Physiotherapy in the Management of Pelvic Floor Dysfunction

Physiotherapy in the Management of Pelvic Floor Dysfunction

Pelvic floor dysfunction is a common yet often underdiagnosed condition affecting women across the lifespan, particularly during the postnatal period and perimenopause.
While medical and surgical interventions play an important role in managing complex cases, early conservative treatment — specifically pelvic floor physiotherapy — is strongly supported by clinical guidelines and research evidence.

Timely referral to a qualified pelvic floor physiotherapist who treats pelvic floor dysfunction can significantly improve patient outcomes, reduce progression of dysfunction, and delay or avoid the need for surgical intervention.
This article outlines key scenarios where physiotherapy can be an effective adjunct in the management of pelvic floor disorders.

The Role of Pelvic Floor Physiotherapy

Pelvic floor physiotherapy involves the assessment and treatment of pelvic floor muscles and associated structures through evidence-based exercise therapy, manual techniques, behavioural education, and biofeedback modalities.

Therapeutic goals typically include:

• Improving pelvic floor muscle strength, endurance, and coordination
  
  
• Addressing myofascial dysfunction and scar tissue restriction
  
  
• Restoring normal bladder and bowel habits
  
  
• Reducing prolapse symptoms
  
  
• Managing pain syndromes, including dyspareunia and chronic pelvic pain
  
  

A physiotherapist trained in pelvic health can tailor interventions according to each patient’s specific functional deficits, symptomatology, and coexisting musculoskeletal issues.

When to Consider Referral to Pelvic Floor Physiotherapy

Referral to physiotherapy is appropriate in a broad range of clinical scenarios, including:

1. Stress Urinary Incontinence (SUI)

First-line management of SUI includes supervised pelvic floor muscle training programs.
The 2017 International Continence Society guidelines recommend at least 3 months of structured pelvic floor rehabilitation before considering surgical options.
Patients reporting leakage during coughing, sneezing, or exercise typically benefit from physiotherapy-led strengthening and coordination retraining.

2. Pelvic Organ Prolapse (POP)

For women with stage I or II prolapse who are symptomatic, pelvic floor muscle training can reduce symptoms and improve support.
Physiotherapy may be combined with pessary management when appropriate.

3. Overactive Bladder (OAB) and Urgency Symptoms

Bladder retraining strategies, combined with pelvic floor muscle control techniques, are central to conservative management of urgency urinary incontinence and frequency syndromes.

4. Pelvic Girdle Pain and Postnatal Musculoskeletal Dysfunction

Pregnancy and childbirth can lead to lumbopelvic instability, sacroiliac joint dysfunction, and pelvic floor muscle weakness.
Physiotherapists can address both local pelvic floor impairments and associated biomechanical dysfunctions contributing to pain or disability.

5. Chronic Pelvic Pain Syndromes

In conditions such as vulvodynia, interstitial cystitis/bladder pain syndrome, and nonspecific pelvic pain, physiotherapy focusing on muscle relaxation, desensitisation, and myofascial release techniques has been shown to improve pain and quality of life.

6. Pre- and Postnatal Rehabilitation

Physiotherapy is increasingly recognised as a key component of postnatal care, even in the absence of overt dysfunction, to promote recovery, optimise pelvic floor function, and support safe return to activity and exercise.

Evidence Supporting Physiotherapy Referral

Numerous studies support the efficacy of pelvic floor physiotherapy, particularly when intervention occurs early. Key findings include:

• Pelvic floor muscle training reduces urinary incontinence rates by up to 70% compared to no treatment (Cochrane Review, 2014).
  
  
• Physiotherapy can significantly reduce prolapse symptom severity and delay surgical consideration in early-stage POP (Pelvic Floor Disorders Network studies).
  
  
• Conservative management is cost-effective and associated with high patient satisfaction rates when appropriately prescribed.
  
  

Physiotherapy should be considered an essential first-line or adjunctive therapy, rather than a last resort, for women experiencing pelvic floor dysfunction.