Pelvic Floor Physio: The Pregnancy and Postpartum Questions Women Are Afraid to Ask

Leaking when you sneeze. A feeling of heaviness after exercise. Sex that hurts after having a baby. These are things women often mention quietly, if they mention them at all.

They can be common during pregnancy and after birth, but that doesn’t mean you have to put up with them. We asked Emma Attard, founder of Femme Space Physiotherapy, the questions women might be unsure or embarrassed to ask: what a pelvic health physio actually does, when to book, whether Kegels are the answer and what happens at a first appointment.

What does a pelvic health physiotherapist do?

“A big part of what we do is helping women understand their bodies,” Emma says.

A pelvic health physiotherapist looks at how the muscles, joints, connective tissues and organs of the pelvis work with the rest of the body. An appointment may involve talking through your symptoms and assessing your pelvic floor, abdominal wall, breathing and movement.

You don’t need to wait until something feels wrong. Emma encourages women to consider an appointment when planning a pregnancy or during pregnancy, as well as when symptoms arise.

“If you’re experiencing leaking, pelvic pain, heaviness, prolapse symptoms, bowel or bladder changes or pain with intercourse, that’s a really good reason to seek help.”

Which symptoms are worth asking about after having a baby?

“Where do I begin!” Emma says. In her clinic, women bring up leaking wee, needing to wee unusually often, accidentally passing wind, pain with intercourse, back or shoulder pain, “mum thumb” and abdominal separation.

Some of these concerns have different possible causes, so an assessment matters. The point Emma wants women to hear is that they can ask about them. “Our mothers put up with these issues because they didn’t know they had a choice, but thankfully our generation doesn’t have to.”

Is leaking wee when you cough, sneeze or jump just part of motherhood?

“Absolutely not,” says Emma.

She often sees women in their perimenopausal years who stopped jumping on the trampoline with their children because they leak. For some, it began after having a baby and gradually became more troublesome.

Urinary leakage can have more than one contributing factor. Pelvic floor physiotherapy may help, but the right approach depends on what is causing your symptoms. You don’t have to wait years to raise it, and you don’t have to dismiss it because other mums joke about it too.

Should you just do more Kegels?

“Strengthening is not the answer for everyone,” Emma says.

Pelvic floor muscles need to do more than squeeze. They also need to relax and work at the right time. Emma asks questions about symptoms and, where appropriate and with your consent, assesses how the muscles are functioning. She then recommends exercises or other strategies suited to the person in front of her and checks that they’re being done correctly.

If you’ve been doing pelvic floor exercises without improvement, that’s a reason to ask for individual advice rather than assume you simply need to do more.

Can pelvic floor physio help during pregnancy, before there’s a problem?

“We can do sooo much during pregnancy!” Emma says.

At Femme Space, that can include understanding your starting pelvic floor function, discussing factors that may affect your recovery, and working through birth preparation such as perineal massage and pushing techniques where appropriate. Emma has also developed a pregnancy and birth preparation program with in-person sessions, online modules and resources.

The aim is to help you understand your options and prepare for recovery, whatever your birth looks like. No appointment or technique can guarantee a particular birth or prevent every pelvic floor problem.

When should you see a pelvic floor physio after birth?

Emma recommends considering a pelvic health physiotherapy check around six weeks after birth, whether you have symptoms or not and whether you had a vaginal birth or a caesarean.

She encourages women to rest in the early weeks, pay attention to how they feel and get individual guidance as they return to exercise. A routine postnatal check with your GP or obstetrician and a pelvic health physio appointment can answer different questions about your recovery.

Emma says new vaginal heaviness, a bulge, or a dragging feeling that worsens during or after exercise are signs to seek an assessment rather than simply wait and see. The same goes for symptoms that worry you or stop you doing things you want to do.

What if I’m embarrassed to talk about leaking, bowel problems or painful sex?

“There is no such thing as TMI in my treatment room,” Emma says.

Women talk to her about bladder and bowel accidents, pain, changes to their bodies after birth, trauma and loss. “We never judge. We simply lend a listening ear and then work as hard as we can to find solutions to improve your symptoms.”

You can start with the words you have. You don’t need to know the medical name for what’s happening, and you don’t need to wait until it feels serious enough to deserve an appointment.

What happens at your first pelvic health physio appointment? Do you need an internal exam?

Expect questions about your symptoms, bladder and bowel habits, sexual function, pregnancies and relevant gynaecological history. Your physio should explain any assessment they suggest and why it may be useful.

An internal vaginal examination can provide information about pelvic floor function, but you do not always need one. There are other ways to assess and begin helping you.

“Yes, of course you can say no,” Emma says. “You can even say yes and then change your mind and say no at any time.” Your physio can work with you to choose an approach you’re comfortable with.

And one last thing Emma wishes women knew before walking through the door? “I don’t care what your vulva looks like and whether or not it has hair on it.”

Pelvic health can be difficult to talk about. The first appointment can simply be a place to start asking questions.