Pelvic floor: exercises, bladder leaks and prolapse

The pelvic floor is a group of muscles most people only think about when something changes: a small leak when laughing, a feeling of heaviness, or a sense that sex feels different. This guide brings together what the NHS says about these muscles, how pelvic floor exercises work, why leaks happen, what pelvic organ prolapse is and how the pelvic floor relates to sex. It is general information, not medical advice. For your own situation, a doctor, a nurse or a specialist physiotherapist is the right person to ask.

What the pelvic floor does

The pelvic floor muscles surround the bladder and the urethra, the tube that carries urine out of the body, and they control the flow of urine, the NHS explains. When they are weak or damaged, leaks can follow, which is why exercising them is often recommended.

To find them, the NHS suggests imagining that you are stopping yourself from peeing and from passing wind. The muscles you feel tightening are the pelvic floor.

How pelvic floor exercises work

Pelvic floor exercises, also called pelvic floor muscle training or Kegel exercises, mean squeezing these muscles and letting them go. The NHS describes the movement like this:

• Squeeze the pelvic floor muscles quickly, without pulling your tummy in.
• Hold the squeeze for a short moment, then relax the muscles fully.
• Repeat, and include both short squeezes and long squeezes.
• Breathe normally and stay relaxed, and lengthen the hold gradually over time.

Doing them properly matters, the NHS notes, and it may take a few months before you notice any benefit. A specialist can check whether you are able to contract the muscles, and by how much, and then build a programme from that assessment.

When contracting the muscles is difficult, specialists have other tools. Electrical stimulation uses a small probe that helps the muscles work while you exercise. Biofeedback shows on a screen when the muscles are squeezed: the NHS says the evidence that it adds much is limited, but it can help some people stay motivated. Vaginal cones, small weights held in place by the pelvic floor, may help with some kinds of leaks, though some women find them uncomfortable.

Bladder leaks

Urinary incontinence, the unintentional passing of urine, is a common problem that affects millions of people, the NHS says. It comes in several forms:

Type	What happens
Stress incontinence	Leaks when the bladder is under pressure, for example when coughing or laughing
Urge incontinence	Leaks with a sudden, intense need to pee, or soon after
Overflow incontinence	The bladder does not empty fully, which causes frequent leaking
Mixed incontinence	Stress and urge incontinence together

Stress incontinence usually comes from weakened or damaged muscles, such as the pelvic floor and the urethral sphincter. Pregnancy and vaginal birth, a family history of incontinence and getting older can all raise the chances, although the NHS stresses that incontinence is not an inevitable part of ageing.

What helps day to day

The NHS lists a number of habits that can ease leaks:

• Daily pelvic floor exercises, done properly.
• Not smoking, since coughing puts strain on the pelvic floor.
• Swapping high impact exercise and sit ups, which add pressure, for strengthening work such as pilates.
• Tightening the pelvic floor before and during any lift, and avoiding heavy lifting when you can.
• Dealing with constipation promptly and never ignoring the urge to poo, because straining weakens the pelvic floor.
• Cutting down on caffeine and alcohol, which irritate the bladder or make you pee more.
• Drinking enough fluid: limiting drinks makes incontinence worse, because it reduces how much the bladder can hold.
• Going easy on spicy and acidic foods, which can irritate the bladder.

What care looks like

The NHS advises seeing a GP for any type of urinary incontinence, and says there is no need to feel embarrassed. The doctor asks about symptoms, may examine the pelvis, and may suggest a diary of what you drink and how often you pee.

Treatments that involve neither medicines nor surgery come first: lifestyle changes, pelvic floor muscle training and, for urge incontinence, bladder training, which teaches ways to wait longer between needing to pee and going. NHS continence services, staffed by specialist nurses and physiotherapists, can diagnose and start treatment, and in some cases you can refer yourself. Pads and other products can help while you wait to be seen. If these steps are not enough, a doctor may discuss medicines or surgery.

Pelvic organ prolapse

Pelvic organ prolapse can happen when the pelvic floor muscles weaken. The NHS says it is common in women over 50 and can affect anyone with a vagina. It may cause no symptoms at all, or:

• A feeling of heaviness, discomfort or pressure in the lower tummy or the vagina.
• A bulge or lump felt or seen inside, or coming out of, the vagina.
• Pain, discomfort or numbness during sex.
• Problems pooing, such as constipation, or peeing, such as a bladder that does not feel empty or small leaks when coughing, sneezing or exercising.

Possible causes include pregnancy and childbirth, long term constipation and straining, a persistent cough, pelvic surgery such as a hysterectomy, and some health conditions, such as joint hypermobility syndrome. It is more common with age, particularly after the menopause.

At the appointment, the doctor asks about your symptoms and examines you. You can ask for someone else to be in the room, and for the examination to be done by a female doctor. Treatment depends on which organs are involved and how much the prolapse bothers you. If it does not, treatment may not be needed. Otherwise, options include pelvic floor training with a specialist physiotherapist, a vaginal support pessary, hormone treatment or, for a severe prolapse, surgery, chosen together with your doctor.

Things the NHS suggests for prolapse

• Regular pelvic floor exercises.
• More fibre, enough water and gentle exercise such as walking, to avoid constipation.
• Avoiding activities that strain the pelvic floor, such as heavy lifting, running and trampolining.
• Not smoking, to avoid a persistent cough.

The pelvic floor and sex

The pelvic floor plays a part in sex too. With vaginismus, the vaginal muscles tighten on their own, and the NHS includes pelvic floor exercises, squeezing and releasing to gain control of these muscles, among the treatments. With vulvodynia, weak pelvic floor muscles are one of the possible causes the NHS mentions, and pelvic floor exercises are part of the care. A prolapse can also cause pain or numbness during sex. Painful sex covers these conditions in more detail, vaginal health basics covers dryness and infections, and cystitis and UTIs covers burning and urgency that come from an infection rather than the pelvic floor. If you use toys with the pelvic floor in mind, sex toy safety explains materials and cleaning.

When to get help

The NHS suggests seeing a GP in these situations:

• Any type of urinary incontinence.
• A lump in or around the vagina, or any other sign of prolapse.
• Vaginal muscles that tighten when something is put into the vagina, if you think it may be vaginismus.
• Pain or discomfort in the vulva that does not go away or keeps coming back.

A doctor, a nurse, a continence service or a specialist physiotherapist can say what applies to you.

Questions about the pelvic floor

Are pelvic floor exercises the same as Kegel exercises?

Yes. The NHS uses both names for the same training: squeezing the pelvic floor muscles and letting them go, with short and long squeezes.

How long do pelvic floor exercises take to work?

The NHS says it may take a few months before you notice any benefit, and that doing them properly is what counts.

Can I see a specialist without a referral?

A GP can refer you to an NHS continence service, and in some cases you can refer yourself. Specialist nurses and physiotherapists there can assess you and start treatment.

Are vaginal weights a good idea?

The NHS describes vaginal cones, small weights held in place by the pelvic floor, as a tool some specialists use alongside training. Some women find them uncomfortable, so it is worth discussing with a specialist first.

Is running bad for the pelvic floor?

High impact exercise can add pressure and increase leaks, the NHS says, and with a prolapse it suggests avoiding running and heavy lifting. Strengthening exercise such as pilates is gentler.