Pelvic Floor Physiotherapy – Bladder, Bowel & Pelvic Health

To exercise the pelvic floor muscles, lie, sit or stand with your knees slightly apart. First, tighten your back passage as though you are trying to stop yourself from passing wind. Then, at the same time, tighten the muscles you would use to stop yourself from passing urine. As you do this, focus on the sensation of “squeeze and lift,” gently closing and drawing up both the back and front passages.

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 is when urine leaks during activities like coughing, sneezing, laughing, or exercising. It happens when the pelvic floor muscles are weak and cannot fully support the bladder. Although more common in women, it can also affect men.

Urinary urgency is a sudden, strong need to urinate that may be hard to control. It can be caused by overactive bladder muscles or nerve signals that trigger the bladder too often and may make you feel anxious about finding a bathroom in time.

Urinary urge incontinence occurs when urine leaks due to a sudden, strong urge to empty the bladder. You may not reach the toilet in time. It is often caused by overactive bladder muscles that contract too frequently or without warning.

Bladder problems can develop for many reasons. Understanding the cause helps your pelvic floor physiotherapist provide the right treatment. Common causes include:

• 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: Strengthening the muscles that support the bladder can improve bladder control and help reduce leakage. These exercises are a core part of pelvic floor physiotherapy.
• Bladder Training: Structured bladder training helps increase the time between toilet visits and reduces urgency, frequency and improves overall bladder function.
• Lifestyle Advice: Guidance on fluid intake, diet, and healthy toileting habits can support long-term bladder health and complement pelvic floor exercises.
• Electrical Stimulation: A gentle electrical current may be used to activate weak pelvic floor muscles, particularly when they are difficult to contract voluntarily. This can help improve muscle strength over time.
• Biofeedback: Sensors provide visual or audio feedback on how your pelvic floor muscles are working. This helps you learn to contract and relax the muscles correctly, enhancing the effectiveness of your exercises.
• Squeezy App for Women: This app guides you through pelvic floor exercises and tracks your progress. Using it regularly supports consistent practice and helps maintain long-term bladder control.

Constipation occurs where there are changes to how you move your bowels. This may include 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 and most people will experience constipation at some point, but this is usually temporary. However, 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 can make bowel movements easier. Your physiotherapist can advise on this and watch this video for tips.
• Helpful Guides: Resources like POGP Good Bowel Health and POGP Improving Your Bowel Function provide additional support.

Faecal incontinence is the unwanted leakage of stool or wind from the back passage. This condition can be distressing and diarrhoea can make it worse. It can occur suddenly without any warning and may be linked to an urgent need to have a bowel movement which may lead to accidental leakage.

What Can Help:

• Pelvic Floor Muscle Exercises: Strengthening the muscles around the back passage can improve control.
• Healthy Diet: Eating enough fibre helps keep stools well-formed.
• Toilet Positioning: Using the right posture can make bowel movements easier. Your physiotherapist can advise on this and watch this video for tips.
• Medication: Some people may benefit from medication. Speak to your healthcare professional.
• ‘Just Can’t Wait’ Card: Gives quicker access to public toilets. Applications are available online here.
• RADAR Key: Provides access to locked accessible toilets across the UK for people with mobility or continence needs. You can order one online via Disability Rights UK.

Obstructive defecation is a term used to describe having difficulty opening your bowels. It is often associated with frequent toilet visits 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. 

In a normal bowel movement, the muscles around the back passage relax to allow stool to pass. In obstructive defecation, these muscles may not relax fully or may even tighten, making bowel movements difficult.

What Can Help:

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

Faecal urgency is a sudden, 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: Eating enough fibre helps keep stools well-formed.
• Holding On Programme: This programme trains your bowel to delay the urge to go. A healthcare professional can guide you through it.
• Pelvic Floor Muscle Exercises: Strengthening the muscles around the back passage improves control and confidence, helping you reach the toilet on time.
• ‘Just Can’t Wait’ Card: Gives quicker access to public toilets. Applications are available online here.
• RADAR Key: Provides access to locked accessible toilets across the UK for people with mobility or continence needs. You can order one online via Disability Rights UK.

• Pelvic Floor Exercises: Strengthening the muscles can help support the pelvic organs and reduce prolapse symptoms. These exercises are a core part of pelvic floor physiotherapy.
• Lifestyle changes: Maintaining a healthy weight, avoiding heavy lifting, and practicing safe toileting habits can support pelvic health.
• Supportive devices: In some cases, a vaginal pessary may be recommended by a healthcare professional to provide additional support.
• Helpful Guides: Resources like POGP Pelvic Organ Prolapse – a Guide for Women. This guide provides information and practical advice on managing prolapse.

This condition causes pelvic pain and difficulty urinating. As there is no single test to confirm it, diagnosis can take time.

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: A 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.