Pelvic Floor Physio: What It Is and Why People Rave About It

Pelvic floor exercises have long been something you get told to do at traffic lights, with no idea if you're doing them correctly. Meanwhile, people who've actually seen a pelvic health physio tend to talk about it the way people talk about a really good mechanic: "Why didn't anyone tell me about this 10 years ago?" If you've got pain, leaks, trouble with orgasms or erections, this may be the most useful appointment you never knew about.

What is your pelvic floor?

It's a hammock of muscles sitting at the bottom of your pelvis, from your pubic bone to your tailbone. It holds up your bladder, your bowel and, if you've got one, your uterus. It controls when you pee and poo, and it also plays a big part in sex. These are the muscles that contract when you come. Everyone's got one, whatever their gender.

What can a pelvic health physio help with?

• Painful sex, including vaginismus, vulvodynia and pain after birth or surgery.
• Leaking when you laugh, cough or jump, or even during sex or orgasm. It's common. It isn't something you just have to accept.
• Recovery after childbirth, including tears, scars and caesarean recovery, and prolapse.
• Changes in menopause.
• Endometriosis and pelvic pain.
• Men's issues, including erection problems, coming too fast, leaks and recovery after prostate surgery.
• Weak orgasms, or trouble reaching them.
• Pain with anal play, haemorrhoids, constipation or bowel problems.

Weak or too tight?

Here's what most of us have got wrong. Everyone assumes the pelvic floor's only ever weak, and that the answer's more squeezes. But many people have a pelvic floor that's too tight and can't relax. For those people, doing more kegels can make their pain worse. A physio can work out which one you have, and that's why it's worth getting checked before you start buying weights.

What happens at an appointment?

This is the part that makes people nervous, so here's how it goes.

1. You'll talk. They'll ask about your symptoms, your bladder and bowel habits, your sex life, and your medical and birth history. Nothing you say will shock them. They've heard all of it.
2. They may look at how you move. Your posture, breathing and hips all matter.
3. They might offer an internal examination, using a gloved finger in your vagina or your rectum, to feel how your muscles are working. It's always your choice. You can say no, or stop at any point, and they can often learn a lot without it. Some use real-time ultrasound on your belly instead.
4. They'll give you a plan. That might include exercises, breathing and relaxation, massage, stretches, or help with your bladder or bowel habits, and sometimes the use of tools like dilators or a wand.

If you've experienced trauma, tell them, if you'd like to. You can bring someone with you, and go at your own pace. A good physio's going to keep checking your consent the whole way through.

How to find one

Look for a physiotherapist who specialises in pelvic health, women's or men's health. The Australian Physiotherapy Association's "Find a Physio" tool and the Continence Foundation of Australia can both help. You don't need a referral for a private physio, although a GP can organise a Chronic Disease Management plan, which might get you a Medicare rebate for some sessions. Ask about costs first. You can call the National Continence Helpline on 1800 33 00 66 for free advice.

What about kegel balls and other toys?

Weighted balls can be fun, and they might be useful for some people. But they aren't right for everyone, and heavier isn't better. If your pelvic floor's tight, they could make things worse. That's why a physio's advice is so useful. If you do want to try them, start light. The Fun Factory SmartBalls Duo are $18.95, and our kegel ball guide explains size and weight. Keep them clean, too, and here's how.

Your physio may also suggest dilators for vaginismus or after certain treatments, and they can tell you which ones are best, how to use them and when to start. Don't try to treat a serious pain problem on your own.

Better sex, too

People often go to fix a problem, and they end up with better sex as well. A pelvic floor that's working properly can lead to stronger orgasms, better control and more awareness of what's going on down there. Some blokes find they've got more control over when they come. People with vulvas can often feel more of what's happening. It's a nice bonus for what's otherwise a very boring exercise program. So book it in. You've got nothing to lose, except maybe the urge to cross your legs every time you sneeze.

This is general information, not medical advice. Please see a health professional about any ongoing symptoms.