Women’s Pelvic Health by Physiotherapist Ava Sukhoo
What is Women’s Pelvic Health?
Women’s pelvic health is the assessment, treatment, and prevention of conditions affecting the pelvic floor, bladder, bowel, reproductive organs, sexual function, and the muscles and joints of the pelvis and lower back.
The pelvic floor is a group of muscles and connective tissues that supports the pelvic organs and contributes to bladder and bowel control, sexual function, breathing, spinal and pelvic stability, and movement. Pelvic floor dysfunction may involve muscles that are weak, overactive, poorly coordinated, painful, or unable to relax appropriately.
Pelvic health physiotherapy provides individualised assessment and conservative management. Treatment is tailored to the specific problem rather than assuming that every patient needs pelvic-floor strengthening. Some patients require strengthening, while others need relaxation, coordination training, pain management, bladder or bowel retraining, or a combination of approaches.
What conditions can we treat?
Our women’s pelvic health physiotherapy service may assist with:
Urinary incontinence, including stress, urgency, and mixed incontinence.
Faecal or flatal incontinence.
Constipation
Urinary frequency, and overactive bladder symptoms.
Pelvic-floor muscle weakness, overactivity, or poor coordination.
Pelvic organ prolapse.
Chronic or persistent pelvic pain.
Pelvic girdle pain during pregnancy or after childbirth.
Vulvodynia and Vestibulodynia.
Vaginismus and difficulty with vaginal penetration.
Pain during sexual activity.
Pelvic trauma and birth-related pelvic-floor dysfunction.
Pregnancy-related musculoskeletal and pelvic-floor symptoms.
Postpartum recovery, including abdominal-wall, pelvic-floor, scar, and functional rehabilitation.
Genitourinary symptoms associated with perimenopause and menopause.
How do I know if I need Pelvic Health Physiotherapy?
Consider consulting a pelvic health physiotherapist if you:
Leak urine when coughing, sneezing, laughing, exercising, or lifting.
Experience a sudden urinary urge or struggle to reach the bathroom in time.
Need to urinate frequently or wake repeatedly at night to urinate.
Notice urine leakage after finishing urination.
Have difficulty starting or emptying your bladder or bowel.
Experience faecal or flatal leakage.
Feel heaviness, pressure, dragging, or a bulge in the vaginal or pelvic area.
Have pelvic, genital, vulval, or pelvic-girdle pain.
Experience pain during sexual activity or difficulty with penetration.
Are pregnant and experiencing pelvic, back, bladder, bowel, or pelvic-floor symptoms.
Are recovering after childbirth.
Have concerns about pelvic-floor function during perimenopause, menopause, or postmenopausal.
Avoid activities, exercise, intimacy, or social situations because of pelvic symptoms. These symptoms are common, but they should not simply be accepted as an inevitable part of ageing, pregnancy, childbirth, or menopause. A physiotherapy assessment can help identify contributing factors and determine whether physiotherapy is appropriate.
Our environment and resources
You will be seen by our women’s pelvic health physiotherapist in a warm, private, and respectful treatment room.
During your first consultation:
The therapist will explain the assessment and treatment process.
You will be invited to discuss your symptoms and goals.
You may be asked to complete a pelvic-health questionnaire.
You may pause, decline, or ask questions about any part of the assessment.
Your privacy, dignity, and informed consent will be respected throughout.
What happens during a consultation?
1. Subjective assessment
The physiotherapist will discuss:
Your main symptoms and concerns.
Bladder, bowel, sexual, pelvic, and musculoskeletal symptoms.
Pregnancy, childbirth, surgery, or trauma history.
Medical conditions and medication.
Physical activity, work, lifestyle, and exercise.
Emotional or psychosocial factors that may influence symptoms.
Your goals and expectations.
2. Physical examination
Depending on your symptoms and consent, the assessment may include:
Posture, breathing, movement, and functional assessment.
Assessment of the spine, pelvis, hips, abdomen, or pelvic girdle.
External examination of the abdomen, pelvis, perineum, or scars.
Pelvic-floor muscle assessment.
Internal vaginal or rectal examination, where clinically indicated, explained beforehand, and freely consented to.
An internal examination is not automatically required. You may decline an internal examination, and the therapist will discuss alternative assessment options with you.
3. Treatment and exercises
Treatment may include:
Pelvic-floor strengthening and/or relaxation.
Pelvic-floor coordination and endurance training.
Breathing and pressure-management strategies.
Bladder or bowel retraining.
Advice regarding toileting habits, constipation, hydration, and activity.
Manual therapy where appropriate and consented to.
Scar, abdominal, pelvic, or musculoskeletal treatment.
Postural and movement retraining.
Individualised exercise and functional rehabilitation.
Advice regarding pregnancy, postpartum recovery, menopause, or sexual pain.
4. Review and home programme
At the end of the session, the therapist will:
Review the assessment findings.
Explain the proposed management plan.
Demonstrate your home exercises or self-management strategies.
Discuss expected responses and warning signs.
Answer your questions and agree on follow-up and review arrangements.
How do I book? To book an appointment, please contact Michelle on [0317658898] or use our online booking system, Bookem.
The Effect of Pelvic Health Physiotherapy during Perimenopause, Menopause and Post Menopause
What is Menopause?
Menopause is a natural life stage, marking the end of menstrual periods and reproductive years. It is diagnosed retrospectively after 12 consecutive months without menstruation when there is no other obvious cause. Perimenopause is the transitional phase before menopause, during which hormonal fluctuations may cause menstrual and physical symptoms.
Menopause commonly occurs between the ages of 45 and 55, although timing varies. Changes in ovarian function and declining oestrogen levels can affect several body systems, including the urogenital tissues, bones, muscles, sleep, mood, and cardiovascular health.
How can Menopause affect Pelvic Health?
Whilst hormonal changes and “hot flashes” often dominate the menopausal diagnoses, the pelvic girdle and pelvic floor muscles often undergo many changes. Genitourinary syndrome of menopause describes a collection of symptoms associated with reduced oestrogen exposure. Symptoms may include:
Vaginal dryness, irritation, or burning.
Pelvic or Genital pain and discomfort.
Pain during sexual activity.
Urinary urgency, frequency, or leakage.
Burning during urination.
Recurrent urinary tract infections.
Reduced sexual comfort or function.
Decreased quality of life overall.
Menopause can also coincide with changes in pelvic-floor muscle strength, endurance, coordination, and the ability to relax. Some women develop weakness and reduced support, while others develop increased muscle tension in response to pain, dryness, stress, or fear of penetration.
Pelvic-floor symptoms during menopause are therefore not explained by muscle weakness alone. A comprehensive assessment is important to determine whether the primary contributors are weakness, overactivity, altered tissue sensitivity, prolapse, bladder dysfunction, bowel factors, musculoskeletal impairments, or a combination of these.
What does the research show?
A 2024 review found that pelvic-floor physiotherapy may be relevant to several postmenopausal conditions, including urinary incontinence, urgency urinary incontinence, pelvic organ prolapse, genitourinary syndrome of menopause, and sexual dysfunction. (Walgren et al., 2024).
In a prospective study of 32 postmenopausal women with genitourinary syndrome of menopause, a 12-week pelvic-floor muscle training programme was associated with improved symptoms, urinary incontinence, sexual function, and quality of life (Mercier et al., 2019). The study was small and did not include a control group, so the findings should be interpreted cautiously.
For women with genitourinary syndrome of menopause, pelvic-floor physiotherapy may include education, pelvic-floor relaxation, coordination training, manual therapy, biofeedback, movement retraining, and graded exposure to penetration where appropriate. Medical management, including vaginal moisturisers, lubricants, or local hormonal treatment, may also be appropriate and should be discussed with a qualified medical practitioner (American Urological Association, Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction and American Urogynecologic Society, 2025).
What can a Pelvic Health Physiotherapist do?
A Pelvic Health physiotherapist can:
Explain how menopause may affect the bladder, bowel, pelvic floor, sexual function, and musculoskeletal system.
Assess pelvic-floor muscle strength, tone, coordination, and relaxation.
Identify contributing factors to urinary leakage, urgency, pelvic pain, prolapse symptoms, or painful intimacy.
Teach an individualised strengthening or relaxation programme.
Provide bladder, bowel, breathing, and pressure-management.
Address pelvic girdle, hip, abdominal, or lower-back dysfunction.
Assist with rehabilitation after childbirth, surgery, or pelvic trauma.
Support a gradual and comfortable return to exercise and intimacy.
Pelvic-floor exercise should not be prescribed as a one-size-fits-all intervention. Correct technique, appropriate dosage, regular reassessment, and the ability to relax the muscles are important. Supervised pelvic-floor muscle training appears to offer advantages over unsupervised training for some quality-of-life and muscle-function outcomes, although the certainty of evidence varies (Kharaji et al., 2023).
Pelvic health is important at every age
Pelvic Health Physiotherapy is relevant to women throughout the lifespan. It may support women during pregnancy, after childbirth, during perimenopause, after menopause, following pelvic surgery, or when managing persistent pelvic pain, urinary, bowel, or sexual symptoms.
The aim is not simply to strengthen the pelvic floor. The aim is to improve comfort, confidence, bladder and bowel control, movement, sexual wellbeing, physical function, and quality of life through an individualised and respectful approach.
References
Zhang Y, et al. The effect of pelvic floor muscle training on health-related quality of life in postmenopausal women: a systematic review and meta-analysis. Menopause. 2024. Confirm final volume, issue, and page details before submission.pubmed.ncbi.nlm.nih
Mercer M, et al. Pelvic floor muscle training as a treatment for genitourinary syndrome of menopause. Menopause. 2021. Confirm the complete author list and final journal citation from the original article.imsociety
The North American Menopause Society. The 2020 genitourinary syndrome of menopause position statement of The North American Menopause Society. Menopause. 2020;27(9):976-992.
American Urological Association, Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction, American Urogynecologic Society. Genitourinary syndrome of menopause: clinical practice guideline. 2025.contemporaryobgyn
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