Physiotherapy – Women's Health Clinic

The pelvic floor muscles

These are a group of muscles which form a hammock that runs from the pelvic bone at the front to the base of the spine at the back. There are three openings in the pelvic floor in women: one for the back passage, one for the vagina/birth canal and one for the bladder. (Men have only two openings). The pelvic floor helps to close these openings, and keep them closed, even on sudden straining such as laughing or coughing.

The muscles of the pelvic floor are made up of two types of fibres which both need to be exercised:

• Slow twitch fibres – their role is to support the weight of the bladder, womb and abdominal contents above
• Fast twitch fibres – these fibres need to react quickly to increased abdominal pressure to keep us dry such as when we cough or sneeze.

In women the pelvic floor can become weaker as a result of childbearing or hormonal changes during the menopause. In all people the pelvic floor can be strained by being overweight or having a persistent smokers cough.

Weakness of these muscles can lead to urinary incontinence. Urinary incontinence is the involuntary leakage of urine and this can be anything from just a few drops of urine now and then to large floods of urine. It affects women more than men and it can affect you at any age for a number of different reasons.

Stress incontinence and urge incontinence are the two most common types of incontinence that we treat.

Stress Incontinence

This is the most common type of incontinence. It is the leakage of small amounts of urine when abdominal pressure is increased, such as when coughing, sneezing, laughing, lifting or exercising.

Urge Incontinence (overactive bladder)

This is characterised by the really strong need to pass urine and sometimes a little bit of urine leaks before you have time to reach a toilet. The bladder muscle contracts too early, sometimes before the bladder is completely full. This can lead to increased pressure within the bladder which overcomes the ability of the pelvic floor and so some urine can leak out.

About 1 in 4 women in the UK currently suffer with some form of urinary incontinence, but we believe that this number is actually more as many women are too embarrassed to report this problem to their GP.*

Bladder problems are not a normal part of aging and can be treated successfully with physiotherapy!

How women’s health physiotherapy can help

A women’s health physio is a physiotherapist who has had specific training in this field. They are experts in pelvic floor rehabilitation and bladder retraining. Your initial appointment with a women’s health physio will usually involve detailed assessment of your symptoms and if appropriate assessing the strength of your pelvic floor. This normally involves an internal vaginal examination in order to feel the pelvic floor muscle working. She will then teach you how to tighten your pelvic floor muscles correctly and give you a structured strengthening programme to improve their strength.  She may use different devices such as an electrical stimulator or weighted cones to help with strengthening the pelvic floor.

It may be that your symptoms are due to an overactive bladder. In this case the physiotherapist will give you a programme to retrain your bladder.

Useful advice

• Try to fit your pelvic floor exercises into your normal daily routine.
• Make sure that you do them in sitting, standing and lying down
• You want to do 5-10 quick holds to strengthen the fast twitch fibres and 5-10 slower holds which you hold for up to 10 seconds to strengthen the supporting muscles.

*(Source: Storage symptoms of the bladder: Prevalence, incidence and need for services in the UK. McGrother, C.W, BJU International, 93: 763–769, 2004
Systematic review and evaluation of methods of assessing urinary incontinence. Martin et al., Health.  Technology Assessment, 10(6):1-132, 2006)