Physiotherapy for urogynaecological conditions

Some of the people we talked to had seen a physiotherapist for treatment for prolapse, urinary incontinence, bladder pain, repeated UTI infections, or chronic pain after surgery. Some physiotherapists specialised in pelvic floor health and may be referred to as women’s health physiotherapists.

This section covers:

  • Accessing physiotherapy
  • Experiences of seeing physiotherapists
  • Exercising the pelvic floor muscles
  • Other physiotherapy approaches and types of support

In this section we use the terms:
Pelvic organ prolapse (prolapse) is a condition in which pelvic organs, like the bladder and uterus (sometimes called the womb), move down or slip out of place and may bulge into the vagina.

Urinary incontinence is the unintentional loss of wee/urine. There are other bladder symptoms that do not involve incontinence, such as needing to urinate a lot, getting up at night a lot for a wee, or difficulties emptying the bladder.

UTIs (Urinary Tract Infections) are when bacteria infect the system that stores urine (such as the bladder). There are other types of conditions that can involve bladder irritation and pain, such as interstitial cystitis (also called bladder pain syndrome).

Accessing physiotherapy

Physiotherapy for urogynaecological conditions can be accessed through referral from the GP. Chloe and Sue Y lived in an area where they could self-refer to see an NHS physiotherapist. However, accessing physiotherapy wasn’t always an easy process for people we talked to. María had chosen not to see a physiotherapist.

Kerry would like for it to be an option to self-refer to physiotherapy for prolapse and for there to be more emphasis on non-surgical treatments.

Once referred by a GP, some people faced long wait times, particularly during the Covid-19 pandemic. Vickie, Elly, Kezia, and Alaina waited several months to get an NHS appointment to see a physiotherapist. Vickie said the wait had involved “some dark times and felt very lengthy for me”.

Vickie and Elly were concerned that their prolapses were becoming more severe whilst waiting for a physiotherapy appointment. Kerry, Kezia, Janet, and Iris felt that being able to refer themselves for physiotherapy would have been helpful, but this is not an available option everywhere.

Elly thinks that there should be an automatic referral for physiotherapy for those showing signs of prolapse after giving birth.

Some were able to look for options outside of the NHS after a long wait or a negative experience with physiotherapists. Kerry, Holly, Kezia and others said they had “lost patience” and “decided to go privately” to see a physiotherapist sooner. Beth, who was concerned that she had torn a muscle during childbirth, felt that she had to “fight” for care, and she eventually sought out a private physiotherapist. Sharon and Phoebe highlighted that private treatment could be very expensive and may not be an option for everyone.

Sharon and Beth had accessed physiotherapy classes and videos online, which they had found helpful. Until they were experiencing problems, Vickie and Catherine said they had not known that women’s health physiotherapy existed. If she had not been able to refer herself for physiotherapy, Chloe felt that she would have just “fallen through the net”.

Sharon felt unsupported by NHS physiotherapy services, so she paid for an online physiotherapy programme.

Hope, Sue X, and Mehar had not thought about seeing a physiotherapist to help with their urogynaecological condition, nor had it been suggested to them.

Experiences of seeing physiotherapists

Typically, a women’s health physiotherapist will discuss the nature and impact of symptoms and talk through exercises that might help. They may also suggest an examination to better understand what is happening with the pelvic muscles and organs.

Jo, a physiotherapist, discusses the importance of pelvic floor physiotherapy and what an appointment with a physiotherapist may involve.

Some women we talked to, like Iris, Alaina and Kerry, told us how important it had been for them to find a physiotherapist who they found supportive. Vickie said that her physiotherapist was so good at listening that she should get a “pay rise”. Without any “blame or shaming”, Iris’s physiotherapist helped her to get back to running despite incontinence. She had an internal massage to treat her hypertonic pelvic floor, so it was very important to her that she trusted her physiotherapist as she found the treatment embarrassing.

Jeannie felt that her NHS physiotherapist listened well and took the time to understand her needs.

Chloe self-referred to an NHS physiotherapist who was empathetic and gave her practical steps to improve her pelvic floor symptoms.

There were some people who told us about negative experiences, where physiotherapists had not been very knowledgeable or lacked a good bedside manner. Elly had been upset by a physiotherapist who told her that her prolapse “doesn’t look that bad” when she had been struggling for two years.

Some women like Leah, Phoebe, and Catherine had seen more than one physio and said they had very different experiences of care. Leah had issues with one of her physiotherapists giving “out of context” advice as they didn’t have as much “specialist knowledge” on treating people with UTIs. She prefers the care that she has had through a specialist UTI clinic, where the exercises are more focussed on internal massage and relaxing her pelvic floor. Eve found one of her physiotherapists “condescending” and was relieved to find another who “gets it”.

Catherine tells us about two very different experiences of physiotherapy and why the clinical relationship is so important.

Exercising the pelvic floor muscles

Elly “passionately” feels that women need to know more about pelvic floor exercises. Chloe, Sabrina, Catherine, and others told us that learning how to do pelvic floor exercises (also known as Kegels) was really important and should be part of a daily routine. Eve found that learning how to do pelvic floor exercises with a physiotherapist has helped her to now feel ready to have another baby. Rosie, who has urinary incontinence, said she had to be quite consistent with these exercises but found “it makes a difference quite quickly”.

Others, like Phyllis, Jackie, Elisabeth, and Sarah, had been doing pelvic floor exercises but felt it had not made a noticeable difference which made it difficult to stay motivated to do them. Sue Y saw two physiotherapists on the NHS, but ultimately found that pelvic floor exercises didn’t help her symptoms as much as she would have liked.

Chloe explains how she does her pelvic floor exercises.

Liz, Amy, Jeannie, and others said that it can be hard to know if you are were doing pelvic floor exercises “properly” unless a knowledgeable health professional was checking. Kerry, Elly, and Catherine felt like they had been sent away without really knowing what to do.

Although some women, like Phyllis, Holly, and Megan, found it “embarrassing” to have an internal examination, several others, like Beth and Jeannie, found it reassuring for the physiotherapist to check that they were doing the exercises the “right” way. You can also read more about experiences of pelvic examinations here.

Elly feels like she was sent off on her own to do pelvic floor exercises after her post-natal check. She thinks her prolapse worsened in part because she didn’t know how to do the exercises correctly.

Elly and Mary X had been given equipment by their physiotherapist to use at home to help with their pelvic floor exercises. Jenni and Jackie bought pelvic floor machines to help them. Jackie had used egg-shaped weights and an electrical stimulator, but she didn’t think it had made much difference.

Many women, like Eve, Jasmine, and Sabrina, told us that it was difficult to keep doing exercises regularly in the long term. Hope said if she knew that she was doing them correctly then she would be more motivated. For Jessy, Jasmine and others, the demands of busy lives meant that their pelvic floor health was not always at the top of the list. This could be especially difficult after having a baby, or while caring for children. A few, like Vickie, Sharon, Liz, and Beth, had found mobile phone apps helped them with their pelvic floor exercises.

Pelvic floor exercises were the last thing on Sabrina’s mind with the demands of having a baby.

Several, like Alaina, Iris, and Leah, and others had been told that their pelvic floor was overworking, hypertonic or ‘tight’, which this could make bladder symptoms worse. Physiotherapists had suggested yoga, Pilates, relaxation, stretching, and massage. Amy, Beth, Sharon, and others had tried a different type of exercises called ‘hypopressives’ which aim to lift the pelvic floor through breathing and exercise techniques.

Holly’s pelvic discomfort has improved after her physiotherapy treatment for overactive pelvic floor.

Other physiotherapy approaches and types of support

Amy said that physiotherapy should not be “just about your pelvic floor”, and we heard about some other physiotherapy approaches and types of support received. Phoebe, Janet, and others had talked to their physiotherapists about bowel management, diet, and the importance of avoiding constipation. Rosie’s physiotherapist had used massage to reduce pain from her episiotomy scar. Fran and Jackie had attended chronic pain management sessions following complications of surgery. Megan found that acupuncture from an NHS physiotherapist had reduced her bladder pain.

Janet is pleased that she was treated in a “holistic” way which included physiotherapy and pelvic floor exercises amongst other things.