Pelvic physiotherapy

The pelvis is a structure located between the hips. The pelvic floor is a group of muscles that support the bladder, bowel, and uterus.  

What is Pelvic Physiotherapy?

Pelvic physiotherapy aims to address any pelvic and pelvic floor problems you may have, such as pain in that area, issues affecting either the bladder and bowel, or both. It is a form of therapy that treats the muscles, nerves and tissues in the pelvic area.  The techniques could include, for example, manual or physical therapy given by physiotherapists and directed pelvic floor exercises you would do yourself.  

For patients with chronic pelvic pain, treatment might involve a programme of exercises to retrain your pelvic floor muscles. Often, endometriosis patients have overly tight pelvic floor muscles because they have unconsciously clenched them in response to pain. This can contribute to pelvic pain, so you would be taught how to relax those muscles.

Pelvic floor physiotherapy has been shown to have real and tangible benefits for women affected by pelvic pain, including endometriosis and post-surgery but more research is needed. Physiotherapy could help to reduce central pain sensitisation, which occurs when your experiences of pain make your brain and body more sensitive to pain signals. By helping to reduce pain sensitisation physiotherapy could help limit or prevent other health effects caused by unmanaged chronic pelvic pain (e.g., difficulty standing or sitting, attending family, social and sports activities) that can have a significant negative effect on quality of life.

It is important to note that the pelvic physiotherapy treatment approach is likely to look different to each individual dependent on their needs.  

With conditions such as endometriosis it may also involve working with other members of the multidisciplinary pelvic physiotherapy team to achieve the best long-term outcome for you.  This team could involve specialists in chronic pelvic pain management, dieticians, psychologists and counsellors.

Treatments may also consist of assessing and addressing any bladder, bowel, or sexual problems, and improving the functionality of your pelvic and pelvic floor muscles.  

Pelvic Health Physiotherapy may also be able to help with.

• Pelvic organ prolapse
• Bowel problems
• Bladder problems including urinary incontinence
• Pelvic pain, including pain during sex
• Antenatal health
• Postnatal recovery
• Pelvic floor rehabilitation

What do pelvic physiotherapy appointments involve?

You will meet with a Pelvic Health Physiotherapist. Pelvic health physiotherapists are specialist physiotherapists who work in many areas including obstetric, gynaecological, colorectal and urology care.

Usually, your appointment will start with your therapist taking a full medical history. They will ask you about your symptoms and any specific problems you are experiencing with your pelvic wellbeing, whether that’s mainly pelvic pain or other pelvic health issues which might be connected to your endometriosis, like urinary or bowel incontinence, constipation, scar tissue, or painful sex. They will discuss with you your priorities and what you want to achieve from your appointments.  

Your pelvic physiotherapist will then assess you, which sometimes might include an internal examination where appropriate. This will enable them to understand what factors are contributing to your problem and work with you to create a treatment plan tailored to your individual needs.

How can I access Pelvic Physiotherapy?

Usually, you will need to ask your GP, consultant, or specialist endometriosis nurse to refer you to what your health board might call either a Women’s Health Physiotherapist or Pelvic Health or Pelvic Floor Physiotherapist.

Unfortunately, physiotherapy specifically for endometriosis is not provided across the whole of Wales and different Health Boards currently provide different services.  Please see the individual Health board physiotherapy pages below for more information about pelvic physiotherapy service provision in your area:  

• Aneurin Bevan University Health Board
• Betsi Cadwalader University Health Board  
• Cardiff & Vale University Health Board
• Cwm Taf Morgannwg University Health Board  
• Hywel Dda University Health Board  
• Powys Teaching Health Board
• Swansea Bay University Health Board  

Further information regarding how to locate pelvic health physiotherapist can be found at the below directories.

Physiotherapists | POGP (thepogp.co.uk)

Find a private or NHS pelvic health physiotherapist (squeezyapp.com)

More information on Pelvic Physiotherapy in Wales

In 2018, the Welsh Government’s All-Wales Endometriosis Task & Finish Group recommended that all endometriosis patients should have access to non-surgical services, such as Pelvic Physiotherapy.  

In recognition of the need for multi-disciplinary care for pelvic pain patients, in 2018, the Welsh Government funded the creation of a network of Pelvic Health and Well-being Coordinators within each health board. They will have a clinical background from an appropriate discipline, e.g. physiotherapy or pain management and be tasked with developing services for their local area.