The Pelvic Floor

The pelvic floor

Urinary Stress Incontinence


  • Urinary incontinence (UI) is a symptom that can affect women of all ages, with a wide range of severity and impact on quality of life. It is common but not normal.
  • Stress urinary incontinence is defined as involuntary leakage of urine on effort or physical exertion (e.g. sporting activities) or on sneezing or coughing.
  • Stress incontinence is often related to weakness of, or damage to, the pelvic floor muscles although women with a strong active contraction of these muscles could also have symptoms if they’re not using them correctly.
  • Risk factors include vaginal (particularly forceps) delivery, increased parity, older age, obesity, and family history
  • There are many barriers to seeking advice/treatment for symptoms of UI. We also know that many women are not able to contract their pelvic floor muscles effectively, so if a woman reports symptoms please refer for further assessment.

Main presenting feature:

  • Leakage of urine on effort or exertion or on sneezing or coughing.

Urinary Urge Incontinence


  • Urinary incontinence is a symptom that can affect women of all ages, with a wide range of severity and impact on quality of life. It is common but not normal.
  • Urgency urinary incontinence is defined as involuntary leakage of urine associated with urgency.
  • Urgency urinary incontinence is often related to over-activity of the detrusor muscle, but symptoms could be due to a urinary tract infection, so this must always be excluded.
  • The cause is often unknown. It is more prevalent in older (post-menopausal) women, but it may be linked to a family history or childhood history of similar symptoms.
  • This type of urinary incontinence often occurs as part of group of symptoms called overactive bladder syndrome (OAB). Other OAB symptoms include urinary frequency and nocturia.
  • There are many barriers to seeking advice/treatment for symptoms of UI. We also know that many women are not able to contract their pelvic floor muscles effectively, so if a woman reports symptoms please refer for further assessment.

Main presenting features:

  • A sudden, intense need to empty the bladder which is often difficult to delay.
  • The urge sensation may be linked to specific triggers, for example arrving home (latch-key urgency), a change of position or the sound of running water.
  • An associated increase in urinary frequency or need to urinate at night

Mixed Urinary Incontinence


  • Urinary incontinence (UI) is a symptom that can affect women of all ages, with a wide range of severity and impact on quality of life. It is common but not normal.
  • Mixed urinary incontinence is a combination of stress urinary incontinence and urgency urinary incontinence.
  • Mixed urinary incontinence is defined as involuntary loss of urine associated with urgency and also with effort or physical exertion or on sneezing or coughing.
  • There are many barriers to seeking advice/treatment for symptoms of UI. We also know that many women are not able to contract their pelvic floor muscles effectively, so if a woman reports symptoms please refer for further assessment.

Main presenting features:

  • Leakage of urine on effort or exertion or on sneezing or coughing.

As well as

  • A sudden, intense need to empty the bladder which is often difficult to delay.
  • The urge sensation may be linked to specific triggers, for example arriving home (latch-key urgency), a change of position or the sound of running water.
  • An associated increase in urinary frequency or nocturia.
  • For more information on stress or urgency urinary incontinence please see the separate information sheets for each condition. 

Prolapse

  • Pelvic organ prolapse (POP) is the descent of one or more of the anterior vaginal wall, posterior vaginal wall, the uterus (cervix), or the apex of the vagina (vaginal vault or cuff scar after hysterectomy).
  • Risk factors include increasing age, parity and family history along with obesity, heavy lifting and constipation.
  • A common problem, occurring in up to 40% of women older than 50 years, which may impact on daily activity and quality of life.

Main presenting features:

  • Symptoms vary depending on the site and severity of the prolapse. The symptoms are likely to vary over the course of the day and over a period of time, including through the monthly cycle in pre-menopausal women.
  • A patient with prolapse might present with vaginal, bladder, bowel, back, abdominal and sexual symptoms, including feeling of ‘something coming down’, pelvic pressure (heaviness, dragging), incomplete bladder or bowel emptying (possibly with the need to support the vaginal wall to aid emptying), low back ache, pain or difficulty during sexual intercourse and vaginal bleeding, discharge or infection.
  • Pelvic organ prolapse may be so severe that there is protrusion of the vaginal wall and/or cervix/vaginal vault below the vaginal introitus.
  • Symptoms are likely to be increased by gravity (e.g. standing for prolonged periods) and abdominal straining (e.g. after a period of heavy work/lifting).

Women's Health Physiotherapy

The physiotherapist will complete a detailed assessment, following which they will work with you with the aim of resolving or reducing your symptoms. This may include:

  • Advice on an individualised pelvic floor muscle exercise programme
  • Advice on fluid intake (following completion/analysis of a bladder diary)
  • Education on daily activities, general exercise, diet, weight loss and smoking cessation
  • Referral to the community continence services, for further tests or assessment of containment products, if required

If conservative management fails the physiotherapist may discuss referral to the urological/gynaecological consultant.

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