Pelvic Floor Physiotherapy

Stress urinary incontinence (SUI) occurs when urine leaks out during activities that put pressure on the bladder. It can happen when you cough, sneeze, laugh, lift, exercise, rise from a chair, walk upstairs or downstairs, or during sexual intercourse. Physical strain increases the pressure on the abdomen, which in turn puts pressure on the bladder. If the pelvic floor muscles or the muscles controlling the bladder are weak, urine can leak out.  While SUI is more common in women, some men can experience it as well. 

Urinary urgency is a sudden, strong need to urinate that’s difficult to delay. It can happen even if your bladder isn’t full and may make you feel anxious about finding a bathroom in time.

Urinary urge incontinence (UUI) happens when you leak urine because of a strong urge to empty your bladder. You may not make it to the toilet in time. It is often caused by bladder muscles that squeeze too often or without warning. 

Overactive bladder (OAB) is a condition that includes:  

• A strong, sudden need to urinate (urinary urgency) 
• Going to the bathroom more than 6 to 8 times during the day (frequency) 
• Waking up more than once at night to urinate (nocturia) 
• Sometimes leaking urine before reaching the toilet (urinary urge incontinence) 

• Life stages: Pregnancy, childbirth, ageing, menopause.
• Weight and lifestyle: Obesity, high-impact activities (e.g., trampolining).
• Medical procedures: Pelvic or prostate surgery.
• Bladder and bowel issues: Overactive bladder muscles, constipation, urinary tract infections, interstitial cystitis.
• Medications and diet: Diuretics (water tablets), caffeine, alcohol, fizzy drinks, spicy or acidic foods.
• Bladder habits and fluid intake: High fluid intake, frequent “just in case” urination, anxiety.
• Neurological conditions: Stroke, MS, Parkinson’s disease, spinal injury, diabetes.

• Pelvic Floor Exercises: Strengthen the muscles that support the bladder and improve control.
• Bladder Training: Helps increase the time between toilet visits to reduce urgency and frequency.
• Lifestyle Advice: Guidance on fluid intake, diet, and healthy toileting habits to support bladder health.
• Electrical Stimulation: A gentle current may be used to activate and strengthen weak pelvic floor muscles when they are difficult to contract.
• Biofeedback: Uses sensors to show how the pelvic floor muscles are working, helping you learn how to contract them correctly.

Constipation is where there are changes to how you move your bowels, including not opening your bowels as often as normal and finding it hard to get your stool (poo) out. Often the stool is hard and lumpy and difficult to pass. Most people will suffer from an episode of constipation at some point in their lives, but usually this is temporary and not serious. Unfortunately, for some people constipation can become a long term issue.  

What Can Help:

• Stay Hydrated: Aim to drink 1.5–2 litres of water-based fluids each day.
• Diet: Eating more fibre can help keep stools soft and easier to pass.
• Toilet Positioning: Using the right posture on the toilet can make bowel movements easier. Watch this video for tips.
• Helpful Guides: POGP Good Bowel Health and POGP Improving Your Bowel Health.

Faecal incontinence is when there is an unwanted leakage of stool or wind from the back passage. It can be an extremely distressing condition that can be made worse by diarrhoea. It can happen without warning or can be associated with an urge to move your bowel but an inability to make it to the toilet on time. 

What Can Help:

• Anal Sphincter Exercises: Strengthening the muscles around the back passage can improve control.
• Healthy Diet: Make sure you’re eating enough fibre to keep stools well-formed.
• Toilet Positioning: Using the correct position can help with better bowel emptying. Watch this video for tips.
• Medication: Some people may benefit from medication—speak to your healthcare professional.
• ‘Just Can’t Wait’ Card: This card gives you quicker access to public toilets. You can apply for one online here.

Obstructive defecation is a term used to describe having difficulty opening your bowels. It is often associated with frequent visits to the toilet and a feeling of being unable to fully empty the bowel. This can result in excessive straining, which can increase the risk of vaginal or rectal prolapse. 

Normally, when you open your bowels, the muscles around the back passage relax to allow stool to pass. In obstructive defecation, these muscles may not relax fully, or they may even tighten, making it harder to have a bowel movement.

What Can Help:

• Fluids: Drink 1.5–2 litres of water-based fluids daily.
• Healthy Diet: Make sure you’re eating enough fibre to keep stools well-formed.
• Stay Active: Aim for 30 minutes of physical activity a day to support bowel movement.
• Belly Breathing: This relaxation technique helps release the pelvic floor. Your physiotherapist can teach you how to do it correctly.

Faecal urgency is a sudden and strong urge to empty your bowels. You may reach the toilet in time, but it can also lead to accidental leakage/faecal incontinence.

What Can Help:

• Healthy Diet: Keep your diet balanced and rich in fibre to regulate bowel movements.
• Holding On Programme: This programme helps train your bowel to delay the urge to go. A healthcare professional can guide you through it.
• Anal Sphincter Exercises: These exercises strengthen the muscles around the back passage to improve control and confidence in your ability to get to the toilet on time.

Bladder pain syndrome is a condition that causes pelvic pain and difficulty urinating. It can be difficult to diagnose because there isn’t a single test that can confirm it.

Repeated difficulty allowing vaginal entry of a penis, finger, or other object. It may lead to involuntary tightening of the pelvic floor muscles, along with fear or pain.

Dyspareunia is painful sex. This can be pain or discomfort at the opening to the vagina or felt deeper into the pelvis.

Pelvic floor muscles may be tense or overactive. This can be linked to conditions such as Endometriosis, Adenomyosis, Irritable Bowel Syndrome (IBS), or Vulvodynia, or may occur alongside other causes mentioned above.

• POGP Fit Following Surgery – Advice & Exercise Following Major Gynaecological Surgery.
• POGP Fit Following Surgery – Advice for Trans Men, Trans Masculine and Non-Binary People Following Hysterectomy.
• POGP Promoting Continence with Physiotherapy.