Pelvic Floor Physiotherapy: What Is It and Who Needs It?

What the pelvic floor does

The pelvic floor muscles form a sling at the base of the pelvis. They support the bladder, bowel and, in women, the uterus. They help control when you pass urine, stool and wind. They contribute to sexual function and work with the deep abdominal muscles and diaphragm to support the spine.

They can be too weak, too tight, or poorly coordinated, and each causes different problems.

Problems it treats

• stress urinary incontinence: leaking when coughing, sneezing, laughing or exercising
• urge incontinence and overactive bladder
• pelvic organ prolapse symptoms such as heaviness or bulging
• bowel control problems
• pelvic pain and pain with intercourse
• pelvic floor problems after pregnancy and birth
• changes around menopause

Who needs it

Pregnancy and childbirth are the most common reasons, but not the only ones. Menopause, chronic constipation, heavy lifting, high-impact sport, chronic cough and some surgeries all affect the pelvic floor. Men benefit too, particularly after prostate surgery.

What happens in an assessment

The physiotherapist takes a detailed history of bladder, bowel and sexual function and any pain. They assess posture, breathing, the abdominal wall and the back. With consent, an internal examination may be offered to assess the pelvic floor muscles directly, because it gives the most accurate information. It's always optional, and treatment can proceed without it.

What treatment involves

Treatment depends on the problem. For weakness, pelvic floor strengthening exercises, often called Kegels, are the mainstay. Our guide to Kegel exercises explains the technique. For tightness or pain, the focus is relaxation, breathing and gentle release, and strengthening can make things worse. Bladder training, advice on fluid and toilet habits, and returning to exercise safely are often included.

Talking about it

Many women put up with pelvic floor problems for years because they feel embarrassed to discuss them. Leaking when laughing, needing to rush to the toilet or discomfort during intimacy are often treated as normal after childbirth or with age.

These problems are common, but they're also treatable. A pelvic health physiotherapist is used to discussing them and will approach the conversation with sensitivity and privacy.

It helps to be specific: when leaking happens, how often, how much and what makes it better or worse. Keeping a simple bladder diary for a few days before the appointment gives useful information and makes the conversation easier.

How long it takes

Pelvic floor strengthening usually takes at least three months of regular practice to show full results.

For guidance on when pelvic floor exercises are recommended, see our article on pelvic floor exercises for women.