Perinatal Pelvic Health Service

What is the Perinatal Pelvic Health Service?

This service supports pregnant people during pregnancy and up to one year after birth who are experiencing pelvic health problems such as incontinence or prolapse. We work as part of a wider team alongside pelvic health midwives, obstetricians, and health visitors, and also play a role in the perineal clinic.

Being pregnant puts extra strain on the pelvic floor complex - a group of muscles and ligaments at the base of the pelvis that support the bladder, bowel, and uterus. These structures are stretched during birth, so it’s common for pregnant women to experience leakage (incontinence) of urine or faeces, or to feel as though their pelvic organs are sitting lower in the vagina, known as prolapse. Sometimes, after having a baby, it’s possible to experience pain during sex.

Often, practising regular pelvic floor muscle exercises during pregnancy and after birth will resolve these problems. You can find information about these exercises below.

Another common problem during pregnancy is pelvic girdle pain. One in five women experience significant symptoms of pain in and around the joints of the pelvis. The tissues in this area become more sensitive during pregnancy, which can mean they are more easily irritated by normal activities or positions. Often, following simple advice and improving your general health and stress levels will reduce symptoms. Information and exercises can be found below.

Referral information

Patient referrals may be initiated by a GP, your midwife or by an consultant.

What do we treat?

Our specialist physiotherapists can help you with a range of conditions including:

bladder incontinence and/or urgency
leaking with exercise or coughing and sneezing
bowel incontinence or urgency and/or constipation
pelvic pain including - vulvodynia/vaginismus/bladder pain syndrome
pelvic organ prolapse (POP)
sexual dysfunction or discomfort
pregnancy-related pelvic girdle pain
perineal trauma.

Physiotherapy can also address some of the many side effects of menopause, including physical aches and pains, vaginal symptoms, and pelvic floor muscle rehabilitation.

What to expect at your physiotherapy appointment

What happens during a pelvic health physiotherapy appointment?
A detailed history of the problems you are experiencing will be taken. Some questions may be of a personal nature to gain a full understanding of your concerns. You will also be given the opportunity to ask any questions you might have.

You may be offered an internal (vaginal or rectal) pelvic floor examination. This is not compulsory but is a valuable part of the assessment, enabling your physiotherapist to provide individualised treatment and ensure you can activate your pelvic floor muscles correctly. Your physiotherapist will discuss the examination in detail during your appointment, and a chaperone can be arranged if you wish

What does pelvic health physiotherapy treatment involve?
Pelvic health physiotherapy treatment is based on exercise and advice tailored to you following a detailed assessment. It may also involve some manual therapy, relaxation and breathing techniques. To achieve the best outcome, it’s important to take an active role in your rehabilitation and follow your physiotherapist’s advice.

Antenatal (pregnancy) education

Pregnancy-related pelvic girdle pain (PGP)
Pelvic girdle pain (PGP) refers to pain felt around the pelvis. The discomfort can be felt over the pubic bone at the front, your lower back, your bottom, your groin, your hips and can spread down your legs. It is a common condition affecting about half of women during their pregnancy.

You may experience the following symptoms:

difficulty walking, standing on one leg or climbing stairs
clicking or grinding in the pelvic area
difficulty lying in some positions or turning over in bed
pain and/or difficulty moving your legs apart
pain and difficulty during sexual intercourse.

Management of PGP

General advice is available in the leaflet below. If your symptoms do not improve, physiotherapy may help. You can be referred by your midwife or GP.

Pregnancy Related Pelvic Girdle Pain and other common conditions in pregnancy

Pelvic floor exercises
The pelvic floor muscles (PFM) are at the bottom of your pelvis. They support the pelvic organs and help control the bladder and bowels.

When to start
If you have a urinary catheter, wait until it is removed and you are passing urine normally before starting these exercises.

Pelvic floor muscle exercises are needed to:

improve muscle strength so that you can control your bladder and bowel
support your pelvic organs, helping to prevent prolapse.

Remember to:

start the pelvic floor muscle exercises as soon as possible, after any catheter has been removed
do the exercises in varying positions, but if you are sore in the early days, lying on your side might be most comfortable
do gentle, rhythmic tightening and relaxing of the muscles, which will help ease discomfort, pain and swelling, and will aid healing if you have stitches following an episiotomy or perineal tear.

View this video for further information: How to do pelvic floor exercises | NHS

Perineal massage
The perineum is the area of skin and muscle between your vagina and anus (bottom). This area naturally stretches to allow your baby’s head and body to be born. This stretching can result in tears to the perineum and vagina if the skin cannot stretch enough to accommodate the baby’s birth.

Perineal massage has been shown to reduce your risk of perineal tears and episiotomies during vaginal childbirth by stretching the muscles and tissues around your perineum.

When to start?
You can start any time after 34 weeks of pregnancy. Details of how and when to perform this are included in the leaflet and video below.

Fit for Birth — exercises and advice
When to start and how to do perineal massage

Postnatal (post-pregnancy) education

Week 1: Bladder care
In the first 24 hours after vaginal or c-section birth:

start your pelvic floor muscle exercises (after any catheters are removed)
drink at least 1.5 to 2 litres of fluid every day
remember to empty your bladder every 3 to 4 hours
try to move regularly
avoid straining.

Pain relief and perineal care
You may have had a tear or a cut of your perineum during birth. The perineum is the area of skin and muscle between your vagina and anus (bottom). It is common to be stitched to help the healing of these tissues. The stitches can take up to 3 months to dissolve.

Scar massage can improve comfort and healing after a tear or cut during vaginal childbirth.

How and when to do scar massage

Start scar massage when the wound is completely closed.
Use a natural lubricant or oil like almond oil, olive oil, coconut oil or non-fragranced moisturising cream. Do not use any oil you are sensitive or allergic to.

Watch the following video for more information: Pain management and wound care.

C-section care
A Caesarean-section (or ‘C-section’) is major abdominal surgery, as well as giving birth to your baby. You may experience higher pain levels and a slower recovery, so try to be mindful of this when returning to movement and activity, and progress gradually.

Pelvic floor exercises
The pelvic floor muscles (PFM) are at the bottom of your pelvis. They support the pelvic organs and help control the bladder and bowels.

When to start

If you have a urinary catheter, wait until it is removed and you are passing urine normally before starting these exercises.

Pelvic floor muscle exercises are needed to:

improve muscle strength so that you can control your bladder and bowel
support your pelvic organs, helping to prevent prolapse.

Remember to:

start the pelvic floor muscle exercises as soon as possible, after any catheter has been removed
do the exercises in varying positions, but if you are sore in the early days, lying on your side might be most comfortable
do gentle, rhythmic tightening and relaxing of the muscles, which will help ease discomfort, pain and swelling, and will aid healing if you have stitches following an episiotomy or tear, on your perineum.

View the video or booklet below for further information on how to perform PFM exercises.
Pelvic floor muscle exercises booklet
How to do pelvic floor exercises | NHS video

Diastasis Recti
During your pregnancy your abdominal (tummy) muscles stretch as your baby grows. This stretches the abdominal muscles and the fibrous structure that runs down the middle of the tummy, called the linea alba, resulting in Diastasis Recti. All women experience changes in their tummy muscles during the third trimester. It is normal for these changes to be present in the early stages post-delivery. 

Recovery can take between 9 weeks and 2 years after delivery - this is normal

To help abdominal (tummy) muscles recover we recommend completing regular low level, core exercises. You can start Postnatal Pilates from around 4 weeks post-delivery. Please speak to a postnatal fitness professional or Pelvic Health Physiotherapist for further guidance. 

View the video below for further information.
After birth – your stomach muscles

After you have had your baby you should aim to gradually build up your exercise and activity over 6-8 weeks. You can start pelvic floor muscle exercises and breathing exercises within the first few hours after birth. The booklet and video below explain essential advice and exercise following childbirth.

At your 6 to 8 week check with your GP, your physical health and mental wellbeing should be reviewed. This is good time to have a review with a specialist Pelvic Health Physiotherapist to support your return to exercise.

Advice and exercises following childbirth
After birth – return to exercise