Pelvic health advice and help

You may find some of these videos and resources for pelvic health physiotherapy useful.

Your pelvic floor muscles are a group of muscles at the base of your pelvis. They support your pelvis and help control your bladder and bowel. They also play a role in sexual function. To learn how to strengthen these muscles watch the educational video below.

Additional resources:

Your pelvic floor muscle works best when it can exercise well. If the muscle is tense and struggling to relax this can impact on its ability to work. Incontinence, constipation and pelvic pain can sometimes be a sign that the pelvic floor muscle isn’t relaxing fully. To learn how to optimise your pelvic floor watch the educational video below.

Additional resources:

Find out how to maintain a healthy bladder (including advice on management of bladder overactivity and urgency).

Top tips for bladder health

  • Government guidelines recommend for women to drink 6-8 glasses or cups of fluid spread out during the day. These drinks should be roughly 250 to 300ml
  • If possible, only one or two of these drinks should be caffeinated. Caffeine is a stimulant and can irritate the bladder and make you urinate more often. Caffeinated drinks can be swapped for decaffeinated alternatives or herbal options
  • Alcohol is a diuretic, meaning it will irritate your bladder and make you urinate more
  • If you are waking during the night to pass urine, try having your last drink 2 hours before going to bed. You can have sips of water after this, for example when taking medication
  • Try to sit on the toilet seat rather than hovering over the toilet seat as this position will make it more difficult for your pelvic floor muscle to relax
  • When sitting on the toilet make sure your feet are flat on the floor, so that your pelvic floor muscle can fully relax, relax your stomach and let your bottom descend into the toilet. Do not strain or push the urine out as this will cause your muscles to tighten up and can make it more difficult for you to pass urine
  • Stopping smoking. The chemicals released into the body when smoking irritate the bladder and may make you urinate more frequently. Smoking will also make you cough more which will put an increased pressure on your bladder, which cause your muscles to get weaker over time
  • Try and avoid constipation. Please refer to the healthy bowel section below for more information
  • Being overweight can increase the pressure on your Pelvic Floor Muscle, which can lead to urinary incontinence. For advice on weight loss please liaise with your practice nurse or refer to the NHS Better Health website
  • Improving your pelvic floor muscle activity and strength, can be effective at reducing urinary accidents / leaks. Please refer to the Pelvic floor strengthening exercises section above for more information. It can take up to 3 to 4 months to notice any changes in your pelvic floor muscles
  • Below are lists of drinks which may irritate your bladder, compared to the drinks which are less likely to irritate your bladder.

    Drinks which may irritate your bladder:

    • Caffeinated drinks, such as tea and coffee
    • Carbonated / fizzy drinks
    • High energy drinks
    • Hot chocolate
    • Alcohol
    • Green tea
    • Blackcurrant juice
    • Citrus fruit juices, such as orange and grapefruit

    Drinks which are less likely to irritate your bladder:

    • Water
    • Fruit / herbal tea
    • Mint / peppermint tea
    • Decaffeinated drinks
    • Milk
    • Diluted fruit juice / squash

Additional resources:

Find out how to maintain a healthy bowel (including advice on constipation).

Additional resources:

Pregnancy-related pelvic girdle pain

Our specialist clinics offer a detailed assessment of your back and pelvis and provide an individual treatment and management plan during your pregnancy. Watch our educational and exercise videos, and find useful information and links to help you during your pregnancy and birth.

Additional resources:

Pelvic girdle pain (PGP) is pain that starts in your pelvis but can be felt in your lower back, hips, groin and down the inside or backs of your legs. It is very common, affecting one in five women in pregnancy.

This video will give you practical advice and dos and don’ts for daily activities, as well as helpful tips to make every-day tasks easier. For example, getting in and out of a car and in and out of bed. There are also a number of exercises that are safe to do during your pregnancy and in the postnatal period. These are not an immediate quick fix but with time can be helpful in managing your back and pelvis.

Before watching the video, please remember this is not an assessment and we cannot give you a diagnosis. Please talk to your midwife, GP or antenatal day unit it you are worried about your health or the health of your baby.

During any assessment for people who have combination of back pain, leg pain, leg numbness and weakness, we always screen for a rare but serious back condition called cauda equina syndrome. This condition can lead to permanent damage or disability and need to be seen immediately at the emergency department. The signs and symptoms of cauda equina syndrome are: If you have any combination of the symptoms below, seek call your GP immediately.

  • Loss of feeling / pins and needles between your inner thighs or genitals
  • Numbness in or around your back passage or buttocks
  • Altered feeling when using toilet paper to wipe yourself
  • Increasing difficulty when trying to urinate
  • Increasing difficulty when yout try to stop or control your flow of urine
  • Loss of sensation when you pass urine
  • leaking urine or recent need to use pads
  • Not knowing when your bladder is either full or empty
  • Inability to stop a bowel movement or leakage
  • Loss of sensation when you pass a bowel motion
  • Change in ability to achieve an erection or ejaculate
  • Loss of sensation of genitals during sexual intercourse

What is pregnancy related pelvic girdle pain?

What causes pelvic girdle pain in pregnancy?

Top tips to help you manage pelvic girdle pain during your pregnancy

Pelvic girdle pain and the use of pelvic belts

Pelvic girdle pain and exercises

Pelvic floor muscle exercises during pregnancy

If, after following the advice and exercises, you are still struggling, we also offer one-to-one assessment and treatment for:

  • antenatal pelvic girdle pain (PGP)
  • low back pain
  • diastasis recti abdominus (separation of the abdominal muscles)
  • rib flare
  • pelvic floor rehabilitation
  • urinary incontinence

After your pregnancy, you may be seen by a member of the pelvic health physiotherapy team. If, however, you have not been referred and would like to discuss any concerns with your bladder, bowels or pelvic floor muscle you can self-refer.

Vaginal delivery

It is important to look after yourself and rest after a vaginal delivery.

What can you do?
  • Start your pelvic floor exercises early
  • Download the Squeezy app or similar pelvic floor training app, to remind you to do your exercises
  • Avoid constipation, as this puts extra pressure on your perineum. When sitting on the toilet, consider putting your feet on a little step, so that your knees are slightly higher than your hips – see the healthy bowel section on this page.
  • It can sometimes sting when passing urine in the first few days especially if you have had stitches. In order to help to reduce this, rinse with water during or after urination and ensure you are well hydrated
  • Follow the advice in the Fit for the Future leaflet created by POGP
  • If appropriate follow the advice 3rd and 4th degree tears

Caesarean section

Caesarean section is major surgery to the abdominal wall. It is important to gradually get back to normal activities, allowing time for your body to heal and recover.

What can you do?
  • Follow the advice in the Fit for the Future leaflet created by POGP
  • It is recommended to wait six weeks before you return to driving, but check with your insurance company before you start driving again to make sure you are covered.
  • Practise doing an emergency stop in a stationary car and make sure you can comfortably look over your shoulder both ways and twist putting your seat belt on.

Returning to exercise

Always listen to your body. Many women feel extremely tired after childbirth. Try not to overdo it, but pace yourself, limit visitors, accept help and rest. Everyone recovers at different rates and return to exercise varies for each person.

If you have any pain, difficulty controlling your bladder or bowels, feeling of heaviness, pressure or dragging in pelvic area, bulging or doming of tummy muscles stop or modify the activity, and seek advice from the pelvic health physiotherapy team.

Type of exerciseVaginal deliveryCaesarean delivery
Pelvic floor exercises.From day one postnatal.From day one postnatal.
Gentle walking (as pain allows)From day one postnatal (gradually increase speed and distance as comfort allows).From day one postnatal (gradually increase speed and distance as comfort allows).
Low impact exercise, e.g. postnatal exercise class, yoga, pilates.From six weeks postnatal.From eight weeks postnatal.
SwimmingFrom six weeks postnatal, if vaginal bleeding has stopped for more than seven days in a row and your stitches are healed.From eight weeks postnatal, vaginal bleeding has stopped for more than seven days in a row and stitches have healed.
High impact exercise such as jogging, jumping, aerobics, heavy weights.From at least twelve weeks postnatal.From at least fourteen weeks postnatal.

Pregnancy abdominal muscle separation

Also known diastasis recti, diastasis rectus abdominus muscles, DRA or DRAM.

During pregnancy and labour it is normal for the abdominal muscles to stretch and separate to accommodate your growing baby. All women have some degree of separation at 35 weeks pregnant and 39% at six months postnatal. This is called diastasis recti.

You may notice your tummy doming or a gap in your tummy muscles when you do things that require lots of abdominal activity such as sitting up from lying, coughing or straining to move your bowels.

What can you do?