Conditions We Treat
Pelvic health physiotherapy and pediatric care — all in one place.
Pelvic floor dysfunction refers to impaired strength, coordination, or relaxation of the muscles that support the bladder, bowel, uterus, and rectum. It is common: urinary incontinence affects an estimated 1 in 3 women, and up to half of people with long-term constipation have coexisting pelvic floor dysfunction. Pelvic floor muscle training is recommended as a first-line treatment for several of these conditions in international clinical guidelines, and biofeedback improves muscle control in over three-quarters of people with pelvic floor dysfunction.
Assessment follows standard pelvic-health practice: a detailed history, an objective examination appropriate to the presenting concern (external, and internal where clinically indicated and consented to), and an individualized treatment plan. The conditions below span bladder, bowel, sexual, and musculoskeletal presentations across women, men, and children.
Bladder & Bowel Health
Urinary Incontinence
The involuntary loss of urine — most commonly stress incontinence (leakage with a rise in intra-abdominal pressure, such as coughing, sneezing, or exertion) or urge incontinence (leakage preceded by a sudden, strong urge). Pelvic floor muscle training is recommended as first-line treatment for stress and mixed incontinence in international clinical guidelines. Assessment first establishes whether the muscles are underactive, overactive, or poorly coordinated.
Overactive Bladder
A symptom complex of urinary urgency and increased daytime frequency, with or without urge incontinence, and often nocturia (waking to void at night). It commonly reflects detrusor overactivity, pelvic floor dysfunction, or both. Management includes bladder retraining, urge-suppression techniques, pelvic floor re-education, and review of fluid and dietary triggers.
Pelvic Organ Prolapse
Descent of the bladder, uterus, or rectum into the vaginal canal as connective-tissue and muscular support reduces, producing vaginal heaviness, pressure, or a bulge. Some degree of prolapse is found on examination in up to half of women who have given birth. Pelvic floor muscle training reduces symptoms and severity in mild-to-moderate prolapse; a pessary is a further conservative option.
Bowel Dysfunction
Includes constipation with obstructed defecation, a sensation of incomplete emptying, and faecal incontinence. Up to half of people with long-term constipation have coexisting pelvic floor dysfunction — difficulty relaxing and coordinating the pelvic floor and anal sphincter. Treatment targets defecation mechanics and coordination, with biofeedback where indicated.
Interstitial Cystitis (Bladder Pain Syndrome)
Chronic bladder pain, pressure, and urinary frequency or urgency in the absence of infection or other identifiable pathology. Pelvic floor muscle overactivity frequently coexists and contributes to symptoms; manual therapy directed at the pelvic floor is a recommended component of bladder pain syndrome management, delivered alongside urological care.
Pelvic, Sexual & Nerve Pain
Dyspareunia (Painful Intercourse)
Recurrent genital pain associated with intercourse, either superficial (at the vaginal entrance) or deep. Causes are multifactorial and frequently involve pelvic floor muscle overactivity. Assessment identifies the contributing structures; physiotherapy addresses the muscular and tissue components alongside any medical or psychological management.
Vaginismus
Involuntary contraction of the pelvic floor muscles that interferes with vaginal penetration, including intercourse, tampon use, and examination. It is a recognized pelvic floor muscle overactivity disorder and is managed with graded pelvic floor down-training, manual therapy, and progressive desensitization.
Vulvodynia
Chronic vulvar pain — burning, stinging, or rawness — of at least three months’ duration without an identifiable cause. Pelvic floor muscle dysfunction is a common associated finding; physiotherapy addresses muscle overactivity and tissue sensitivity within multidisciplinary management.
Vestibulodynia
Provoked pain localized to the vaginal vestibule, typically triggered by touch, tampon insertion, or intercourse. It is the most common subtype of vulvodynia in pre-menopausal women. Physiotherapy targets pelvic floor overactivity and desensitization, usually within a combined medical, physiotherapy, and psychology approach.
Clitorodynia & PGAD
Clitorodynia is localized clitoral pain; persistent genital arousal disorder (PGAD) is unwanted physiological arousal occurring without desire. Both are associated with pelvic floor muscle and pudendal nerve involvement and are assessed and managed within a multidisciplinary framework.
Pudendal Neuralgia
Neuropathic pain in the distribution of the pudendal nerve (perineum, genitals, and perianal region), characteristically worse with sitting and eased by standing. Physiotherapy addresses contributing pelvic floor muscle tension and nerve mechanics alongside medical management.
Coccydynia (Tailbone Pain)
Pain localized to the coccyx, typically provoked by sitting and by the transition from sitting to standing. Common precipitants include a fall onto the tailbone, childbirth, and prolonged sitting. Treatment includes manual therapy, seating modification, and pelvic floor release.
Levator Ani Syndrome
Chronic or recurrent aching, pressure, or pain in the rectum or deep pelvis caused by spasm of the levator ani muscles. It is a functional anorectal pain disorder managed with manual release, down-training, and, where appropriate, biofeedback.
Chronic Pelvic Pain Syndrome
Non-cyclical pelvic pain of at least three to six months’ duration without a single identifiable pathology. Central sensitization and pelvic floor muscle overactivity are common contributors. Physiotherapy management emphasizes down-training and graded activity rather than strengthening, within a multimodal plan.
Vulvar Skin Conditions
Dermatological conditions of the vulva, such as lichen sclerosus, are diagnosed and managed medically. Where they are accompanied by pelvic floor muscle guarding and pain, physiotherapy addresses the musculoskeletal component alongside dermatological or gynaecological care.
Sexual Dysfunction
Difficulty with arousal, sensation, orgasm, or comfort related to pelvic floor muscle function — overactive or underactive — including after childbirth, pelvic surgery, or menopause. Physiotherapy addresses the muscular and neuromuscular components as part of overall care.
Endometriosis, Hormones & Menopause
Endometriosis
A chronic condition in which endometrial-like tissue grows outside the uterus, affecting an estimated 1 in 10 women of reproductive age. Associated pelvic floor muscle overactivity and central sensitization contribute to pain. Pelvic floor physiotherapy is an adjunct to medical and surgical management, targeting the musculoskeletal pain component.
Menopause-Related Symptoms (GSM)
Declining estrogen through perimenopause and menopause causes genitourinary syndrome of menopause (GSM) — vaginal dryness, irritation, and urinary urgency — and can unmask incontinence and prolapse. Physiotherapy addresses pelvic floor function and symptoms alongside medical options such as vaginal estrogen.
Pregnancy & Postpartum
Pelvic Girdle Pain & SPD
Pain at the pubic symphysis, sacroiliac joints, or posterior pelvis during pregnancy, related to hormonal ligamentous laxity and altered load. Physiotherapy — manual therapy, targeted exercise, and support strategies — is the recommended conservative management.
Diastasis Recti
Separation of the rectus abdominis muscles along the linea alba, present in most women in late pregnancy and persisting in an estimated one-third at 12 months postpartum. Structured, progressive exercise improves abdominal function and the inter-recti distance more effectively than general abdominal exercise alone.
Postpartum Incontinence & Prolapse
Urinary incontinence and prolapse are common after childbirth. Supervised pelvic floor muscle training in the antenatal and postnatal periods reduces the risk and severity of postpartum urinary incontinence. A postpartum assessment evaluates the abdominal wall, pelvic floor, and any perineal injury.
Perineal & C-Section Scar
Perineal tears (including OASIS — third- and fourth-degree — injuries) and caesarean scars can cause persistent pain, adhesion, and restricted mobility. Scar mobilization and pelvic floor rehabilitation, commenced once the tissue has healed, address pain and function.
Male Pelvic Health
Post-Prostatectomy Incontinence
Urinary incontinence is common in the weeks and months after radical prostatectomy, as continence relies more heavily on the pelvic floor once the prostate is removed. Pelvic floor muscle training is a recommended part of recovery, and beginning it before surgery (pre-habilitation) may help continence return sooner.
Chronic Pelvic Pain Syndrome (CP/CPPS)
Persistent pain in the pelvis, perineum, groin, or genitals — historically labelled chronic prostatitis — in the absence of active infection. Pelvic floor muscle overactivity is a frequent contributor, and physiotherapy emphasizes down-training, manual therapy, and graded activity within a multimodal plan.
Post-Vasectomy & Scrotal Pain
Chronic testicular, scrotal, or lower-pelvic pain that can follow vasectomy or arise without a clear cause. Where pelvic floor muscle tension and nerve sensitivity contribute, physiotherapy addresses the musculoskeletal component alongside urological care.
Erectile & Ejaculatory Function
The pelvic floor muscles have an established role in erection and ejaculation. Where tension or weakness contributes to erectile difficulty or to premature or delayed ejaculation, pelvic floor muscle training is used as one component of care, alongside medical assessment.
Bowel & Anorectal Health
Constipation with obstructed defecation, a sense of incomplete emptying, difficulty controlling gas or stool, and rectal or tailbone pain. Assessment targets defecation mechanics and pelvic floor coordination, with biofeedback where indicated.
Core & Post-Surgical Recovery
Rebuilding deep abdominal and pelvic floor function after abdominal, hernia, or pelvic surgery, with a progressive, individualized exercise plan.
Pediatric Pelvic Health
Nocturnal Enuresis (Bedwetting)
Involuntary night-time wetting beyond the age at which bladder control is usually established. It is common and rarely simply behavioural; contributors include bladder capacity, deep sleep and arousal, and — frequently — underlying constipation. Care addresses bladder and bowel habits, with pelvic floor coordination work where relevant, alongside the child’s physician.
Daytime Wetting & Urgency
Daytime leaks, urgency, and frequency in children, often related to an overactive bladder or to holding patterns. Management includes education, timed voiding, urge-management strategies, and age-appropriate pelvic floor coordination retraining.
Dysfunctional Voiding
Habitual tightening of the pelvic floor during urination, producing a hesitant or interrupted stream, incomplete emptying, and recurrent urinary tract infections. Physiotherapy retrains relaxed, coordinated voiding, with biofeedback appropriate to the child’s age where helpful.
Constipation & Stool Withholding
Chronic constipation and withholding are very common in children and are closely linked to bladder symptoms. Addressing toileting posture, bowel habits, and pelvic floor coordination is central, and is coordinated with the child’s medical care.
Faecal Incontinence (Encopresis)
Involuntary soiling, most often the result of chronic constipation with overflow rather than behaviour. Management combines a medical bowel-management plan with bowel retraining and pelvic floor coordination.
Recurrent UTIs & Bladder–Bowel Dysfunction
Where recurrent urinary tract infections are linked to incomplete emptying or constipation (bladder–bowel dysfunction), improving voiding mechanics and bowel habits can reduce recurrence, alongside the care of the child’s physician.
Giggle Incontinence
Involuntary loss of urine specifically triggered by laughing, most common in school-aged children. Bladder education, urge-management strategies, and pelvic floor coordination can help a child gain more control.
Babies & Infants
Torticollis & Plagiocephaly
Congenital muscular torticollis is shortening of the sternocleidomastoid muscle, producing a head tilt and rotational preference, and is frequently associated with positional plagiocephaly (asymmetrical head flattening). Early physiotherapy, ideally before three months of age, improves outcomes; addressing the muscular restriction is central to head-shape correction.
Tongue Tie & Feeding Difficulties
A shallow or slipping latch, clicking, long or tiring feeds, and discomfort can accompany a tongue tie (ankyloglossia) — restricted movement of the tongue — and the jaw, neck, and body tension that often travels with it. Physiotherapy and gentle infant bodywork address the movement and tension side of feeding, alongside lactation support and any release performed by a dentist or physician. We do not diagnose tongue tie or perform releases.
Tummy-Time Intolerance
Difficulty settling in or building strength through tummy time, often linked to neck or trunk tightness, reflux, or a positional preference. Graded strategies help a baby tolerate and benefit from tummy time, supporting head control and shoulder-girdle strength.
Low Muscle Tone (Hypotonia)
Reduced resting muscle tone that can make a baby feel ‘floppy’ and affect posture, feeding, and the timing of motor milestones. Assessment identifies contributing factors and guides a play-based strengthening and postural program, coordinated with the child’s physician where needed.
Pediatric Development & Movement
Gross-Motor Delay
Delay in achieving gross-motor milestones such as head control, rolling, sitting, crawling, and walking. Paediatric physiotherapy assessment identifies the movement components involved and provides a targeted, play-based program with home strategies for the family.
Toe Walking & Walking-Pattern Concerns
A persistent up-on-the-toes pattern beyond the toddler years, or questions about in-toeing, out-toeing, and flexible flat feet. Assessment looks at calf length, strength, and sensory or neurological contributors, and guides appropriate management.
Coordination & Balance
Clumsiness, frequent falls, or difficulty with age-appropriate coordination and balance in toddlers and preschool-aged children, addressed with a targeted, play-based program.
W-Sitting & Postural Habits
The W-sitting position and other habitual postures, and their effect on hip, core, and movement development, with guidance on positioning and strengthening.
Sources: prevalence and evidence statements above are drawn from the Cleveland Clinic (pelvic floor dysfunction), the World Health Organization (endometriosis), and published clinical-practice guidelines on pelvic floor muscle training. Figures are general epidemiological estimates and are not specific to any individual’s outcome.
The assessment
An initial assessment includes a subjective history of your symptoms, medical and obstetric background, and goals, followed by an objective examination relevant to your presentation. Internal (vaginal or rectal) examination is the standard method for assessing pelvic floor muscle function and is performed only where clinically indicated and with informed consent. Findings are explained, and you receive an individualized plan, which may include pelvic floor muscle training, manual therapy, biofeedback, bladder or bowel retraining, and a home program.
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If your concern is not listed, or you are unsure which applies, an assessment identifies the contributing factors and establishes an evidence-based plan.
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