# Pelvic health Pelvic health problems involve the muscles that hold up the bladder, bowel and other pelvic organs (the pelvic floor). They include leaking when you cough or run, sudden urges, heaviness and pelvic pain. These are common at any age, including during pregnancy and after birth. We assess the pelvic floor and the body around it, then build a plan for daily life, exercise and sport. ## Symptoms - Leaking urine when you cough, sneeze, laugh, run or jump - Sudden, strong urges to pass urine, or needing to go very often - Leaking gas or stool, or finding them hard to control - Heaviness, dragging or a bulge low in the pelvis (possible prolapse) - Pain in the pelvis, pubic bone or tailbone - Pain during or after sex - Pelvic or low back pain during pregnancy or after birth ## Assessment We start with your symptoms: when you leak or feel pressure, how often you go to the bathroom, and any pain. We ask how they affect daily life, exercise and sex, and about pregnancy, birth, surgery and your general health. You can share as much or as little as you like. Then we check your breathing, posture, back, hips and belly muscles, and how they work with the pelvic floor when you lift, run or jump. If it would help, we may offer an internal examination. It happens only with your consent, and it is never required. ## Treatment Some pelvic floors need strengthening. Others hold too much tension and need to learn to relax first. Treatment often includes: - **Pelvic floor training:** learning to squeeze, lift and fully let go, then building strength and timing for coughing, lifting and running. - **Relaxation and breathing:** for muscles that stay tense, which can add to pelvic pain, urgency or pain with sex. - **Bladder training:** a plan to slowly stretch the time between bathroom trips and settle sudden urges. - **Biofeedback and muscle stimulation:** tools that show how your muscles are working, or help weak muscles switch on. - **Core and whole-body exercise:** for the belly, back and hips, which work with the pelvic floor. - **Hands-on treatment (manual therapy):** for tight or tender muscles, scars, and the joints of the pelvis and low back. See [pelvic floor physiotherapy](https://backinactionphysiotherapy.com/services/pelvic-floor-physiotherapy) for more. ### During pregnancy and after birth During pregnancy, we treat back pain and pain around the pelvis (pelvic girdle pain), and help you stay active. Registered massage therapists can also ease aches and discomfort in pregnancy. See [massage therapy](https://backinactionphysiotherapy.com/services/massage-therapy). After a vaginal birth or a caesarean (C-section), we check how the pelvic floor and belly muscles are healing. That includes any gap between the belly muscles down the middle (diastasis recti). ## Getting back to exercise and sport Running, jumping, skiing and snowboarding put high loads through the pelvic floor. We plan your return around the activity you want back. After birth, your postnatal check with a doctor, nurse practitioner or midwife comes first. Before you run, we test how your pelvic floor copes with hopping, jogging on the spot and single-leg strength work. We then build up in stages, from strength and low-impact exercise to running and jumping. The same staged approach applies to anyone who leaks on trail runs or when landing jumps. [Pilates](https://backinactionphysiotherapy.com/services/pilates) can be a gentle way to rebuild core strength after pregnancy. ## When to come in Book an assessment if you leak urine, gas or stool, feel heaviness or a bulge, or have pelvic pain or pain with sex. You can also book during pregnancy, after birth, or before you return to running or skiing. We also see some men with pelvic floor problems, such as leaking after prostate surgery or pelvic pain. That care is limited and decided case by case, so call the clinic first and our pelvic health physiotherapist will tell you whether we can help. Go to the emergency department right away, or call 911, if any of these happen: - you cannot pass any urine at all - new numbness around the groin or buttocks - sudden loss of bladder or bowel control with back pain, or new weakness in both legs - heavy bleeding, whether during pregnancy, after birth or at any other time - severe pain in the belly or pelvis, or a fever with pelvic pain - chest pain, trouble breathing, or a painful, swollen calf, during pregnancy or after birth ## Who treats it - [Dana Elliott, Physiotherapist, MScPT, BSc](https://backinactionphysiotherapy.com/team/dana-elliot) - [Nicole Klopfer, Physiotherapist, B Physiotherapy (Hons) (UMelb), M Physiotherapy (Manips) (UWA), PGrad Cert Cont & PF Rehab (UMelb), GunnIMS](https://backinactionphysiotherapy.com/team/nicole-klopfer) ## Services - [Physiotherapy](https://backinactionphysiotherapy.com/services/physiotherapy) - [Pelvic Floor Physiotherapy](https://backinactionphysiotherapy.com/services/pelvic-floor-physiotherapy) - [Pilates](https://backinactionphysiotherapy.com/services/pilates) - [Registered Massage Therapy (RMT)](https://backinactionphysiotherapy.com/services/massage-therapy) ## Frequently asked questions ### Is it normal to leak urine after having a baby? It is common. Many people leak when they cough, sneeze or run after giving birth, and some first notice it years later or around menopause. Common does not mean you have to put up with it. Pelvic floor training, taught and checked one-on-one, is often the first treatment for this kind of leaking. Habits such as going to the bathroom just in case, or straining when constipated, can also play a part. ### Should I just do Kegel exercises? Not always. Pelvic floor squeezes (Kegels) help many people with leaking, but only when they are done the right way. Some people push down instead of lifting, or hold their breath as they squeeze. Others have muscles that are already too tight, and more squeezing can make pain or urgency worse. That is why we check how your muscles work before we give you a program. ### Do I have to have an internal examination? No. An internal examination can show how well the pelvic floor muscles squeeze, relax and work together, which is hard to judge from the outside. We explain what it involves, and you decide. You can say no, or ask us to stop at any time. If you would rather not have one, we assess you through your symptoms, an external check and how you move, and treatment can still go ahead. ### When can I start running again after having a baby? No set date. It depends on how your birth went, how you are healing, and how your pelvic floor and belly muscles handle impact. Wait until after your postnatal check, and if you can, a pelvic floor assessment, before your first run. Watch for leaking, heaviness or pelvic pain during or after a run. If they appear, ease back and get checked rather than pushing through. Skiing and snowboarding follow the same idea, with extra thought for falls and long days on your legs. ## Massage for recovery Massage therapists do not diagnose, so start with a physiotherapist. Once you have a diagnosis and a plan, our registered massage therapists can help with the recovery. [About massage therapy](https://backinactionphysiotherapy.com/services/massage-therapy) *This page is general information, not a diagnosis or a substitute for an assessment. If you are unsure, see a health professional.*