What is a Womens Health Physio?

Have you ever thought, “I didn’t even realise a physiotherapist could help with that”?

You’re not alone.

We regularly hear women say they had been experiencing symptoms for months or even years before discovering that women’s health physiotherapy is a thing, and that it can help.

Physiotherapy is often associated with treating back pain and sporting injuries. While these are certainly areas physiotherapists work in, women’s health physiotherapy takes this knowledge further, applying it to the specific changes that women can experience across the lifespan.

A Women’s Health Physiotherapist has undertaken additional education and clinical training following their physiotherapy degree to develop specialised knowledge in areas including the pelvic floor, pregnancy, postpartum recovery, bladder and bowel health, pelvic pain, sexual health and musculoskeletal conditions affecting women.

Importantly, women’s health physiotherapy is not just about the pelvic floor (we often say, you are more than just a vagina)- it is about understanding the whole person in front of us, meaning we often want to assess from your head to your toes, plus ask a number of questions about your whole life (you may think you bowel habits as a child or your foot pain 3 years ago isn't relevant - but we want to know everything!)

What does a Women’s Health Physiotherapist treat?

Women’s health physiotherapy can support women across many different stages of life.

Some of the conditions commonly treated include:

Pregnancy-related pain and physical changes

Pregnancy can place significant physical demands on your body. As your baby grows your posture, centre of gravity, joints, muscles and pelvic floor are all adapting.

A Women’s Health Physiotherapist can help with conditions such as:

Pelvic girdle and pubic symphysis pain
Low back pain
Hip pain
Tailbone pain
Rib and upper back pain
Carpal tunnel symptoms
Pelvic floor symptoms during pregnancy
Incontinence (bladder and bowel)
Preparation for birth
Exercise during pregnancy

Pregnancy-related pain is common, but it is not something you have to put up with - we can assess what is contributing to your symptoms and provide strategies to help you remain comfortable, active and confident throughout your pregnancy.

Postpartum recovery

Having a baby is associated with major physical, mental and emotional changes, regardless of your mode of birth.

Postpartum physiotherapy can help you understand your birth story, what the symptoms you may be experience mean, and how to safely return to the activities that matter to you.

This may include support for:

Pelvic floor weakness or difficulty contracting the pelvic floor
Bladder or bowel changes such as incontinence and urgency
Pelvic organ prolapse symptoms
Abdominal wall changes/abdominal separation
Caesarean or perineal scar management
Pelvic or back pain
Pain with intercourse
Returning to exercise

There is no single “correct way” to recover postpartum.

Some women feel relatively well after birth, while others experience significant pain, weakness, leakage, heaviness or changes in sexual function.

You don't have to wait until something is severely affecting your life before asking for help. And if you are symptom free, we still recommend a check up to ensure your current strategies are working best for you.

What about abdominal separation?

Abdominal separation, (we prefer abdominal stretching) commonly referred to as diastasis recti, occurs in all women who are pregnant, as the abdominal wall adapts to the growing uterus - it is a necessary change to allow for baby to grow, but understandably can come with uncertainty.

A Women’s Health Physiotherapist can assess your abdominal wall, breathing and movement patterns and help develop an appropriate exercise program based on your body and goals. Ideally, we can help keep you moving comfortably and fully, learning how to modify rather than avoid movement.

Pelvic floor physiotherapy

The pelvic floor is a group of muscles that sits at the base of the pelvis, and has several important roles, including supporting the pelvic organs, contributing to bladder and bowel control, sexual function and stability of the pelvis.

Pelvic floor problems can occur at any age and are not only associated with pregnancy and childbirth.

We can assist with:

Urinary incontinence
Faecal or bowel leakage
Urinary urgency and frequency
Difficulty emptying the bladder or bowel
Pelvic organ prolapse
Pelvic floor weakness
Pelvic floor overactivity or tightness
Difficulty relaxing the pelvic floor
Pelvic pain
Sexual pain
Pain associated with penetration
Recovery following birth
Menopausal changes

A strong pelvic floor should move; that means it should both squeeze and lift, and also drop and open.

This is important.

Many people assume that pelvic floor physiotherapy simply means doing more pelvic floor squeezes.

But for some women, the pelvic floor is already working too hard and has difficulty relaxing. In these situations, repeatedly strengthening or contracting the muscles may not be appropriate, if they are unable to soften and relax.

A thorough assessment helps determine whether the pelvic floor needs strengthening, coordination, relaxation, improved endurance, or a combination of different approaches such as external support devices or changes to posture.

Pelvic organ prolapse

Pelvic organ prolapse occurs when one or more of the pelvic organs moves downwards and creates a change in the sposition of the vaginal walls.

Women may describe symptoms such as:

A feeling of heaviness/pressure/bulging (sometimes described as the sensation of a dislodged tampon)
A sensation of something “dropping”
Difficulty emptying the bladder or bowel
Changes in sexual function

Prolapse can be understandably frightening, particularly when a woman first notices a bulge or pressure.

However, a diagnosis of prolapse does not mean that you have to stop exercising, lifting or moving. Management will depend on your body and the activities that contribute to your symptoms. We can do a lot to support you and your pelvic floor; both by reducing the downward pressure (managing constipation, breathing patterns, rib and belly tightness), as well as increasing the upwards support (pelvic floor strength/coordination, pessary, external support devices).

Sexual pain and pelvic pain

Sexual pain is another area where many women don't realise physiotherapy may be able to help.

Pain with penetration can feel burning, stinging, aching, tight, sharp or uncomfortable. Some women describe feeling as tif something is in the way/blocking the vaginal opening.

There can be many contributing factors, including:

Pelvic floor muscle overactivity/sensitivity
Scar tissue
Vulval or vaginal conditions
Hormonal changes
Pelvic pain conditions e.g. endometriosis, adenomyosis
Nervous system sensitivity
Previous negative or traumatic experiences

This is an area where trauma-informed care is particularly important; we discuss your symptoms and past history thoroughly and understand when the body is consenting to assessment and treatment, and when we need to give it space and focus elsewhere.

Pain during sex is not something you should be told to simply “push through”.

What happens during a Women’s Health Physiotherapy appointment?

One of the most common concerns women have before their first appointment is fear of the unknown, and potentially being embarrassed. Each session is very individual and based on your comfort levels. Initially, we spend a lot of time discussing your symptoms, educating you on potential contributing factors and then discussing the options for assessment and treatment.

We may ask about:

Your current symptoms
When your symptoms started
Your bladder and bowel habits
Pregnancy and birth history
Menstrual or menopausal symptoms where relevant
Sexual function and pain
Previous injuries or surgery
Exercise and activity
Your work and daily activities
Your goals
What you are most concerned about

This conversation is an important part of the assessment.

Will I need an internal examination?

Not necessarily.

This is an important point that we want every woman to know before attending a pelvic health appointment.

Depending on your symptoms, an internal vaginal or rectal assessment may provide useful information about the pelvic floor muscles and surrounding tissues. However, it is not automatically required, and you should never feel that you have to consent to an internal examination simply because you have booked a pelvic health appointment.

An assessment may include:

External assessment

Your physiotherapist may look at how your:

Back
Pelvis
Hips
Abdominal wall
Breathing
Posture
Movement patterns

are working together.

Internal assessment

If appropriate, and only with your informed consent, your physiotherapist may assess the pelvic floor muscles internally, both laying down and standing/moving.

This may provide information about:

Muscle strength
Endurance
Coordination
Muscle tone
Ability to relax
Tenderness
Scar tissue
Muscle control

When should I see a Women’s Health Physiotherapist?

You don't have to wait until your symptoms are severe.

Consider speaking with a Women's Health Physiotherapist if:

You leak urine when coughing, sneezing, exercising or running
You experience urinary urgency or frequency
You have difficulty controlling your bowel or bladder
You feel heaviness or pressure in your pelvis
You notice a vaginal bulge
Sex is painful
You experience pelvic pain
You have ongoing pain during pregnancy
You are preparing for birth
You are recovering after having a baby
You are unsure how to return to exercise after pregnancy
You have concerns about abdominal separation
You want help strengthening or relaxing your pelvic floor
You are experiencing pelvic health changes around perimenopause or menopause
Something doesn't feel right and you aren't sure who to ask

If you're unsure whether women's health physiotherapy is appropriate for you, you can contact our team to discuss your concerns and determine the most appropriate next step.