Pelvic Floor Rehabilitation: Interview With Dr. Schifone

On the occasion of World Physiotherapy Day, we spoke with Dr. Simona Schifone, a physiotherapist specializing in pelvic floor dysfunction rehabilitation at UPMC Salvator Mundi International Hospital. The pelvic floor supports the pelvic organs, helps maintain continence, and plays an important role in sexual function. Yet disorders affecting this area are still too often underestimated or associated with embarrassment, leading many women to forgo a specialist assessment.

This is not a rare issue. According to the World Health Organization, at least 40 million women worldwide live with long-term health conditions related to childbirth each year, including urinary incontinence, which affects between 8% and 31% of women during the postpartum period.

We discussed these topics with Dr. Schifone, from the first weeks after childbirth through menopause.

What are the first signs women should pay attention to, and which are often underestimated or mistaken for something else?

These are often subtle symptoms that many people consider “normal” when they are not: involuntary urine leakage when coughing or sneezing, a frequent and urgent need to urinate, a feeling of heaviness in the genital area or lower abdomen, chronic constipation, and pain during sexual intercourse. The key point is that none of these symptoms should be considered inevitable. The sooner they are recognized, the sooner treatment can begin, and outcomes tend to be better. Prevention, however, remains essential.

Why do pregnancy and childbirth place such significant strain on these muscles, and when should postpartum rehabilitation begin?

During pregnancy, the pelvic floor supports the growing weight of the fetus, while hormonal changes make tissues more elastic and compliant. Vaginal delivery adds considerable stretching and, in some cases, direct trauma such as tears or episiotomies. The result may be reduced muscle tone or altered sensation.

Many women are not guided through birth preparation programs that include exercises and perineal massage, which can help prevent tears. For this reason, I recommend an initial specialist assessment approximately 4 to 6 weeks after delivery. Whether the birth was vaginal or by cesarean section, the pelvic floor should still be evaluated. We assess muscle strength, coordination, and relaxation capacity, and then develop a personalized rehabilitation plan. This may include exercises performed in the outpatient clinic as well as simple exercises to do at home, aimed at restoring function and preventing future complications.

Which exercises do you recommend for new mothers during this stage, and what should they avoid?

The process begins with very gentle movements: short, light pelvic floor contractions to gradually restore awareness and sensation without overloading the tissues. The next step is coordinating diaphragmatic breathing with pelvic floor contractions. Whether lying down or sitting, this involves taking deep breaths combined with contractions held for a few seconds, followed by complete relaxation. As recovery progresses, functional exercises are introduced. These help women learn how to “protect” the pelvic floor during everyday activities and light physical exertion, such as lifting their baby.

Activities to avoid include running, jumping, and traditional abdominal exercises. These are high-impact activities that increase intra-abdominal pressure and may delay recovery.

Pelvic floor disorders often worsen during menopause. What is the link with hormonal changes, and how can physiotherapy help?

It is no coincidence that urinary incontinence affects approximately 45% to 50% of women during this stage of life. During menopause, estrogen levels decline progressively. These hormones are essential for maintaining the elasticity, blood supply, and tone of pelvic floor tissues. Over time, collagen levels also decrease, supporting structures become weaker, and the risk of urinary incontinence, pelvic organ prolapse, and discomfort during intimacy increases.

Physiotherapy addresses these issues from several angles: muscle strengthening, functional retraining, and restoring tissue elasticity. In some cases, I use biofeedback: through a vaginal probe, patients can see their muscle activity in real time and learn how to contract and relax the pelvic floor correctly. This is an effective way to improve body awareness, not just muscle strength.

Which exercises do you recommend for women in menopause to counteract the loss of muscle tone?

The focus is primarily on developing awareness of the pelvic floor so that strengthening and flexibility exercises can then be introduced. Exercises designed to support pelvic floor health and well-being are known as PFMT (Pelvic Floor Muscle Training). This therapeutic program aims to increase awareness, improve muscle tone, and promote relaxation of the pelvic floor through exercises that also involve, and often focus on, the abdominal and respiratory muscles. The goal is to improve muscular control during activities such as sneezing, coughing, long walks, or any situation that increases intra-abdominal pressure and may lead to urine leakage. This approach works on the body as a whole rather than targeting a single muscle, and that comprehensive strategy is what makes a lasting difference over time.

Urinary incontinence and pelvic pain remain difficult topics to discuss. What happens when stigma keeps women from seeking care, and what would you say to someone who has never spoken about these issues with anyone?

Stigma remains one of the main barriers today. Many women view certain symptoms as an inevitable consequence of aging, pregnancy, or menopause and therefore tend to minimize them. Others feel embarrassed discussing these issues and postpone seeking help for years.

Unfortunately, this delay can lead to worsening symptoms and a greater impact on daily life, relationships, and sexual well-being.

To anyone who has never spoken to anyone about these concerns, I would like to say that incontinence, prolapse, and pain are not conditions that should simply be accepted. Effective and minimally invasive treatment options are available today. Speaking openly about these disorders is the first step toward treatment and the recovery of well-being.

As Dr. Schifone emphasizes, pelvic floor disorders should not be passively accepted. Book an assessment with the pelvic floor rehabilitation team at UPMC Salvator Mundi International Hospital.