Anal Fissures:

Passing hard and/or large stools can tear the anal lining, initiating a fissure. Another trigger can be loose stools or diarrhoea. Both types of trauma can initiate tearing, which can cause the anal sphincter to reflexively contract and spasm, extreme pain, and further tightening of the muscle. This tightening of the muscles raises resting pressure, worsens the tear, and significantly reduces local blood flow. Because of this, crucial nutrients and oxygen are diminished, impairing healing and perpetuating the cycle.

Haemorrhoids:

Haemorrhoids develop when the soft, blood-filled tissue around the anus becomes swollen. This is often from straining, pelvic floor tension, heavy lifting, prolonged sitting, or the pressure of pregnancy. The swelling can lead to grape-like lumps inside the rectum or around the anus, which may bleed or cause itching and discomfort.

A Shared Physiological Pathway

Both conditions share a common thread: excess pressure (from stool consistency, muscle tension, posture and hormones) combined with poor circulation (due to sphincter spasm or venous engorgement).

• In fissures, spasm restricts blood flow, slows healing, and guides management toward relaxation and tissue perfusion.
• In haemorrhoids, venous congestion worsened by tension and strain requires strategies to manage pressure and support venous return.

Holistic pelvic floor physiotherapy uses management strategies to break the spasm–ischaemia–pain loop by:

1. Releasing muscle tension using myofascial release or trigger-point techniques to improve blood flow.
2. Retraining coordination of pelvic and abdominal muscles to reduce strain during defecation.
3. Optimising toileting posture using squatting or stool support with diaphragmatic breathing to ease passage and relieve pressure.
4. Supporting venous drainage through pelvic alignment and movement guidance.

This multifaceted approach not only supports the healing of fissures and the reduction of haemorrhoids, but also addresses the root causes: elevated pressure and poor blood flow in the pelvic region. Improving circulation and relieving strain promotes lasting relief, not just temporary fixes.

Jennifer runs an in-home clinic in Maungaraki, Lower Hutt. She helps women from the Wellington region, including Porirua, Upper Hutt, the Kāpiti Coast and the Wairarapa, with their pelvic health physiotherapy needs, at all stages of life.

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What Is Genitourinary Syndrome of Menopause (GSM)?

GSM is a modern term that describes the collective changes to the genital and urinary systems, due to the decline in estrogen and progesterone that accompanies menopause. These changes can affect the vulva, vagina, urethra, and bladder, and the symptoms can impact everything from intimacy to everyday comfort.Common symptoms include:

• Vaginal dryness, itching, or burning
• Pain during intercourse (vaginismus and dyspareunia)
• Increased urinary frequency or urgency
• Urinary tract infections (UTIs)
• Reduced vaginal elasticity or tightness.

These aren’t just “mild discomforts” to brush off, as they can deeply affect a woman’s quality of life. And yet, so many women suffer in silence, believing this is just something to “get through.” It isn’t. Help is available.

How pelvic physio can support women with GSM:

Pelvic floor dysfunction and rehabilitation:

Hormonal changes during menopause can significantly impact the pelvic floor muscles, contributing to symptoms such as urinary incontinence, vaginal wall prolapse, and sexual dysfunction. A pelvic health physiotherapist can assess for muscle weakness, overactivity, or imbalance and develop individualised treatment plans. Interventions may include physiotherapy-guided pelvic floor muscle training, manual therapy, biofeedback, and structured relaxation techniques. These strategies are designed to restore muscular strength, coordination, and neuromuscular control, which supports continence, vaginal wall integrity, and overall pelvic health.

Sexual health and psychosexual rehabilitation:

Sexual function remains a key component of overall health and well-being at all stages of life. In the context of GSM, management may include vaginal lubricants, moisturisers, low-dose vaginal estrogen therapy, and psychosexual counselling. Painful intercourse (dyspareunia) may result not only from vaginal dryness but also from pelvic floor muscle dysfunction, including increased muscular tension. Addressing these issues through manual therapy, guided relaxation techniques, and pelvic floor muscle rehabilitation can significantly improve comfort and sexual function.

The use of tools such as vaginal dilators or pelvic wands can aid in maintaining vaginal tissue flexibility and pelvic floor muscle relaxation, which reduces pain and discomfort that can be associated with penetration. By integrating these modalities with clear, evidence-based guidance, women are empowered to take an active role in their care, make informed treatment decisions, and better advocate for their pelvic and sexual health.

A stigma-free approach to conditions like dyspareunia and hypoactive sexual desire disorder (HSDD) is also essential in restoring intimacy and enhancing quality of life.

Improving blood flow and tissue health:

With the decline of estrogen and progesterone during menopause, vaginal tissues often become thinner, less elastic, and more prone to dryness and fragility. Targeted therapeutic strategies, such as gentle movement, breathwork, and internal manual techniques can help stimulate local blood flow and support tissue health. In addition to these physiotherapy-based approaches, women benefit from tailored education on the use of non-hormonal vaginal moisturisers and lubricants, as well as the potential role of local or systemic hormone therapy in restoring tissue integrity.

Integrated Medical Care:

Optimal management of GSM often requires a coordinated, multidisciplinary approach involving primary care providers, gynaecologists, pelvic health physiotherapists, urologists, and hormone therapy specialists. Collaborative care ensures that treatment is evidence-based, individualised, and delivered with respect for each woman’s values and preferences. A female-centred model should prioritise symptom relief, functional improvement, and overall quality of life.

Genitourinary syndrome of menopause is not just a medical issue that needs to be managed. It often highlights physical, emotional and deeply personal aspects of a woman’s life. Holistic pelvic health physiotherapy is a vital part of a rehabilitation toolkit, helping turn GSM into an opportunity for women to address not only their symptoms, but to also reconnect with their bodies.

Jennifer runs an in-home clinic in Maungaraki, Lower Hutt. She helps women from the Wellington region, including Porirua, Upper Hutt, the Kāpiti Coast and the Wairarapa, with their pelvic health physiotherapy needs, at all stages of life.

The post Reclaiming Comfort: A holistic look at genitourinary syndrome of menopause and how pelvic health physiotherapy can help appeared first on Positive Pelvic Health.

Vaginismus is a condition where the muscles around the vagina involuntarily tighten, making penetration painful or impossible. This can be during sexual intercourse, tampon use, or medical examinations. It’s often misunderstood, misdiagnosed, or for some women minimised and brushed aside. 

Here are some common causes:

1. Psychological Factors: Anxiety, fear of pain, past trauma (such as sexual abuse or assault), negative/cultural/religious beliefs about sex, or relationship issues can all contribute to the development of vaginismus.
2. Emotional Factors: Stress, guilt, shame, or emotional discomfort around sex or intimacy can lead to muscle tension and avoidance behaviours.
3. Physical Causes: Medical conditions such as infections, endometriosis, childbirth injuries, menopause-related dryness, or past surgeries can make penetration painful, leading the body to involuntarily tense up as a protective response.
4. Learned Response: If a person experiences pain during penetration, they may begin to subconsciously anticipate pain, leading to a cycle of fear and muscle tightening.

Vaginismus is a real condition with real solutions and it is definitely not “in your head.” Thankfully, pelvic floor physiotherapy is one of the most empowering and effective treatment options available.

Understanding vaginismus from a holistic perspective

Vaginismus doesn’t just affect the pelvic muscles; it affects the whole person and every woman’s journey is unique. I therefore use a biopsychosocial approach, which considers the biological (physical), psychological (emotional), and social (relational) aspects of the condition. Although it can be useful to gently assess the pelvic floor muscles to identify areas of tension, guarding, or overactivity, there is so much more to consider. I listen. I validate. And I work collaboratively with you to create a treatment plan that respects your boundaries whilst meeting your goals.

What a typical treatment journey may look like for a woman with vaginismus:  

• Education: Understanding how your pelvic floor works and why it may be reacting with fear or tension is the first step toward healing.
• Breathwork and Relaxation Techniques: These techniques can help calm the nervous system, release subconscious guarding, and build a new relationship with your body.
• Manual Therapy: Gentle, internal and external techniques to reduce muscle tension and restore balance to the body and pelvic floor.
• Dilator Training: If appropriate, I guide you through gradual desensitisation using vaginal dilators, which help stretch the vaginal tissues. This is always explored at a pace that is right for you.
• Empowerment Coaching: I support your emotional healing, helping you rebuild trust in your body, regain confidence, and reconnect with pleasure.

Pelvic health physiotherapy is empowering, not invasive

Many women are hesitant about seeking pelvic health physiotherapy because they fear it will be invasive or retraumatising. For me, a woman’s full, informed consent and comfort are central to everything I do. You are always in control.

Real Healing is Possible

Healing from vaginismus isn’t always linear, and it’s not always easy, but it is absolutely possible. It is about giving you the tools, education, and support, to reclaim your optimal pelvic health, on your terms. I have worked with women who once felt hopeless and have supported them rediscover joy, intimacy, and ownership of their bodies.

If you’re struggling with vaginismus, please be assured that your body is not broken, and you do not have to navigate this alone. Pelvic health physiotherapy offers a safe, compassionate, and effective way forward that can be transformative and life changing.

You deserve to feel at home in your body. I’m here to help you get there.

Jennifer runs an in-home clinic in Maungaraki, Lower Hutt. She helps women from the Wellington region, including Porirua, Upper Hutt, the Kāpiti Coast and the Wairarapa, with their pelvic health physiotherapy needs, at all stages of life.

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Although it is important to involve pelvic floor function in an assessment, the main focus is to enable women to learn how to connect with these muscles. In pregnancy, a lot of women focus solely on doing their pelvic floor exercises (and think this is going to be the extent of my recommendations).  It is very common for women to simply squeeze their pelvic floor muscles, without thinking or even considering whether they can relax them afterwards. By understanding how to move the pelvic floor muscles through their full range of movement (which includes contracting and fully relaxing), women can feel more comfortable during pregnancy and prepare for the birth of the baby as it descends through the birth canal.

So, what else needs to be considered when thinking about pelvic health in pregnancy? Understanding your bladder, bowel, and vaginal health, alongside exploring your breathing, movement patterns and a pregnancy-safe exercise regime helps to optimise your body throughout the trimesters. This is particularly the case if you are experiencing hip, low back, or general pelvic girdle pain, especially as your bump grows bigger. Being unable to stand, walk or simply turn over in bed due to pain can be incredibly limiting and frustrating. Women often report issues such as incontinence and constipation starting in pregnancy (when they have never had a problem before). It does not need to be this way. Quite often making small changes can make a big difference, so please do not suffer unnecessarily!

It is ideal to have an assessment at Positive Pelvic Health at around 20 weeks and 36 weeks gestation, but please do not hesitate to get in touch at any time. Vaginal examinations can be completed during the second and third trimesters for low-risk pregnancies, to help understand more about pelvic floor function. It is really important for me to stress that if a woman does not feel comfortable having a vaginal examination during pregnancy (or at any other time in her life), other assessment tools can be used to understand how her body is working.

A pregnancy pelvic health assessment at Positive Pelvic Health provides the opportunity to discuss post-natal healing timescales and what can be done in the early weeks after birth to optimise recovery. It is very easy to focus solely on the birth, without thinking of what happens in the days and weeks after your baby arrives. Some women also want to know about when they can return to physical activity in a safe and effective way, so having discussions about their activity level prior to conception, during pregnancy and their goals for the future are beneficial. This means women have a plan for moving forward in the post-natal period in a safe, but empowering way!

So hopefully I have been able to show why a pelvic health physiotherapy assessment has significant benefits in pregnancy, but if in doubt please do not hesitate to get in touch, so you can feel Positive about your Pelvic Health during pregnancy.

Jennifer runs an in-home clinic in Maungaraki, Lower Hutt. She helps women from the Wellington region, including Porirua, Upper Hutt, the Kāpiti Coast and the Wairarapa, with their pelvic health physiotherapy needs, at all stages of life.

The post Is it worth having a pelvic health physiotherapy consult during pregnancy? appeared first on Positive Pelvic Health.

A pelvic health physiotherapy session can take place 6 weeks after having a baby. It is important to have time to recover after birth, since so much healing is taking place in the early weeks and quite often symptoms of tearing, scarring, bruising, heaviness and dragging can subside when given a little time. It is also logistically hard just to get out of the house for an appointment before then!

Because a Positive Pelvic Health initial consultation is 75 minutes long, it is a good idea to bring your new-born baby along with you. Lots of time is spent talking about your pregnancy, the birth and your first few post-natal weeks, especially with regards to how you, your body and, in particular, your pelvis is feeling. By exploring how the bladder, bowel and vagina are functioning, it can provide extra information regarding how the pelvic floor is impacted after birth. Lots of women presume their pelvic floor will need strengthening, however, for some learning to relax the pelvic floor muscles is much more beneficial.

I feel it is vital to consider other aspects of health, such as sleep, fluid intake, diet, physical activity levels (before conception, during pregnancy and after birth), musculo-skeletal pain and any other medical conditions that a woman may have. This ensures a fully holistic and whole-body approach is taken and outcomes of rehabilitation optimised.

During the physical assessment, a head-to-toe approach is used. What happens above and below, is just as important as what is happening with the pelvis! By looking at movement patterns, breathing, abdominal diastasis, scar healing and mobility, alongside assessing the superficial and deep pelvic floor muscles, it allows a comprehensive rehabilitation and exercise programme to be formulated and actioned.

Since I have worked as an ante-natal breastfeeding educator and a breastfeeding peer counsellor for many years, alongside raising 4 boys, I am able to adapt the session to meet the needs of you and your baby. Whether it is getting you an extra pillow to help your posture when breastfeeding or holding baby whilst you complete your physical assessment, it can make a huge difference to helping you optimise what you gain from your Positive Pelvic Health session.

By having a post-natal pelvic health physiotherapy consultation, it really can make a huge difference to your recovery and help you achieve your goals. Whether you want to get back to competing in triathlons, wearing your baby in a carrier without having low back pain or having confidence to have sexual intercourse with your partner, pelvic health physiotherapy can help with all these things and much, much more!

Jennifer runs an in-home clinic in Maungaraki, Lower Hutt. She helps women from the Wellington region, including Porirua, Upper Hutt, the Kāpiti Coast and the Wairarapa, with their pelvic health physiotherapy needs, at all stages of life.

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Chronic Pelvic Pain (CPP) affects one in every six women and refers to ongoing pain that can occur anywhere in and around the pelvis, including over the perinium, buttocks, legs, lower back, hips and lower abdominals. Every woman has her own individual symptoms of CPP which can include aching, sharp and burning sensations (and everything in-between) and this can really affect a woman’s ability to function optimally. Alongside CPP, the bladder can become affected, for example, needing to urinate frequently, having hesitancy and not always feeling empty after voiding, with constipation or difficulty emptying the bowel also being a potential issue. The actual act of emptying the bladder and bowel can become painful as well. In addition, sexual intercourse can also become uncomfortable or painful, whether it is at penetration or deeper inside.

There are many reasons why pelvic pain occurs, including (but not limited to):

• endometriosis
• fibroids
• sexually transmitted diseases
• child-birth
• during pregnancy
• irritable bowel syndrome
• ovarian cysts
• hormonal or menstrual changes
• after gynaecological, gastro-intestinal or colorectal surgery

Causes of CPP can be difficult to diagnose; as pain can be multi-facetted. By looking at the whole person and taking an approach that addresses the biological, psychological and social aspect of their pain, it can lead to a full resolution of their symptoms.

Due to complexity of CPP it is really beneficial initially to speak to your GP or specialist about your symptoms, so a full investigation can be completed to explore possible medical reasons for the pain. Quite often by the time a woman consults a pelvic health physiotherapist for CPP she will have already seen multiple healthcare providers, had numerous exploratory tests and it is often the ‘last thing to try’. This scenario can be avoided; early intervention and a multi-disciplinary approach are likely to avoid symptoms worsening over time, with a higher chance  of positive outcomes.

What does a pelvic health physiotherapist do to help pelvic pain?

At Positive Pelvic Health a pelvic pain physiotherapy assessment takes an ‘outside, in’ and full body approach. Pain is complex. Bodies are complex. The pelvis is complex. Time is therefore needed to explore exactly how, when, and why the pelvic pain is occurring. This is why an initial consultation is 75 minutes long, to enable a woman to have time to explain her story, explore her medical history and fully screen her pelvic function.

After working for many years with people with persistent pain and also completing post-graduate study in this area, my goal is that every woman leaves my clinic feeling better than when she arrived. Although physical intervention is important, it is also vital to provide education to help an individuals understanding of pain mechanisms and how external factors such a stress and sleep can impact symptoms. The development of a personalised pain management toolbox, that a woman can use themselves on a daily basis, makes a huge difference to CPP. By making small adjustments, positive changes frequently occur, improvements can regularly be seen and felt, with flare ups being less likely to occur.

Does the assessment include a vaginal examination?

Because an ‘outside, in’ approach is utilised at Positive Pelvic Health it is always best to explore what is happening physically throughout the body on the outside first. If a vaginal examination can cause anxiety and/or pain, it is often best to wait or possibly avoid a vaginal examination until a woman feels ready. It is important that a woman feels relaxed and comfortable with all aspects of her Positive Pelvic Health consultation;  thus, when an internal assessment or muscle release work is undertaken, the body will respond in an much more optimal way.

Jennifer runs an in-home clinic in Maungaraki, Lower Hutt. She helps women from the Wellington region, including Porirua, Upper Hutt, the Kāpiti Coast and the Wairarapa, with their pelvic health physiotherapy needs, at all stages of life.

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Holistic Pelvic Care™ can assist symptoms of pelvic dysfunction, including urinary and faecal leakage, constipation, low libido, prolapse, pelvic pain (including during sexual intercourse). It can be beneficial both during pregnancy and the postnatal period. By restoring the energetic balance of the pelvic bowl and body, women are empowered to then practice self-care in a nourishing and respectful manner. Jennifer has learnt directly from Tami Lynn Kent regarding the Holistic Pelvic Care™ concepts and techniques. She has observed, on both a personal and professional level, the dramatic and positive impact this approach can have on a woman’s general well-being and feminine vitality.

For more information, please refer to the Wild Feminine website: www.wildfeminine.com

Jennifer runs an in-home clinic in Maungaraki, Lower Hutt. She helps women from the Wellington region, including Porirua, Upper Hutt, the Kāpiti Coast and the Wairarapa, with their pelvic health physiotherapy needs, at all stages of life.

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