Pelvic Floor Physiotherapy

Overactive Bladder Syndrome

Painful bladder syndrome is a complex, difficult to treat and poorly understood, yet benign, condition affecting the bladder and the functioning operations of the bladder.  At Core Body Clinic we aim to offer hope to patients by educating, providing pain relief and ensuring patients are confident in a long term management strategy to get their lives back.  

Bladder pain syndrome is characterised by:

  • Pain
  • Increased frequency of needing to pass urine
  • and/or urgency when toileting.  
  • difficulty initiating voiding


These symptoms would be differentiated from more sinister conditions and any changes should be reported to your GP and a referral for examination by a urologist should be made.  Only then, once all necessary tests have been carried out by the urology team can PBS / OBS be assigned as a diagnosis.   Bladder pain syndrome or overactive bladder syndrome can fit under the umbrella term of chronic pelvic pain because it may occur without any identifiable diagnostic markers.  This means a battery of tests may be performed and not provide a diagnosis.  Therefore, patients with Painful Bladder syndrome or overactive bladder syndrome experience a long and drawn out process of hospital visits and tests.

PBS can involve a wide variety of pain locations including: Bladder, urethra, vagina, groin, and, prostate in men.  Hence, it is sometimes difficult to differentiate the syndrome from chronic pelvic pain.  In addition, the duration of symptoms may eventually lead to a more chronic pain manifestation. OBS may be the only symptom with incresased urgency and thus may eventually be a more specific diagnosis. 

Patients sometimes present with the diagnosis of ‘Interstitial cystitis (IC)’.  This is a difficult to treat and diagnose condition and is sometimes grouped along with bladder pain syndrome.  It is a debilitating condition and again, it is poorly understood because of the paucity in diagnostic markers which differentiate it from other benign conditions.  This will often lead to a delay in diagnosis and a more chronic pain pattern for the patient.  IC is thought to primarily begin as a chronic inflammatory condition that affects the bladder wall.  There is sometimes evidence of inflammation, yet in other patients there is nothing.  Pain may also persist after the inflammation has reduced.  This condition mostly affects women.  



  • PBS/IC can share common symptoms with pelvic pain:
  • Frequency, urgency and pain in the bladder
  • Pain over the abdomen, bladder region, genital region
  • Increased nocturnal micturition (ie, needing to get up at night)
  • A feeling that the bladder does not empty after toileting
  • Needing to go to the toilet more during the day, more chronic manifestations may experience this due to lot bladder capacity.
  • Pain after sexual intercourse (ejaculation in men) where the bladder feels irritated and a sense of needing to go to the toilet, despite an empty bladder
  • Pain is worse when there is stress



The diagnosis of bladder pain syndrome or overactive bladder syndrome are typically by process of elimination of other disorders.  Patients often present having undergone several tests with no diagnosis, often leaving them very low in mood. It is always important to emphasise the necessity of doing this to exclude other conditions of a sinister nature such as bladder, prostate, urethral or other pelvic / gynaecological cancers. 

Typical examination procedures include: ultrasound, MRI, cystoscopy, cytology and biopsy.  There may be urine flow test which measures how quickly we urinate or a bladder ultrasound to measure residual urine after toileting.  Again, most of these tests exclude other causes and once completed a diagnosis of bladder pain syndrome/PBS is made.  



Patients presenting at the clinic have often gone through a number of different treatments including:

  • Medication,
  • Pain management,
  • Bladder distension,
  • Bladder installation
  • Botox injections
  • Surgery can sometimes be offered in extreme cases



History taking: 

  • An in-depth assessment about the condition - when did it start and what has happened up to now?
  • What are the drivers of the patient’s pain. 
  • We look at behaviour; what they do, what coping strategies they have and whether they work or not. 
  • How long it takes to work and does it last? 
  • We want to know how long pain spikes or lasts for. 
  • What tests or treatment has already been done.
  • How does the pain make the person feel?


This is called the history and it is a story unique to the patient and helps us understand how they feel about the condition. It is perhaps one of the most important components of pain management.  



We look at:

  • posture
  • breathing patterns
  • spinal and hip ranges of movement
  • muscle strength 
  • nerve length
  • Ultrasound Examination of the Bladder


We are assessing the patient to determine if they have any drivers for their pain.  More chronic presentations will be easily aggravated by movements of joints and muscles close to the bladder/pelvic floor.  While these are not necessarily the cause, they become part of the problem.  Sometimes, the initial cause remains a mystery.  However, we aim to work through the assessment to understand your condition and the potential drivers.  Looking at the general condition of the individual is essential with evidence supporting that a better conditioned body favours recovery from chronic syndromes.


  • Dynamic ultrasound (DUS) of the bladder and pelvic floor

DUS is an important and unique assessment procedure that we use at Core Body Clinic.  It is important because it provides a functional understanding of how the muscles switch on and more importantly, switch off.  Quite often in bladder pain syndrome the muscles are chronically sensitised and the patient has difficulty turning the muscles off.  This level of sensitivity constantly drives up the pain and with this the muscles fail to disengage.  Through a training process the muscles become too good at staying in a contracted state. We know that over time chronically tensed and active muscles over sensitise muscles and nerves leading to a chronic pain state and with it, a painful bladder syndrome.  Dynamic ultrasound helps to examine and re-train a painful and chronically irritated area while avoiding physical examination which may further aggravate pain.  Many patients have had unsuccessful internal massage which can leave them further irritated and damage confidence in therapy.  We term the use of ultrasound:  ‘looking inside while staying outside’.  It is a very dignified way of assessment because the ultrasound transducer if placed on the lower abdomen allowing the patient to remain dressed.  The ultrasound provides a real-time understanding of pelvic movement and relaxation and gives the patient a visual understanding of how muscles in the pelvis function.  We have found this procedure in examination and treatment provides the patient with a real sense of control and helps to manage their pain in a much better way.


Physiotherapy Treatment for Painful Bladder Syndrome:

We formulate a treatment plan based on the assessment findings and this is unique to the individual.  Treatments may look familiar but they will not be identical between patients.

Treatment may include:

  • Ultrasound muscle retraining
  • Relaxation and breathing techniques
  • Stretches and active release techniques
  • Weight training
  • Cardiovascular conditioning
  • Diet and drink advice
  • Manual therapy to the abdomen and spine
  • Coaching techniques on pain management
  • Electrical nerve stimulation (percutaneous tibial electrical nerve stimulation) using TENS or Acupuncture - PTNS 
  • Rarely we use internal massage or instruct the patient in the use of a Therawand.



At Core Body Clinic we aim to build confidence in our patients by helping them to understand the chronic nature of pain.  We offer physical therapies to assist with pain relief and exercise rehab to provide patients with a sense of control to manage their condition long term.  We emphasise that chronic pain is a state in which long term changes have taken place in the soft tissue and, more importantly, in the central nervous system (Nerves and brain).  We stress that pain is “an unpleasant experience” (as described by the NISP) where beliefs, previous experiences and learned behaviour all have an impact on how we tolerate and feel pain, which in turn determines how our body and muscles or bladder reacts. With this, we aim to educate patients stressing that, because pain develops over time there is an opportunity to unlearn and rewire the nervous system to a point where pain is more manageable and even cured.  

For more information, call Core Body Clinic or send an email confidentially to This email address is being protected from spambots. You need JavaScript enabled to view it.

Pelvic Floor Physiotherapy & Men's Health Physiotherapy

Pelvic Floor Physiotherapy and Men’s Health physiotherapy is a specialist branch of physiotherapy that deals with male pelvic pain (chronic prostatitis) and pelvic organ dysfunction.  At Core Body Clinic we are trained both in musculoskeletal physiotherapy, chronic pelvic pain therapy and men’s health physiotherapy combining a unique skill set to comprehensively assess and diagnose problems affecting the pelvis.

** If you are an international patient or someone who cannot attend the clinic then you can have a session via Video link - Click here**

Hard Flaccid

Seeing patient Face to Face and Online

"No two patients with hard flaccid are the same. We must treat every patient as an individual".

Adrian Wagstaff, Male Pelvic Physio 

For Online bookings please click here

What is Hard Flaccid?

Hard Flaccid Syndrome is a condition affecting the penis and is of unknown aetiology among men.  However, our observations suggest hard flaccid syndrome to be more prevalent between the ages of 18 and 35.  It is characterised by a change in penis size, shape and feel.  Penile stiffness or swelling when the penis is in a flaccid state and flaccid size is a common characteristic.  The penis is sometimes firmer to the touch, it is engorged and rubber in texture, and is often accompanied by a change in size or shape of erection.  There may be a loss in nocturnal erections, and it may require a greater degree of stimulation to achieve an erection.  There is often a loss in libido and a shattering of confidence.  However, the most common reason for someone seeking help when suffering from hard flaccid is because of alarming changes in penile shape and size.  Patients often self-diagnose hard flaccid from reading online forums.  It is different from peyronnie’s disease because there are no visible signs of tissue scarring and plaque formation. Nevertheless, hard flaccid is a distressing and poorly understood condition.  At Core Body clinic, our pelvic physiotherapists are experts in the treatment of Hard Flaccid syndrome. 

Chronic Prostatitis and Chronic Pelvic Pain Syndrome (CPPS)

Chronic Prostatitis (or prostatitis 3b) or Chronic Pelvic Pain Syndome (CPPS) are often considered synonymous where pain in the pelvis is of a persistent nature.  

In Prostatitis, there is often as an infection affecting the prostate gland.  However, only about 5-10% are actually bacteria related with the vast majority related to inflammation or non-specific pain syndromes. Prostatitis can affect all men at any age and accounts for about ¼ of all pelvic pain conditions, genital or urinary conditions in young to middle aged men.  Where pain persists after a period of time and after medicine has failed to resolve pain, by process of elimination, CPPS or Chronic Prostatitis type 3b is a diagnosis often assigned.   


Our pelvic therapists at Core Body Clinic are experts in treating Incontinence. We understand it and we really care about helping you.   

Erectile Dysfunction and Shockwave Therapy

Erectile dysfunction describes a condition where an erection is either not possible or not sufficient for the desired task of sexual activity. 

One of the main drivers causing erectile dysfunction is poor vascular blood flow and patients who respond well or fair to PDE5i medication are shown to have the best outcome.  Patients who are non-responders have shown to improve and become good responders to PDE5i medication following Focus Shockwave .   

At Core Body Clinic we also use Focus ShockWave in the treatment of Pelvic Pain in both men and women, and we are currently using in Hard Flaccid syndrome and erectile function after Prostatectomy.

You can find out more by calling or emailing the clinic or booking online

How does Shock wave help Erectile Dysfunction?

While medication like PDE5 inhibitors provide a solution to erectile dysfunction, they do not change the underlying pathophysiology of loss in vascular supply and reduced nitric oxide release.  Focus shockwave has angiogenic properties and delivers electro shock impulses into the target tissue stimulating healing through the process of angiogenesis.  New blood vessels are formed and the release of nitric oxide is enhanced dialating blood vessles and increasing cell permeability.  The overall effect increases and enhances perfusion and thus provides a longer standing change in erectile tissue physiology and therefore enahnced erectile function. 

Research has shown that these changes achieve better and even spontaneous erectile function, where this might have been unachieveable.  Some patients experience pain during an erection and ShockWave therapy can help by modulating the release of substance P, a powerful peripheral nerve neurotransmitter responsible for the reduction of pain.



Research has demonstrated that Focus ShockWave therapy can lead to a significant improvement in erectile function and has been shown to improve the International Index of Erectile Function which lasts at least 9 months .  A systematic review (pooling of lots of randomised controlled trials) with a cohort of over 800 patients treated for erectile dysfunction using focus shockwave therapy found that the treatment was indeed highly effective, safe and led to significant improvements in erectile function. Further reading can be found here.


How many sessions are required?

It is necessary to repeat the sessions for at least 6 weeks and in a consistent weekly manner.  In some instances it is necessary to repeat 2 sessions a week.

6 to 8 sessions are needed in most cases.  This can last for up to 18 months with a repeat course recommended after this time. 


Is it safe?

Shock Wave therapy is very safe provided it is delivered by trained practitioners.  Some patients experience a little ache like pain during the treatment that can last for 24 to 48 hours afterwards. 



Is this the only treatment I need?

Erectile dysfunction can have many causes that interact to cause ED.  Therefore, having a holistic approach to treatment is key in ensuring you get the best out of the Shock wave therapy. Other treatments may include:

  • Pelvic floor exercises to release your pelvic floor

  • Specialised Breathing and relaxation work.  Relaxation through breathing has been found to be hugely beneficial for all types of conditions.

  • Re-education of the  pelvic floor, hip and abdominal musculature

  • General exercise


more reading.........

How does an erection happen?

An erection occurs when we become aroused and messages from the brain signal the penile muscles (Corpus Carvernosa) to relax.  Blood enters the erectile tissue (Corpus Carvenosa) via the pudendal artery and inflates the penis.  The Tunica Albugenia then contracts to trap the blood in the penis and keep it in an erect state.

The erectile tissue  of the Corpus Carvenosa and Corpus spongiosum are under autonomic control are extensions of the pelvic muscles of the skeletal and consciously controlled Bulbospongiosus and Ischiocarvenosus.  It must be noted that these are different. 

What Causes Erectile Dysfunction?

There are many causes of erectile dysfunction and finding out the likely cause is a good starting point in getting the right treatment.  This is a list of possible causes:

Problems affecting the flow of blood to your penis

Conditions of the nervous system, which is made up of your brain, nerves and spinal cord

Changes or disease causing change in hormone levels

Physical structure problems in the penis



Psychological and emotional well-being

Intra-pelvic pain syndromes like Chronic Pelvic pain

Hard Flaccid or HF

Post surgical injury to nerves and muscular tissue (Prostatectomy / TURPS)


We would always recommend you also seeing your GP to help rule out any other co-morbid factors.


To find out more:

To find out more please email the clinic or call. 

Ask for Adrian Wagstaff to call you back. 

If you are confident you require Shock wave then simply book online using the online services.


Diastasis Recti

Diastasis Recti - This is a term describing the separation of the abdominal muscles. The abdominal muscles consist of the rectus abdominus, the deeper transversus abdominus, and then the internal and external oblique muscles.

Prostate Cancer: Physiotherapy and Rehabilitation

Prostate Cancer touches one in eight men and many opt for surgery to the remove the prostate (radical prostatectomy).  Other treatments include hormone therapy, radiotherapy and in some instances chemotherapy, largely depending on the stage and grade of cancer.  Radical surgery has a 15 year survival rate of almost 90%.  However, this life saving surgery can often leave a man suffereing incontinence and erectile dysfunction.  

Pelvic Floor and Womens Health Physiotherapy

What is Pelvic Floor and Womens Health physiotherapy and how can it help me?

Women's Health Physiotherapy is a specialist branch of physiotherapy where the physiotherapist has undergone specialist training and achieved advanced competencies in pelvic and gynechalogical anatomy, pathology, diagnosis and treatment. They are trained to assess and treat women suffering from pelvic floor weakness, problems with the bowel and bladder, pain in the pelvis and those women who have had a baby or who are pregnant and having problems.  At Core Body Clinic our physiotherapists are dual trained in musculoskeletal physiotherapy and Women's Health Physiotherapy.  They have a detailed understanding of pelvic anatomy and pelvic floor function and they are skilled in many techniques to treat pain and rehabilitate function. 

Pudendal Neuralgia


Pudendal Neuralgia (PN) in its truest form is a tunnel entrapment neuropathy and can affect both women and men.  It is not a common condition, though patients often present with the diagnosis and no formal investigations.  It is said to affect 1 in 100000 people and around 3-5% of pelvic complaints .  The pudendal nerve is a major nerve (like the sciatic nerve) arising from the sacral plexus (S2,3,4).  It is an important nerve for differential diagnosis in cases of CPP (Chronic pelvic pain). The pudendal nerve is a mix of motor, autonomic and sensory functions and therefore affects bowel, bladder, sexual and other autonomic functions.