Women’s and Men’s Pelvic Health

Understanding Pelvic Health

Pelvic health covers the function of the pelvic floor muscles, bladder, bowel, sexual function and the pelvic joints. Dysfunction within the system can alter your ability to comfortably and confidently work, exercise and partake in activities of daily living — symptoms can include urinary or faecal leakage, pelvic or low back pain, bowel or bladder urgency, painful intercourse, or pelvic organ prolapse. Both women and men can be affected though causes differ. Women typically experience symptoms associated with childbirth, surgery, repetitive load or strain, pelvic trauma, hormonal changes, and altered biomechanics. Men often experience symptoms associated with their prostate, this can be due to benign enlargement of the prostate or through cancer of the prostate. Symptoms can be due to prostate surgery. Muscle or nerve problems can disrupt control, as can an overactive bladder. Bowel dysfunction can be linked to chronic constipation, chronic diarrhoea, inflammatory bowel disease, rectal prolapse or haemorrhoids to name just a few.

Evidence based pelvic physiotherapy identifies the specific drivers of dysfunction, restores muscle control and coordination, and improves load tolerance and quality of life.

Does Any of This Sound Familiar

Leakage of urine when you cough, sneeze, laugh, exercise or lift

Urgency or frequency that may disrupt sleep or daily activities

Difficulty fully emptying the bladder or bowel; straining or constipation

Pelvic heaviness, visible or felt bulge, or diagnosed prolapse

Pain with intercourse, inserting tampons, or persistent pelvic pain

Pelvic, groin or low back pain related to activity, pregnancy or surgery

Tried pelvic rest, pads or medications with only temporary relief

If this resonates, a specialist pelvic health assessment can identify treatable causes and deliver strategies to restore control and confidence.

What Causes Pelvic Health Problems

Pregnancy and childbirth related changes

Muscle stretch, nerve irritation or trauma from vaginal birth increase risk of urinary leakage, prolapse and altered pelvic floor function.

Pelvic organ prolapse

Descent of pelvic organs due to connective tissue and pelvic floor weakness or overload producing heaviness, bulge or urinary/bowel symptoms.

Urinary incontinence

Stress incontinence from increased intraabdominal pressure; urgency incontinence from bladder overactivity; mixed presentations are common.

Bowel dysfunction

Faecal incontinence, urgency or constipation from sphincter or pelvic floor dysfunction or visceral hypersensitivity.

Pelvic pain and sexual pain

Myofascial pelvic floor dysfunction, trigger points, scar tissue, nerve entrapment or central sensitisation leading to dyspareunia or chronic pelvic pain.

Post-surgical or pospost-radiationt radiation changes

Altered pelvic floor mechanics, scarring and neural changes causing pain, voiding or bowel symptoms.

Biomechanical and load contributors

Poor trunk and hip control, pelvic girdle dysfunction, heavy lifting, chronic cough and obesity increase pelvic floor load and symptom persistence.

Why Pelvic Health Problems Might Not Be Getting Better

Incorrect or incomplete assessment

Symptoms may be attributed to the bladder or bowel while pelvic floor muscle dysfunction, timing or coordination problems are overlooked.

Passive management only

Pads, pessaries or medication without pelvic muscle retraining and load management often gives limited results.

Poor motor control or hypertensive pelvic floor

Both underactive and overactive pelvic floor presentations exist; strengthening when muscles are already overactive can worsen symptoms.

Unaddressed bowel or bladder habits

Constipation, straining, bladder irritation (caffeine, fluids, infections) and toileting posture perpetuate symptoms.

Psychosocial and pain-related factors

Anxiety, fear of leakage or pain, poor sleep and central sensitisation maintain symptoms and reduce adherence to therapy.

Lack of graded exposure and functional training

Failing to retrain pelvic floor function within real-life activities (lifting, coughing, exercise, sex) limits translation of clinic gains.

How Evidence-Based Pelvic Physiotherapy Helps

Comprehensive assessment and individualised diagnosis:

We assess pelvic floor muscle strength, endurance and coordination, bladder and bowel habits, sexual and pain history, posture, breath and core control, pelvic joint mobility and psychosocial factors to identify modifiable drivers.

Pelvic floor muscle training with specificity:

Progressive, individually tailored pelvic floor training (including strength, endurance and coordination) is first line for stress urinary incontinence, prolapse symptom improvement and many continence problems. Training is integrated with breathing, bracing and functional tasks for real world transfer.

Managing overactive pelvic floor and pain presentations:

For overactive pelvic muscles or painful pelvic floor presentations we prioritise down training strategies — relaxation, breathing, soft tissue release, trigger point techniques and graded exposure to reduce guarding and pain.

Bladder and bowel retraining and behavioural strategies:

Timed voiding, bladder training, fluid and dietary modification, toileting posture advice and constipation management reduce urgency, frequency and bowel dysfunction.

Load management and functional integration:

Progressive return to lifting, exercise and sport with taught pelvic floor co-contraction strategies, ergonomic advice and staged exposure prevents recurrence and restores confidence.

Adjuncts used selectively:

Biofeedback, electrical stimulation, discussing pessary fitting, topical scar desensitisation and referral for specialist investigations (urodynamics, imaging, gynaecology/urology/colorectal input) are used when indicated.

Prehabilitation and post operative pathways:

Pre op pelvic floor optimisation and structured post op rehabilitation improve recovery after prolapse, incontinence or pelvic surgery.

Education and psychological informed care:

Pain neuroscience education, reassurance, goal setting and graded activity improve adherence and outcomes; we address fear, sleep and lifestyle factors that affect recovery.

The Importance of Early, Targeted Care

Early pelvic health assessment and targeted physiotherapy can improve continence, reduce prolapse symptoms and pelvic pain, and restore participation in work, exercise and intimacy. Tailored rehabilitation that matches muscle recruitment (strengthening vs down training), addresses bowel and bladder habits, and integrates functional tasks is supported by strong evidence as firstline care for most nonsurgical pelvic conditions.

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Last updated 2025

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