Your pelvic floor is the hammock of muscles at the base of your pelvis. It supports your bowel, bladder, and (in women) the uterus. It also controls your continence and coordinates the act of going to the toilet. When these muscles are not working as they should — too weak, too tight, or poorly coordinated — the result is what doctors call pelvic floor dysfunction.
Pelvic floor physiotherapy is a specialist field of physiotherapy that focuses on assessing and treating these problems. It involves muscle retraining, biofeedback, manual therapy, education, and behavioural changes — all tailored to what is happening for you specifically. It is a substantial step beyond generic "Kegel" exercises.
Pelvic floor physiotherapy is recommended — and often well-established as effective — for:
- Faecal incontinence — when the pelvic floor and sphincter muscles are weak or poorly coordinated
- Obstructed defaecation — difficulty emptying the bowel despite a normal urge, often due to muscles that squeeze when they should relax (called pelvic floor dyssynergia)
- Chronic constipation with a pelvic floor component
- Post-prolapse repair or post-childbirth rehabilitation
- Chronic pelvic pain, including levator ani syndrome and proctalgia fugax
- Selected pre- and post-operative situations, particularly procedures involving the rectum or sphincter
It is suitable for both men and women, although the pattern of conditions differs between them.
The first appointment is usually 45–60 minutes. It involves:
- A detailed history covering your bowel habits, symptoms, any related urinary or pelvic symptoms, and (where relevant) obstetric or surgical history
- An examination of pelvic floor function. This is done in a private, respectful, sensitive way and — with your consent — usually involves an external assessment and an internal examination (vaginal and/or rectal) to feel how the muscles are working. The physiotherapist will explain everything before each step.
- An explanation of what they find in plain language, with a tailored treatment plan
If the idea of an internal examination feels intimidating, please mention it when you book. Pelvic floor physiotherapists are experienced at making this comfortable and respectful, and they will pace the examination to suit you. For most people, the assessment itself ends up being a more positive experience than they had expected.
The plan is tailored to what is going on for you. Common components include:
Pelvic floor exercises
Targeted strengthening and relaxation training — customised to your specific muscle pattern. Generic "Kegel" exercises are not always appropriate; for an overactive pelvic floor, you actually need relaxation training, not more squeezing. This is one of the reasons proper assessment matters.
Biofeedback
A small sensor gives you visual or audio feedback while you contract and relax the pelvic floor. This is particularly useful for dyssynergic defaecation — where the goal is to learn to relax the pelvic floor during attempted bowel motions rather than tense it. Published evidence supports biofeedback as the most effective first-line treatment for this pattern.
Bowel retraining
Addresses timing, positioning, posture on the toilet, and habit. Simple changes — like using a footstool to raise your knees, or going at the same time each day — make a meaningful difference for many patients.
Manual therapy and relaxation techniques
Helpful for chronic pelvic pain, muscle spasm, and chronic pelvic floor tension. May include gentle internal release techniques and home stretches.
Education
Understanding your pelvic floor — what is normal, what is going wrong, and why — is empowering. It is hard to fix something you do not understand.
A typical course is 4–6 sessions over 2–3 months, with home exercises in between. Meaningful improvement is usually evident within this timeframe.
The evidence base is strong:
- For faecal incontinence, published series show pelvic floor physiotherapy with biofeedback improves symptoms in around 60–70% of patients in the short term, with some loss of benefit over longer follow-up.
- For obstructed defaecation due to dyssynergia, published success rates are around 60–80%.
- Both are considered first-line treatment before any surgical option is considered.
- A referral to a pelvic floor physiotherapist will be arranged at consultation when appropriate — our rooms can suggest practitioners in your area.
- A GP referral under a Chronic Disease Management (CDM) plan may give you partial Medicare rebates for a limited number of sessions per year — your GP can assess eligibility.
- Many private health funds cover physiotherapy under extras cover — check with your fund.
- You do not strictly need a referral, but having one helps the physiotherapist understand your medical context, and outcomes tend to be better with coordinated care.
It should not be painful. The examination is gentle and paced; treatment focuses on comfort and gradual progression. If anything is uncomfortable, tell your physiotherapist straight away — adjustments are always possible.
Not quite. Generic Kegels (squeezing the pelvic floor) are not appropriate for everyone — for some conditions (overactive pelvic floor, chronic pelvic pain), more contraction actually makes things worse. Pelvic floor physiotherapy assesses your specific pattern and prescribes the right exercises for you — which may be strengthening, relaxation, or both.
Most people have 4–6 sessions over 2–3 months. Some need fewer; some with longstanding or complex problems need more. Your physiotherapist will reassess your progress along the way and adjust accordingly.
If a proper trial of pelvic floor physiotherapy has not produced enough improvement, the next steps depend on what is going on. For faecal incontinence, options include sacral neuromodulation or surgery. For obstructed defaecation, further investigation (such as defaecating proctography) and selected surgical options may be considered. There is almost always a useful next step.
Need a specialist opinion?
If something in this article matches what you're experiencing, the most useful next step is a proper assessment. A GP referral is required.