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Writer's pictureJessica Higton

The Pelvic Floor

Updated: Oct 21


The pelvic floor plays a crucial role in our everyday health and wellbeing. Located at the base of the pelvis, the pelvic floor is a group of twenty three muscles that support the bladder, uterus (in women), bowel and other pelvic organs. It is responsible for controlling functions like urination, bowel movements and sexual health. When the pelvic floor muscles are weakened or damaged, it can lead to several health issues. Let’s explore what pelvic floor problems are, their causes, and how physiotherapy can help.


What are pelvic floor problems?

Pelvic floor dysfunction occurs when these muscles become weak, overactive or overly strained, affecting their ability to function correctly. Common pelvic floor issues include:

  • Bladder problems including bladder leaks, increased frequency of needing to pass urine, increased urgency and/or leaking on the way to the toilet.

  • Bowel problems including leaks of wind or stool, sudden urge to open bowels or constipation and straining.

  • Pelvic organ prolapse; when the pelvic organs, such as the bladder, uterus, or bowel, descend due to weakened support from the pelvic floor muscles and other structures. Symptoms include the feeling of dragging, heaviness or a bulge in the vagina.

  • Pelvic pain; there are different types of pelvic pain including painful intercourse (dyspareunia), vulval pain (vulvodynia), vaginismus (sudden tightening of the vagina when something is inserted into it), painful bladder syndrome (interstitial cystitis) as well as pain from conditions such as endometriosis and adenomyosis.

  • Gynaecological cancer; the pelvis including the pelvic floor can be affected after surgery and treatment for gynaecological cancer.

  • Gynaecological surgery; rehabilitation of the pelvic floor and abdominal muscles after gynaecological surgery is vital to ensure return to full function, hobbies and sports.


Causes of pelvic floor problems

Pelvic floor problems can arise from various factors, including:

  1. Childbirth: The physical strain of pregnancy and childbirth can weaken, stretch or tear the pelvic floor muscles, especially if there was a difficult delivery or the use of forceps.

  2. Aging: As we age, our muscles including the pelvic floor weaken over time which may lead to incontinence, prolapse or other pelvic floor problems.

  3. Chronic straining: Conditions like chronic constipation or heavy lifting can strain the pelvic floor over time which affects how well it works.

  4. Obesity: Excessive weight puts additional pressure on the pelvic floor, leading to dysfunction.

  5. Hormonal changes: During menopause, lower oestrogen levels can contribute to pelvic floor dysfunction.



How can physiotherapy help?

Pelvic floor physiotherapy is one of the most effective, non-invasive treatments for pelvic floor problems with a good evidence base for its effectiveness.

Here’s how physiotherapy can help:

  • Exercises: the pelvic floor muscles can be weak in which case strengthening exercises are needed or for others the pelvic floor can be overactive and needs to relax. Specific physiotherapy targeted at how the muscles present is needed to improve pelvic floor muscle function.

  • Manual therapy: this hands-on approach can help release tight muscles and improve how the muscles work.

  • Education and lifestyle changes: a physiotherapist provides personalized advice on managing factors like posture, body mechanics and dietary habits that affect the pelvic floor.


Top 5 Tips to improve your pelvic floor

  1. Practice pelvic floor exercises if you feel your pelvic floor is weak, however as mentioned above it’s important to note that some women have an overactive pelvic floor. In such cases, focusing on relaxation techniques such as diaphragmatic breathing exercises and gentle pelvic floor stretches. If you are unsure how your pelvic floor is working, a women’s health physiotherapist can help you.

  2. Avoid straining. Whether lifting heavy objects or pushing too hard during bowel movements, straining can weaken or further stress the pelvic floor over time. Practice safe lifting techniques (bend at the knees, not the waist) and put your feet on a stool to enable easier bowel movements.

  3. Avoid constipation. Constipation is one of the main causes of pelvic floor strain. To prevent it, ensure you drink plenty of water and consume a diet rich in fibre. This keeps bowel movements regular and reduces pressure on the pelvic floor.

  4. Good posture. Maintaining good posture is key to ensuring that your pelvic muscles work efficiently. Avoid slumping or sitting for extended periods without proper support. Stand tall and ensure your spine is well-aligned, as this reduces unnecessary strain on the pelvic region.

  5. Seek professional advice early. You don’t have to live with pelvic floor problems, and while these issues may feel embarrassing, they are more common than you might think and can be resolved or greatly improved with women’s health physiotherapy. Early intervention can lead to quicker recovery, so don’t hesitate to reach out for help.


In summary, pelvic floor problems can be distressing and upsetting and are more common than many realise but with individualised care and treatment, they can often be significantly improved or resolved. Whether you’re experiencing incontinence, pelvic pain or prolapse, physiotherapy offers a holistic approach to women’s health, addressing the root cause of the problem and guiding you towards a stronger, healthier pelvic floor. By incorporating these five tips into your daily routine and seeking professional guidance from a physiotherapist, you can take control of your pelvic health and improve your quality of life. It’s never too late to address pelvic floor problems.

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