Physiotherapy can help a range of pelvic health conditions which include:

Problems with your pelvic floor muscles at any stage in life:
•    Leaking urine
•    Leaking poo/wind
•    Bladder or bowel urgency
•    Pelvic organ prolapse
•    Pelvic pain

Problems occurring in pregnancy or up to six months after birth:

•    Pelvic girdle pain
•    Lower back pain 
•    Rib pain 
•    Hip pain 
•    Coccyx pain

If you have these symptoms, and it's been more than six months since you were pregnant, please do not complete this form. Instead, please discuss the problem with your GP so that they can assess your problem and help you access the right support for your symptoms. Sometimes this will involve referring you to your local musculoskeletal physiotherapy service.

These are common problems that can affect women and people assigned female at birth but they are not something you have to put up with, seeing a pelvic health physiotherapist can help to reduce or resolve these problems.

What is self-referral and what do I need to do?

Self-referral allows you to contact the Pelvic Health Physiotherapy Service directly, without seeing your GP/healthcare professional first. 

Please read the information on this website before making a self-referral. Go to the Pelvic Health Physiotherapy Service webpage and select the tile that best matches your symptoms. You may find that the self-management advice improves your symptoms and that a self-referral is not needed.

If you choose to refer, please complete all questions on the form, this is to help the Physio team decide on the correct treatment for you.  Any incomplete forms will not be accepted, and you risk not being seen by the physio team.

If you are unable to complete the form, please ask your GP, Midwife or healthcare professional for help

Who is the self-referral NOT for?

The referral is not for men, children or for separation of the stomach muscles (diastasis recti of the abdominus muscle).  These will need to be referred to the Pelvic Health team by your GP.

If you have seen other healthcare professionals or had tests or treatments for your symptoms, then please DO NOT self-refer and instead discuss your problem with your GP.  This will help to ensure that you are directed to the right service. If your GP or healthcare provider feels that pelvic health physio is the most appropriate treatment option, they will need to complete a referral on your behalf

General screening 

The below information is about your general health, not just your pelvic health problem and it's important that you read it carefully. This will make sure that any potential serious problems or 'red flags' are dealt with correctly by your GP or healthcare professional. 

You will have opportunity to tell us about your pelvic health symptoms further down the page.

If you have any of the following symptoms, please speak to a GP before referring yourself to pelvic health physiotherapy:

• Burning or stinging sensation when you pee
• Blood in your pee.
• Unusual or unexpected bleeding or staining from the vagina.
• Blood in your poo (without other symptoms of piles).
• Persistent change in your bowel habit (needing to go more often, having runny poo and/or tummy pain).
• Persistent lower tummy pain, bloating or discomfort (caused by eating and maybe associated with loss of appetite or significant weight loss).
• Difficulty starting your urine stream
• Difficulty emptying your bladder completely
• If you strain, push, or use your hands to empty your bladder
• If you have ever had urinary retention or urinary tract infections related to incomplete emptying of your bladder

I have read and understood the above, and I don’t have any of the above symptoms

Cauda equina 

Cauda Equina Syndrome is a rare but severe condition where the nerves at the bottom of the spine become compressed. 

If you have new sudden and severe low back pain and/or leg pain AND any of the following symptoms which started within the last two weeks, or your symptoms are getting worse then please do not complete this form and call NHS 111 or attend A&E as you may require immediate medical attention:

• Loss of feeling and/or pins and needles between your inner thighs or genitals.
• Numbness in or around your anus or buttocks.
• Altered feeling when using toilet paper to wipe yourself.
• Increasing difficulty when you try to stop or control your flow of pee.
• Loss of sensation when you pee.
• Leaking urine or recent need to use pads.
• Not knowing when your bladder is either full or empty.
• Unable to hold on when you need to poo.
• Inability to stop a bowel movement or leaking.
• Loss of sensation in the vulva/vagina during sexual intercourse.

If you have had low back pain and/or leg pain AND any of the symptoms above for more than two weeks and they are not getting worse then please make an appointment with your GP, before seeing a pelvic health physiotherapist.

I have read and understood the above, and I don’t have any of the above symptoms