Most people first hear the words pelvic floor physio in a fairly stressful moment. You sneezed and leaked a little. You have been putting off going for a run because you are not sure what will happen. Something feels heavy, or sore, or just not right, and you have been hoping it would sort itself out.
This is common, it is treatable, and you are not being dramatic for wanting it looked at. According to Continence Health Australia, one in three women who have ever had a baby will experience incontinence, and women make up around 80 per cent of Australians living with it. Common does not mean normal, and it certainly does not mean you have to live with it.
This guide walks through what a pelvic floor physio does, the signs that suggest you would benefit from seeing one, and what happens at a first appointment. We will also cover the difference between a pelvic floor that is too weak and one that is too tight, and why doing Kegels when you have the second problem can make things worse.
What Is Pelvic Floor Physio?
Pelvic floor physiotherapy is a sub-specialty of physiotherapy focused on the muscles, ligaments and connective tissue that sit at the base of your pelvis. A pelvic physio assesses how those muscles are working, identifies what is driving your symptoms, and builds a treatment plan to fix the underlying problem rather than just managing around it.
It is a genuine area of postgraduate training, not simply something any physiotherapist offers. Practitioners complete additional study in pelvic health, continence and women’s health on top of their physiotherapy degree. At Bounce Back, our women’s health physiotherapists hold exactly that additional training, and you can read more about them on our women’s health physiotherapy page.
Pelvic floor physio commonly helps with:
- Bladder symptoms: leaking with coughing, sneezing, laughing, lifting or exercise; urgency; going to the toilet more often than you would like
- Bowel symptoms: constipation, straining, difficulty controlling wind, or a feeling of incomplete emptying
- Pelvic organ prolapse: heaviness, dragging or a bulging sensation
- Pelvic and abdominal pain: including pain with intercourse, persistent pelvic pain and pain associated with endometriosis
- Pregnancy and postnatal recovery: pelvic girdle pain, abdominal separation, birth preparation and returning to exercise afterwards
- Returning to running, lifting or sport with confidence after having a baby or after surgery
What Your Pelvic Floor Does
Your pelvic floor is a sling of muscle running from your pubic bone at the front to your tailbone at the back. It has four jobs, and it needs to do all of them well.
- Support: it holds your bladder, bowel and uterus in position
- Control: it opens and closes to let you control your bladder and bowel
- Stability: it works with your deep abdominals, back muscles and diaphragm to support your spine and pelvis
- Sexual function: it plays a direct role in comfort and sensation
The important thing to understand is that a healthy pelvic floor is not simply a strong one. It needs to contract when you need it and, just as importantly, fully relax when you need that instead. A muscle that never lets go is not a strong muscle. It is an exhausted one.
Signs You Might Benefit From Seeing a Pelvic Floor Physio
You do not need to be in crisis to book. Most of the people we see have been managing for months or years. If any of the following sound familiar, an assessment is worth your time:
- You leak urine when you cough, sneeze, laugh, jump, lift or exercise
- You need to know where every toilet is, or you rush to get there
- You get up more than once overnight to go to the toilet
- You feel heaviness, dragging or a bulge in your vagina, especially by the end of the day
- You strain to empty your bowels, or never feel finished
- Sex is painful, or you cannot use tampons comfortably
- You have persistent lower back, hip or pelvic pain that has not responded to other treatment
- You are pregnant, or you have had a baby at any point and were never properly assessed afterwards
- You have a gap or doming through your abdominal muscles
- You want to get back to running or the gym after birth and are not sure it is safe yet
That last one matters more than people realise. “How long since you had a baby?” is not a question with a six-week answer. If you had a baby fifteen years ago and never had your pelvic floor assessed, that assessment is still worth doing.
Tight or Weak? Why Kegels Are Not Always the Answer
The default advice for anything pelvic floor related is “do your Kegels”. Squeeze, hold, repeat. And for a pelvic floor that is genuinely weak and underactive, that advice is correct and effective.
But a significant number of people have the opposite problem. Their pelvic floor is overactive: chronically tight, holding tension, and unable to fully relax. It is sometimes called a hypertonic pelvic floor. If that is you, squeezing a muscle that is already refusing to let go will usually make your symptoms worse, not better.
Both problems can cause leaking. A tight muscle is a tired muscle, and a tired muscle cannot react quickly when you sneeze. So people who leak assume they are weak, start squeezing harder, and get more symptomatic.
Signs of an Overactive (Tight) Pelvic Floor
- Pelvic, tailbone or lower abdominal pain with no clear injury
- Pain with intercourse, internal examinations or inserting a tampon
- A slow or hesitant urine stream, or having to strain to start
- Feeling like you never fully empty your bladder or bowel
- Constipation and straining
- Symptoms that got worse after you started doing pelvic floor exercises
Signs of an Underactive (Weak) Pelvic Floor
- Leaking with coughing, sneezing, laughing, lifting or impact
- Heaviness, dragging or a bulging sensation
- Difficulty controlling wind
- A sense that you cannot really feel the muscles working when you try to squeeze
Why You Should Not Guess
You cannot reliably tell which pattern you have from a symptom list, and plenty of people have elements of both. Research consistently shows that a large proportion of women perform a pelvic floor contraction incorrectly when working from verbal or written instruction alone, often bearing down instead of lifting.
This is the real argument for getting assessed rather than following a video. A physiotherapist can tell you what your muscles are actually doing, and then give you the right exercise, which might be learning to release rather than learning to squeeze. If you have been doing pelvic floor exercises for months with no change, that is not a sign you need to try harder. It is a sign you may be doing the wrong exercise for your problem.
What Happens at Your First Appointment
For a lot of people this is the barrier, so let us be direct about it.
The Conversation
Your first appointment starts with a conversation, and it takes up a decent chunk of the session. Your physio will ask about your symptoms, your bladder and bowel habits, your pregnancy and birth history if relevant, your exercise, your work, and what you actually want to get back to. Nothing you say here will be a surprise to them. This is what they do all day.
The Physical Assessment
The physical assessment usually starts well away from your pelvis. Your physio will look at how you move, breathe, stand and load through your hips and lower back, because pelvic floor problems very often involve everything around them. They may assess your abdominal muscles for separation.
Is an Internal Examination Required?
An internal vaginal examination is the most direct way to assess how your pelvic floor muscles contract and relax, so your physiotherapist may recommend one. It is a routine part of pelvic health practice and it should never be uncomfortable in the way people fear. It does not involve stirrups and it is not like a cervical screening test.
It is also entirely your choice. Your physiotherapist will explain exactly what is involved, ask your permission before and during, and stop immediately if you want to stop. You can decline, and you can change your mind partway through.
If you would rather not, or it is not appropriate for you, there are alternatives. Real-time ultrasound lets your physio see your pelvic floor working through your abdomen with nothing internal at all. Plenty of people start there and never do anything else. Some people prefer to wait until the second or third appointment when they feel more comfortable. All of that is completely reasonable.
What to Wear and What to Bring
Wear something comfortable you can move in. Bring any relevant scans, specialist letters or referrals. If you have a bladder diary from your GP, bring that too. And if you have a baby, feel free to bring the baby: a pram in the room is entirely normal and nobody will mind.
Pregnancy and Postnatal Pelvic Floor Physio
Pregnancy and birth are the most common reasons people come to see a women’s health physio, and the two windows where it makes the most difference.
During pregnancy, physiotherapy helps with pelvic girdle pain, lower back pain, rib and hip pain, and staying active safely. If you are pregnant and dealing with pain through your lower back, buttocks or pubic bone, our guide to pelvic girdle pain in pregnancy goes into more detail. Pelvic floor work in pregnancy also covers preparation for birth itself.
After birth, an assessment is worth doing whether you had a vaginal birth or a caesarean. A caesarean does not exempt you: nine months of pregnancy loads your pelvic floor regardless of how your baby arrived. A postnatal check typically looks at pelvic floor function, abdominal separation, scar healing, and building a realistic plan to get back to the activity you want.
The six-week GP check is a medical clearance, not a musculoskeletal assessment. It is not the same thing as having your pelvic floor assessed, and being told you are “cleared for exercise” at six weeks does not mean your pelvic floor is ready for running.
Does Pelvic Floor Physio Work?
The evidence for pelvic floor muscle training is unusually strong for a conservative treatment.
A Cochrane systematic review pooling 31 trials across 14 countries found that women with stress urinary incontinence who completed pelvic floor muscle training were around eight times more likely to report being cured than women who had no treatment, with 56 per cent reporting cure compared with 6 per cent in the control groups. The review’s authors describe this as high-quality evidence, and it is why pelvic floor muscle training is recommended as a first-line treatment.
That is research across a population, not a prediction about any individual, and outcomes vary depending on your symptoms, how long you have had them and what is driving them.
It is also worth noting that the strongest results in the research come from supervised programs rather than people working from a pamphlet, which brings us back to why the assessment matters.
How Many Sessions of Pelvic Floor Physio Will I Need?
Straightforward problems that are mostly about learning the right technique often improve within a handful of appointments across a couple of months. Longer-standing issues, persistent pelvic pain, or symptoms that have been building for years generally need a longer runway, because you are retraining a muscle pattern rather than applying a fix.
Most of the work happens between appointments. Pelvic floor muscles respond to consistent, correctly performed training over time, in the same way any other muscle does. Your physio’s job is to make sure you are doing the right thing and to progress it as you improve. Your job is the bit at home. Your physiotherapist should give you a clear sense of expected timeframes at the end of your first appointment, and if they do not, ask.
Some people also benefit from moving into our clinical exercise and reformer classes once their one-on-one work is established, so the progress carries on in a supervised group setting.
Referrals, Rebates and Funding
You do not need a GP referral to see a pelvic floor physiotherapist privately. You can book directly.
A referral is only needed if you want to access one of the funded pathways:
- Private health insurance: rebates apply depending on your level of extras cover. At Bounce Back you pay in full at the clinic and claim your rebate directly through your fund
- Medicare Chronic Disease Management plans: your GP can prepare a plan covering a limited number of allied health visits per calendar year, shared across all disciplines
- DVA: covered with a referral
- WorkCover: accepted where the condition relates to an approved claim
- NDIS: available to self-managed and plan-managed participants where it is relevant to your plan
If cost is a concern, speak to our reception team before you book. It is a completely normal question and it is better asked upfront.
Frequently Asked Questions.
Q: What does a pelvic floor physio do?
A: A pelvic floor physio assesses and treats the muscles at the base of your pelvis that control your bladder, bowel and pelvic support. They work out whether your pelvic floor is too weak, too tight, or simply not coordinating well, then build a treatment plan around that. Treatment usually combines hands-on techniques, specific retraining exercises and education, and commonly addresses incontinence, prolapse, pelvic pain, and pregnancy and postnatal recovery.
Do I need a referral to see a pelvic floor physio?
You do not need a referral to see a pelvic floor physio privately, and you can book directly. A referral is only required if you want to claim through a funded pathway such as a Medicare Chronic Disease Management plan, DVA or WorkCover. Private health insurance rebates do not require a GP referral, and NDIS participants who are self-managed or plan-managed can book directly.
Is an internal examination always required at pelvic floor physio?
An internal examination is not always required at pelvic floor physio, and it is always your choice. It is the most direct way to assess how your muscles contract and relax, so it may be recommended, but your physiotherapist will explain it fully and ask your consent before and during. If you prefer not to, real-time ultrasound can assess your pelvic floor through your abdomen instead, and you can also choose to delay it to a later appointment.
How do I know if my pelvic floor is tight or weak?
You generally cannot tell whether your pelvic floor is tight or weak from symptoms alone, because both patterns can cause leaking. Tight pelvic floors more often produce pain, a slow urine stream, constipation and difficulty emptying, while weak pelvic floors more often produce leaking with impact and a sense of heaviness. Many people have elements of both, which is why an assessment is the only reliable way to know which exercises will help you.
Can pelvic floor exercises make things worse?
Pelvic floor exercises can make things worse if your pelvic floor is already overactive and holding too much tension. Squeezing a muscle that cannot fully relax tends to increase pain, straining and urinary symptoms. If your symptoms got worse after you started doing Kegels, stop and get assessed rather than pushing harder, because the right treatment for a tight pelvic floor is learning to release it, not learning to squeeze it.
How long does pelvic floor physio take to work?
How long pelvic floor physio takes to work depends on what is causing your symptoms and how long you have had them. Problems that are mainly about correcting technique often improve within a handful of appointments over a couple of months, while long-standing symptoms or persistent pelvic pain usually need longer because you are retraining a muscle pattern. Consistency with your home program between appointments makes the biggest difference to how quickly you progress.
Is it too late to see a pelvic floor physio if I had my baby years ago?
It is not too late to see a pelvic floor physio years after having a baby, and a large number of the people we assess are well beyond the postnatal period. Pelvic floor muscles respond to correct training at any age and any stage, including after menopause. If you were never properly assessed after birth, that assessment is still worth doing regardless of whether it has been one year or twenty.
Do men need pelvic floor physio too?
Men do need pelvic floor physio in some circumstances, and pelvic floor dysfunction is not exclusively a women’s issue. It is commonly used after prostate surgery, and for bladder and bowel control problems, persistent pelvic pain and some sexual function concerns. If you are unsure whether it applies to you, phone the clinic and ask before booking so we can point you to the right practitioner.
Ready to Get It Looked At?
If you recognised yourself anywhere in this article, the useful next step is an assessment, not another six months of hoping it settles.
Bounce Back’s women’s health physiotherapists work from our clinic in Narellan, serving families across the Macarthur region. You can read more about the team and the conditions we treat on our women’s health page, or book an appointment online whenever suits you.
And if you are not sure whether pelvic floor physio is the right fit, phone the clinic on (02) 4648 1669 and ask. It is a short conversation, and it is a far better use of your time than guessing.
