A Day in the Life of a Pelvic Health Physio: What I Actually See in a Typical Day

One of the things I love about working in pelvic health is that no two days are ever the same.

People often have an image of pelvic health physiotherapy being all about pelvic floor exercises, but the reality is so much broader. My day can involve pregnancy, birth preparation, prolapse, pelvic pain, bladder symptoms, scar management, returning to running, abdominal rehabilitation and helping women feel confident in their bodies again after having a baby.

Here’s a snapshot of what an average day in my clinic can look like.

Patient 1: Getting back to running after birth

My first patient is six months postpartum following a second degree tear. She has been fitted with a cube pessary and is coming in for a six month review.

She is keen to get back to running, but whenever she tries to increase her activity she notices prolapse symptoms.

This is where the assessment is about much more than simply asking whether she can do a pelvic floor contraction. We look at her symptoms, how her pelvic floor is functioning, how she is managing pressure and loading, and what happens when she runs or exercises.

The goal is to work out how we can gradually get her back to the activities she enjoys while managing her symptoms and giving her confidence in her body.

Patient 2: Five months after a caesarean

Next is a mum who is five months post emergency caesarean section.

Her main concerns are De Quervain’s tenosynovitis, which is causing thumb and wrist pain, as well as lower back pain from the physical demands of looking after a baby.

There is a lot of lifting, feeding, carrying, getting up and down from the floor and spending time in awkward positions when you have a baby.

Her longer term goal is to return to running, so we’re not just looking at her thumb and back in isolation. We’re looking at the bigger picture and working towards rebuilding the strength and capacity she needs for running again.

Patient 3: Pregnancy pelvic floor check

My third patient is 29 weeks pregnant with her first baby.

She is experiencing some round ligament pain and has come in for a baseline pelvic floor assessment.

She also wants to make sure she understands how to bear down effectively.

I love these appointments because pregnancy is such a good time to build knowledge and confidence before birth. We can talk about pelvic floor function, pressure management, positions for birth, bearing down and what it actually means to relax the pelvic floor.

It’s not about preparing someone to have a “perfect” birth. It’s about giving them information and tools so they understand their body and feel more prepared for whatever their birth looks like.

Patient 4: Three months after a second degree tear

Next is a mum who is three months postpartum following a second degree tear.

She had experienced tailbone pain following the birth and also had a larger genital hiatus and perineal body measurement.

She is back for a follow up to see how her symptoms are progressing.

These appointments are often about checking the things that aren't always obvious from the outside. How does the area feel now? Is there pain or pressure? How is the pelvic floor functioning? Has anything changed as activity levels have increased?

Sometimes it's about reassurance that things are progressing well. Other times we need to identify something that needs a little more attention.

Patient 5: Seven months after a forceps birth

My fifth patient is a new mum who is seven months post forceps delivery and a second degree tear with her second baby.

She has started noticing a feeling of heaviness and is also concerned about diastasis recti.

She has come in wanting guidance on rehabilitation.

This is a really common situation. Women can spend months after having a baby wondering whether something is “normal” or whether they are doing something wrong.

Rather than giving her a generic list of exercises, we assess where she is now and work out what her body needs.

That might involve abdominal rehabilitation, pelvic floor work, breathing and pressure management, strength training and gradually increasing her overall physical capacity.

Patient 6: Nine weeks postpartum

Next is a follow up with a woman who is nine weeks post low forceps delivery.

She is generally doing well but is experiencing some mild discomfort when walking.

At nine weeks postpartum, the aim isn't necessarily to get her doing everything straight away. We want to understand what is causing the discomfort, make sure her recovery is progressing appropriately and gradually build her tolerance for everyday activity.

Sometimes the most important part of the appointment is simply helping someone understand what they are feeling and what they can safely start doing again.

Patient 7: Preparing for baby number two

My seventh patient is 34 weeks pregnant with her second baby and is experiencing symphysis pubic dysfunction/ pelvic girdle pain.

At this stage, we are also moving into birth preparation.

We talk about perineal massage, pelvic floor down-training and how to relax the pelvic floor rather than constantly thinking about strengthening it.

This is something I wish more women knew: a strong pelvic floor isn't just a pelvic floor that can squeeze hard. It also needs to be able to relax, lengthen and respond to changes in pressure.

Birth preparation is about helping women understand their bodies and giving them practical strategies they can use during labour.

Patient 8: Preparing for surgery

And then I finish the day with a completely different type of appointment.

My final patient is 43 and in perimenopause, with a history of adenomyosis. She is preparing for an elective hysterectomy and has also been diagnosed with overactive bladder.

This is prehabilitation, or “prehab”.

Rather than waiting until after surgery to think about rehabilitation, we can work on things beforehand.

We can discuss bladder habits, pelvic floor function, breathing, pressure management, strength and what to expect during recovery.

Having an understanding of your body and a plan going into surgery can make the rehabilitation process feel much less overwhelming.

And that's just one day

Eight patients. Eight very different reasons for coming to see a pelvic health physiotherapist.

One wants to run again.

One has wrist and back pain from caring for her baby.

One is preparing for her first birth.

One is recovering from a tear.

One is worried about heaviness and her abdominal muscles.

One is navigating discomfort after a difficult birth.

One is preparing her pelvic floor for birth.

And one is preparing for major surgery.

That’s what I love about pelvic health physiotherapy.

It isn't just about pelvic floor exercises.

It's about helping women understand what is happening in their bodies, whether that's during pregnancy, after birth, during perimenopause or around surgery.

It's about rehabilitation, prevention, education, strength, confidence and getting women back to the things that matter to them.

And sometimes, that thing is simply being able to go for a run without wondering what their pelvic floor is going to do.