Episode 8 | Ask the Expert | Guest: Diedre – Pelvic Health Physiotherapist
Pelvic floor exercises are one of those things everyone has heard of and almost nobody fully understands. Most people associate them with pregnancy and the postnatal period. Very few know that pelvic health physiotherapy extends far beyond that – to men and women of all ages, across a wide range of conditions that significantly affect quality of life.
In this episode of the London Bridge Sports Medicine podcast, Dr Ajai Seth is joined by Diedre, a specialist pelvic health physiotherapist with over ten years of experience in the field. This is an introduction to pelvic health – what it covers, who it helps, and why so many people go years without getting the right support.
What is pelvic health physiotherapy?
Pelvic health physiotherapy was historically referred to as women’s health physiotherapy – a name that reflected its origins but not its current scope. The field now uses “pelvic health” deliberately, to reflect that it is relevant to everyone.
At its core, the specialism focuses on the pelvic floor – the group of muscles sitting at the base of the pelvis, through which the urethra, rectum, and reproductive structures pass. It also addresses the surrounding muscles, connective tissues, and neural structures, and incorporates an understanding of bladder and bowel function.
Conditions that pelvic health physiotherapy can help include:
- Bladder dysfunction – including urinary leakage with coughing, sneezing or exercise (stress incontinence), urgency, frequency, or difficulty fully emptying
- Bowel issues – including constipation, urgency, and leakage
- Pelvic pain – including pain during or after sex, pain in the perineal area, and discomfort around the genitalia
- Pelvic organ prolapse – where pelvic organs shift position due to muscle weakness or connective tissue changes
- Sexual dysfunction – in both women (pain with penetration or touch) and men (pain with erection or ejaculation, discomfort around the testicles or perineum)
- Postnatal recovery – addressing the physical impact of childbirth on the pelvic floor
Why does the pelvic floor matter so much?
Research on quality of life in people with pelvic health conditions makes a striking point. Studies on women with prolapse symptoms, for example, have found that their quality of life scores were significantly worse than those of people living with cancer or diabetes. This is not because prolapse is more medically serious than those conditions – it is because pelvic symptoms are often invisible, under-discussed, and therefore unaddressed.
People with bladder leakage stop leaving the house. People with pelvic pain stop exercising, stop socialising, stop having sex. People with unexplained discomfort around their genitalia spend years in the medical system looking for an answer that is sitting, unrecognised, in a physiotherapy specialism most of their doctors have never referred to.
“The symptoms can be really quite scary if you’re not sure what they are or what’s causing them,” says Diedre. And the isolation that comes from having symptoms you feel you can’t discuss compounds that.
This affects people of all ages
Pelvic health problems are not confined to older adults or women who have given birth. Diedre has seen patients as young as 20 or 21 with urinary incontinence. Bedwetting and bladder issues can persist from childhood into teenage years and beyond. Men in their 20s and 30s can present with unexplained pelvic pain or sexual discomfort. Athletes can develop pelvic floor dysfunction through the demands of high-impact sport or heavy lifting.
Her youngest patient with incontinence was in her early twenties. Her oldest was 89. The conditions she treats span that entire range.
Why does diagnosis take so long?
The delay between symptoms starting and appropriate treatment beginning is one of the most frustrating patterns Diedre describes. For men in particular, unexplained pelvic pain or sexual dysfunction tends to travel through a lengthy medical pathway – investigations for infection, structural causes, urological referrals – before anyone suggests physiotherapy.
Part of the problem is awareness. Many GPs are not fully aware of what pelvic health physiotherapy can offer, and so the referral does not happen. By the time a patient eventually arrives at a pelvic health physiotherapist, it may be years after their symptoms began – and chronicity makes conditions harder to treat.
Diedre is clear: “We would always say you should definitely get those symptoms checked medically first.” Ruling out infection, structural causes, and anything that needs medical management is the right starting point. But if investigations come back clear and symptoms persist, pelvic health physiotherapy should be the next step – not a last resort after years of waiting.
What does treatment involve?
Assessment involves an internal examination to evaluate the pelvic floor muscles – whether they are weak, overactive, or restricted – and to identify any trigger points or areas of dysfunction. External muscles, neural tissues, and bladder habits are all assessed as part of the picture.
Treatment is tailored to the findings. Critically, the approach depends entirely on what the assessment reveals:
- Weak pelvic floor: progressive strengthening exercises, building from basic contractions to more functional movements
- Overactive or tight pelvic floor: relaxation and downtraining techniques, soft tissue release, breathing work
- Bladder retraining: structured approaches to improving bladder capacity and reducing urgency
- Anxiety and psychological support: not formal psychology, but the kind of reassurance and guidance that makes an enormous difference when symptoms are frightening and isolating
For more than 80% of patients, Diedre says, treatment significantly improves symptoms. The important caveat: self-prescribing pelvic floor exercises without assessment can make things worse if the muscles are already overactive. Getting assessed first is essential.
What to do if you recognise these symptoms
- See your GP first. Rule out infection, structural causes, and anything requiring medical investigation.
- Ask for a referral to a pelvic health physiotherapist. This can be done via the NHS (though waiting times vary) or privately. Private health insurance often covers it.
- Don’t wait years. The sooner pelvic health is assessed, the more straightforward treatment tends to be. Chronicity makes conditions harder to address.
- Don’t self-prescribe. Pelvic floor exercises are not one-size-fits-all. Assessment determines whether strengthening or relaxation is needed – and getting that wrong can worsen symptoms.
The bottom line
Pelvic health is one of the most undertreated areas of physiotherapy – not because effective treatment doesn’t exist, but because awareness is low and stigma is high. The conditions it addresses are common, often distressing, and highly treatable. The gap between when symptoms start and when people get the right help is almost always longer than it needs to be.
If you have symptoms that fit – whatever your age or gender – it is worth asking the question.
For a more detailed discussion of men’s pelvic health specifically, listen to episode 16 of the LBSM podcast, where Diedre goes into greater depth on bladder issues, sexual dysfunction, and post-surgical rehabilitation in men.
Diedre is a specialist pelvic health physiotherapist with over ten years of experience treating men and women across a wide range of pelvic floor, bladder, bowel, and sexual health conditions.
To book an appointment with the LBSM team, visit lbsm.co.uk/booking
Listen to the full episode below ↓
