The pelvic floor is a group of muscles attaching at the front to your pubis symphysis joint and at the back to your sacrum. It acts like a hammock, holding all your pelvic organs, and it allows you to control your bladder and bowel.
Many women with PGP also experience problems with their pelvic floor, known as pelvic floor dysfunction.
There are different symptoms to look out for with pelvic floor problems, including:
If you have problems with your pelvic floor, you may have a weak or a an overly tight or ‘overactive’ pelvic floor.
During and after pregnancy, women may notice changes to how their pelvic floor muscles are working, as shown above.
Your muscles may be weak or too tight (also described as overactive, hypertonic). They also may be tighter on one side than the other.
Changes in your pelvic floor can also be linked to previous pelvic floor injuries, e.g. after a vaginal tear, forceps birth or episiotomy during birth.
Many women with PGP find that they have a tight or overactive pelvic floor. This can happen when your other joints and muscles in the pelvis aren’t working properly, so you may hold your pelvic floor muscles too tightly.
Ask for an assessment of your pelvic floor from a women’s health physiotherapist. As with PGP, pelvic floor problems usually respond well to manual therapy.
If you have weak pelvic floor muscles, your physiotherapist may suggest you do more kegel exercises to strengthen your pelvic floor muscles.
For an overactive or tight pelvic floor, it is likely that your physiotherapist will undertake some manual therapy to release the tension in the pelvic floor muscles. This means they will use their gloved fingers inside your vagina to release the tension, with your informed consent.
Then you would be given exercises to retrain your pelvic floor muscles to contract and relax properly. Focussing on contracting the muscles alone is likely to increase pelvic floor tightness and pain. The therapist may use a biofeedback device to show you how to do these exercises correctly. However, biofeedback treatment alone is unlikely to address the muscle overactivity.
You may also be asked to release the trigger points yourself or exercise other muscles linked to the pelvic floor (e.g. tummy and bottom muscles). There may be other lifestyle changes to consider too alongside treatment, including:
Like other manual therapy:
As your pelvic floor function improves, this may make manual therapy for your pelvic joints more effective.
Find a women’s health or pelvic health physiotherapist with experience in pelvic floor manual therapy. They will specialise in myofascial (muscle and soft tissue) release and trigger point therapy. Either your therapist can check your pelvic joints at the same time, or you may need to see a specialist manual therapist separately.
Talk to your GP or midwife about a referral for NHS women’s health or pelvic health physiotherapy. Having said that, not all women’s health physiotherapists use trigger point release to treat an overactive or tight pelvic floor. Some women with an overactive or tight pelvic floor choose to pay for a private women’s health physiotherapist for treatment.
You can also find a list of specialist pelvic floor physiotherapists here:
As with treatment for PGP, it can be difficult to find the right practitioner either on the NHS or privately. If you are not noticing any improvement after each treatment then it may be worth trying another practitioner.
Read more about pelvic floor problems and find a specialist practitioner:
