Pelvic Floor Dysfunction

What Is Actually Happening? 

The pelvic floor is a layered group of muscles that supports the bladder, uterus and bowel. It contributes to bladder and bowel control, sexual function and stability around the pelvis.

For the pelvic floor to function effectively, the muscles must be able to contract, sustain a contraction, relax fully and respond automatically to changes in abdominal pressure.

In some women, the muscles are weak and unable to provide sufficient support during coughing, sneezing, lifting or exercise. In others, the muscles are overactive and remain in a heightened state of tension, contributing to pain, urgency or difficulty emptying the bladder or bowel.

Some women have adequate strength but poor coordination. The muscles may contract at the wrong time, fail to relax when needed or not respond automatically during movement.

Pelvic floor dysfunction can develop following pregnancy and childbirth, pelvic surgery, persistent constipation, chronic coughing, hormonal change or pain. In some cases, there is no single identifiable cause.

Understanding the specific type of dysfunction is the first step towards effective treatment.

How It Commonly Presents 

Pelvic floor dysfunction can present in several different ways.

Women may experience urine leakage during coughing, sneezing, laughing, running or exercise. Others notice a sudden and difficult-to-control need to pass urine. You can read more about urinary incontinence→

Vaginal heaviness, dragging or a feeling that something is coming down may be associated with pelvic organ prolapse→ 

Difficulty controlling wind, bowel urgency, constipation or incomplete bowel emptying may also occur. You can read more about bowel dysfunction→

Where the muscles are overactive or unable to relax effectively, women may experience pelvic pain, discomfort with penetration, burning or a persistent sensation of tightness.

Symptoms are highly individual. Assessment is therefore essential to establish whether weakness, overactivity, reduced endurance, altered coordination or a combination of factors is contributing.

Do I Need Medical Investigations? 

Pelvic floor dysfunction can usually be assessed clinically without scans or other investigations.

A detailed history helps establish the nature of your symptoms and whether bladder, bowel, prolapse, hormonal, pain-related or childbirth-related factors may be contributing.

Where appropriate and with your consent, an internal vaginal examination can assess pelvic floor strength, endurance, coordination, muscle tone and the ability to relax.

Further medical assessment may be recommended if symptoms include unexplained bleeding, recurrent urinary infections, significant or worsening pelvic pain, difficulty emptying the bladder or bowel, or a sudden change in pelvic function.

Where necessary, we can work alongside your GP or recommend appropriate onward referral.

Conservative Management 

Treatment depends on the type of pelvic floor dysfunction identified during assessment.

Where the muscles are weak, rehabilitation may focus on improving strength, endurance and the ability to respond automatically during coughing, lifting and exercise.

Where the pelvic floor is overactive, treatment may instead involve relaxation training, breathing coordination, reducing protective muscle guarding and restoring comfortable movement.

For women with altered coordination, rehabilitation focuses on developing awareness and retraining the muscles to contract and relax at the appropriate time.

Advice may also address bladder habits, bowel management, constipation, exercise modification and the management of abdominal pressure during lifting or physical activity.

Treatment is gradually progressed and incorporated into everyday activities so that improved pelvic floor function becomes meaningful outside the clinic.

Pregnancy, Childbirth and Hormonal Influence 

Pregnancy and childbirth place considerable demand on the pelvic floor. Symptoms may develop during pregnancy, immediately following delivery or many years later.

Perineal tearing, assisted delivery, prolonged pushing and the birth of a larger baby may increase the likelihood of pelvic floor dysfunction. However, symptoms can also occur following an uncomplicated vaginal birth or caesarean section.

Hormonal changes during perimenopause and menopause can affect vaginal and urinary tissues. Reduced oestrogen may contribute to dryness, irritation, bladder symptoms, discomfort or reduced tissue support.

Where appropriate, vaginal oestrogen prescribed by a GP may support tissue health alongside pelvic floor rehabilitation.

Our Specialist Approach 

At Solent Specialist Physiotherapy in Gosport, pelvic floor rehabilitation is delivered within a structured, evidence-based framework.

Assessment includes detailed history-taking and evaluation of bladder, bowel, pelvic support, pain and sexual symptoms. Where appropriate, an internal examination can assess muscle strength, endurance, coordination, tone and relaxation. This is never carried out without your informed consent.

Rehabilitation is individually tailored and progressively staged. Where pelvic floor activation is difficult, neuromuscular electrical stimulation (NMES) may sometimes be used to help establish a clearer contraction. NMES is used as part of a structured rehabilitation programme rather than as a standalone treatment. You can read more about our approach to NMES here→

Management is discreet, clinically detailed and focused on restoring confident function rather than simply providing a generic exercise sheet.

Long-Term Outlook 

Pelvic floor dysfunction often responds well to appropriately prescribed rehabilitation, although progress depends on the nature and duration of the symptoms.

Meaningful change takes time. Improvements may include fewer episodes of leakage, reduced urgency or heaviness, easier bladder or bowel emptying, improved comfort or greater confidence during exercise and everyday activities.

The aim is not simply to make the pelvic floor stronger. It is to restore muscles that can contract, relax and respond appropriately when needed.