What does a pelvic floor physio do?

“Most of the time in pelvic pain or pelvic health, things are quite complex. So we need to know the whole picture.”

Chances are, you’ve never heard of a pelvic floor physio before but it’s likely someone close to you could benefit from seeing one. Not to be mistaken for a women’s health physio, a pelvic floor physiotherapist, as the name suggests, addresses pelvic floor issues specifically.

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As Alex Lopes, Director of Pelvic Health Melbourne, outlines, the key difference is that these physios are also trained in internal examinations, both vaginal and anal. “We assess bladder, we assess the endo, we assess pelvic floor muscle,” she says. 

The purpose of a pelvic floor physio

The pelvic floor physio’s forté is broad, working with neurotypical and neurodivergent children with bladder issues, men struggling with erectile dysfunction and, of course, a multitude of women-prevalent issues. These patients are generally pre- or post-natal, dealing with an overactive bladder, menopause or suffering from intimacy pain. I was shocked to learn that 60 per cent of women over 50 experience intimacy pain because “the vagina shrinks,” as Alex points out, something that can be treated with specialist help. 

Winnie Wu, a women’s health and pelvic floor physiotherapist at Movement Laboratory in Sydney, emphasises the need to visit one as a preventive measure, too. Even if you have the slightest symptoms – like not being able to empty your bladder properly, for example – it’s worth a visit. All those little signs may point to something bigger, so it’s best to nip it in the bud. 

But there’s a clear disconnect between education and the work being done. When were we ever taught about pelvic health at school? Preventative care is only possible when the knowledge gap shrinks, so consider this your first (or maybe second or third) step to getting there. With at least one in nine Australian women and uterus owners affected by endometriosis, this story needs to be about education and finding health professionals that truly treat people’s pain.

The goal of the pelvic floor physio, according to Winnie, is all about improving overall function, quality of life and wellbeing. “When you look at the big picture, it’s about someone feeling a lot happier, confident, no pain or less pain, and that they can manage their own condition.”

The pelvic floor physio appointment

Although we can self-refer in Australia, finding a specialist might be the toughest part. As Alex explains, there’s no directory specific to this branch of physio just yet so the best approach is to visit the Australian Physiotherapy Association as a reference point. Look for practices that mention intimate examinations and treatment of the bladder and bowel. 

A typical first appointment will involve a long series of questions about your goals, pelvic floor, bowel, sexual function and more. As Winnie notes, “Most of the time in pelvic pain or pelvic health, things are quite complex. So we need to know the whole picture.”

This may lead to an internal vaginal examination, with other options available for those who aren’t comfortable with this, like external palpation (pressing on the surface of the body) or external visualisation. Here, they are looking at tissue health by relaxing and contracting it to get a better idea of your symptoms and potential diagnosis. 

Is it just Kegels?

Years ago, Kegels took female-oriented media by storm. I would sit at my desk and tense and release awkwardly, all in the name of my pelvic floor and some very efficient multitasking. While it can be an important aspect of pelvic health, Winnie reminds me it isn’t the only answer. “That’s not the way to treat the pelvic floor. Without actually knowing what your pelvic floor is like, it’s quite a dangerous concept.” 

Instead, unique treatment plans are crafted for each patient, which always involves a huge education piece as a starting point. “70 to 80 per cent of the time, there will be pelvic floor training,” which, Winnie clarifies, is not necessarily Kegel exercises but muscle training. “It can be up-training or down-training, so it could be getting someone to relax and learning how to regulate that tone. Or it could be strengthening, getting someone to increase muscle bulk.” 

For endometriosis and menstrual pain patients, it’s about learning how to regulate the pain and giving them tools to assist at home. This may involve manual treatment of the pelvic floor (including internal massage or internal release stretches), plus other tools like breathing and stretches and eventually some movement work like clinical Pilates. As Winnie notes, this emphasis on self-management and care is incredibly empowering for patients.

It’s unfortunate that so much of the health puzzle falls into our hands, but I find these conversations encouraging. There are specialists out there who are willing to listen, who understand and who, ultimately, want to help deal with women’s often-unspoken pain. They’re the ones I want on my team.

For more on pelvic floor health, try this.