A pelvic physiotherapist specialises in physiotherapy for pelvic health. They will see men, women and children who may be experiencing issues with bladder and bowel control, prolapse, constipation and straining, bedwetting, post-pelvic surgery rehabilitation, bladder pain and more.

They use techniques and exercises that help strengthen, relax, stretch and control the pelvic floor muscles, as well as support bladder and bowel function.

When it comes to incontinence, pelvic physiotherapists are accustomed to discussing causes, associated symptoms and other details of your own experience with the condition. It will always remain a confidential conversation and all treatment will be personalised to your individual needs. In some cases, and with other interventions, pelvic physio can treat incontinence symptoms, or at the very least improve their severity.

But let’s dive a little deeper into what an appointment with a pelvic physio looks like!

First things first, when should you see a pelvic physiotherapist?

There are a number of conditions or health experiences that should be overseen by a pelvic physiotherapist. These include:

• Bladder control issues such as leaking urine when you cough, sneeze, bend or run, or having a sudden and/or frequent urge to urinate.

• Bladder voiding issues - not being able to completely empty the bladder or feeling as though it’s not empty after doing a wee

• Prolapse

• Pregnancy and postpartum

• Pre and post-gynaecological surgery

• Bedwetting and/or day wetting in children

• Pelvic and abdominal pain associated with IBS, endometriosis and any other gastrointestinal conditions

• Perineal or vulva pain

• Pain with sex, bladder and/or bowel movements and non-menstrual pelvic pain

• Vaginismus (inability to tolerate vaginal penetration due to muscle spasm at the vaginal entry)

If you’re not sure whether seeing a pelvic physiotherapist is right for you, speak to your GP or call/email a pelvic physiotherapy office to enquire.

You do not require a GP referral to see a pelvic physiotherapist, but you should always seek assistance from them from any initial pelvic changes or pain.

Your pelvic physiotherapist will ask about why you’re visiting them, what your symptoms are, your health history related to your symptoms, and also what your goal is from physio treatment.

Some examples of questions might include:

• How have you experienced this issue? Is it improving or worsening?

• What have you tried to do to improve things so far? Has it helped at all?

• Do you experience problems with your bladder, bowel, sexual problems or a combination of some - or all?

• Do you have any past medical problems, including childbirth history and any previous operations?

Please note that while some of these questions can feel quite personal and sensitive, your pelvic physiotherapist will always treat your answers with the utmost confidentiality and respect. Many of these questions need to be answered to best inform your physiotherapist so they can provide the best and safest treatment possible for maximum effectiveness.

Of course, if there’s anything you truly don’t wish to share, then you are under no obligation to.

Once you’ve answered some questions, your pelvic physio will likely talk you through the pelvic anatomy and its function as a whole, then explain what exactly could be contributing to your individual symptoms.

With your consent, your physio may need to do a physical examination of your pelvic floor muscles. This doesn’t always occur in the first appointment, but it will need to at some stage to help correctly diagnose and treat your condition. This is especially important if incontinence is involved.

 A physical examination can involve an external assessment of your pelvis, abdomen and spine where they’ll use their hands to feel muscle movements for example. You may even be encouraged to complete an external ultrasound of the suspected affected area post-appointment.

For women, while your physio is performing an external examination, they may also ask you to try and contract your pelvic floor muscles so they can see what happens from the outside in the vulva and abdomen.

An internal examination may also need to be performed vaginally or rectally for females, and rectally for males.

To do this, you will be asked to remove your clothing and underwear behind a curtain and lay on the physio bed. They will provide you with a sheet or towel to cover yourself for discretion. Once you’re comfortable and ready, the physio will ask you to proceed to the optimum position.

For vaginal exams, this will usually be on your back with your knees bent and feet flat on the bed. In some cases, your physio may want to check your muscles while you stand or sit.

Once you’re ready, the physio will guide you through some deep breaths to help relax your pelvic floor and vaginal opening. When you’re relaxed and ready, they will then insert a gloved and lubricated finger into the area to assess the strength and flexibility of your pelvic floor muscles, ligaments and fascia. They will likely ask you to contract and relax your pelvic floor muscles a few times and guide you on how to do so if you’re not sure.

For rectal exams, your physio will ask you to lay on your side as if you’re sitting on a chair - knees bent up towards your chest. You will be given a towel to cover yourself for discretion. The physio will then take you through some slow, deep breaths to help you relax the anus and pelvic floor. Once you’re relaxed and ready to proceed, the physio will insert a gloved and lubricated finger into the anus. They may then ask you to squeeze as if you’re trying to stop gas and then release, a few times. They may also ask you to contract and relax your pelvic floor. They can also check your pelvic floor muscles, hip muscles and tailbone.

Once your internal examination is done, you’ll be provided with some tissue and/or wet wipes to remove any excess lubricant before getting dressed and going through any immediate findings with your physio.

Physical examinations are performed with care and precision. Your physio will only proceed with your consent and stop at any time throughout if you become uncomfortable or feel any pain.

This may vary between practitioners, however, as a general rule of thumb you can expect an initial appointment to run for around 45 minutes to one hour.

Subsequent appointments may be slightly shorter in length and run for around 30 minutes depending on your needs.

This too can vary between practitioners and clinics. As a guide, you’re looking at around £80 and £140 for an initial assessment.

Keep in mind, you may be able to claim some of the cost on private health insurance if you have it.

Physiotherapy can also be access on the NHS - read here for accessibility requirements.

In your first appointment, your physio will outline the amount of subsequent appointments required to treat your condition, and the frequency of which these appointments should occur.

For example, if you’re a woman seeing a pelvic physio for bladder leakage, you may need around 12 weeks of treatment to begin with. This can then be reassesed at your 12 week appointment as to whether you need to continue.

We hope you’ve found this article insightful and it eases any confusion or worry about seeing a pelvic physiotherapist. If you have any further questions, you can always contact your nearest physiotherapy clinic or speak to your GP.