Your Guide to Pelvic Health Physiotherapy: What to Expect at Your Assessment
With Emily Faragasso
Pelvic Health Physiotherapist
For many women, pelvic health symptoms can feel confusing, embarrassing, or simply something they “just have to live with.” Issues such as bladder leakage, pelvic pain, heaviness, prolapse symptoms, painful intercourse, or postnatal weakness are incredibly common- but they are not something you should ignore.
While most women are familiar with pelvic exams performed by a GP or gynaecologist, fewer understand the role of pelvic health physiotherapy and how a specialised assessment can help identify and treat the muscular and movement-related contributors to these symptoms.
Understanding what happens during a pelvic health physio assessment can help remove the fear and uncertainty, allowing you to feel informed, comfortable, and empowered to seek support
Why Might You Need a Pelvic Health Physio Assessment?
The pelvis is far more than just reproductive organs. It is a complex system made up of:
Pelvic floor muscles
Connective tissues and fascia
Bladder and bowel structures
Reproductive organs
Hips, pelvis, spine, and abdominal muscles
Breathing and pressure management systems
When this system is not functioning well, symptoms can appear in many different ways.
Common reasons people seek pelvic health physiotherapy include:
Urinary leakage or urgency
Pelvic organ prolapse symptoms
Pelvic pain
Pain with intercourse
Pregnancy-related pelvic girdle pain
Postnatal recovery
Abdominal separation (diastasis recti)
Constipation or bowel dysfunction
Return to exercise after birth
Research consistently shows pelvic floor muscle training is highly effective for many pelvic floor conditions, particularly urinary incontinence.
The evidence shows that women with stress urinary incontinence who completed pelvic floor muscle training were eight times more likely to report cure compared with women who received no treatment. Women were also significantly more likely to report improvement in symptoms and quality of life (Dumoulin et al., 2018).
Research has also shown that pelvic floor muscle training during pregnancy and postpartum can reduce the likelihood of urinary incontinence after birth. Studies found that continent pregnant women who performed supervised pelvic floor muscle training were less likely to report urinary leakage up to six months postpartum (Boyle et al., 2014).
Importantly, pregnancy and childbirth affect the pelvic floor regardless of whether birth was vaginal or via caesarean section. Muscles, connective tissue, breathing mechanics, posture, and abdominal wall function can all change during pregnancy and postpartum recovery.
What Happens During a Pelvic Health Physio Assessment?
Every assessment is tailored to the individual, with your comfort, safety, and consent at the centre of care. Your physiotherapist will take the time to explain each step clearly, check in with you throughout the assessment, and ensure you feel heard and supported at all times. We understand that pelvic health assessments can feel vulnerable, particularly for women with previous medical, birth, abuse or pelvic trauma experiences. You are always in control of the process- nothing is performed without your informed consent, and you can stop at any part of the assessment if you aren’t feeling safe & comfortable.
Our priority is creating a safe, respectful, and non-traumatising environment where your boundaries are listened to and honoured.
1. A Detailed History
The assessment begins with a thorough discussion about your symptoms, lifestyle, and goals.
This may include questions about:
Bladder or bowel symptoms
Pain patterns
Pregnancy and birth history
Exercise habits
Sexual function
Previous surgeries or injuries
Sleep, stress, and daily activities
Although some questions can feel personal, they help your physiotherapist understand the bigger picture and identify contributing factors.
Pelvic health symptoms are rarely caused by one thing alone — they often involve a combination of muscle function, pressure management, movement patterns, hormonal changes, and lifestyle factors. It is helpful to us to do a thorough assessment to fine tune what we need to look into further.
2. Physical and Biomechanical Assessment
Your physiotherapist will then assess how your body moves and functions as a whole.
This may include assessment of:
Posture and alignment
Hip and spinal movement
Breathing mechanics
Core muscle coordination
Ribcage and pelvic positioning
Abdominal wall function
Diastasis recti (abdominal separation)
Functional movements such as squats, lifting, or walking
The pelvic floor does not work in isolation. Breathing patterns, abdominal pressure management, posture, and movement strategies can all influence pelvic floor symptoms. Pelvic health physiotherapy is more than looking at just your pelvic floor.
What About the Internal Pelvic Examination?
An internal pelvic examination is sometimes recommended, but only when appropriate and always with your informed consent.
You are always in control of the assessment process, and you can decline or stop the examination at any time.
An internal examination allows the physiotherapist to assess:
Pelvic floor muscle strength
Endurance and coordination
Muscle overactivity or tension
Pain or sensitivity
Scar tissue
Vaginal wall support and prolapse
Ability to relax the pelvic floor
This assessment helps determine whether the pelvic floor muscles are weak, overactive, poorly coordinated, or struggling to relax effectively. Contrary to popular belief, not every pelvic floor issue is caused by weakness alone. Some women actually have pelvic floor muscles that are too tense or overactive, which can contribute to pain, urgency, constipation, or difficulty emptying the bladder properly.
Research supports digital vaginal assessment by trained clinicians as one of the most clinically useful ways to assess pelvic floor muscle function and guide individualised treatment planning.
The examination is typically gentle and performed in a private, respectful environment. Many women are surprised by how informative the assessment is and how much reassurance they gain from understanding what is happening in their body.
Pelvic Floor Problems Are Common — But Treatable
Many women normalise symptoms like leaking, heaviness, or pain after childbirth or during menopause. However, these symptoms are common, not “normal.”
Pelvic floor dysfunction can significantly affect:
Confidence
Exercise participation
Sleep
Sexual wellbeing
Work and social life
Mental health and body confidence
Evidence-based pelvic health physiotherapy can make a meaningful difference. Research supports pelvic floor rehabilitation as a first-line conservative treatment for urinary incontinence and postpartum pelvic floor dysfunction.
A pelvic health assessment is not simply about identifying weakness.
It is about understanding how your body functions as a whole so treatment can be individualised to you.
Treatment may include:
Pelvic floor rehabilitation
Breathing retraining
Strength and exercise programs
Return-to-running guidance
Manual therapy
Scar management
Education and lifestyle strategies
Support with confidence returning to activity
Most importantly, pelvic health physiotherapy aims to help women feel informed, supported, and empowered in their recovery.
You do not need to “put up with” pelvic floor symptoms, and seeking help early can often prevent symptoms from worsening over time.
Please reach out to us if you have any more questions or concerns that are stopping you from seeking treatment on what is often a very manageable issue.
References
Dumoulin C, Hay-Smith J, Mac Habée-Séguin G, Mercier J. Pelvic floor muscle training versus no treatment for urinary incontinence in women: Cochrane systematic review with meta-analysis. Neurourology and Urodynamics. 2015.
Boyle R, Hay-Smith EJC, Cody JD, Mørkved S. Pelvic floor muscle training for prevention and treatment of urinary and fecal incontinence in antenatal and postnatal women. Neurourology and Urodynamics. 2014.