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How to Pelvic Floor: The Physio’s Guide to Leaking, Prolapse and Pain

  • Writer: Dr Natalie Hutchins
    Dr Natalie Hutchins
  • 12 minutes ago
  • 3 min read

Introduction


Pelvic floor dysfunction affects millions of women in the UK, yet many symptoms- bladder leakage, pelvic organ prolapse, and pain- are still dismissed as “normal after childbirth” or “just part of ageing”. But the reality is that whilst they’re common, they’re not normal or inevitable.


In this episode of The Women’s Handbook Podcast; How To be A Woman, I’m joined by specialist women’s health physiotherapists Monica Donaldson and Tamara Gerdis from Physio Down Under to explore pelvic floor health across the female life course: from adolescence, through pregnancy and childbirth, to menopause and beyond.


This episode focuses on evidence-based assessment and non-surgical management, helping women understand what the pelvic floor actually is, how dysfunction presents, and why individualised care matters.


Guest bios


Monica Donaldson and Tamara Gerdis are specialist women’s health physiotherapists and co-founders of the Physio Down Under specialist clinic. They have extensive experience in pelvic health across all life stages, including pregnancy, postnatal recovery, menopause, pelvic pain conditions, and pelvic organ prolapse. Their clinical approach integrates anatomy, biomechanics, neuromuscular coordination, and patient education to improve long-term pelvic health and quality of life.


What we cover in this episode


1. The pelvic floor: what it is and how it can go wrong


[00:00 – 14:43]

  • Pelvic floor anatomy and function

  • The role of the pelvic floor in bladder, bowel, and organ support

  • Pelvic floor dysfunction as a spectrum (weakness, overactivity, poor coordination)

  • Why pelvic floor exercises are not always appropriate

  • Common symptoms women experience


2. The pelvic floor and childbirth


[14:43 – 36:31]

  • Preparing the pelvic floor during pregnancy

  • Perineal trauma and degrees of tearing

  • Labour positioning and effective pushing mechanics

  • Early postnatal recovery and bowel care

  • Postnatal bladder symptoms after vaginal birth and caesarean section

  • Why postnatal leakage should not be normalised


3. The pelvic floor and menopause


[36:31 – 01:02:13]

  • Hormonal changes and pelvic tissue health

  • Genitourinary syndrome of menopause (GSM)

  • Pelvic organ prolapse explained

  • Non-surgical management of prolapse

  • Vaginal oestrogen and pelvic health physiotherapy

  • When surgery is, and is not, appropriate


4. The pelvic floor in teens and young women


[01:02:52 – 01:16:56]

  • Pelvic floor function during adolescence

  • Difficulty using intravaginal products as a clinical sign

  • Pelvic floor related pain conditions

  • Early intervention

  • Links with gynaecological conditions such as endometriosis


5. Pelvic floor devices, aids and book club recommendations

[01:16:56 – end]

  • Manual therapy tools and self-management aids

  • Vaginal weights and strengthening devices

  • Electrical stimulation and chair-based magnetic devices

  • Devices designed to reduce penetration-related discomfort

  • Perineal preparation methods for childbirth

  • Evidence-based resources for pelvic and sexual health


What you will learn in this episode:

 

  • What exactly is the pelvic floor and what does it do?

  • Why do some women leak urine even years after childbirth?

  • Can pelvic floor problems occur after a caesarean section?

  • Why do pelvic floor exercises sometimes make symptoms worse?

  • What is pelvic organ prolapse and how common is it?

  • Can prolapse be managed without surgery?

  • How does menopause affect pelvic floor health?

  • When should teenagers or young women be assessed for pelvic floor issues?

  • What pelvic floor devices are supported by evidence and which are not?

  • When should you see a pelvic health physiotherapist?


Key takeaways

 

·       Pelvic floor problems are common, but they are not inevitable and should never be dismissed as “just part of life” at any age.


·       Not all pelvic floor dysfunction is due to weakness: understanding whether muscles are overactive, underactive or poorly coordinated is essential before starting treatment.


·       Assessment matters. Before exercises, devices or programmes, it’s important to know what your pelvic floor actually needs.


·       With the right assessment and conservative care, pelvic health physiotherapy can make a meaningful, often life-changing difference to quality of life.




Further Resources
 


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