Pelvic floor dysfunction is a common and often under-recognised condition that affects many women at various stages of life. It’s an umbrella term used to describe the many pelvic issues, specifically those that arise from the inability to properly contract or relax the muscles of the pelvic floor.
If the muscles of the pelvic floor are too weak, then the organs such as the bowels, bladder and uterus will not be supported, when the pelvic floor muscles are too tight or overactive, they may cause pain or difficulty emptying the bowels or bladder (1).
Pelvic floor dysfunction can contribute to conditions such as urinary incontinence, pelvic organ prolapse, and some types of pelvic pain and sexual dysfunction. These are very common after childbirth and are not something you have to just “live with”. Effective treatments exist to improve the strength and control of the pelvic floor.
Signs and Symptoms of Pelvic Floor Dysfunction
Pelvic floor dysfunction can cause a wide array of symptoms. You may experience just one, or several of the following:
- Bladder leakage (urinary incontinence): Leaking urine with coughing, sneezing, laughing or running (stress incontinence), or difficulty reaching the toilet in time (urge incontinence).
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Pelvic organ prolapse symptoms: A sensation of heaviness, pressure, or a bulge in the vagina – some women describe feeling like “something is coming down” or that they are sitting on a small ball. Tampons may dislodge or fall out due to reduced support.
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Pelvic or lower back discomfort: A dragging or heavy feeling in the pelvic region or lower back, often worsened by prolonged standing – this can be related to prolapse or muscle strain.
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Reduced vaginal sensation or sexual dysfunction: Decreased sensation during intercourse, difficulty achieving orgasm, or pain during sex (dyspareunia). Some women with overactive pelvic floor muscles experience vulvar pain or vaginal pain with intimacy.
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Recurring UTIs or pelvic discomfort: Recurrent urinary tract infections may occur if the bladder isn’t emptying fully (2). Some women also report pelvic pain or pressure that is hard to pinpoint.
It’s important to remember that pelvic floor issues can present in different ways. Any persistent bladder leakage, pelvic pressure, or pelvic pain is not considered a normal part of having a baby or getting older – these are signs of pelvic floor dysfunction that can be treated. If you notice symptoms like the above, a women’s health physiotherapist can help identify the underlying pelvic floor problem and guide you toward relief.
Causes and Risk Factors
Pelvic floor dysfunction usually develops due to a combination of factors that weaken or cause the pelvic muscles to become over tense. Common causes and risk factors include:
Gynaecological Causes
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Pregnancy and childbirth: Carrying a baby places significant strain on the pelvic floor, and vaginal delivery can stretch or sometimes injure these muscles. It’s no surprise many women notice pelvic floor issues postpartum. (Even women who deliver via C-section aren’t fully spared, as pregnancy alone can weaken the pelvic support structures.)
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Strain and pressure on the pelvis: Anything that chronically increases pressure on the abdomen and pelvis can contribute. Examples are obesity (being overweight), chronic coughing (from asthma, smoking, etc.), or frequent straining due to constipation. High-impact sports or heavy lifting without proper technique may also put stress on the pelvic floor over time.
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Hormonal changes: After menopause, the body produces less oestrogen. Lower oestrogen levels can lead to thinner, less elastic tissues supporting the pelvic organs, making pelvic floor weakness and prolapse more likely. This is why some pelvic floor symptoms can worsen in midlife and beyond.
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Pelvic surgery or trauma: Surgeries involving the pelvic organs including hysterectomies, cancer treatments or other gynecological investigations or surgeries can sometimes damage pelvic floor muscles or nerves. Past pelvic radiation treatments or chronic pelvic pain conditions can also affect muscle function (3).
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Overactive or tight pelvic muscles: Not all pelvic floor dysfunction is due to weakness – some women have the opposite problem: muscles that are too tight, spasmed or they just have trouble relaxing. This can be associated with conditions like endometriosis, painful periods, or pelvic pain syndromes. In these cases, the muscle tension itself becomes an issue, leading to pain with intercourse, difficulty emptying the bladder or bowels, or even persistent pelvic pain.
How can Physiotherapy help?
Pelvic floor physiotherapy is the first-line conservative treatment for most pelvic floor dysfunctions, and it is highly effective for many women. A trained pelvic floor physiotherapist can assess your pelvic floor muscle function and tailor a treatment program to your specific needs – whether that’s improving strength, flexibility, or coordination.
Research shows this approach works: there is Level 1, Grade A evidence supporting pelvic floor muscle training as a first-line treatment for urinary incontinence (3). Studies have found that up to 80% of women with stress incontinence achieve cure or significant improvement in symptoms after undergoing pelvic floor physiotherapy treatment programs.
In short, physiotherapy can be life-changing, helping you regain confidence in bladder control and return to activities you enjoy.
Physiotherapy Treatments
Pelvic floor physiotherapy is much more than just doing Kegel exercises—it involves a personalised approach based on whether your pelvic muscles are too tight, weak, or poorly coordinated. About one in three women perform pelvic floor exercises incorrectly without guidance, so working with a trained physiotherapist is important. Treatment may focus on relaxation and stretching for overactive muscles, or strengthening for weak ones, while also improving coordination to ensure your pelvic floor works effectively during daily activities.
Physiotherapy includes a holistic approach, to address factors beyond just exercise, including lifestyle strategies that further improve symptoms. This includes education, lifestyle changes, bladder training, toileting advice, and potentially biofeedback or manual techniques to restore normal pelvic function. Importantly, it’s a safe, conservative, and empowering treatment recommended by health professionals as a first-line approach to pelvic floor issues.
Physiotherapy is conservative and safe, it carries none of the risks of surgery or medications and empowers you with the exercises and education to make a diference in your life. Our goal as physiotherapists is to give you back control over your body in a respectful, supportive manner.
Assessment, what to expect?
Seeing a pelvic health physiotherapist is a supportive and professional process. During your first session, your physio will take time to talk with you about your symptoms, medical history, and goals.
A postnatal physiotherapy assessment, for example, includes detailed questioning to determine your individual goals and concerns. You will be encouraged to discuss issues like bladder habits, any pain symptoms, sexual or prolapse concerns, and how these problems affect your daily life. This conversation happens in a private, judgment-free space – we understand that these topics can be sensitive, and we aim to make you feel as comfortable as possible.
An assessment may include:
- Examination of your posture, especially your lower back and pelvis.
- Testing of your abdominal muscles.
- An internal examination (if appropriate and consented to).
An internal examination is important to check muscle tone at rest, the strength of your contractions, endurance and coordination, as well checking for any tender areas. This examination also checks for issues such as a pelvic organ prolapse or scarring from child birth.
While a lot of useful information is gained from an internal examination, if you are concerned about this, please talk to the physiotherapist during your consultation as they may still be able to help without this procedure.
Physiotherapy treatments
Treatment of pelvic floor dysfunction is very individualised, however the below techniques may make up a treatment program.
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Pelvic floor strengthening: Your physio will teach you the correct way to perform pelvic floor contractions (often called Kegel exercises). The focus might be on building strength and endurance (e.g. holding a squeeze for several seconds) and on quick contractions for when you cough or sneeze. If a weakness is identified, a structured exercise program will progressively challenge your muscles to become stronger and more responsive. Studies show supervised pelvic floor strengthening over a few months can significantly improve or even cure symptoms of stress incontinence.
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Relaxation and down-training techniques: If your pelvic floor is too tight or you have difficulty letting the muscles go, therapy will include strategies to relax them. This can involve breathing exercises, gentle stretching of the pelvic muscles, and techniques to learn the sensation of “letting go.” For example, guided imagery or pelvic floor drop exercises may be used. Manual therapy by the physiotherapist can also help: they might perform internal trigger point release or massage to areas of muscle spasm or scar tissue. This hands-on approach can relieve pain and improve muscle flexibility.
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Biofeedback and visualisation: Many women benefit from visual or tactile feedback to ensure they are doing exercises correctly. Your physio might use biofeedback devices that measure pelvic muscle activity, or an ultrasound machine so you can see the pelvic floor moving on a screen as you contract/relax. This real-time feedback can dramatically improve your ability to isolate the right muscles and perform exercises effectively. It’s especially useful if you’ve had trouble sensing your pelvic floor or if you’re among the 30% of women who weren’t doing kegels correctly before.
- Continence devices or supports: In certain cases, devices like a pessary might be recommended. A pessary is a small silicone device fitted inside the vagina to help support a prolapsed bladder or uterus. This can alleviate that “heavy” feeling and help with urinary leakage in some women. Pessaries can be fitted by a pelvic health physiotherapist who is trained to fit and manage them. If a pessary is appropriate for you, we will discuss it and ensure you get the right fitting and follow-up. Using a pessary does not replace the need for exercises, but it can be a helpful added support while your muscles get stronger.
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Bladder and bowel training: Depending on your symptoms, part of treatment may involve retraining your bladder or bowel habits. For urge incontinence, your physio might help you with strategies to gradually increase bladder capacity and reduce urgency (for instance, timed voiding techniques and urge suppression strategies). For bowel issues, they will advise on proper positioning on the toilet (like using a footstool to elevate your knees) and techniques to relax the pelvic floor for easier bowel movements. They will also discuss diet and fluid intake to address constipation or bladder irritants if those are factors.
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Education and lifestyle advice: Expect to learn a lot about your pelvic floor – your physio will provide information that empowers you to manage your condition. This includes teaching you how to correctly engage the pelvic floor during daily activities (like lifting a child or coughing) to protect it, as well as tips for lifestyle modifications. Lifestyle factors can make a big difference: you’ll get advice on maintaining a healthy weight, managing chronic coughs or allergies, quitting smoking (to reduce coughing), and avoiding heavy lifting or straining improperly. You may also discuss optimal nutrition and fluid habits (e.g. limiting excessive caffeine or bladder irritants) to support your pelvic health. All of these changes complement the physical exercises to enhance your results.
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Progression and maintenance: Pelvic floor rehab is typically done over a series of weeks or months. Research suggests that an intensive 4 to 6 month program of regular, supervised pelvic floor training yields the best outcomes. Don’t worry – this doesn’t mean you’ll need weekly physio for half a year – but you will be guided through progressively challenging exercises and periodic check-ins. As you improve, your sessions may be spaced out more. Upon “graduation,” your physiotherapist will create a maintenance plan for you, which might involve continuing a set of exercises a few times a week long-term. This helps ensure that your pelvic floor remains strong and symptoms do not return.
Integrating with other services
Physiotherapy is the cornerstone of pelvic floor dysfunction treatment at our clinic, but we also acknowledge that optimal care sometimes involves a combination of approaches. We take a holistic view of your health. In addition to physiotherapy, we may liaise with or refer you to other healthcare professionals as needed:
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Lifestyle and medical management: Addressing underlying factors is important. For example, if weight is contributing to your symptoms, gentle weight loss can significantly improve pelvic floor outcomes (one study noted up to a 70% improvement in overactive bladder symptoms with weight loss). Improving your diet to avoid constipation, treating any chronic cough, and managing fluid intake (avoiding excessive caffeine/alcohol) can all reduce strain on the pelvic floor. Sometimes a GP may prescribe a topical oestrogen cream for postmenopausal women to strengthen vaginal tissues, or medications to calm an overactive bladder. These medical therapies can complement your physiotherapy program.
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Collaborative care: Our physiotherapists work closely with gynecologists, urologists, and GPs. If your assessment reveals something that needs further medical investigation (for instance, significant pelvic organ prolapse, or if you have hematuria/blood in urine that hasn’t been evaluated), we will recommend you see the appropriate specialist. We can also correspond with your doctor about your progress. In the case of pelvic pain conditions, we often collaborate with pain specialists or psychologists as needed, since a multi-disciplinary approach can be most effective.
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Surgical interventions (if needed): The good news is that many women won’t require surgery once they undergo proper pelvic floor physio; conservative management is effective in a majority of mild-to-moderate cases. However, if your symptoms do not sufficiently improve or you have an advanced prolapse, surgery might be an option down the line. Typically, healthcare providers only consider surgery after a course of supervised pelvic floor therapy has been tried. If it comes to that point, your physiotherapist will ensure you have tried all appropriate non-surgical measures first, and we will support you through any decision. Even if surgery is chosen (for example, to repair a severe prolapse), physiotherapy remains crucial – both pre-surgery and post-surgery – to optimise outcomes and prevent recurrence. We will help with your rehabilitation and exercises after any surgical intervention to make sure you heal well and regain function.
In summary, we recognise that pelvic floor dysfunction can have many contributors and consequences, so we like to address it from all angles. Conservative treatments are the first choice in virtually all cases, with physiotherapy playing a central role. Other interventions – from lifestyle changes to medical treatments – are integrated as needed to support your recovery. We aim to give you a comprehensive plan so that no aspect of your pelvic health is overlooked.
The Takeaway Message
Facing pelvic floor issues can be daunting, but remember: you are not alone, and effective help is available. Our women’s health physiotherapy team has helped many women overcome postpartum pelvic challenges, incontinence, prolapse symptoms, prepartum issues and pelvic pain. We understand the personal nature of these problems and provide care that is both clinical and compassionate. Good rapport and trust are paramount – we will listen to your story and work at a pace you’re comfortable with. Many pelvic floor problems can be significantly improved or completely resolved with the right approach, allowing you to get back to the activities you love without fear of leakage or pain.
If you recognize any signs of pelvic floor dysfunction in yourself – whether it’s a little leak when you laugh, a sense of pressure “down there,” or any other concern – consider reaching out for an assessment. Early intervention is best, but even if you’ve been living with symptoms for years, it’s never too late to seek help. A thorough physiotherapy evaluation will give you clarity about what’s happening and what can be done.
At our clinic, we are dedicated to empowering women to restore their pelvic health. You don’t have to just “put up” with these issues or feel embarrassed – these conditions are common and treatable. With targeted physiotherapy, education, and support, you can regain control and confidence in your body.
Take the first step: Contact us to schedule an appointment with one of our friendly women’s health physiotherapists. We will guide you through every stage – from assessment to recovery – with professionalism and genuine care. Your pelvic floor is integral to your overall well-being, and with the right help, you can strengthen it, alleviate your symptoms, and improve your quality of life.
Let us help you move toward a future free from pelvic floor difficulties – you deserve to feel your best.