What to expect from pelvic floor physiotherapy for pelvic floor dysfunction

The pelvic floor supports the bladder, bowel and reproductive organs. Dysfunction may mean the muscles are weak, overactive, painful, or unable to tighten and release at the right time. Symptoms can include leakage, constipation, pelvic pressure, pain with sex or difficulty emptying the bladder.

At the first appointment, expect questions about symptoms, pregnancy or surgery history, exercise, bowel and bladder habits, and your goals. The clinician may assess breathing, abdominal and hip movement, posture and functional tasks. An internal examination can be discussed, but it should be consent-based and may not be needed.

Treatment depends on the pattern found. It may include pelvic floor contractions, lengthening and relaxation, breathing coordination, biofeedback, hands-on treatment, bladder or bowel strategies, and graded return to activities. A muscle that is already tense may need release practice before strengthening.

Keep track of what changes your symptoms and follow the prescribed dose rather than adding more repetitions on your own. Use an exhale during effort when instructed, avoid holding your breath, and tell the physiotherapist if an exercise causes pain, pressure or leakage.

Arrange medical review for new bleeding, unexplained weight change, fever, severe or rapidly worsening pain, or a new lump or swelling. Seek urgent help if you cannot pass urine or stool, develop sudden severe pelvic pain, or feel faint. Persistent symptoms may need assessment by a doctor alongside physiotherapy.

Ask which muscle pattern is affecting you, what improvement should look like, whether you need relaxation or strengthening first, and when your programme should be reviewed.