Conditions We Treat
Pelvic health physiotherapy and pediatric care — all under one roof.
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 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.
Pediatric Development
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.
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.
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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