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Diagram of the pelvic floorThe 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.

Symptoms of pelvic floor problems

There are different symptoms to look out for with pelvic floor problems, including:

  • incontinence – leakage of wee, poo, or both
  • bladder emptying problems (urgency, frequency or incomplete emptying)
  • pelvic girdle pain (PGP) which is not improving with manual therapy or keeps coming back after good treatment 
  • lower back ache or pelvic pain and/or pain low down in your tummy
  • vaginal pain or discomfort during sex
  • urinary tract infections (UTIs)
  • constipation and/or difficulty having a poo
  • a bulge in the vagina or a feeling of pressure in the vagina or rectum.

Women can be told that if they have these symptoms the pelvic floor is weak, which is often not the case. However, as with any muscle, the pelvic floor muscles may become weaker if they are not working properly, so addressing the problem is important. 

Why do pelvic floor problems start?

Pelvic floor problems can start if the pelvic floor muscles are too tight or ‘overactive’ (sometimes referred to as ‘muscle spasm’), or if they are tighter on one side than the other. If your other joints and muscles in the pelvis aren’t working properly, this may mean you hold your pelvic floor muscles too tightly. 

An overactive pelvic floor can also be linked to previous pelvic floor injuries, e.g. after a vaginal tear, forceps birth or episiotomy during birth. 

What can I do about it?

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. For an overactive or tight pelvic floor, this means the physiotherapist will use their fingers in your vagina to release the muscles. 

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:

  • bladder and/or bowel retraining
  • relieving constipation
  • minimising heavy lifting
  • reducing weight.

Like other manual therapy:

  • this treatment can be uncomfortable at the time, but the pain should get better soon after treatment
  • you should see a difference after each treatment
  • you should see continued improvement between treatments over time.

 As your pelvic floor function improves, this may make manual therapy for your pelvic joints more effective. 

Who can provide this pelvic floor treatment?

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:

Pelvic Physiotherapy

I have tried this treatment but I am still experiencing pain, what should I do next?

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:

Pelvic Physiotherapy

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