Pelvic floor or ‘lady bits’ worries? Why it’s time to see a women’s health physiotherapist

Pilates, Epping, Pregnancy, Ante Natal women’s health physiotherapist

Pelvic floor or ‘lady bits’ worries? Why it’s time to see a women’s health physiotherapist.

From pelvic pain during pregnancy, to urinary incontinence we often refer our Pilates participants and private clients to see a women’s health physiotherapist (WHP).

Unfortunately, women’s healthy physiotherapy services in the UK are so scarce and not readily available on the NHS to everyone, that not many women know a) what one is; b) what one does; or c) if they should see one.

As a Pilates teacher of 15 years, specialising in pre and post natal women and more recently the older population, I find it really disappointing that it’s usually me, a Pilates teacher, who is the first person to share with a woman who is struggling, that help is available.

We all know that post natal care is limited for new mums. And that whilst women on the continent receive women’s health physiotherapy as standard after birth, women in the UK rarely get their undercarriage or abdominals checked by a GP before they are signed off as ‘fit for life’.

This isn’t meant to be a political rant (apologies if it appears that way) more of a way of saying: Don’t feel shy about visiting a women’s health physiotherapist. Anyone can see one. If you need reassurance, or something doesn’t feel right, find one and book in. Women’s health physiotherapists would love for all women to get to see them.

Incontinence (even mild) during exercise or when sneezing isn’t something you should put up with.

Worries about returning to work because of the state of your bits are real and you don’t have to gloss over them.

If something doesn’t feel the same, DON’T JUST PUT UP WITH IT. There are specialists who can help.

What is a women’s health physiotherapist (WHP)?

A WHP specialises in all things pelvis, pelvic floor, incontinence, sexual disfunction and the pelvic muscular ‘stuff’ that can occur during pregnancy and after.

They specialise in:

  • Pelvis and pelvis pain
  • Urinary or faecal incontinence
  • Pelvic floor dysfunction
  • Pelvic girdle pain
  • Lower back pain
  • Pelvic organ prolapse and symptoms
  • Symphysis Pubis Dysfunction

In a nutshell it’s all the bits and pieces from the navel to the tailbone that requires hands on attention from a physiotherapist who specialises in the area. Sometimes it’s an outside in approach. Sometimes it requires internal examination or assessment.

Grading your pelvic floor

Did you know you can actually grade your pelvic floor according to its competence?

WHPs are widely available on the continent. In France and Belgium postnatal women are routinely examined and assessed by WHPs to ensure they are fit for life. Apparently these routine checks were implemented after WW2 to help re-populate the male population.

How do you get to see a WHP?

Anyone can self refer to a private WHP. If you have private health insurance you’ll need to check with your individual policy that you’re covered and may need a GP referral.

What will a WHP do?

Any internal examination is optional but beneficial. If you need an internal examination or treatment, your WHP will wear gloves to feel internally with one finger (palpate). This is usually with a finger (no cold speculums) and you’ll be asked to squeeze, to hold and to perform quick squeezes. This is to assess pelvic floor muscle function, to detect prolapse and/or pain.

Pelvic Floor Exercises

The internal and more detailed examinations a WHP can perform are vital if you are struggling with your pelvic floor. ‘One in four women are not performing pelvic floor exercises correctly based on written instructions alone,’ says WHP Zoë Eggleton, who practises both privately and for the Holly House Hospital. Thorough examination and assessment can help women to do exercises that will really improve their pelvic floor function.

When should you consider a visit to the WHP during pregnancy?

According to Zoë, pregnant women should consider visiting a WHP if they’re experiencing any of the following:

  • Leaking (losing urine) either steadily or when coughing/jumping.
  • Pelvic pain during exercise
  • Unable to exercise due to leaking or pelvic pain
  • Leaking or pelvic pain which is making normal activity difficult
  • Symphysis Pubis Dysfunction (SPD)
  • Pelvic girdle pain or lower back pain
  • Prolapse symptoms*
  • Concerns about diastasis recti (abdominal separation)

When should you consider a visit to the WHP post natal (or any other time)?

According to WHP Zoë, women should consider visiting a WHP if they’re experiencing any of the following:

  • Pelvic Girdle Pain which hasn’t settled down within six weeks of birth.
  • Prolapse symptoms*
  • Diastasis Recti**
  • Urinary or Faecal incontinence
  • Any concerns about sexual or pelvic floor function
  • SPD

Women who experienced SPD during pregnancy should consider a visit to the WHP for an assessment. If symptoms continue after the initial six week post natal period, a WHP can help to assess muscle tightness or stiffness in the joint, they can help mobilise and perform soft tissue work to ease the discomfort and help restore normal function to the pelvis.

Prolapse Symptoms

According to Zoë, 1 in 2 women have some sort of prolapse post birth but not all are symptomatic. Symptoms might be a pressure down below, a sensation of a lump in your vagina or that something has dropped or feels out of place. Symptoms may be worse during ovulation or during your period.

Diastasis Recti (abdominal separation)

Abdominal separation isn’t routinely checked by your GP. Midwives will check that your uterus has contracted but not the distance between your abdominals. You’re at greater risk if you’ve had a big baby (or a big bump), if you’ve had two pregnancies close together or if you’ve had twins (or more).

Abdominal separation is something I can check for in a post natal Pilates class. It’s something a WHP can also check for and assess.


WHPs can also help with C-sections after the initial six-week post natal period. A WHP can help with massage and therefore breaking down any external adhesions. They will also be able to refer on if more specialised care is needed.

Mummy MOT

In addition to WHP services, Zoë also offers a Mummy MOT which is a one hour consultation available to all post natal women (this is a private service). During the MOT you’ll go through delivery history and any previous obstetric history. You’ll have a bladder/bowel assessment as well as assessment for prolapse. You’ll discuss sexual function, pelvic floor exercises and be offered an assessment. You’ll get your tummy checked for separation and a postural assessment. You’ll also get advice on returning to exercise safely post baby.

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