Pelvic Floor Dysfunction: Signs, Causes and First Steps

Pelvic floor dysfunction is an umbrella term that covers several different problems, which is why generic advice about it so often misses. This guide explains what falls under it, the symptoms across bladder, bowel and pelvis, why it is not always about weakness, and the practical first steps. Written for UK readers, and it points at assessment rather than at products.

TL;DR

• It is a term for the pelvic floor not doing its job, which can mean too weak, too tight, or poorly coordinated.
• Symptoms span bladder, bowel, sexual function and pelvic pain.
• It is very common and it is treatable. It is not something to live with quietly.
• Weakness and tension look similar from the outside and need opposite treatment.
• The single highest-value step is an assessment by a women's health physiotherapist.
• Constipation, breath holding and habitual gripping all make it worse and are all modifiable.

What pelvic floor dysfunction actually covers

The pelvic floor supports your pelvic organs, keeps you continent, contributes to trunk stability and plays a role in sexual function. Pelvic floor dysfunction means one or more of those is not working properly. It splits broadly three ways.

• Underactive, or too weak. The muscles cannot generate or sustain enough force. Typically leaking, urgency and a sense of heaviness.
• Overactive, or too tight. The muscles cannot fully release. Typically pain, difficulty emptying, a slow stream and constipation.
• Poorly coordinated. The muscles work, but not at the right time. Typically leaking despite reasonable strength, or bearing down when they should lift.

The reason this matters is that the standard advice, do your pelvic floor exercises, is right for the first group and can make the second group worse.

Symptoms worth taking seriously

Bladder: leaking when you cough, laugh, sneeze or exercise, sudden urgency, going very frequently, a slow or stop-start stream, or feeling you have not emptied.

Bowel: constipation and straining, difficulty controlling wind, needing to press to empty, or a feeling of incomplete emptying.

Pelvis and sexual function: a heavy or dragging sensation, a feeling of something coming down, pain with sex, pain with tampons or smear tests, or ongoing pelvic, hip, tailbone or lower back ache.

None of these are things to accept as a normal consequence of having had children or of getting older. Common is not the same as normal, and almost all of it responds to treatment.

What causes it

• Pregnancy and birth, including caesarean, since pregnancy itself loads the pelvic floor for nine months.
• Menopause and falling oestrogen.
• Chronic constipation and repeated straining.
• Chronic coughing.
• Heavy lifting with breath holding.
• Surgery in the pelvis, and scarring.
• Persistent stress and habitual clenching.
• Pain conditions elsewhere in the pelvis causing protective guarding.

First steps that are worth taking

1. Get assessed

This is genuinely the highest-value thing on the list, because it tells you which of the three problems you have. A women's health physiotherapist can assess internally and give you a starting point in a single appointment, which is worth more than months of guessing at a routine from the internet.

Referral is available through a GP. The Pelvic, Obstetric and Gynaecological Physiotherapy network and the Chartered Society of Physiotherapy both list practitioners for private appointments. The NHS overview of urinary incontinence covers when to seek help.

2. Deal with constipation

The most modifiable cause on the list and one of the most overlooked. Repeated straining works against everything else you do. Fibre, fluid, not delaying when you need to go, and a footstool so your knees sit above your hips all help.

3. Stop the habits that feed it

• Exhale when you lift rather than holding your breath.
• Stop holding your stomach in all day.
• Stop going to the toilet just in case, which trains the bladder to signal earlier.
• Do not hover over toilet seats, which forces the muscles to brace while trying to empty.
• Cut back caffeine and fizzy drinks if urgency is your main symptom.

4. Then, and only then, exercise appropriately

If the problem is weakness, our twelve-week pelvic floor routine is the programme and our kegel technique guide covers doing it correctly. If it is tension, squeezing is the wrong direction and our guide to pelvic floor tension covers what to do instead.

Either way, strengthening the glutes, hips and deep abdominals reduces the demand on the pelvic floor. A light loop and a soft ball cover that work, and our Postnatal Recovery Kit includes both plus a latex-free band, a cotton strap and a printed pelvic floor guide for £14.99. It supports a programme rather than being one.

Shop the Postnatal Recovery Kit

FAQs

What are the signs of pelvic floor dysfunction?

The common ones are leaking with coughing or exercise, sudden urgency, a heavy or dragging feeling in the pelvis, difficulty emptying your bladder or bowel, constipation and straining, and pain with sex. Ongoing pelvic, tailbone or lower back ache without another explanation can also be part of it.

Is pelvic floor dysfunction always weakness?

No, and this is the most important thing to know about it. The pelvic floor can also be too tight or poorly coordinated, and those produce overlapping symptoms. Because squeezing exercises help weakness and worsen tension, getting the distinction right before you start is what makes the difference.

Can pelvic floor dysfunction be cured?

Many people get complete resolution of symptoms, particularly with stress incontinence, and most of the rest get substantial improvement. Pelvic floor muscle training is the recommended first-line approach and it works for the majority. Persistent cases have further options worth discussing with a clinician.

Which doctor treats pelvic floor dysfunction?

Start with your GP, who can refer you to a women's health or pelvic health physiotherapist. Physiotherapy is the usual first-line treatment. Depending on symptoms you may also be referred to a urogynaecologist or a continence service. You can also see a specialist physiotherapist privately without a referral.

Does pelvic floor dysfunction go away on its own?

Some postnatal symptoms improve on their own in the first few months as tissues recover. Symptoms lasting beyond that generally do not resolve without doing something, and they tend to become more entrenched over time. That is an argument for getting assessed early rather than waiting to see.

Can exercise make pelvic floor dysfunction worse?

It can, in two ways. Squeezing exercises worsen an already tight pelvic floor, and high-impact or heavy training done with breath holding increases downward pressure. Neither means avoiding exercise. It means getting the type right, which is what an assessment is for.

Conclusion

Pelvic floor dysfunction is three different problems wearing one name, and the advice that helps one can worsen another. Get assessed, sort out constipation and breath holding, and then do the right kind of work rather than more of the default kind.

If weakness is confirmed, our twelve-week routine is the programme, and the Postnatal Recovery Kit covers the supporting strength work at £14.99.