News, Pelvic Health, Physiotherapy
What Is Pelvic Floor Dysfunction and How Can Physiotherapy Help?
Oct
Pelvic floor dysfunction means the muscles at the base of your pelvis have trouble squeezing, relaxing or working together at the right time. It can show up as bladder leaks, difficulty emptying your bowels, pelvic heaviness or pain. A pelvic health physiotherapist can check how the muscles are working and guide you through exercises or bladder and bowel strategies suited to your symptoms. [1]
You might notice a leak in the middle of a fitness class or find yourself looking for the nearest toilet before an MRT transfer. It can feel awkward to bring up symptoms like these. A simple sentence about what happens and when it happens is enough to start the conversation.
What do the pelvic floor muscles do?
The pelvic floor is a layer of muscles at the bottom of your pelvis. These muscles help support your bladder and bowel and, if you have one, your womb. They also help you control when you pass urine or stool. [1] [4]
When you cough or lift something heavy, pressure inside your tummy rises. Your pelvic floor helps you hold urine at that moment. When you sit down to pass urine or stool, the muscles need to relax so you can empty. The timing matters in both situations. A muscle can have enough strength to squeeze and still be hard to relax when you need it to. [1] [2] [3]
What are the signs of pelvic floor dysfunction?
The same symptom can have several causes. It helps to notice whether it comes on during a particular activity, at the toilet or at a certain time of day. That gives your clinician a better idea of what to check.
Bladder leaks or a sudden urge to pee
A few drops of urine when you cough, sneeze, jump or run can fit a pattern called stress urinary incontinence. Here, stress means the pressure on your bladder during that movement. You may also feel a sudden, strong urge to pee, with or without a leak on the way to the toilet. Urgency can be part of overactive bladder. Some women experience both patterns. [2]
Bowel leakage or difficulty emptying
You might strain on the toilet, need to go back soon after or still feel you have stool left to pass. Other people notice leakage of wind or stool. If the muscles have trouble relaxing in time, it can be harder to empty your bowels. Constipation has several possible causes. It helps to tell your clinician whether your stool is usually hard, whether you feel blocked or whether you spend a long time straining. [1] [3]
Pelvic heaviness or a vaginal bulge
Some women describe a dragging feeling or a sense of something pressing down in the vagina. You might notice it after a long shift on your feet, while carrying groceries or towards the end of the day. Heaviness or a bulge can be a sign of pelvic organ prolapse and is worth having assessed. [4]
Pelvic pain or pain during sex
Pelvic pain can feel like an ache, pressure or burning. Some people notice pain during sex. Pelvic floor muscles that are tense or tender can play a part. Other conditions, such as endometriosis or problems with the bladder or bowel, can also cause pelvic pain. If you find it hard to describe, start with where you feel it and when it begins. [5]
You can have more than one symptom at a time. For instance, you might leak when you run and also have trouble emptying your bowels. Mention both at your visit, even if only one prompted you to book. Together, they help your clinician decide what to check first. [1]
Why can pelvic floor symptoms develop?
Pregnancy and childbirth can affect how the muscles work. After birth, you might first notice a leak while lifting your baby or a heavy feeling when you spend more time on your feet. Symptoms can also arise around menopause or as you get older. Women who have never been pregnant can experience pelvic floor symptoms too. [1]
Tell your clinician about long-term constipation and straining, or any past pelvic surgery, as these can be relevant. It also helps to say what you were doing when you first noticed the problem. If it happens on a park connector run, for instance, you might remember whether it starts on the first kilometre or only when you get tired. [1]
What does a pelvic health physiotherapist assess?
At BMJ Physiotherapy, the first visit starts with a private conversation. We ask about your symptoms, how they affect your day and what you would like to get back to. That might mean carrying your child upstairs or sitting through a work meeting comfortably. Your physio may also ask about your bladder and bowel habits, medicines, past surgery, or pregnancy and birth if they are relevant.
The physical assessment may look at how you breathe and move, including how you use the muscles around your tummy and hips. Your physio may offer an internal vaginal examination if it would help check how the pelvic floor muscles squeeze and relax. They will explain why they are offering it and what it involves. The exam goes ahead with your consent. You can choose an external assessment. If you go ahead, you can pause or stop the exam at any point. You can also bring a companion to your visit.
If you tend to forget details at appointments, jot down what happens and when. For bladder symptoms, it may help to keep a short diary of what you drink, when you go to the toilet and when leaks happen. Bring those notes, a list of any medicines you take and any relevant test results. If you have questions about the assessment, you can ask them at the start.
How can physiotherapy help?
Your physio uses the assessment to decide what to work on with you. The plan may include one or more of these approaches. [1]
- Practise strength and timing. If the assessment shows that the muscles need more strength or better timing, your physio may teach you how to squeeze and release them and practise using them during activities like lifting.
- Learn to relax the muscles. If the muscles are difficult to release, your physio may use breathing or guided practice to help you notice tension and let it go.
- Work on bladder or bowel habits. Bladder training may help with urgency. If emptying your bowels is difficult, your physio may talk through your toilet position and how to relax the muscles to pass stool with less straining. [1][3]
Ask what to practise at home and how it relates to the activity you want to get back to. At follow-up, you can talk about what feels easier, what still brings on symptoms and whether the plan needs adjusting.
When should I see a GP or a pelvic health physiotherapist?
A pelvic health assessment is a reasonable first step if urine leaks or pelvic heaviness keep getting in the way of daily life. Arrange a GP review if pelvic pain keeps returning or you notice a change in bowel habits that persists. Seek medical advice promptly if you have pelvic pain with unusual vaginal bleeding, or if you could be pregnant and have pelvic pain or bleeding. [1] [3] [6] [7]
Go to an emergency department if pelvic pain is severe or getting worse, or if it comes with heavy vaginal bleeding, dizziness or feeling faint. [6] [7]
Frequently asked questions
Is pelvic floor dysfunction the same as prolapse?
Pelvic floor dysfunction describes difficulty with how the muscles work. Pelvic organ prolapse is when one or more pelvic organs, such as the bladder or womb, move down towards or into the vagina. The two can occur together. A clinician can assess whether prolapse is contributing to a feeling of heaviness or a bulge. [1] [4]
How do I know if Kegels are right for me?
Kegels are exercises that involve squeezing and releasing the pelvic floor. They can be part of a plan for some types of leakage. A physio can check how well you squeeze and let go, then help you decide what to practise. Mention it if squeezing brings on pain or if it is hard to relax afterwards. [1]
Do I need a referral to book with BMJ?
You can book a pelvic health assessment directly with BMJ. If you plan to make an insurance claim, check your policy before the appointment. Some insurers ask for a doctor’s referral.For more details, read our guide to referral requirements for physiotherapy insurance claims.
If you are in Singapore and would like to talk through your symptoms, our service page explains the first visit and lets you message the BMJ team on WhatsApp. Pelvic Health Physiotherapy at BMJ
Sources
- NICE guidance on pelvic floor dysfunction
- SingHealth guide to urinary incontinence
- National University Hospital guide to constipation
- SingHealth guide to pelvic organ prolapse
- SingHealth guide to chronic pelvic pain
- NHS guidance on when to seek care for pelvic pain
- KK Women’s and Children’s Hospital urgent obstetrics and gynaecology guidance
