Problems Down There

PFD - Pelvic Floor Dysfunction

Problems ‘down there’ during pregnancy and after birth

What is pelvic floor dysfunction? (PFD)

Pelvic floor dysfunction (PFD) is a term for a group of related conditions caused by the pelvic floor not working correctly. These symptoms can include. 

  • Urinary incontinence – leaking of urine (wee)
  • Overactive bladder – the urgency to go to the toilet often 
  • Pelvic organ prolapse – when one or more of the organs move down into the vagina 
  • Anal incontinence – accidental bowel leakage 
  • Dyspareunia – discomfort during sex

Is PFD normal? 

 It is quite common to experience incontinence during pregnancy and after having a baby.  

  • 40-50% of women in their 2nd and 3rd trimesters of pregnancy, and immediately after birth, have urinary leakage. 
  • 25% of pregnant women can also have anal incontinence. 

Although common, it is very important to know that these symptoms should only happen for a short time, should be mild, and should go away quickly. 

If you experience any significant pelvic floor symptoms during pregnancy or after, or mild symptoms that do not improve within six weeks of childbirth, you should seek help from your GP in the first instance. Simple treatments will often improve the symptoms and prevent long-term problems. 

Stress incontinence 

Stress incontinence is the accidental leakage of wee when you do something that increases the pressure in the tummy. This could include jogging, dancing, jumping, coughing, laughing, or lifting your baby. 

Stress incontinence is caused by the pelvic floor not supporting the urethra well enough. The urethra is the bladder pipe through which you wee. Many women experience this when they return to activities such as running, exercise, or dance classes after they have had a baby. 

Overactive bladder 

An overactive bladder is when your bladder squeezes and tries to empty without you wanting it to. 

You might experience the need to rush to the toilet quickly to wee or find you are going for a wee more often than normal. You may wake up at night needing to wee or experience accidental leakage when rushing to the toilet. This can sometimes be a significant leakage of wee which you cannot stop. 

Overactive bladder syndrome is caused by the muscle in the wall of the bladder contracting and squeezing when it should be relaxed. The abnormal bladder muscle contractions in overactive bladder syndrome cause urinary frequency, urgency, and nighttime weeing. 

Often overactive bladder problems are developed at the same time as stress incontinence, and you may be affected by both conditions. 

Pelvic Organ Prolapse is when your bladder, bowel, or womb moves down from their normal position, causing a bulge inside your vagina. 

It is caused by damage to the pelvic floor which normally supports these organs and keeps them in place. The usual symptoms are the sensation of vaginal dragging or pressure and/or noticing a bulge or lump in the vagina. 

Sometimes you can also develop problems with not emptying your bladder completely when weeing or not emptying the bowels which can cause constipation. 

Sexual intercourse may also be affected by discomfort or a sensation of something being in the way in your vagina. 

Accidental bowel leakage 

Accidental bowel leakage is when you accidentally leak wind or poo from your bottom. This is rarer than urinary incontinence, overactive bladder, or prolapse symptoms, but has a bigger impact on quality of life and can be very upsetting to experience. 

Accidental bowel leakage is usually caused by disruption to the ring of muscles that surrounds your bottom or anus due to tearing during childbirth. This is known as a third or fourth-degree tear. Everyone who has a vaginal birth is checked for these types of tears. Sometimes, even if they are repaired well, you can still develop accidental bowel leakage symptoms.  

Often, you will also develop the need to rush to the toilet to open your bowels if you have problems with accidental bowel leakage. 

Discomfort with sexual intercourse 

After pregnancy and childbirth, discomfort with sexual intercourse can include discomfort in your vagina during sex, a feeling of your vagina being loose or open, or of something being in the way during sex. 

The discomfort may be due to changes in the tissues at the entrance of the vagina, caused by scar tissue after a vaginal tear during childbirth.

It could also be an altered sensation, with a sensation of looseness of the vagina or decreased sensation. This is caused by changes in the pelvic floor and the way the nerves running through this area are reacting.


Physiotherapy treatment for PFD

Pelvic floor physiotherapy, supervised by a specialist physiotherapist, is proven to improve most mild to moderate pelvic floor problems that occur after pregnancy and childbirth. Getting support quickly if symptoms of pelvic floor dysfunction occur is important, as prompt physiotherapy helps to prevent the problem from worsening and will often cure it. 

How Physiotherapy Treatment Works 

Usually, the pelvic floor specialist physiotherapist or physiotherapy assistant practitioner will see you for several sessions after assessing the problems you are having. These will be face-to-face or over the phone, as needed.

A key part of physiotherapy treatment is to offer an (optional) internal examination to guide you on how to correctly do your pelvic floor exercises. The reason for this is that up to 65% of women who practice their pelvic floor exercises are doing them incorrectly and so won’t be seeing improvement in their symptoms. The examination will then help the physiotherapy team to provide you with a specific exercise programme for you.

Tools such as Biofeedback and electrical stimulation are devices that can be used to help improve your pelvic floor. They cannot be used during pregnancy or for the first 12 weeks following giving birth.

Electrical stimulation uses little electrodes to stimulate your pelvic floor muscles to contract and help you to learn how to contract your pelvic floor muscles effectively. 

The exercises and techniques you learn as part of pelvic floor physiotherapy will often give you lifelong skills to maintain the health of your pelvic floor.

As well as exercises, your physiotherapist will also help you with lifestyle advice for bladder and bowel health. Physiotherapy treatment may often last for 3-4 months to allow time for the muscles to develop and to see an improvement in your symptoms.

Physiotherapy works if you stick with it! Evidence shows 3-4 months of physiotherapy will improve urinary or prolapse symptoms. Your physiotherapist is there to guide you with advice and your exercise programme. However, you have to put the work in to see the benefits!

Medications for PFD 

Medications can be helpful for those experiencing certain pelvic floor dysfunction conditions such as overactive bladder syndrome – urgency, frequency, and leakage of urine. 

For those with constipation or accidental bowel leakage, the use of prescribed laxatives or medications that slow the transit through the bowel can be a useful treatment. However, for all these conditions, pelvic floor physiotherapy is usually the most impactful and useful treatment. 

What if physiotherapy or medications don’t work?

Most pelvic floor dysfunction symptoms will improve after supervised pelvic floor physiotherapy. If you are still experiencing pelvic floor problems after completing a course of physiotherapy, then we will recommend that you see a doctor specialising in pelvic floor dysfunction.

This will be either a urogynecologist – a gynecologist who specialises in pelvic floor dysfunction problems – or a pelvic floor specialist colorectal surgeon, who looks after pelvic floor problems which affect the bowel.

Your physiotherapist will usually be able to refer you to the specialist doctor, as all pelvic floor specialists work together in a joint team. A small number of patients may need to have operations to treat stress incontinence or pelvic organ prolapse, or to have specialised procedures to help with overactive bladder problems or accidental bowel leakage.This video explains more about bladder and vaginal problems during and after pregnancy.

Getting More Help

If you have downloaded and trialled the Squeezy app and are still finding it difficult to squeeze and relax your pelvic floor muscles or think that you may need treatment from a physiotherapist due to other pelvic health issues you may be experiencing. please self-refer to pelvic health physiotherapy for further support and guidance.

Perinatal Pelvic Health Physiotherapy services are available from the time you find out you are pregnant, up to a year after you give birth. 

Visit: or call 03330 433966  Services cover Suffolk and North East Essex

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