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Understanding Internal and External Pelvic Floor Physiotherapy: A Comprehensive Guide

Pelvic floor health is an essential—yet often overlooked—aspect of our overall well-being. Whether you're dealing with postpartum recovery, incontinence, pelvic pain, or just looking to improve core stability, pelvic floor physiotherapy can play a key role. This therapy comes in two primary forms: internal and external pelvic floor physiotherapy. In this blog, we’ll explore what these two types of therapy involve, how they differ, and who might benefit from each.


What Is the Pelvic Floor?

The pelvic floor is a group of muscles and connective tissues that span the bottom of the pelvis. These muscles support vital organs such as the bladder, uterus (in people assigned female at birth), and rectum. They are responsible for important functions like:

  • Bladder and bowel control

  • Sexual function

  • Supporting posture and core strength

  • Stabilizing the pelvic joints

When these muscles are too tight, too weak, or uncoordinated, a range of issues can arise—including incontinence, prolapse, pain, or sexual dysfunction.


What Is Pelvic Floor Physiotherapy?

Pelvic floor physiotherapy is a specialized form of physical therapy aimed at assessing and treating dysfunctions in the pelvic floor muscles. Depending on your symptoms and condition, your therapist may use external and/or internal techniques to help restore function, strength, and coordination.


External Pelvic Floor Physiotherapy


External physiotherapy focuses on treating the pelvic floor from the outside of the body. This can include:

  • Postural assessments

  • Manual therapy techniques (e.g., massage or myofascial release of surrounding muscles such as the glutes, inner thighs, or lower back)

  • Biofeedback

  • Breathing exercises and core retraining

  • Strengthening or relaxing exercises

This approach is non-invasive and can be particularly beneficial for:

  • People uncomfortable with or not ready for internal assessments

  • Pediatric and adolescent patients

  • Certain cultural or personal preferences

  • Situations where external structures (e.g., hips, back, abdominals) are contributing to pelvic floor dysfunction

External therapy can also help prepare the muscles and tissues for internal work if needed later on.


Internal Pelvic Floor Physiotherapy


Internal physiotherapy involves direct assessment and treatment of the pelvic floor muscles via the vagina or rectum. It allows the therapist to:

  • Assess strength, tone, and endurance of individual muscles

  • Identify trigger points or tension

  • Perform internal myofascial release

  • Teach proper muscle activation

  • Provide targeted feedback for exercises

Although more intimate, this approach offers a highly accurate understanding of what’s going on inside and can lead to faster and more effective results.

Common reasons for internal pelvic floor therapy include:

  • Urinary or fecal incontinence

  • Pelvic organ prolapse

  • Pain with intercourse (dyspareunia)

  • Chronic pelvic pain

  • Pre- and post-natal recovery

  • Endometriosis-related discomfort

  • Recovery from pelvic surgery

Therapists are always trained to explain each step, gain informed consent, and ensure comfort throughout the process.


Which One Do You Need?

Not everyone needs internal therapy, and not everyone benefits from external therapy alone. The best approach often depends on:

  • Your symptoms

  • Your goals

  • Your comfort level

  • The underlying cause of dysfunction

An experienced pelvic floor physiotherapist will perform a thorough assessment and work with you to develop a plan that feels safe, appropriate, and effective.


Final Thoughts

Pelvic floor physiotherapy—both internal and external—is a powerful tool that can improve quality of life in ways many don’t expect until they experience it. Whether you’re an athlete, a new parent, or someone struggling with chronic pain, understanding and caring for your pelvic floor can lead to better function, less pain, and more confidence in your body.

If you suspect pelvic floor issues or simply want to learn more about your body, don’t hesitate to consult a qualified pelvic health physiotherapist. Your pelvic health matters—and help is available.


Have questions or want to share your experience with pelvic floor physiotherapy? Leave a comment below!

 
 
 

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