During pregnancy, postural changes, muscle imbalances, and altered alignment occur that can lead to issues such as hip pain, swelling in the legs and pelvic area, lower or mid back pain, tingling and numbness in your hands and fingers, and pelvic girdle pain. Pelvic girdle pain is a common presentation that can also present with pain around the front of the pelvis, coccyx pain and pubic pain.

A specialist pelvic health physiotherapist can help treat and even treat cure symptoms. Depending on your presentation, your specialist pelvic health physiotherapist might:

>     provide manual pelvic physiotherapy therapy treatment and assist you with muscle training
>     provide education, taking the time to make sure you understand your prenatal presentation
>     educate you on how to exercise the pelvic floor muscles correctly – this may include use of real-time ultrasound
>     provide advice regarding specific lifestyle changes
>     suggest interventions such as stability support devices to alleviate discomfort
>     provide you with prescriptive exercises to alleviate pain and/or prevent the pain from recurring or getting worse

Approximately 1/3 of women have some presentation of diastasis rectus abdominis (DRA). Most if not all, women will experience some level of normal DRA separation and widening during pregnancy. The level to which this is experienced is predominantly driven by genetics and is not something you should blame yourself for!

DRA looks like a gap in the middle of your tummy above and below the umbilical cord. Sometimes it can present with like a cone shape in the middle, referred to as doming.

To conduct a thorough assessment of your DRA and the depth of your connective tissue, your specialist pelvic health physiotherapist will utilise real-time ultrasound. She will also assess your rib position and how your diaphragm is working to coach optimal breath technique and patterns and prescribe breath and relaxation exercises.

You should not be scared or anxious about DRA. There is a lot that can be discussed, done and managed to reduce your fears. With the right approach and professional management, a guided return to your exercise of choice is possible.

Depending on your presentation, your specialist pelvic health physiotherapist might:
>     provide manual therapy to aid with movement and function
>     provide education regarding good gut, bladder and bowel habits
>     provide advice regarding specific lifestyle changes
>     provide you with a prescriptive rehabilitation program that gradually loads the deep abdominal muscles alongside breath work to incorporate the activation of the core and pelvic floor function

Up to 9 in 10 first-time mothers who have a vaginal birth will have some degree of tear, graze or episiotomy, all of which will require time to heal.

As your body continues to heal and recover, the connective tissue and muscle layers can sometimes become tight and present with pain.

After a c-section, your scar may feel painful and itchy and sensitive for a number of weeks. Sometimes some bruising and tenderness will persist for a few weeks. You may feel the c-section and surrounding area is numb and can present with nerve irritation or sensitivity for several weeks.

A pelvic health specialist can assess your scar and surrounding areas to ensure you are healing. They can also provide you with advice regarding scar management and massage.

Here are some of the signs and symptoms you should look out for that may indicate that your c-section scar is not healing. The following should not be present six weeks after your c-section:

>     swelling or redness around the wound or
abdominal area
>     severe abdominal pain
>     painful urination
>     pus or discharge from the wound
>     high fever

If you are still suffering from problems with your scar more than six weeks after childbirth, then you should seek advice and information from your doctor.

1 in 3 women are affected by pelvic organ prolapse (POP).

POP is the descent of one or more of the pelvic organs of the vagina. The pelvic floor muscles support the pelvic organs. You can different types of prolapse, but the bladder (cystocele), bowel (rectocele) and the womb (uterine) are the most common.

During early-stage POP, you may not have any symptoms, but you might experience a feeling of heaviness or dragging or a lump or bulge in your vagina. Difficulty emptying your bladder or bowel, recurrent urinary tract infections, sexual pain, and lower back pain can also be symptoms of a more progressed prolapse.

A specialist pelvic health physiotherapist can assess, treat and rehabilitate your prolapse.

Depending on your presentation, your specialist pelvic health physiotherapist might:

>     assess your prolapse and pelvic floor through vaginal examination and/or by using real-time ultrasound.

>     help treat and rehabilitate your prolapse using several strategies including: educating you on how to exercise the pelvic floor muscles correctly, providing advice to help you empty your bladder and bowel more effectively, or to help you to have pain-free sexual intercourse, fit you with a pessary, develop a personalised exercise program for you or recommend specific lifestyle changes.

A pessary is a device made from either plastic or silicone that is inserted into the vagina to support the pelvic organs and help reduce the symptoms of prolapse. It substitutes the support usually provided by the endopelvic fascia.

Surgery may be considered if conservative measures have failed or if the prolapse is severe.

Dyspareunia is persistent or recurrent pain either in or around the vagina that occurs just before, during or after intercourse. There are many reasons for this; sometimes, the pelvic floor muscles are overworking.

Vulvodynia & vaginismus are two forms of dyspareunia

Vulvodynia can present as burning, increased pain with sitting, sensitive to touch, stinging.
Vaginismus is a condition that presents with a muscle spasm in the pelvic floor muscles.

Medical treatments that can lead to pain include pelvic surgery, hysterectomy, and some cancer treatments.

If pain occurs during deep penetration or is more acute in particular positions, it may be the result of medical treatment or a medical condition such as cystisis, endometriosis, fibroids, interstitial cystitis, irritable bowel syndrome (IBS), ovarian cysts, pelvic inflammatory disease or prolapse.

Your specialist pelvic health physiotherapist can help diagnose, treat and even cure dyspareunia. Depending on your presentation, your specialist pelvic health physiotherapist can:

>     provide manual therapy to release tension
>     provide pelvic floor down training and pelvic stretches
>     prescribe breath and relaxation exercises including medical vibrators
>     provide you with prescriptive exercises to alleviate pain and/or prevent the pain from recurring or getting worse
>     recommend pain management medicines or that you seek advise from your GP or a consultant
>     recommend psychosocial counselling

Up to 7 million people in the UK suffer from some degree of incontinence.

– Stress incontinence is urine leaking on an activity that increases intra-abdominal pressure such as coughing, sneezing, laughing, lifting, or exercising.
– Urge incontinence can also be called an overactive bladder. You may feel the feeling of urgency to rush to the toilet, with some leaking; urinating more often than usual; waking more than once a night to urinate and leaking urine while asleep.

There are many different causes of urinary incontinence, and the great news is incontinence can be treated and cured in many cases.

Depending on the type of urinary incontinence you are experiencing your specialist pelvic health physiotherapist might:

>     provide advice regarding specific lifestyle changes
>     provide education regarding good bladder and bowel habits
>     ask you to complete a bladder diary to help to determine if bladder retraining is necessary. In particular women with urge incontinence may need to learn urge suppression with control techniques to reduce the sensation of urgency. You may also need to void at specific intervals to train the bladder to give correct signals of fullness.
>     provide you with a personalised exercise program that will help keep your bowel empty
>     recommend that you use weights, support pessaries, electrical stimulation, or biofeedback, in addition to your other methods of management

Overactive bladder (OAB) can cause frequent urges to pass urine. You may feel the feeling of urgency to rush to the toilet, with some leaking; urinating more often than usual; waking more than once a night to urinate and leaking urine while asleep.

The great news is that an overactive bladder can be treated and cured in many cases.

Depending on your clinical presentation, your specialist pelvic health physiotherapist can assist might:

>     provide advice regarding specific lifestyle changes
>     provide education regarding good bladder and bowel habits
>     ask you to complete a bladder diary to help to determine if bladder retraining is necessary. In particular women with urge incontinence may need to learn urge suppression with control techniques to reduce the sensation of urgency. You may also need to void at specific intervals to train the bladder to give correct signals of fullness.
>     provide you with a personalised exercise program that will help keep your bowel empty
–     recommend that you use weights, support pessaries, electrical stimulation, or biofeedback, in addition to your other methods of management

Pelvic pain is a common presentation that can also present with pain around the front of the pelvis, coccyx pain and pubic pain. It can come on very suddenly and can persist for an extended period.

Some causes of pelvic pain are urinary tract infection, ovarian cysts, pelvic inflammatory diseases, constipation, irritable bowel syndrome (IBS), pregnancy and hernia.

Depending on the cause of the pelvic pain you are experiencing your specialist pelvic health physiotherapist might:

–     provide physical therapy
–     prescribe breath and relaxation exercises
–     provide advice regarding specific lifestyle changes
–     provide you with prescriptive exercises to alleviate pain and/or prevent the pain from recurring or getting worse
–     recommend pain management medicines or that you seek further advice from another medical professional