Your Pelvic Floor

• Pelvic Floor Muscles - Why Care About Them?

  Your pelvic floor muscles are a group of muscles that span the outlet of your pelvis. They attach from the pubic bone at the front, to the coccyx bone at the back, forming the floor of your pelvis. Pelvic floor muscles have the following uses:

  • Control - They help you to control wee, wind and poo.
  • Support – They act like a hammock to support your pelvic organs (bladder, womb and bowel) and keep them in the correct position.
  • Sexual function – They can help improve sex by increasing your sensation, your grip and orgasm.
  • Stability - They help to keep your pelvis and hips stable.

• Pregnancy, Childbirth & Pelvic Floor Muscles

  Pregnancy

  Anyone who is pregnant can be affected by pelvic floor dysfunction. This is when the pelvic floor muscles are not working correctly. It is important to be aware of how pelvic floor problems occur and what you can do to reduce them.

  During pregnancy, the pelvic floor muscles come under pressure from the extra weight of your growing baby, amniotic fluid, placenta and the enlargement of the womb. This extra downward pressure and effect from pregnancy hormones (chemicals in the blood stream) causes stretching and tiring of the pelvic floor muscles. The stretching means your muscles do not do their jobs as well.

  Childbirth 

  During a vaginal birth, your pelvic floor muscles will stretch for you to deliver your baby. Some women may sustain tearing of the perineum and pelvic floor muscles which will take time to heal. This can affect how well the muscle works. After birth the nerves that make the pelvic floor muscles work may not be doing this so well and mean that your muscles feel weak.

  Getting Help

  It is common to be embarrassed or to think that pelvic floor problems are normal while you are pregnant and after childbirth. Please read the "Who can help?" below if you have any worries.

• Why Are Pelvic Floor Symptoms Not Talked About?

  There are lots of reasons women tell us why they may not seek help with pelvic floor problems. This includes:

  "It's normal after childbirth"

  "I'm too embarrassed to talk about it"

  "What if treatment is painful or risky?"

  "I'm too busy with my new-born baby" 

  "I don't know that help is available"

  Remember - help is available. This page contains advice, self care tips and information on when, where and why to seek help.

Pelvic Floor Dysfunction (PFD)

Pelvic floor dysfunction (PFD) is a term for a group of related conditions caused by the pelvic floor not working correctly. 

Click the titles below for more information on PFD conditions and the treatments available if you need help.

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• What is Pelvic Floor Dysfunction?

  Pelvic floor dysfunction (PFD) is a term for a group of related conditions caused by the pelvic floor (muscles, fascia and ligaments) not working correctly. These symptoms can include;

  • Urinary incontinence - leaking of urine.
  • Overactive bladder - urgency to go to the toilet often. 
  • Pelvic organ prolapse - descent of one or more of the organs into the vagina.
  • Anal incontinence - accidental bowel leakage.
  • Dyspareunia - discomfort during sexual intercourse.

  Is PFD normal?

  It is quite common to experience incontinence during pregnancy and after having a baby.

  • 40-50% of women in their 2^nd and 3^rd trimesters of pregnancy and immediately after birth have urinary leakage.
  • 25% of pregnant women can also have anal incontinence.

  Although common, it is very important to know that these symptoms should only happen for a short time, should be mild and should go away quickly.

  If you experience any significant pelvic floor symptoms during pregnancy or afterwards, or mild symptoms that do not improve within six weeks of childbirth; then we advise that you seek help. Simple treatments will often improve the symptoms and prevent long term problems.

• Stress Incontinence - Accidental Wee

  Stress incontinence is accidental leakage of urine when you do something that increases the pressure in the tummy. This could include jogging, dancing, jumping, coughing, laughing or lifting your baby.

  Stress incontinence is caused by the pelvic floor not supporting the urethra, the water pipe from the bladder though which you wee, well enough. Many women experience this when they return to activities such as running, exercise or dance classes after they have had a baby.

• Overactive Bladder

  Overactive bladder is when your bladder squeezes and tries to empty without you wanting it to.

  You might experience the need to rush to the toilet quickly to wee or find you are going for a wee more often than normal. You may wake up at night needing to wee or experience accidental leakage when rushing to the toilet. This can sometimes be a significant leakage of urine which you cannot stop.

  Overactive bladder syndrome is caused by the muscle in the wall of the bladder contracting and squeezing when it should be relaxed. The abnormal bladder muscle contractions in overactive bladder syndrome cause the urinary frequency, urgency and night time weeing.

  Often overactive bladder problems are developed at the same time as stress incontinence, and you may be affected by both conditions.

• Pelvic Organ Prolapse

  Pelvic Organ Prolapse is when your bladder, bowel or womb moves down from their normal position, causing a bulge inside your vagina.

  It is caused by damage to the pelvic floor which normally supports these organs and keeps them in place. The usual symptoms are the sensation of a vaginal dragging or pressure and/or noticing a bulge or lump in the vagina.

  Sometimes you can also develop problems with not emptying your bladder completely when weeing or emptying the bowels and can cause constipation.

  Sexual intercourse may also be affected with discomfort or a sensation of something being in the way in your vagina.

• Accidental Bowel Leakage

  Accidental bowel leakage is when you accidently leak wind or poo from your bottom. This is a rarer than urinary incontinence, overactive bladder or prolapse symptoms, but has a bigger impact on quality of life and can be a very upsetting to experience.

  Accidental bowel leakage is usually caused by disruption to the ring of muscles which surrounds your bottom or anus due to tearing during childbirth. This is known as a third or fourth degree tear. Everyone who has a vaginal birth is checked for these types or tears. Sometimes, even if they are repaired well, you can still develop accidental bowel leakage symptoms. 

  Often, you will also develop the need to rush to the toilet to open your bowels if you have problems with accidental bowel leakage.

• Discomfort With Sexual Intercourse

  After pregnancy and childbirth, discomfort with sexual intercourse can include discomfort in your vagina during sex, a feeling of your vagina being loose or open or of something being in the way during sex.

  The discomfort may be due to changes in the tissues at the entrance of the vagina, caused by scar tissue after a vaginal tear during childbirth, or mismatching of the vaginal tissues after stitching.

  It could also be altered sensation, with a sensation of looseness of the vagina or decreased sensation. This is caused by changes in the pelvic floor and the way the nerves running through this area are behaving.

• Physiotherapy Treatment for PFD

  Pelvic floor physiotherapy, supervised by a specialist physiotherapist, is proven to improve most mild to moderate pelvic floor problems which occur after pregnancy and childbirth. Getting support quickly if symptoms of pelvic floor dysfunction occur is important, as prompt physiotherapy helps to prevent the problem worsening and will often cure the problem.

  Therapy Assistant Practitioners

  Therapy assistant practitioners work to support women/birthing people who may be at risk of pelvic floor symptoms or who have mild symptoms based on the self-assessment questionnaire results. They run pregnancy and after birth pelvic floor workshops offering pelvic health advice at the midwifery hubs.

  How Physiotherapy Treatment Works

  Usually, the pelvic floor specialist physiotherapist or physiotherapy assistant practitioner will see you for a number of sessions after assessing the problems you are having. Often these will be face to face initially, with telephone follow ups to check on your progress. There may be further face to face contact if needed to help you.

  A key part of physiotherapy treatment is to offer an (optional) internal examination to guide you on how to correctly do your pelvic floor exercises. The reason for this is that up to 65% of women who practice their pelvic floor exercises are doing them incorrectly and so won’t be seeing improvement with their symptoms. The examination will then help the physiotherapy team to provide you with a specific exercise programme for you.

  Tools such as biofeedback, which are devices which show you how well you are contracting your pelvic floor can form a helpful part of treatment for some people with pelvic floor dysfunction. Electrical stimulation is using little electrodes to stimulate your pelvic floor muscles to contract help you to learn how contract your pelvic floor muscles effectively. The exercises and techniques you learn as part of pelvic floor physiotherapy will often give you lifelong skills to maintain the health of your pelvic floor.

  As well as exercises, your physiotherapist will also help you with lifestyle advice for bladder and bowel health. Physiotherapy treatment may often last for 3-4 months to allow time for the muscles to develop to then see improvement in your symptoms.

  Physiotherapy works, if you stick with it! Evidence shows 3-4 months of physiotherapy will improve urinary or prolapse symptoms. your physiotherapist is there to guide you with advice and your exercise programme, however you have to put the work in to see the benefits!

• Medications for PFD

  Medications can be helpful for those experiencing certain pelvic floor dysfunction conditions such as overactive bladder syndrome - urgency, frequency and leakage of urine.

  For those with constipation or accidental bowel leakage, the use of prescribed laxatives or medications which slow the transit through the bowel can be useful treatments. However, for all these conditions, pelvic floor physiotherapy is usually the most impactful and useful treatment.

• What if Physiotherapy or Medications don’t Work?

  Most pelvic floor dysfunction symptoms will improve after supervised pelvic floor physiotherapy. If you are still experiencing pelvic floor problems after completing a course of physiotherapy, then we will recommend that you see a doctor specialising in pelvic floor dysfunction.

  This will be either a urogynecologist, a gynaecologist who specialises in pelvic floor dysfunction problems or a pelvic floor specialist colorectal surgeon, who looks after pelvic floor problems which affect the bowel.

  Your physiotherapist will usually be able to refer you on to the specialist doctor, as all pelvic floor specialists work together in a multidisciplinary team. A small number of patients may need to have operations to treat stress incontinence or pelvic organ prolapse, or to have specialised procedures to help with overactive bladder problems or accidental bowel leakage.