Let's Talk About the Pelvic Floor!

Amy Martin of Anna Barnsley Physiotherapy has some advice for us ladies. Let’s Talk about the Pelvic Floor!

We are so British when it comes to talking about the pelvic floor! It seems such a taboo subject. We all have a pelvic floor, but to many, this vital complex of muscles remains a mystery. It is estimated that 32% of women in the UK suffer from incontinence; one of the main symptoms of pelvic floor dysfunction. Incontinence appears to be becoming widely established as ‘normal’ no thanks to adverts for incontinence pads and women being led to believe that it is a normal consequence of pregnancy and childbirth. It really isn’t! For so many women embarrassing leaks needn’t be an issue. In most cases it is a relatively simple problem to address.

What is the pelvic floor?

The pelvic floor can be thought of as a sling or hammock of muscles that span from the front to the back of the underside of your pelvis (from your pubic bone to the base of your spine at the back). The job of these muscles is to support the organs of your lower abdomen such as your bladder, womb and bowels and therefore give you control over going to the toilet.

What can go wrong?

Like any muscle in the body, the pelvic floor can become weak and this can affect people at any age. Weakness can be caused by pregnancy, childbirth and being overweight as the tissues become overstretched. Did you know that other lifestyle influences can cause the pelvic floor to weaken? Smoking can cause a chronic cough which can also cause excessive pressure on the pelvic floor. Lack of exercise or a sedentary lifestyle will mean the other muscles that support the pelvic floor are weakened.

So, how do you know you have a weak pelvic floor? The following is a list of related symptoms;

  • Incontinence

There are several different types of incontinence but stress incontinence is linked to the pelvic floor. Stress incontinence is a leakage of urine when the intra-abdominal pressure is increased. (Such as those little accidence when sneezing or laughing!) It occurs because weakness in the pelvic floor means that the bladder is not adequately supported. Sometimes incontinence of faeces or difficulty controlling passing wind can also occur.

Urge incontinence is when there is an overwhelming urge to pass urine, sometimes causing urine to be passed before a toilet can be reached. This is due to the bladder sending messages to the brain saying that it’s full when often it isn’t and the bladder muscles therefore contract too early. This can be helped by bladder retraining which pelvic floor muscle exercises can assist with.

  • Pelvic Organ Prolapse

When the organs of the pelvis are not well supported by the pelvic floor they can drop down and bulge into the vagina. Symptoms of this include sensations of fullness, discomfort or of a pressure forcing down, discomfort during sex, incontinence or a slow stream of urine.

Additional symptoms of pelvic floor weakness could include:

  • Reduced sensation and satisfaction during sex
  • Constipation, straining and pain during bowel movements
  • Recurrent cystitis

What can be done about it?

Firstly, don’t be embarrassed to seek help or advice. Weakness of the pelvic floor can have a huge impact on quality of life and there are people out there that can help you. If you are concerned about your symptoms or if you have symptoms of a prolapse, it is best to see your GP to get this checked out, especially as a prolapse can sometimes need surgical intervention. If this is the case, exercising your pelvic floor will still be beneficial pre and post operatively to help prevent further problems down the line.


Exercising the pelvic floor itself has been proven to be highly effective. However, you need to make sure you are working the correct muscles, in the correct way.

It is also essential that you don’t neglect your core muscles such as your Transversus Abdominis (TA). The TA is a deep abdominal muscle which circles the abdomen and acts to stabilise the lower back and pelvis. It also has an effect on the pelvic floor because as it tightens, it almost acts as a vacuum, pulling the pelvic floor up and therefore providing it with additional support.

This anatomical drawing illustrates the relationship of these muscles and how weakness of the pelvic floor and TA can lead to other problems such as lower back pain- more about this another time.... 

Don’t be a statistic! For the vast majority pelvic floor weakness is easily remedied with perseverance.  However, ‘a stitch in time saves nine’ so it’s better to start exercising your pelvic floor to prevent problems rather than waiting for them to happen. Strengthening does take time and it is therefore essential to get into a good routine. Physiotherapists specialising in women’s health (like me, Amy Martin, of Anna Barnsley Physiotherapy!) can guide you through exercises to strengthen the pelvic floor muscles and resolve problems for the long-term.