Pelvic floor FAQs

The pelvic floor – what it is, where it is, how it works, what it does and the importance of treating it well.

What is the Pelvic Floor?

It’s a group of muscles and ligaments that sits across the bottom of your pelvis like a hammock. It connects to your pubic bone at the front and your coccyx at the back.  

 

Is the pelvic floor part of the core?

Yes it is 100%. But unfortunately it’s rarely part of any strength and conditioning programmes and attention is only paid to it when it becomes dysfunctional.  We’re on a mission to change this and would love to see a pro-active approach to training the pelvic floor, especially in athletes doing impact work or heavy lifting.  

 

I’m super fit and healthy and don’t leak do I need to do my pelvic floor exercises?

Yes, every woman should do her exercises every day regardless of whether she has issues. The pelvic floor needs specific attention, especially as we age, and the sooner we start to exercise it the better. Click here to be guided through some exercises.

 

What does the Pelvic Floor do?

Like any other muscle it should be able to contract and relax, and it should be able to move. It has three main jobs:

• Keep you dry – your pelvic floor should be able to stop you leaking urine, wind, or faeces, which means that it has to resist pressure from above when you laugh, sneeze or cough, and impact from below when you jump, run or skip.   
• Relax on the loo – your pelvic floor should be able to relax enough when you go to the loo so that you can fully empty your bladder and bowel.
• Sex – your pelvic floor contributes to sexual pleasure.

 

How does the pelvic floor work?

The pelvic floor works with your deep core. It coordinates with your back and abdominal muscles, and diaphragm. When they all work together in harmony it makes for a dynamically strong core. Your pelvic floor should move with your breath and body, adapting to the body’s every motion. 

What are some good beginner pelvic floor exercises?

Start with this set of short videos on pelvic floor for beginners.

 

Can pelvic floor dysfunction cause back pain?

Yes. If you’re struggling with back pain it might be worth checking in on your pelvic floor. The best person to talk to is a women’s health physio (WHP). You can find a great directory of them at https://www.squeezyapp.com/directory/

Why is my pelvic floor not working?

Many things can affect your pelvic floor. Some things are in your control and others aren’t. Here’s a list:

1. Childbirth – some of you will have had a baby and however many years ago that was the impact of a birth can last. How the baby was delivered is significant e.g. vaginal, instrumental or via C-section
2. Overweight – if you’re overweight or obese then your pelvic floor has to do more work. Just 10% weight loss can lead to a 50% reduction in leaking.
3. Weight lifting and impact exercise –  these kinds of exercise commonly lead to issues but plenty can be done without having to give up. Exercise is so important on every level of health and wellbeing.  
4. Hysterectomy – it is very common for women to notice a change in their pelvic floor function after having a hysterectomy.
5. Coffee, alcohol and sugar – are all potential bladder and bowel irritants and as we age we tend to become more sensitive to them. 
6. Posture – poor and/ or tense posture significantly impacts your ability to breath properly and it interrupts the diaphragm / pelvic floor connection. In theory, this one’s simple to fix by addressing your breathing: unclenching the tummy (which most women do by default) and relaxing it as much as you can.  
7. Stress and Anxiety – like posture, when we’re stressed / anxious we tend to grip and hold a lot of tension in our abdomen. This also happens if we’re worried about prolapse (fear everything will drop out) or leaking.  Learning to relax and let go is a real skill. Meditation, breathing, yoga – all can be skills to practise.
8. Diet – being constipated is one of the most significant risk factors when it comes to prolapse so we need to address it if you’re constipated. If you are, look at your hydration and fibre intake (food – not supplements) as a matter of priority.

You’ll be really comfortable getting into some of these changes but others will prove a challenge. We suggest your first change is the one that feels most comfortable and achievable.  

 

What are signs of a pelvic floor problem?

Urinary Stress Incontinence or leaking urine

This is common. You leak urine because of an increase in pressure from above your pelvis – laughing, coughing, sneezing or breath holding – or impact from below (running, jumping etc).

The stats in the UK report 1 in 3 women suffer from this but it’s still not normal and we really want to help you with this issue.

Bowel and bladder urges

This is when you get an urge that is so intense that you need to go straight away and you’re worried you won’t make it to the toilet in time.

With bladders it can be called ‘key in the door incontinence,’ which means that a trigger (seeing a loo or putting the key in your door) has made you need to go. Women suffering with this need to work on taking back control of their bladders by training to relax themselves and the pelvic floor.

Painful vagina

Typical symptoms include itchiness, painful sex, being very aware of your vagina and frequent urination. The pain can range from annoying in some women to life-limiting in others.  

Vaginal heaviness

If there’s even a small chance this could be a prolapse see a doctor ASAP.

Constipation

Not a pelvic floor issue as such, constipation can influence and exacerbate pelvic floor dysfunction and is increasingly common in women as we age.

 

5 pelvic floor warning signs that must not be ignored

See a doctor if …

 1.You’re leaking any urine at all.

This symptom is often normalised and women tolerate it; thinking nothing can be done. But help is available through a good women’s health physio or gynaecologist. Don’t ignore this because, over time, it’s likely to worsen. Seek help and start learning to strengthen your pelvic floor to counter any leaking.

2. You have a dragging feeling in your vagina.

This can be subtle in the morning but get steadily worse during the day due to gravity and standing for long periods of time. Some women find that they’re no longer able to hold a tampon in their vagina where they previously could. Again this feeling can progress if ignored.

3. You feel a lump from your vagina.

The dragging sensation due to pelvic floor weakness in point 2 above, can progress until you may feel a lump that hangs down in the vagina. This lump often comes and goes during the day or can be pushed back inside with a finger. This is called a prolapse where the wall of the vagina or the uterus starts to hang down and you can feel it when standing or walking. Seek medical help for this.

4. Sex is painful. 

Painful sex can down to several physical or psychological factors: a lack of oestrogen, infection, overactive pelvic floor muscles …

The important thing is not to ignore it. Pain is a sign that something’s not right and needs to be investigated.

5. You notice any changes

Every few months grab a mirror and look at your vulva and vagina. Look for any changes such as new moles, rashes, itching, bleeding.

Get to know yourself and if you notice any changes – seek help.

Where do I get help?

The NHS Squeezy App (£3) has good quality information, reminds you to do your exercises and supports you though it. 

There’s also a Women’s Health Physio Directory on the Squeezy website, listing qualified physios you can approach for an assessment.

In theory, GPs can help but it can be a postcode lottery and you may need to go private to get the support you need within the timeframe you need it.