In recent years, the number of women seeking pelvic floor rehabilitation treatment has increased significantly. What used to be a discreet, almost hidden topic is now becoming a more open and accessible conversation. Women of all ages, after childbirth, before childbirth, after gynecological surgeries, or simply in daily life, turn to dedicated physiotherapy to care for pelvic health. Awareness is growing, knowledge is expanding, and shame is giving way to professional treatment that restores quality of life.
The pelvic floor is a complex system of muscles, tissues, and ligaments that support the pelvic organs: the bladder, vagina and uterus, the intestines, and the rectum. When there is weakness, excessive tightness, or lack of coordination between the muscles, it can cause symptoms such as urinary leakage, pain during intercourse, back and pelvic pain, organ prolapse, or a feeling of heaviness and pressure in the area.
And although all these symptoms are common, they are not “fate” and not something that one must “live with.” Numerous studies indicate that focused physiotherapy treatment is highly effective and significantly improves function and quality of life.
Why is this happening right now?
Three main processes can be identified:
Awareness: The topic is no longer considered embarrassing. Women talk to each other, in groups, in HMOs, and in clinics. Social networks broke years of silence.
Clinical evidence: Clinical studies in the European Journal of Urology in 2020 showed that pelvic floor physiotherapy is the first recommended line of treatment for urinary leakage and organ prolapse before surgical intervention.
Quality of life: Women understand that it is legitimate to want to feel strong, comfortable, and whole in their bodies.
So what exactly does a pelvic floor physiotherapist do?
The treatment begins with a comprehensive conversation and a gentle examination. The goal is to understand the patterns of using the pelvic muscles: Are they weak? Are they actually too tight? Is there breathing that increases internal pressure?
In most cases, the program will include:
o Customized exercises to activate the pelvic muscles
o Learning relaxation and release for those who suffer from excessive tightness
o Breathing exercises that reduce load and regulate intra-abdominal pressure
o Guidance for proper movement in daily life: Lifting, coughing, sports, and routine
o Guidance for appropriate physical activity
o Habits regarding voiding, nutrition, sleep, and stress management
o Treatment with dilators in cases of pain during intimate relations
o In certain cases: Biofeedback to view muscle activity in real time
Progress is made gradually, at a personal pace and without pain.
Who is it suitable for?
The treatment is suitable for women of all ages. Among the common situations in which it is recommended to consider seeking treatment:
o Urinary leakage during coughing, laughing, running, or jumping
o A feeling of “heaviness” or pressure in the pelvis, especially at the end of the day
o Pain during intercourse or when inserting a tampon
o After childbirth, even if no clear injury exists
o During menopause, which brings changes with it
o Back, hip, or pelvic pain without a clear imaging finding
Myths worth breaking
“If there is urinary leakage after childbirth it’s normal and will go away on its own”
Leakage may be common in the last trimester of pregnancy and in the first weeks. After childbirth, it is treatable.
“Pelvic floor muscles only need strengthening”
Some women actually suffer from excessive tightness, and in that case, relaxation must be learned first.
“Only women who gave birth need treatment”
Women who have not given birth can also develop symptoms.
“There is nothing to do about organ prolapse, only surgery”
In many cases, gradual rehabilitation improves function and can prevent worsening.
“If I do Kegel exercises I’m covered”
Some women do not activate the muscle correctly, and muscle activation is one recommendation within a broad perspective on the story the woman brings to the meeting with the physiotherapist.
What can you already start doing today at home?
o Spend a minute stopping to check your breathing: Low breathing into the abdomen and not only into the chest
o Do not tighten your abdomen all day; it increases load on the pelvis
o Drink water throughout the day to prevent constipation, not all at once
o Be more active during the day
o Ensure sufficient and quality sleep
o Remember: Pain is not an inevitable part of daily life
A woman’s body goes through changes at every stage of life. Pelvic floor rehabilitation is an opportunity to return to connection, control, and ease. It is a gentle, respectful, and focused treatment that restores confidence, function, and quality of life to the body. And perhaps most importantly, there are solutions, there is help, and no woman needs to remain with this alone.
Limor Iluz is a district physiotherapist, Maccabi Healthcare Services, Northern District, and a pelvic floor therapist for women, men, and children.