Pregnancy related pelvic pain is described as any pain occurring in the pelvis (specifically between the iliac crests and the gluteal fold, particularly in the vicinity of the sacroiliac joints). The pain can radiate down the back of the thigh (known as the posterior thigh), and can also occur in conjunction with, or separately in the area between your left pelvic bone and your right pelvic bone, known as the pubic symphysis. This pain can cause a reduced capacity to stand, walk and sit. 

A thorough assessment is important to determine the contributing factors to your pain and develop an integrated holistic management plan to aid your recovery. 

In the last 4-6 weeks of pregnancy, women can begin more specifically preparing their bodies for birth. During this time point of the pregnancy, oestrogen levels surge, resulting in extra stretchiness to the connective tissue- this is an amazing process that helps our body have capacity to birth vaginally!

During vaginal delivery, the pelvic floor muscles and connective tissue need to stretch to over 3x their usual length to allow the baby to pass through the vaginal canal. Furthermore, the role of the pelvic floor muscles is not to ‘push ’the baby out but more to lengthen and ‘get out of the way’ to allow the uterine contractions to push the baby out with the pelvic floor lengthening and stretching around it.
Prepare your body for the birth:

• Pelvic floor awareness – learn how to activate and relax your pelvic floor muscles
• Breathing techniques – supportive breathing for each stage of labour
• Optimal birth positions – positions that support comfort, pelvic opening, and progress.

Postpartum Physiotherapy

Postpartum physiotherapy is specialized rehabilitation designed to support recovery after childbirth. It focuses on restoring strength, mobility, and function in the pelvic floor, abdomen, and spine, helping you return safely to daily activities and exercise.

Treatment addresses common postpartum concerns such as incontinence, pelvic pain, and diastasis recti, and typically begins 6–8 weeks after birth, depending on individual recovery.

Key Areas of Focus

• Pelvic floor rehabilitation to support bladder and bowel control and pelvic organ support
• Core recovery, including assessment and treatment of diastasis recti
• Pain management for pelvic girdle, lower back, and perineal discomfort
• Body mechanics and education for lifting, carrying, and feeding your baby with less strain
• Individualized care following vaginal or cesarean birth, including scar management

Postpartum physiotherapy supports a safe, confident return to movement while respecting your body’s healing process.

Perineal Tears and Cesarean Section Recovery

During childbirth, the body goes through significant changes and, in some cases, physical trauma. A perineal tear is a tear of the tissue between the vagina and anus that can occur during vaginal delivery.
Cesarean birth is the delivery of a baby through surgical incisions made in the belly and uterus. 
Both require time, care, and proper rehabilitation to heal well.

Common symptoms after delivery

•  Pain or discomfort in the perineal or abdominal area 
•  Scar sensitivity or tightness 
•  Pelvic floor weakness or heaviness 
•  Urinary or bowel control issues 
•  Pain during movement or intimacy 

How physiotherapy can help

Postnatal physiotherapy supports recovery in a safe and structured way:

• Pelvic floor rehabilitation to restore strength, coordination, and control 
• Scar treatment (perineal or C-section) to improve mobility, reduce pain, and prevent adhesions 
• Guided exercises to rebuild core strength and address abdominal separation (diastasis recti) 
• Pain management and support for returning to daily activities 
• Education and reassurance to help you understand your body and recover with confidence 

Early, guided support can make a significant difference—helping you heal properly, prevent long-term issues, and feel strong and comfortable in your body again.

Diastasis Rectus Abdominis (DRA) commonly known as abdominal separation is when the outer layer of the abdominal muscles separate through the center of the abdominal wall. This is most commonly seen during and after pregnancy, however it can be present in other populations including men and athletes.

DRA is generally not painful, however it can lead to back pain if the stomach muscles have weakened and are not supporting the trunk adequately. Usually people become aware of having an DRA when they sit up or get up from the floor and notice a doming through the middle of their tummy. Sometimes however, people are not aware of it and it can go undiagnosed for a long time.

What is Endometriosis?

Endometriosis is a common disease in which tissue similar to the lining of the uterus grows outside the uterus in other parts of the body.
 

If you’re experiencing debilitating menstrual pain, pelvic pain, and increased sensitivity or activity in your pelvic floor muscles, then it is a good idea to have yourself checked for endometriosis. Endometriosis and some Chronic Pelvic Pain (CPP) conditions are common, with endometriosis affecting 1 in 10 women and CPP affecting 1 in 5. These conditions can be associated with inflammation that can be reduced with an integrated and multi-disciplinary approach to management to reduce pain. 
 

What are the Symptoms of Endometriosis or Chronic Pelvic Pain 

The most common symptoms of endometriosis are: 

• Menstrual pain
• Pelvic pain, either cyclical or non-cyclical
• Overactive/oversensitive pelvic floor muscles

Other symptoms can include: 

• Pain during sex
• Infertility or hormonal imbalance
• Heaving bleeding
• Fatigue
• Bladder dysfunction, including frequency, urgency or pain
• Bowel dysfunction
• Gastrointestinal upsets such as diarrhoea, constipation, nausea, bloating

If you experience painful vaginal penetration, whether it is from sexual intercourse, pap smears or tampons, then you may have Genito-Pelvic Pain Disorder (GPPD), Vaginismus, Provoked Vulvodynia or Vestibulodynia. Women often describe the pain as a burning, stabbing, blocked or tightness sensation.

The pain may be present with the initial penetration, or it may only occur with deeper penetration. A lot of the time, it is caused by tension in the pelvic floor muscles, or as the result of skin sensitivity. If you are anticipating pain, then the vaginal muscles will tighten protectively and this can make everything more intense. This can easily cause a cycle of pain:  
The pain cycle describes how pain triggers muscle tension, fear, and reduced movement, which then increase sensitivity and create even more pain. It’s a loop where the body tries to protect itself but ends up reinforcing the very discomfort it’s trying to avoid. 

Breaking the Cycle

Physiotherapy typically interrupts the cycle through:

• Relaxation and down‑training of the pelvic floor
• Graded movement and exposure
• Breathing techniques
• Manual therapy
• Education to reduce fear and catastrophizing
• Strengthening once relaxation is possible

Physiotherapy for breast cancer involves tailored exercises, manual therapy, and education to manage treatment side effects, such as reduced shoulder mobility, scar tissue tension, lymphedema, pain, and fatigue. Interventions span from pre-surgery preparation to rehabilitation during and after treatment, aiming to restore strength, improve range of motion, and boost confidence. 

Key Aspects of Physiotherapy for Breast Cancer:

• Pre-habilitation: Many hospitals offer pre-surgery sessions to teach exercises that prevent shoulder stiffness.
• Shoulder & Upper Limb Management: Specific stretches and exercises are used to regain range of motion and prevent issues like "cording" (axillary web syndrome).
• Lymphedema Management: Techniques include manual lymphatic drainage, kinesio taping, and specialized compression advice to reduce swelling.
• Scar tissue mobilisation.
• Pain Management: Physical therapists address post-surgical pain, myofascial tightness, and scar tissue management.
• Fatigue & Strength Recovery: Tailored strength training, resistance exercises, and cardiovascular exercise (walking, cycling) help combat cancer-related fatigue and improve physical function.
• Breathing Exercises: Used to improve chest wall mobility and relaxation. 

Hormonal changes during perimenopause and menopause—particularly the decline in estrogen—can have a significant impact on muscles, joints, and connective tissue. These changes may affect strength, mobility, and overall comfort in daily life.

Many women notice new or worsening musculoskeletal symptoms during this stage, which are common—but very manageable with the right support.

Common presentations

• Joint stiffness and generalised aches
  Often worse in the morning or after periods of rest 
• Reduced muscle strength and endurance
  Making everyday tasks or exercise feel more demanding 
• Tendon sensitivity and overload
  Commonly affecting areas such as the hips (e.g. gluteal tendinopathy), shoulders, and elbows 
• Frozen shoulder (adhesive capsulitis)
  More prevalent in women aged 40–60, causing pain and significant restriction in shoulder movement 
• Reduced bone density
  Including osteopenia and osteoporosis, increasing the importance of safe, targeted exercise 
• Postural changes and spinal discomfort
  Including increased thoracic stiffness, back pain, and changes in alignment over time 

How Physiotherapy Can Help 

Women’s health physiotherapy takes a whole-body approach to support you through these changes. Treatment focuses on: 

•  Restoring strength and muscle function 
•  Improving joint mobility and flexibility 
•  Managing tendon load and reducing pain 
•  Supporting bone health through appropriate exercise 
•  Addressing posture and movement patterns 
•  Helping you return to (or continue) the activities you enjoy 

Supporting Long-Term Strength & Confidence 

You don’t have to accept pain or stiffness as a normal part of menopause. With the right guidance, it’s possible to stay strong, active, and confident in your body throughout this transition and beyond. 

Perimenopause & Menopause Physiotherapy

Perimenopause and menopause bring significant changes to a woman’s body—far beyond hormones alone. Fluctuating and declining estrogen levels can affect the pelvic floor, muscles, joints, and connective tissues, often leading to new or unfamiliar symptoms.

You might notice:

•  Pelvic floor weakness—or sometimes tightness 
•  Bladder leaks, urgency, or increased frequency 
•  Vaginal dryness or discomfort 
•  Pain during intimacy 
•  Joint stiffness and muscle aches 
•  Reduced bone density 
•  Core weakness and changes in posture 

These changes are very common—but importantly, they are treatable and manageable with the right support.

How Women’s Health Physiotherapy Can Help

At this stage of life, physiotherapy focuses on restoring strength, improving function, and helping you feel confident in your body again. Every treatment plan is tailored to your individual needs and goals.

Pelvic Floor Rehabilitation

Support for both weakness and overactivity of the pelvic floor, including:

•  Strengthening exercises for bladder control 
•  Relaxation techniques to reduce pain and tension 
•  Guided training and biofeedback where appropriate 

Bladder & Bowel Support

Practical strategies to help you regain control and reduce symptoms:

•  Managing urgency and frequency 
•  Education on fluid intake and daily habits 

Core Strength & Postural Support

Hormonal changes can affect connective tissue and stability. Treatment may include:

•  Deep core activation and coordination 
•  Back, hip, and pelvic stability exercises 
•  Postural retraining for everyday movement 

Pain Management

Targeted treatment for:

•  Pelvic pain 
•  Lower back or hip discomfort 
•  Joint stiffness
   Using a combination of hands-on therapy and movement-based rehabilitation 

Sexual Health Support

Sensitive, confidential care to address:

•  Pain during intercourse 
•  Vaginal tightness or discomfort 
•  Guidance on positioning, lubrication, and muscle relaxation 
•  Use of vaginal dilators if appropriate 

Common Conditions Treated

Women’s health physiotherapy can support a wide range of concerns during perimenopause and menopause, including:

•  Urinary incontinence (stress or urgency) 
•  Pelvic organ prolapse (particularly early stages) 
•  Painful intercourse (dyspareunia) 
•  Lower back and hip pain 
•  Abdominal separation (diastasis recti) 
•  Movement concerns related to reduced bone density or osteoporosis 

Supporting You Through This Transition

You don’t need to accept these changes as something you simply “live with.” With the right guidance, it’s possible to feel strong, supported, and in control of your body.

Whether your goal is to return to exercise, improve daily comfort, or address specific symptoms, women’s health physiotherapy can help you move through this stage with confidence.