Pelvic Floor Physiotherapy

What is Pelvic Floor Physiotherapy?

For pelvic health problems such as urinary incontinence, pelvic organ prolapse or other painful problems, Kegel exercises just might be the most overused and misused therapeutic approach. Kegels aren’t appropriate for every pelvic floor problem, and if done incorrectly, won’t help at all, and might even make things worse. So now what?


Pelvic health physiotherapy is establishing itself as the first choice in treating incontinence, pelvic pain and other related problems. A physiotherapist with advanced, specialized training in pelvic health can assess and correctly treat pelvic floor dysfunction. These conditions generally fall into one of two main categories:

HYPOTONICITY (weak pelvic floor muscles)

  • stress incontinence
  • urge incontinence
  • pelvic organ prolapse

HYPERTONICITY (tight pelvic floor muscles)

  • chronic pelvic pain
  • urinary urgency
  • fecal urgency
  • dyspareunia
  • vaginismus
  • vulvodynia
  • pudendal neuralgia
  • interstitial cystitis
  • chronic prostatitis
  • pregnancy-related pre-natal pelvic gridle pain
  • post-pregnancy pelvic girdle pain

The highly esteemed Cochrane Collaboration scientific review concluded in 2010 that physiotherapists with specialized training in pelvic floor rehabilitation should be sought first for treatment of incontinence, before surgical intervention is considered. This specialized training and teaches the safe and appropriate use of internal examination to teach the proper exercises for the condition being treated.

Pelvic pain is very often caused by pelvic floor dysfunction, and most commonly, pelvic floor muscles which are too tight, or hypertonic. Pelvic floor muscles are a group of muscles that support the urethra, uterus, bladder, prostate and rectum by attaching to the tailbones and hip bones. In females, these muscles also wrap around and support the vagina. that attach to the front, back and sides of the pelvic bone and sacrum. These muscles act like a sling or hammock to hold these organs in place for proper, pain-free function. When they contract, these muscles maintain continence (hold in your pee), and they must relax to permit urination and bowel movements. In women, their relaxation is necessary to facilitate sexual intercourse.

If these muscles become too tight (hypertonic), you could experience urgency or frequency of bladder emptying or bowel movements, as well as cause pelvic pain. If there is not enough muscle tone (hypotonic) you can suffer stress incontinence and possibly pelvic organ prolapse. In some cases, you can have a combination of some pelvic floor muscles that are too tense and others too relaxed.  Hypertonic muscles can cause the following symptoms:

  • urinary frequency, urgency, hesitancy, stopping and starting of the urine stream, painful urination, or incomplete emptying
  • constipation, straining, pain with bowel movements
  • unexplained pain in your low back, pelvic region, hips, genital area, or rectum
  • pain during or after intercourse, orgasm, or sexual stimulation
  • uncoordinated muscle contractions causing the pelvic floor muscles to spasm

Pelvic floor dysfunction can be properly evaluated and diagnosed by specially trained physicians and physiotherapists. This involves the use of internal and external “hands-on” or manual techniques to evaluate the function of your pelvic floor muscles. Your pelvic health physiotherapist will also assess your ability to contract and relax these muscles. Your bones and muscles of your lower back, hips and sacro-iliac joints may evaluated as well because these joints can stress your pelvic floor muscles.  If an internal examination is too painful, it could be caused by the connective fascial tissue of your abdomen, thighs, groin or low back being too tight. This connective fascial layer of tissue forms the container of the muscles, and this tissue often needs to be relaxed before any internal work can be performed.

When your pelvic floor muscle dysfunction involves a combination of tight and weak muscles, the tightness is treated first, before the weakness. Only once the muscles have reached a normal resting tone, and are able to relax fully, can their strength be properly assessed and strengthening exercises can begin if appropriate.

Self-care is an important part of treatment and pelvic floor rehabilitation. Your physiotherapist can advise you on daily self-care to support your recovery and avoid other problems along the way. Healthy and safe habits around bladder movements and bowel movements as well as relaxation techniques such as reverse Kegel moves can be very helpful.

Your medical doctor may prescribe diazepam for local application to the vaginal or rectal areas to hep relax them if hypertonic. Practising good posture can help keep pressure off your bladder and pelvic organs. Yoga and other stretching techniques can also be helpful in avoiding spasms or tightening in the pelvic floor muscles.

Stress, anxiety, thoughts, attitudes and beliefs can perpetuate any painful health condition, and those involving pelvic floor dysfunction are certainly no exception. Understanding how we often internalize these stresses in our pelvic base, and how our pain perception works can be an effective way of reducing the risk of ongoing pelvic pain and dysfunction.