Pelvic Floor Health and Pelvic Pain

What the pelvic floor is

The pelvic floor is a group of muscles and other tissues that form a sling across the pelvis. In women it holds the uterus, bladder, bowel and other pelvic organs in place. It can become weak or injured, and the main causes are pregnancy and childbirth, with others including being overweight, surgery and getting older. [1] This page covers pelvic floor training and general pelvic pain.

Leaking urine

Urinary incontinence is the unintentional passing of urine. Stress incontinence is leaking when the bladder is under pressure, for example when you cough or laugh. [2] The NHS says to see a clinician for any type of incontinence, and not to feel embarrassed. [2]

Pelvic floor muscle training

A Cochrane review of 31 trials found pelvic floor muscle training (PFMT) can improve, and in some people resolve, symptoms of stress incontinence and other types of urinary incontinence, and could be part of first-line care. [3] Women with stress incontinence in the training groups were much more likely to report cure than those with no treatment. [3] Trials were small to moderate and follow-up was often under 12 months. [3]

The NHS describes a pattern of quick squeezes and slower holds, breathing normally, and notes that you may need a few months of exercises before seeing benefit. [4] For prolapse, training is usually done with a specialist women's health physiotherapist. [5]

Other everyday steps from the NHS: tighten the pelvic floor before and during lifting, treat constipation promptly because straining weakens the pelvic floor, and cut down on caffeine, which can irritate the bladder. [4]

During and after pregnancy

A Cochrane review of 46 trials found that continent pregnant women doing PFMT probably have a lower risk of urinary leakage in late pregnancy. [6] See pregnancy, postpartum and breastfeeding.

Pelvic organ prolapse

Pelvic organ prolapse is when the uterus, bladder or bowel bulge into the vagina. It may cause no symptoms, or a feeling of heaviness, a lump or bulge, discomfort during sex, or bowel and bladder problems. [5] Options include pelvic floor training with a specialist physiotherapist, vaginal estrogen, supportive pessaries and surgery. [5] If it is not bothering you, treatment may not be needed. [5]

Pelvic pain

Pelvic pain is felt in the lower belly. It may be sudden and severe, or last six months or longer. [7] Common causes in women include period pain, endometriosis, ovarian cysts and pelvic pain in pregnancy; causes in any person include constipation, irritable bowel syndrome, UTIs and sexually transmitted infections. [7] Diagnosis can take time, and the NHS advises sharing as much information as possible and not self-diagnosing. [7] Treatment depends on the cause and can include antibiotics, painkillers, physiotherapy and hormone treatments. [7]

Supplements and natural remedies for pelvic pain: we did not find reliable evidence in the sources we read. Proper evidence not found. See endometriosis and fibroids and period pain.

When to get help

See a clinician for pelvic pain that comes and goes or does not go away, persistent bloating, unexplained weight loss, feeling full quickly, or ongoing bowel changes. [7] Seek urgent care for pelvic pain with fever, blood in urine or stool, unusual vaginal discharge or bleeding, or if you are or may be pregnant. [7] Call 911 for severe or worsening pain, pain in the tip of the shoulder, fainting or heavy vaginal bleeding. [7] See abnormal bleeding, persistent pain and when to get help.