Pelvic floor dysfunction is common amongst women and can lead to a variety of symptoms. Examples of pelvic floor dysfunction include:
You can find out more in this leaflet: Lets talk about continence
The Pelvic Floor Muscles are a group of muscles that span the underside of your pelvis, forming the ‘floor’ of your pelvis. They insert into the pubic bone at the front, they fan out to the side into your sitting bones, and then into your tailbone/coccyx at the back.
The Pelvic Floor Muscles support the bladder, reproductive organs, and bowels inside the pelvis, keep us continent of urine and faeces, provides stability to the spine and pelvis when we are active, and have an important role in sexual function.
The muscles can become dysfunctional (not work properly), this can be due to a number of factors including pregnancy and delivery, age, menopause, chronic choughs, chronic constipation. Typically, we think of pelvic floor muscles becoming weaker, with a reduction in endurance and function. This leads to symptoms such as urinary incontinence, pelvic organ prolapse and problems with bowel control.
If you think your muscles are weak follow the advice below.
You may find it easier to start the exercises in lying or sitting but it is important to progress these to standing or functional positions where you feel you need more support from your pelvic floor muscles.
Further information and resources on Pelvic Floor Muscles can be found below:
This animation shows the location of your pelvic floor muscles – Pelvic Floor Anatomy
The following is a video and leaflet explaining pelvic floor muscle exercises further:
Squeezy: pelvic floor support app (squeezyapp.com)
It can be important to link your pelvic floor with your breath and having good breathing technique is important.
Very often, in day to day life we breathe shallowly mostly using our upper chest, rather than focusing on using our diaphragm.
Sit or lie comfortably with one hand lightly on your upper chest and one hand on your upper abdomen (tummy or belly), where it meets your lower ribs. Focus your attention on your breathing.
If comfortable for you, breathe in slowly through your nose, and then out through either your nose or mouth.
Aim to keep your upper chest more relaxed as you breathe in and out. You may need to adjust your position or posture so that the bottom of your ribcage can move freely. If you are slouched then the ribcage may be restricted.
Try imagining that you have a balloon in your abdomen and as you breathe in, the balloon is gently inflating with the breath. This should cause your tummy to gently rise, and your lower ribs to lift outwards. As you breathe out, imagine the balloon gently deflating – your abdomen should gently fall.
To link this with your pelvic floor exercises as you breathe out lift and squeeze your pelvic floor muscles holding as you take a few gentle breaths.
The kidneys filter our blood to remove excess water, waste, and produce urine, which travels along the ureters to the bladder. The bladder stores the urine and then empties it out.
We tend to get the initial desire to pass urine when it is holding approximately 150mls, but we often ignore these first signs. Generally, people visit the toilet to pass urine when it is convenient, and the bladder is holding approximately 400mls urine. This volume tends to be larger for the first void (wee) of the day.
A healthy bladder will need emptying up to 6-8 times per day, and not more than once during the night.
A healthy bladder should give us plenty of warning when it is getting full, be free of infections, and empty fully without pain or blood in our urine.
Aim to drink between 1.5 – 2 litres (6-8 mugs) daily.
Urinary incontinence is a common condition affecting 1 in 3 women. However, it should not be accepted as the norm and can improve with simple advice and exercises found below:
There are two main types of urinary incontinence:
Stress and urge incontinence can also occur together and this is known as mixed incontinence.
Bladder Frequency, urgency and urge incontinence may be due to an overactive bladder
If you are experiencing stress incontinence and/or urge incontinence strengthening your pelvic floor muscles can help to improve your symptoms – see the Pelvic floor exercises section for more information on this.
You may want to avoid drinks that can irritate the bladder if you experience urinary frequency, urgency or urge incontinence.
Bladder training can often help to reduce frequency, urgency and urge incontinence. This is explained in this leaflet - Bladder Training
Here is an example of a bladder diary (as described in the leaflet) that you can complete - Bladder Diary
If you have difficulty fully emptying your bladder, see the link below for helpful techniques
Pelvic floor dysfunction can contribute to difficulties emptying the bladder. This can be due to either a weak or a tense pelvic floor. Assessment by a pelvic health physiotherapist will be able to guide you on whether your pelvic floor muscle needs strengthening or releasing if the above hasn't worked.
Bladder investigations
You may have been referred for investigations by your Consultant, Urology Nurse or Bladder and Bowel Nurse. The links below provide information regarding two common bladder tests:
Healthy bowel habits are important as straining to empty your bowels can make urinary incontinence worse, see the healthy bowel section for more advice.
Menopausal symptoms can influence pelvic floor dysfunction symptoms. See the menopause section for some useful information regarding the menopause.
Healthy Bowels should empty anything between 3 times per day and 3 times per week.
A stool (poo) should be easily passed without straining, pain, or blood.
It is important to avoid constipation and straining to empty your bowels as this can contribute to pelvic floor dysfunction.
Adjusting your position on the toilet
Drinking enough fluids
Eating plenty of fibre
All of the above can help, along with taking any medication prescribed for you. If you have difficulty emptying your bowels the section below has more information on this.
Constipation refers to infrequency or difficulty opening your bowels, where stools may be hard, lumpy or painful to pass.
Further information and tips for avoiding constipation can be found below:
It is important that you regularly check your stools to rule out more serious conditions that can affect bowel function.
Key signs and symptoms to look out for can be found on the bowel cancer UK website - Bowel Cancer Symptoms
Adapting the position you use to sit on the toilet can help ‘straighten out’ the back passage, which makes it easier to pass stools. This sheet gives information about the best position to use - Correct Position for Emptying Bowels
The following videos may also be useful:
It is also important to ensure you fully relax the pelvic floor when passing a stool, difficulty relaxing the pelvic floor can also contribute to problems with emptying.
The video below guides you through techniques to encourage relaxation of the pelvic floor whilst on the toilet:
Pelvic floor dysfunction can contribute to difficulties emptying the bowels. This can be due to either a weak or a tense pelvic floor. Assessment by a pelvic health physiotherapist will be able to guide you on whether your pelvic floor muscle needs strengthening or releasing if the above hasn't worked.
Menopausal symptoms can influence pelvic floor dysfunction symptoms. See the menopause section for some useful information regarding the menopause.
Bowel control problems can affect people in different ways:
The information below may be helpful:
Your pelvic floor muscles are responsible for controlling both your bladder and your bowels. Improving your pelvic floor strength can help to manage these symptoms. See the pelvic floor exercise section for further information on this.
Menopausal symptoms can influence pelvic floor dysfunction symptoms. See the menopause section for some useful information regarding the menopause.
The organs within a woman’s pelvis (uterus, bladder and rectum) are normally held in place by ligaments and muscles. If these support structures are weakened, the pelvic organs can bulge (prolapse) from their natural position into the vagina. When this happens it is known as pelvic organ prolapse. Sometimes a prolapse may be large enough to protrude outside the vagina
If you would like to see a drawing representing a prolapse please follow this link to the Royal College of Obstetrics and Gynaecology page Pelvic organ prolapse | RCOG
The POGP (Pelvic, Obstetric and Gynaecological Physiotherapy), a UK based Physiotherapy Professional Network affiliated to the Chartered Society of Physiotherapy have put together this leaflet explaining Pelvic Organ Prolapse and how to reduce the symptoms that you can read through here
Strengthening weak pelvic floor muscles can help to prevent or reduce pelvic organ prolapse symptoms. They can be strengthened by doing regular pelvic floor muscle exercises. See the pelvic floor exercise section for further information on this.
The POGP (Pelvic, Obstetric and Gynaecological Physiotherapy website contains useful information about using a pessary to manage prolapse symptoms.
Healthy bowel habits are important as straining to empty your bowels can make prolapse symptoms worse, see the healthy bowel section for more advice.
Some women find it helps to support the perineum (the area between the vagina and back passage) with a clean pad or toilet paper.
Menopausal symptoms can influence pelvic floor dysfunction symptoms. See the menopause section for some useful information regarding the menopause
Pain during and/or after sex is known as dyspareunia - Dyspareunia – Pain with Intercourse
There are many causes of dyspareunia. Some women have tension in their pelvic floor muscles (sometimes known as an overactive or tight pelvic floor) and this may contribute to pain having sex. If you think you may have tension in your pelvic floor and would like to check, please see this information slide here
See below for some useful information that you may find helpful if you have an overactive or tight pelvic floor:
Vaginal dryness can be a cause of pain during intercourse. If you haven’t already, trying a natural lubricant can sometimes reduce this discomfort. There are a number of different types of lubricant including water based, oil based and silicone based. Please check the manufacturers instructions as some lubrications are not compatible with latex, silicone and other products. If you have tried these and are still having pain with intercourse, this is something Physiotherapy may be able to support you with.
Taking care of the vulval (genital area) skin is important - Care of Vulval Skin
This leaflet is useful if you have found having a smear test painful - Smears Without Tears
We see many women who have been referred to physiotherapy due to symptoms of persistent (also known as chronic) pelvic pain. These can include bladder pain syndrome (interstitial cystitis), chronic pelvic pain and vulvodynia:
See below for some useful information that you may find helpful if you have a persistent pain condition:
The ‘Education Programmes for Patients’ offer self-management health and wellbeing 6 week courses, including one focused on chronic pain. Participants need to self-refer (the form is on website below). The website also has some video relaxation sessions, and other resources.
See below for some useful information that you may find helpful if you have an overactive or tight pelvic floor:
Taking care of the vulval (genital area) skin is important - Care of Vulval Skin
This leaflet is useful if you have found having a smear test painful Smears without Tears
If you have endometriosis Endo Cymru has some useful information and you can also contact Endometriosis UK for support.
The Vulval Pain Society provides support for women with vulval pain.
Menopausal symptoms can influence pelvic floor dysfunction symptoms. See below for some useful information regarding the menopause:
OAK Menopause
There are education sessions run to better understand the menopause. You must be registered with a GP within Gwent to access these sessions.
If you would like to register your interest or find out more about the upcoming sessions
Contact methods
Information and fact sheets about menopause are available from:
Information for women diagnosed with premature ovarian insufficiency:
You may be referred to Physiotherapy prior to urogynaecology or gynaecology surgery
This is to ensure that your pelvic floor muscles are working to their best ability so they can help to support the surgery being completed.
It may be that you are referred to physiotherapy post surgery
This booklet gives further advice that may aid your recovery following gynaecological surgery
Aneurin Bevan University Health Board and partners have developed the ‘melo’ website to look after the mental wellbeing of its residents. Melo can help you to develop new skills that will support you when life is difficult.
Melo Cymru - Mental Wellbeing Resources, Courses + Advice Gwent Wales
Maintaining a healthy weight can help to alleviate bladder leakage symptoms
Weight Management Service - Aneurin Bevan University Health Board (nhs.wales)
Stopping Smoking can help to alleviate bladder leakage by reducing coughing associated with smoking - Help Me Quit
You may find further information on the below websites and apps
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