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When should I see a physio?

by | Sep 23, 2022 | Body Positive, Women's Health, Women's Health and Fitness Summit

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A pelvic health physiotherapist is the starting point to work out any issues you may be experiencing. These might be new or changing experiences due to having children, hitting menopause, or even changing your exercise routine. Bypass the Instagram doctors and get the right info from the right people.

I have been talking, writing, and teaching about vaginas for over a decade. This has included the fitness industry, clients, my friends, family, and anyone who watches my Instagram reels and TikToks!

My openness around this subject means that people feel very comfortable reaching out to me and asking me hairy and/or personal questions. Of this, I am grateful. Because I know that shame and secrecy are 2 significant hurdles to getting the right help and support.

The questions I get all vary in nature, but are mostly personal and about changes that have them concerned. However, my answer always starts the same way:

First thing – you need to see a pelvic health physiotherapist to find out what is causing this issue before we look at solutions.

What is the difference between a women’s health physiotherapist and a pelvic health physiotherapist?

Firstly, it is crucial to understand the differences between regular physiotherapists and pelvic health physiotherapists.

A pelvic health physiotherapist has a specialised postgraduate qualification in this area. If your issues concern anything to do with your pelvic area, like:

  • continence issues (both fecal or urinary) or just not feeling like you are fulling emptying your bladder or bowel
  • pelvic pain (in general, or painful sex or when trying to insert fingers or tampons into the vagina)
  • ongoing urinary tract infections
  • prolapse
  • unsure how to contract your pelvic floor
  • lower back pain
  • diastasis (the splitting of the abdominal muscles)
  • any other concerns (and this might include mastitis)

Originally physiotherapists who undertook these extra studies were referred to as women’s health physiotherapists because women were the majority of their clients. However, as men have pelvic floor muscles, they are also susceptible to issues. For example, regaining continence after prostate cancer or surgery. But there is also a growing number of young men who can push themselves to rectal prolapse – from pushing too hard. This can be a result of inappropriate lifting at the gym or constipation.

Therefore the more inclusive term is pelvic health physiotherapist.

You can find a pelvic health physiotherapist near you by using this website.

How can a pelvic health physiotherapist help me?

A pelvic health physio is a person who can help diagnose any concerns you have. Unfortunately, your GP does not have these specialised skills and rarely will include actual questions about your pelvic health or toileting habits at checkups.

Getting the right diagnosis is key to unlocking your solutions.

More pelvic floor exercises do not always mean a strong pelvic floor.

Here is Mary’s story.

Mary notices that she is starting to leak while running or doing high-intensity work at the gym. She fully understands that her pelvic floor is responsible for her continence, so Mary steps up her pelvic floor contractions. Several times a day, she squeezes her pelvic floor tight and sees how long she can contract it.

However, now Mary is leaking not only during those high-intensity workouts but during her daily walk. Even Mary can see that her increased pelvic floor contractions are making her problems worse, not better.

Because Mary has not had a proper diagnosis, she is unaware that her pelvic floor is not relaxing completely. And clamping on her pelvic floor and keeping it on; does not necessarily mean it is getting stronger. But the muscles may be experiencing fatigue from overuse and not be able to contract in the responsive way that the pelvic floor is designed.

Mary goes to the pelvic health physio and receives the correct diagnosis. She has been prescribed a pelvic floor training regime that includes “down training” (learning how to relax her pelvic floor fully). After a few short weeks, Mary notices that her pelvic floor is working, and she can now enjoy her runs, wee-free!

Core includes pelvic floor.

This is Sarah’s story.

Sarah is a 34-year-old lawyer. Sarah has not had any children and takes her health and well-being seriously. She recently started pilates to focus on her core, as she has some lower back niggles from long hours sitting at work. However, since beginning pilates, Sarah now finds she cannot hold off going to the toilet when she needs to go. So now when she has gotta go – she’s gotta go! This is playing havoc with her work and the need to be present at long meetings.

Sarah goes to see a pelvic health physiotherapist because her inability to control herself impacts her work and even her ability to sit through a full-feature film!

The pelvic health physiotherapist can diagnose that when Sarah hears the word “core” while at pilates, she is isolating and contracting her deep core muscles – her transverse abdominus, her internal and external obliques, and her rectus abdominals. However, she is not contracting her pelvic floor. These muscles work together as a team. A sealed unit that manages her intra-abdominal pressure. When one of the team players is not doing their bit, there will be dysfunction.

In Sarah’s case, all the downward pressure on her pelvic floor was causing stress. Her pelvic floor was letting her know it needed to be included as part of her core training!

The pelvic health physiotherapist, with the use of ultrasound, showed Sarah the difference between contracting her core with her pelvic floor.

If you want to see an example of why and how pelvic health physiotherapists use real-time ultrasound – CLICK HERE.

However, not all pelvic health physiotherapists are created equal.

Tune into my next blog which will give you tips on finding the best pelvic health physio for you!

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Golda sahaya Rani R, Aruna S, & Vijayaraghavan R. (2020). Plyometrics and lifestyle effects on bone mineral density among premenopausal women: demographic and physiological analysis. International Journal of Research in Pharmaceutical Sciences, 11(3), 4126–4134. Retrieved from

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