Consultation and Treatment
What to expect during a consultation:
Firstly, the physiotherapist will take a thorough history asking personal questions about your sex health, bladder and bowel habits, menstruation and kind of delivery as well as the duration of the delivery. She may also ask you questions about your pain, when you notice it the most, how it affects your daily life and what your goals might be.
The more information you can give, the better the physical therapist can help determine the right course of treatment for you.

Education will be done on:
- Bladder and bowel function in relation of the pelvic floor muscle
- Bladder and bowel irritants
- Optimizing bladder and bowel habits
- Toilet posture
- Optimise breathing, core function and muscle condition around the pelvis
- Activation and relaxation of the pelvic floor
- Techniques and advice regarding dyspareunia (painful intercourse)


After a conversation, there will be an external and internal exam to assess range of motion and strength of different muscle groups.

External Examination:
- Soft-tissue structures of the abdomen, trunk, bony pelvis, and legs
- Skeletal structures of the pelvic ring and lumbar spine
- Scar mobility examination.
- Biomechanics/Motor Control evaluation

Skin inspection and internal examination


1.Skin inspection:
- Vulva skin colouring, atrophic or dermatologic changes, fissures
- This is important to determine if the patient needs a referral to a medical doctor.
- Internal pelvic floor muscle examination
- Healthy muscles do not hurt when they are palpated.
- A physical therapy internal examination also includes examination of the vulvar and peri-urethral connective tissue, palpation of all pudendal nerve branches, the pelvic floor muscle and a more involved investigation of a patient’s motor control, muscle length, and strength and endurance.

2.Physical Therapy Assessment and Treatment Plan

Following the history taking, the physical examination, and assessment a treatment plan will be formulated, discussing short and long-term goals. (2hour session during first consultation)
There after the sessions will be hands for an hour per week or every second week for
roughly for 3 months
Physiotherapy options
  • Multidisciplinary approach – referral to other professionals for advice and help to improve the outcome of a successful rehabilitation e.g. medical doctor for medication.
  • Pain physiology education
  • Peripheral and central nervous system desensitization strategies
  • Behavioural and lifestyle modifications.
  • Pelvic Floor and Pelvic Girdle Neuromuscular Re-education

  • Manual Therapy Techniques:

- Pelvic Girdle alignment

- Connective Tissue Manipulation

- Myofascial release and myofascial trigger point release

- Neural mobilizations

- Joint mobilizations


  • TENS:
Trans Cutaneous Electrical Stimulation is a neuromodulation therapy where a low voltage electrical current is used to stimulating the nerves in the pelvic floor or lower back via a vaginal or an anal electrode to strengthen the pelvic floor muscle or to inhibit the detrusor overactivity.

  • Biofeedback:
- Biofeedback tells you when your bladder and urethral muscles contract, to help you gain awareness and control of your urinary tract muscles.
- This means that weak muscles can be better activated on demand, muscles that are too tense can be relaxed, and overall muscle activity can be coordinated.

- Biofeedback can take different forms:
  • The physiotherapist's hand: can you squeeze your muscles round a finger
  • A tampon: can you resist its removal?
  • Manometry: small balloons are put in your vagina or anus and filled with air or water. You contract your pelvic floor muscles and the pressure on the balloons measures the strength of the muscles in your pelvic floor.

Electromyography (EMG): electrical sensors are placed on the skin inside the vagina or the anus to measure the electrical activity of your muscles at rest and when they contact. The reading is shown either on a graph or screen.


  • Home exercise program development to supplement in-office treatments.
- Foam rolling
- Pelvic floor muscle relaxation exercises
- Diaphragmatic breathing
- Scar mobilising
- Stretching when appropriate
- Strengthening if weak
- Dilator exercises

  • Vaginal weights:
Vaginal weights are plastic cone (variable sizes and weight) inserted into the vagina for progressive length of time during daily activities to strengthen the pelvic floor muscle.