax. You remain in control throughout.
🤝 Your Comfort Matters

You can decline any part of the assessment. Alternative approaches (external palpation, real-time ultrasound) can provide information without internal exam. We work at your pace.

Evidence-Based Care

Treatment Approaches

Treatment is tailored to YOUR specific presentation — whether you need to strengthen, relax, or coordinate.

🎯

Biofeedback

Real-time feedback using sensors or ultrasound shows you if you're contracting correctly. Essential for learning proper technique.

⚡

Electrical Stimulation

Gentle current helps activate weak muscles or relax overactive ones. Can be used with or without internal probe.

🤲

Manual Therapy

Hands-on techniques to release tight muscles, mobilise scars, and improve tissue mobility.

🫁

Breathing Retraining

Coordination of breath with pelvic floor movement. Essential for core function and relaxation.

🏋️

Exercise Prescription

Home exercise programme tailored to your goals — strengthening, relaxation, or functional training.

📋

Lifestyle Advice

Fluid intake, bladder habits, bowel management, and activity modification to protect your pelvic floor.

Practical Guide

Essential Pelvic Floor Exercises

These exercises form the foundation. BUT — technique matters. "Knights" (tightening incorrectly) can make things worse. Get assessed first.

🫂
The Knack (The Prep)
All types
Contract your pelvic floor just before and during a cough, sneeze, or lift. Trains automatic response to pressure.
⏱️
Slow Twitch Fibres
For weakness
Contract, hold for 10 seconds, relax fully for 10 seconds. Builds endurance. Repeat 8-10 times.
⚡
Fast Twitch Fibres
For weakness
Quickly contract and release — like a flick. Builds speed for coughs and sneezes. Repeat 10-15 times.
🌬️
Breath Coordination
For overactivity
On exhale, feel pelvic floor gently lift. On inhale, allow it to descend and relax. No gripping.
🦋
Happy Baby Stretch
For overactivity
Lying on back, hold feet, knees wide. Breathe deeply, allowing pelvic floor to release with exhale.
🪑
Functional Squat
Advanced
With good form, squat while maintaining core control. Breathe — don't hold breath.
⚠️ Common Mistake

Many women "bear down" or hold their breath when trying to contract. This increases pressure and worsens symptoms. If you're unsure, you're probably doing it wrong. Get guidance.

Lifelong Health

Pelvic Health Across Life Stages

Your pelvic floor changes throughout life. Here's what to expect and when to seek help.

🧒
Adolescence
Period pain, sports-related leakage, constipation. Often dismissed but treatable.
🤰
Pregnancy
Increased pressure, hormonal changes. Preventative exercises reduce risk of future issues.
👶
Postpartum
Healing, returning to exercise, addressing birth-related trauma. Essential for all mothers.
👵
Perimenopause+
Oestrogen decline affects tissue health. Prolapse, urgency, dryness — all treatable.

It's NEVER too early or too late to seek help. We treat patients from teens to 90s.

Separating Fact from Fiction

Pelvic Health: Myths vs Facts

❌ Myth: "Leaking after childbirth is normal — just part of being a mum."
✅ Fact: Common, but NOT normal. It's treatable. 80% improve with physiotherapy.
❌ Myth: "Kegels are all you need — do them every time you pee."
✅ Fact: Never do Kegels while peeing — it can cause bladder infections. And Kegels alone may not be right for everyone.
❌ Myth: "Pelvic floor issues only affect older women."
✅ Fact: Young athletes, pregnant women, and even teenagers can have pelvic floor dysfunction.
❌ Myth: "If you have prolapse, you need surgery."
✅ Fact: Many prolapses improve significantly with physiotherapy. Surgery is not the only option.
❌ Myth: "More Kegels are always better."
✅ Fact: For overactive pelvic floor, Kegels make things worse. Treatment must be tailored.
❌ Myth: "It's too late for me to see improvement."
✅ Fact: It's never too late. We see significant improvement in women in their 70s, 80s, and 90s.
Common Questions

Pelvic Floor FAQ

❓ Is internal examination necessary?
Not always. It provides the most accurate information, but we offer alternatives: external palpation, real-time ultrasound, or starting with external assessment only. You remain in control.
❓ How many sessions will I need?
Most women see significant improvement in 4-8 sessions. Some need longer, some less. We give you a home programme so you continue progressing between visits.
❓ Can I come during my period?
Yes. If you're uncomfortable with internal assessment that day, we can do external assessment or focus on other aspects. Just let us know.
❓ Will I have to stop exercising?
No — we help you return to exercise safely. We may modify certain activities temporarily, but the goal is to get you back to what you love, without symptoms.
❓ Is it painful?
Assessment and treatment should NOT be painful. You may feel pressure or awareness, but sharp pain is a signal to stop. We work within your comfort level.
❓ Do you treat women who haven't had children?
Absolutely. Many of our patients are young athletes, women with chronic constipation, or those with pelvic pain — regardless of whether they've had children.
Downloads & Tools

Free Resources for Pelvic Health

Practical tools to support your journey.

Our women's health physiotherapists are here to help — in a safe, confidential, judgment-free environment.

Continue Learning

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