Pelvic Floor Physiotherapy

To exercise the pelvic floor muscles, lie sit or stand with your knees slightly apart. Tighten up your back passage as though you are trying to stop yourself passing wind. At the same time tighten the muscles that you would use to stop yourself from passing urine. The feeling is one of ‘squeeze and lift’, closing and drawing up the back and front passage.

There are two ways to exercise your pelvic floor muscles: 

Short Squeezes 

• Quickly tighten up your pelvic floor muscles 
• Hold for 1 second and relax 
• Repeat this up to 10 times

Long Squeezes 

• Tighten your pelvic floor muscles for up to 10 seconds 
• Relax fully for 4 seconds 
• Now tighten again for the same time 
• Relax fully for 4 seconds 
• Repeat this up to 10 times

Stress urinary incontinence (SUI) is when urine leaks during activities that increase pressure on the bladder, such as coughing, sneezing or lifting. If the pelvic floor muscles are weak, this pressure can cause leakage. SUI is more common in women but can affect men 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 exercise.
• Medical procedures: Pelvic or prostate surgery.
• Bladder and bowel issues: Overactive bladder muscles, constipation, urinary tract infections.
• Medications and diet: Water tablets, caffeine, alcohol, fizzy drinks, spicy or acidic foods.
• Bladder habits and fluid intake: High fluid intake, frequent “just in case” toilet visits, anxiety.
• Neurological conditions: Stroke, Multiple Sclerosis, 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: Sensors provide visual or audio feedback on how your pelvic floor muscles are working, helping you learn 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 Function.

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

What Can Help:

• Pelvic Floor Muscle 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.

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.
• Pelvic Floor Muscle 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.

• POGP Pelvic Organ Prolapse – a Guide for Women. Provides information and practical advice on managing prolapse.

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 contribute to pelvic pain.

• Relieving Pelvic Floor Muscle Tension: Tips and exercises to release tension in pelvic floor muscles.
• Relaxation techniques: Learning to relax your pelvic floor and abdominal muscles can help reduce pelvic pain.
• Your Pelvic Floor – Dyspareunia: Guide to understanding dyspareunia, including treatment options.
• Brook – Painful Sex: Information on causes, symptoms, and ways to manage painful sex.
• Pelvic Pain: Comprehensive guide to understanding pelvic pain and management strategies.

• 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.