Self-referral to antenatal and postnatal physiotherapy

The pelvic floor is a group of muscles and connective tissues that support the bladder, bowel and uterus. It also helps with bodily functions like urination, defecation and sexual function.

If you are suffering from any of the following symptoms, please share a few details about yourself to make your self-referral.

Urinary incontinence (having to pass urine frequently/urgently or leaking when you
cough,sneeze and run etc.)
Faecal incontinence (not being able to hold wind or faeces)
Obstructive defecation (feeling like your faeces is ‘stuck’)
Pregnancy related hip, back or pelvis pain including sciatca
Diastasis recti (when the muscles in your abdomen ‘cone/peak’ when you sit up. This is tummy muscle weakness/separation)
Vaginal prolapse (heaviness/dragging in the vaginal area)
Perineal tension (the area of skin between your vagina and anus)
Painful intercourse
Vulvodynia (pain to the area around the opening of the vagina
Perineal tension
Carpal tunnel syndrome related to pregnancy

Current About you
Pregnancy
your medication
FYI and you
Complete

First name

Last name

Hospital number

Date of birth

Your email address

Telephone

Address

Address 2

City/Town

Postal Code

Named midwife

Do you need an Interpreter?

Yes

If Yes, for what language?