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General information about Pelvic physiotherapy

Pelvic floor physiotherapy is a conservative, effective and research-proven treatment for rehabilitating the muscles that support the pelvic organs. It is the medically recommended first-line treatment for conditions such as urinary leakage, organ prolapse and pelvic pain - in both women and men - even before turning to medication or surgery.

The pelvic floor is a smart system of muscles, ligaments and connective tissue that spans the bottom of the pelvis, much like a supporting hammock. This "hammock" plays several critical roles in our everyday quality of life:

Supporting the internal organs: holding up the bladder, the rectum and, in women, also the uterus.
Sphincter control: timed opening and closing of the urethra and the anus — which allows us to hold on when needed and to empty easily at the right time.
Sexual function and posture: active participation in sexual function, maintaining pelvic stability and working together with the core and breathing muscles.

Why do these muscles weaken or become damaged?

Like any other muscle in the body, the pelvic floor muscles can weaken, stretch or simply lose their coordination (or, conversely — become overly contracted and tense). The best-known causes are pregnancy and childbirth, but there are many other factors: hormonal changes during menopause, chronic constipation, prolonged coughing, heavy lifting, and surgery in the pelvic area (such as prostate surgery in men).

Pelvic floor physiotherapy is performed by physiotherapists who have completed dedicated, in-depth training in the field. The goal is not just to "strengthen the muscles", but to restore their precise function: being able to contract forcefully when needed (for example, just before a sneeze), and to relax completely when you want to empty your bladder or bowels or have sex.

What does pelvic floor physiotherapy involve?

Initial consultation and assessment (history taking): a conversation about your symptoms, toilet habits, medical history and lifestyle.
Tailored physical examination: assessment of posture, breathing and the function of the abdominal and pelvic muscles, to determine whether the muscles are weak, overly tense or uncoordinated.
Personal rehabilitation plan: a combination of in-clinic treatment (sometimes using assistive equipment such as biofeedback) together with a simple, precise home exercise program that will help you achieve results and maintain them.

It is recommended to seek assessment and treatment from a pelvic floor physiotherapist if you experience one or more of the following:

Urinary leakage: on exertion (when coughing, sneezing, laughing or running) or due to a sudden urge that is hard to hold back.
Difficulty with sphincter control: leakage of gas or stool.
Emptying difficulties: persistent constipation, a feeling that the bladder does not empty completely, or a very frequent need to use the toilet.
A feeling of heaviness or pressure in the vagina: a sensation that "something is coming down" or bulging (a possible sign of pelvic organ prolapse).
Pain: chronic pain in the pelvic area, discomfort when sitting, or pain during sexual intercourse.
Preparation and rehabilitation: pregnant and postpartum women, menopausal women, and men before or after prostate removal surgery.

Frequently asked questions about Pelvic physiotherapy

Does physiotherapy really help with urinary leakage?

Yes, and research data show high success rates. A comprehensive scientific review by Cochrane (covering 31 studies and 1,817 women) produced clear-cut findings for women with stress urinary incontinence who trained their pelvic floor muscles: ● 8 times more women reported a complete cure after training compared with untreated women (56% vs. 6%). ● 74% of those who trained experienced treatment success, compared with only 11% in the control group. ● Patients reported high satisfaction as well as improved sexual function. Based on this evidence, the world's leading health bodies (such as the UK's NICE) state that supervised pelvic floor muscle training is the first recommended treatment for urinary incontinence. In fact, for about half of women with stress urinary incontinence, physiotherapy training is as effective as surgery — without the risks of a surgical procedure.

Why isn't it enough to do Kegel exercises on your own, following instructions from the internet?

The pelvic floor muscles lie deep in the body and can't be seen, so it's very hard to know whether you're contracting them correctly. In a classic study of women who were given a brief verbal explanation of Kegel exercises, only about half performed the contraction ideally. A quarter of the women performed the exercise in a way that could actually worsen leakage — for example, bearing down instead of squeezing and lifting. The researchers concluded that verbal or written instructions alone are not adequate preparation for a training program. This is exactly why international guidelines recommend supervised training: the physiotherapist checks that the contraction is performed correctly and also makes sure the muscles know how to relax. It often turns out that the problem isn't weakness at all, but overly tight muscles that need to be taught to relax.

Does the treatment include an internal examination?

Sometimes, yes. An internal examination, vaginal or rectal, allows direct assessment of the pelvic floor muscles: their strength, endurance, ability to relax, and coordination. British guidelines recommend using such an examination to confirm that the contraction is performed correctly before starting a supervised training program. However, the examination is performed only with full consent, and where possible. If you don't feel comfortable, there are other ways to assess muscle function and build a treatment plan.

Is pelvic floor physiotherapy needed after a C-section too?

Yes, definitely. The main strain on the pelvic floor builds up during the months of pregnancy itself, not only in the birth canal. Many women are sure that if they gave birth by C-section (planned or emergency), their pelvic floor was "spared" from damage. In practice, carrying the weight of pregnancy for nine months weakens and stretches the pelvic floor muscles regardless of how the baby was delivered. In addition, a C-section is abdominal surgery in every sense: physiotherapy after a C-section also includes treatment of the surgical scar (to prevent adhesions, pain or numbness around the scar) and gradual, safe rehabilitation of the abdominal and core muscles.

What is pelvic floor biofeedback?

Biofeedback is an assistive device that translates the activity of the internal muscles into a visual display on a screen — so you can "see" in real time how you contract and relax. Because it's hard for us to sense the pelvic floor muscles, using a gentle sensor (external or internal) connected to a computer screen provides instant feedback (for example, via a graph or a small game on the screen). This way you learn exactly what full relaxation looks like and how a correct contraction is performed, which significantly shortens the learning time and makes the treatment more effective.