Do you know what’s ‘normal’ for you? (Credits: Getty Images)

Pelvic health is important for us all, but particularly for women and some non-binary people.

The risks of having a weak pelvic floor include incontinence and less sensation during sex – and nobody wants that.

By now, we’ve all heard that pelvic floor exercises are useful (and if you need a reminder of how to do them, we’ve got your back).

But what about the signs you need to look out for, that tell things might need extra attention from a health professional?

Clare Bourne, a leading pelvic health physiotherapist and author of Strong Foundations, shares with us her top pelvic health warning signs.

Leakage of urine during exercise 

Clare says: ‘Incontinence of urine, or bladder leaks as they are sometimes referred to, are never normal at any time in life.

‘It can be easily normalised at different life stages, for example after having a baby or when going through menopause, however this is not the case.

‘Urinary leakage can occur during different day to day moments like coughing or sneezing, as well as during activity and movement.’

However, it is most common during activities where there is impact, such as running, or lifting weights.

This is called stress urinary incontinence (SUI) and first line treatment in the UK is to receive guided pelvic floor rehabilitation, which pelvic health physiotherapists are specially trained to do. 

Pain during intercourse 

Intercourse and sex shouldn’t be painful.

‘If there is pain, this can be related to the pelvic floor muscles and a condition called vaginismus, where the pelvic floor muscles tighten up in response to penetration during intercourse, or using a tampon or mooncup, or a medical examination,’ Clare says.

‘Pelvic health physiotherapists assess women to help understand why they might be experiencing pain or discomfort with intercourse, and then set out a treatment plan to improve symptoms.’

Heaviness in the vagina

If it feels like something is there when it shouldn’t be, or there’s a heaviness, don’t ignore it.

‘This can be a common symptom of a vaginal prolapse which is the descent of one or more of the vaginal walls (front or back) and/or the cervix into the vagina,’ Clare says.

‘It can occur at any stage of life, but is more common after pregnancy and childbirth.

‘The good news is though it sounds really scary, there is help to improve symptoms.

‘Pelvic floor rehabilitation is first line treatment, as well as preventing constipation. Some physiotherapists will also fit vaginal pessaries to support symptoms short or long term.’

Constipation

‘In order to do a poo our pelvic floor needs to be able to relax fully, and sometimes when we try to poo our pelvic floor actually tightens rather than relaxes,’ Clare says.

‘This can lead to us struggling to open our bowels. Constipation and struggling to poo is often not just related to the pelvic floor muscles, and pelvic health physiotherapists will support you to understand why you might be experiencing this, working alongside other specialists to help you find a solution.’

Not emptying fully 

If you’re able to poo, but it feels like not everything is coming out, this can be the result of the pelvic floor muscles not relaxing fully, or can be related to a vaginal prolapse involving the back wall of the vagina. 

‘First step is to understand what is causing this sensation and then making a plan to improve it,’ Clare says.

Urgency when you need to wee

Urgency or weeing often should be looked into.

‘These symptoms can leave women feeling that their bladder is controlling their life, and women can experience urinary leakage with urgency as well, called urge incontinence,’ Clare says.

‘Commonly women report experiencing urgency on their return home once they put their “key in the door” and experiencing leakage on the way to the toilet.

‘Considering what you are drinking can help, reducing caffeine, fizzy drinks or artificial sweeteners. Working with a pelvic health physiotherapist on bladder training and pelvic floor rehabilitation is also important to help symptoms.’

Struggling to hold in faeces or wind 

Anal incontinence is more common than we think, with one in 10 experiencing faecal incontinence.

‘Incontinence of wind or faeces can really impact a woman’s confidence, self-esteem and ability to go out and live her life,’ Clare says.

‘Therefore support and early treatment is so important. Strengthening the pelvic floor and anal sphincter muscles helps to improve symptoms.’

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The risks include incontinence and less sensation during sex.