Specialist pelvic health · London
Pelvic floor assessment, specialist physiotherapy + Modified Oxford scale for incontinence, prolapse and sexual dysfunction.
A structured specialist assessment of how the pelvic floor is working. It combines a physio examination (Modified Oxford scale) and pelvic floor ultrasound. Urodynamics and manometry are added when needed. It is used for urinary and bowel incontinence, prolapse, pelvic pain, and sexual dysfunction.
Reviewed by Pulse Atlas Editorial Board, · 6-minute read · Last updated 2026-07-30 · Next review 2027-07-30
Key facts
What a pelvic floor assessment is, in six lines.
The essentials — grading, imaging, adjunctive tests and where it sits in the wider pathway.
-
Definition
A structured pelvic floor assessment. Urodynamics and manometry are added where the picture calls for them.
-
Modified Oxford Grading Scale
Standardised 0–5 grading of pelvic floor muscle strength on digital examination.
-
Trans-perineal / endovaginal ultrasound
Real-time imaging of pelvic floor anatomy, prolapse and sphincter integrity.
-
Complements colorectal physiology
Sits alongside anorectal manometry and colorectal physiology for a complete floor picture.
-
Multi-disciplinary team-linked
Direct pathways into gynaecology, colorectal and urology teams when needed.
-
Structured rehabilitation plan
Personalised pelvic floor rehabilitation programme with measurable milestones.
How it’s done
From questionnaire to plan — what happens, in order.
A structured seven-step pathway from first history to a written, personalised plan.
- 01
Consultation and questionnaire
Symptom history — incontinence, prolapse, pain, sexual dysfunction — with validated questionnaires (ICIQ, PISQ, POP-SS).
- 02
Modified Oxford scale examination
Specialist pelvic health physiotherapy examination grading strength 0–5, plus endurance and coordination.
- 03
Trans-perineal ultrasound
Dynamic ultrasound of pelvic floor anatomy at rest, on squeeze and on Valsalva.
- 04
Bladder diary
A 3-day frequency-volume chart, capturing fluid intake, voids and leakage episodes.
- 05
Optional urodynamics
Pressure–flow studies where storage or voiding dysfunction needs objective characterisation.
- 06
Optional anorectal manometry
High-resolution manometry when faecal incontinence, obstructed defecation or sphincter injury is suspected.
- 07
Structured personalised plan
A written plan — physiotherapy, biofeedback, bladder retraining, pessary or surgical referral — with follow-up scheduled.
What it shows
What a pelvic floor assessment can identify.
The presentations this assessment is designed to characterise — with one important red flag.
-
Pelvic floor weakness
Reduced Modified Oxford grade with poor squeeze endurance — a treatable driver of stress incontinence.
-
Muscle overactivity / dyssynergia
Non-relaxing pelvic floor causing voiding difficulty, constipation and pelvic pain.
-
Uterovaginal prolapse (POP-Q)
Staged prolapse using the POP-Q system with dynamic ultrasound correlation.
-
Rectocoele / enterocoele
Posterior compartment prolapse identified on examination and imaging.
-
Stress / urge / mixed incontinence
Characterises the incontinence phenotype to direct therapy.
-
Faecal incontinence
Assesses sphincter integrity, sensation and rectal capacity.
-
Post-obstetric sphincter injury
Endoanal ultrasound findings after third or fourth-degree tears.
-
Red flag: OASIS with symptoms — urgent colorectal MDT
Symptomatic obstetric anal sphincter injury needs urgent colorectal MDT referral.
Treatment options
What treatment can look like, once we know what’s going on.
The mainstays — from physiotherapy and biofeedback through to pharmacology, neuromodulation and surgical referral.
-
Pelvic floor physiotherapy
First-line supervised programme with a specialist pelvic health physiotherapist.
-
Biofeedback
EMG or manometric biofeedback to retrain coordination and strength.
-
Bladder retraining
Scheduled voiding, urge-suppression techniques and fluid modification.
-
Pessary for prolapse
Fitted vaginal pessary — ring, shelf or Gellhorn — for symptomatic prolapse.
-
Anti-muscarinic / mirabegron
Pharmacological management for overactive bladder and urgency.
-
Sacral nerve stimulation
Neuromodulation for refractory urge incontinence or faecal incontinence.
-
Surgery for prolapse / incontinence
Referral into gynaecology or urogynaecology for surgical repair when indicated.
-
Structured multi-disciplinary follow-up
Joint gynae, colorectal and urology review with measurable outcomes.
Red flags
When something needs urgent attention, not a routine slot.
Presentations where the right route is urgent specialist review or A&E — not a private appointment down the line.
-
OASIS with symptoms
Symptomatic obstetric anal sphincter injury — urgent colorectal MDT.
-
Recurrent UTI
Repeated urinary infection needs urology work-up beyond pelvic floor assessment.
-
Post-radiotherapy pelvic floor dysfunction
Radiation-induced changes require specialist onco-gynaecology input.
-
Neurogenic bladder (spinal cord)
Spinal cord pathology needs urgent neurology and urodynamic assessment.
-
Cauda equina syndrome
New saddle anaesthesia, bilateral leg weakness or urinary retention is a 999/A&E emergency.
-
Persistent vulvodynia
Chronic vulval pain benefits from a specialist multi-disciplinary vulval clinic.
-
Post-op fistula
Suspected vesico-vaginal or recto-vaginal fistula needs urgent surgical review.
-
Frozen pelvis (deep endometriosis)
Suspected deep infiltrating endometriosis needs specialist endometriosis centre referral.
-
Post-menopausal prolapse with erosion
Vaginal erosion or bleeding on top of prolapse needs urgent gynaecology assessment.
Sources
The evidence base for this guide.
UK guidelines and international standards that shape the assessment and its follow-through.
Frequently asked
Everything we get asked about pelvic floor assessment.
Straight answers on what the exam involves, when urodynamics is needed, and when a symptom warrants urgent review.
-
What does a pelvic floor assessment involve?
A specialist history and questionnaire, a Modified Oxford scale physiotherapy examination, dynamic trans-perineal or endovaginal ultrasound, and — where indicated — urodynamics or anorectal manometry, ending in a written personalised plan.
-
What is the Modified Oxford scale?
A validated 0–5 grading of pelvic floor muscle strength on digital vaginal examination — 0 is no contraction, 5 is a strong contraction with lift. Endurance and repetitions are recorded alongside.
-
Is a pelvic floor assessment painful?
It shouldn’t be. The examination is gentle and consented step by step; you set the pace, and any part can be stopped at any time.
-
Do I need urodynamics as well?
Only if storage or voiding symptoms need objective characterisation before treatment — most patients don’t. The clinician will explain if it’s indicated.
-
How does this differ from a gynae ultrasound?
Gynae ultrasound looks at the uterus and ovaries. A pelvic floor assessment looks at the muscles, sphincters and support structures — a different question, a different technique.
-
When should I see my GP urgently instead?
New saddle numbness, bilateral leg weakness, sudden inability to pass urine, or heavy vaginal bleeding with pain — call 999 or attend A&E. A private appointment is not the right route for those symptoms.
Related tests
Looking for a different test?
-
Anorectal manometry
High-resolution manometry for faecal incontinence and obstructed defecation.
Learn more -
Colorectal physiology
The full colorectal physiology work-up alongside pelvic floor assessment.
Learn more -
Gynae ultrasound
Ultrasound of the uterus and ovaries — a different question, a different scan.
Learn more -
All tests
Browse every test and procedure we arrange.
Learn more -
Endometriosis
Related condition guide.
Learn more -
Menopause
Related condition guide.
Learn more -
Coil IUD IUS Insertion And Removal
Related treatment option.
Learn more -
Colposcopy With Lletz
Related treatment option.
Learn more
In practice, in London
Booking pelvic floor assessment privately in London — what actually happens
With pelvic floor assessment, the London question is usually about report turnaround and the radiologist reading it — not whether the scan is available. On the NHS, pelvic floor assessment typically sits behind a triage step and a wait that can stretch from a few weeks into months. In London’s private sector, the same appointment often lands within days. That speed matters when symptoms are disrupting work, sleep, or a plan you’d already committed to — and it’s the single most common reason people call us in the first place.
In practice, a private pelvic floor assessment appointment in London means a named consultant, a proper hour in the room (or the equivalent on a video call), and a report you can actually read. Most of the imaging suites and endoscopy units we use sit within a mile of Harley Street or in Chelsea and Fulham, and turnaround on findings is measured in days, not weeks. For pelvic floor assessment specifically, the difference between a routine report and a sub-speciality read is where private care earns its keep.
Fit matters more than people expect. For pelvic floor assessment, the right consultant depends on what you actually need — a second opinion, a definitive diagnosis, a bridge into treatment, or reassurance that nothing’s being missed. We match on that, not on who has the biggest brochure. If a test isn’t the right next step, we’ll say so before you book anything.