Women’s Pelvic Health

Stress Urinary Incontinence can present as leaking when you cough or sneeze, or with activity. It is often due to weakness of the pelvic floor muscles. It can also present in pregnancy, and can occur following a vaginal delivery. This can be very successfully treated with assessment of the pelvic floor muscles, specialist strengthening exercises, a graded approach to sport and exercise, lifestyle and activity advice.
Urge Incontinence, frequency and Overactive Bladder syndromes can disrupt normal bladder function. You may develop the need to empty your bladder urgently, sometimes leaking in the process, or you may empty too frequently, or sometimes you may leak without warning. Expert assessment of how your pelvic floor muscles are working, retraining of bladder and fluid habits, and pelvic floor muscle retraining are highly effective ways of resolving these issues.

Bowel dysfunction is when you have difficulty controlling or emptying your bowel. This may include difficulty with controlling wind, faecal leaking, bowel urgency or constipation. There are many non-medical reasons for bowel habits to change, including pelvic organ prolapse, pregnancy, childbirth, dietary habits and poor functioning of the pelvic floor muscles.
Specialist physiotherapy treatment can be highly effective in helping you to manage and resolve these issues. This may include assessment of the pelvic floor muscles, specific muscle retraining, manual therapy, breathing exercises, bowel care strategies and advice on lifestyle and diet.

This is caused by weakening of the vaginal walls and/or weakening of supporting ligaments and may cause a bulging or heaviness felt vaginally or low in the pelvis. In can also affect the function of your bladder or bowels.
In most cases, symptoms can be significantly improved with guided pelvic floor retraining, modification of exercise and activity, and constipation management. National Institute for Health and Care Excellence guidelines recommend guided physiotherapy as first line of treatment for POP as research shows that physiotherapy is highly effective in the treatment of mild and moderate (stage one and stage two) prolapses.

This happens when the two halves of the ‘six pack’ abdominal muscles separate during pregnancy because they cannot stretch any further. Symptoms you may notice include a bulging or doming in your tummy when you sit up or raise your legs, a gap in the midline abdominal muscles, or abdominal discomfort with activities such as leaning forward, lifting, or walking. This is a common problem that can be successfully treated, but it is often left unaddressed, leading to further issues such as back pain.
For some women, and men, a DRAM can occur for reasons other than pregnancy, such as over-training of the abdominal muscles.
Physiotherapy treatment includes specific muscle retraining to restore the strength and function of the abdominal wall, postural education, graded exercises, personalised guidance on lifestyle, activities and return to sport.

Pelvic Girdle Pain (previously called Symphysis Pubis Dysfunction)
This may cause pain in your pubic bone, groin, hips, pelvis, buttocks or tailbone. It happens in about 1 in 5 pregnancies and it can present at any time in your pregnancy. Sometimes it can continue or even begin after delivery. Activities such as walking, carrying, moving the legs apart, standing on one leg and sexual intercourse can worsen the pain.
The causes are usually related to uneven movement in the joints while under the extra load of pregnancy, weakening of the tummy, buttock and pelvic floor muscles, the position of the baby and sometimes hormonal fluctuations can influence it too.
With specialist treatment and advice, these symptoms can be significantly improved and even fully resolved. Treatment may include manual therapy, muscle retraining and strengthening, postural training, advice and strategies for daily activities such as work, childcare, exercise etc, provision of support belts and birth preparation guidance.

Back, neck and rib pain can occur at any time during or following pregnancy. The causes are usually related to the extra load of pregnancy, weakening of the postural muscles, the changing shape of the ribcage as the baby grows, and sometimes hormonal fluctuations can influence it too. Treatment usually involves manual therapy, simple exercises, muscle and postural retraining, advice and strategies for daily activities and exercise.
Carpal Tunnel Syndrome presents as pain, tingling, numbness or weakness in your hands and wrists. Treatment may include provision of splints, exercises, postural advice and manual therapy.
Coccydynia is a painful tailbone. It can occur after a vaginal delivery, excess sitting, poor postures, or trauma such as falling onto the base of your spine, then worsened by pregnancy etc. Treatment may involve manual therapy, pelvic floor work, postural retraining, seating advice and specific exercises.

 Many women still have lots of questions and need more advice after their medical six-week postnatal check. This physiotherapy check-up and advice appointment is a great way to get further advice and much more, and so helping you to feel your best. You can have this appointment at any time once you have had your GP postnatal check. These are the sorts of things we can cover:
Assessment of your pelvic floor muscles, check the recovery from perineal tears, episiotomy and caesarean section, assess your core and tummy muscles and check for any abdominal muscle separation, check of your spine and posture, assessment and advice on bladder or bowel issues, advice on scar healing, create an individual plan for a safe return to exercise and sport.

There are various causes for the conditions listed below. These can often be successfully managed and treated with specialist physiotherapy. Treatment may include retraining or down training of the abdominal and pelvic floor muscles, relaxation and stretching exercises, manual therapy, use of vaginal dilators, lifestyle advice, dietary and fluid advice, and other strategies. For some people, pelvic pain conditions can relate to past experiences, a difficult child birth, trauma, sexual abuse, stress or anxiety. In such cases it is sometimes useful to also have help from a specialist counsellor alongside or after your physiotherapy care. Advice on this can be given.

Dyspareunia is painful intercourse, which you might feel as discomfort at the vaginal entrance or you may experience deep pelvic pain during or after intercourse. Causes can include tight, overactive pelvic floor muscles, childbirth issues, pelvic organ prolapse, hormonal changes or one of the other conditions explained in this section.

Bladder pain syndrome (previously called interstitial cystitis) can present like a urinary tract infection or cystitis, but if the urine tests are negative and you have persistent symptoms, it may be that over activity of the pelvic floor muscles are the cause.

Vaginismus is a condition where you experience involuntary tightening of your vaginal muscles, such as when trying to insert a tampon, during gynaecological examinations, or during sexual intimacy and intercourse.

Vulvodynia is persistent pain, throbbing or stinging around the vulva and the vaginal opening. It caused by sensitisation or irritation of nerves in this area, or sometimes by infection or other medical conditions and may need medical assessment. If medical causes are ruled out, physiotherapy treatment can help.

 Women’s health physiotherapy can be really helpful before and after your surgery, for example if you are having a vaginal repair for prolapse and/or a hysterectomy. Before surgery, we assess your current lifestyle and activity levels, and discuss any bowel or bladder issues you may have, and liaise with your surgeon if need be. At your after-surgery check-up we ensure you are progressing at your suitable pace. The session may also include a check your pelvic floor muscles, guidance on any bladder or bowel questions issues, and help to avoid constipation. There is also advice on returning to daily activities and how to progress exercises at a safe pace. A similar approach is taken if you are having a an abdominal wall repair (Diastasis of Rectus Abdominis Muscle repair). In this case the focus will be on lifestyle and activities, safe progression of postural and abdominal exercises, return to sport and maintenance.

 Women’s health physiotherapy can help to return advise you on the healing and recovery process, give graded exercises to restore your tummy and pelvic floor muscles, manage any pain you might have and help get you get back to doing all the things you wish to. When appropriate, referral to other health professionals e.g. GP or gynaecologists.

Perimenopause (a time of transition leading up to periods stopping) and menopause are natural stages in a woman’s life. It is a time when ovulation becomes irregular and then stops, you produce less of the oestrogen hormone and periods eventually stop. It usually occurs between the ages of 45-55, but can happen earlier e.g. after removal of the ovaries.
The experience of this transition differs from woman to woman, but there are some common physical changes that can occur:
Muscles and ligaments may become less supportive, symptoms of prolapse may appear, you may have bladder changes such as urgency and leaking, intercourse may feel uncomfortable, and bone density can decrease. In addition to the commonly-known hot flushes, some may notice fatigue, brain-fog and lowering libido.
Woman’s health physiotherapy can be really helpful at this stage in life. There is a lot we can do to help your understanding of this life transition and to enhance your well-being.
Physiotherapy begins with a health and lifestyle assessment, then may involve tailored exercises to safely optimise your bone density and muscle mass, pelvic floor exercises, advice on lifestyle and strategies, guidance on activity and general exercise, management of any bladder changes or prolapse, and guidance on when to consult with other healthcare professionals eg regarding HRT.