Pelvic health issues, such as prolapse, incontinence and sexual difficulties, can occur at any time during your lifespan, even if your postnatal recovery was uncomplicated with no experience of symptoms at that time, or even if you have never had children, and risk increases with age.
If you are experiencing symptoms, and you are no longer pregnant or within your first postnatal year, you can still access the support you require- get in touch with your GP for your local referral pathways.
In the meantime, there may be some things you can do for yourself- use these links to navigate to gain more information about your body, symptoms and potential management options.
Get to know your vulva! Quite often many women and birthing people will refer to their vulva as the vagina, however this is anatomically incorrect.
The vulva is what you see from the outside and the vagina is the muscular structure inside. Every vulva is different. Look at the diagram and see if you can identify these on yourself.
Sometimes your vulva may look different during pregnancy due to the increased pressure and weight of baby(s).
It is useful to get to know your vulva to be able to identify any changes from what is normal for you and you can also look to see if you are doing pelvic floor exercises correctly.
Your vagina is the passage through which your baby passes during vaginal birth.
Above your vagina is your urethra, the small hole you wee from.
Either side are your labia: T he larger labia are on the outside, and the smaller labia on the inside.
Below your vagina is your anus, which is a ring of muscle which helps to control when you need a poo (open your bowels). Your anus has two sphincter muscles, an internal ring which sits inside an external ring, like a circle inside a circle. Between your vagina and your anus is your perineum.
The pelvic floor plays an important role in your health and wellbeing, and should be kept strong and active, just like any other muscle. Strong pelvic floor muscles boost your core strength and stability. They can improve your sexual function too. They:
During pregnancy your body goes through many changes and it can be difficult to know what changes are normal and when you should seek help.
As your pregnancy progresses, changes can happen to your bladder, bowel, vaginal, and sexual health as your pelvis comes under more pressure. This causes stretching and tiring of the pelvic floor muscles meaning they may not work as effectively. It is important to be aware of how to optimise your pelvic health to support your pelvic floor function.
During a vaginal birth, your pelvic floor muscles will stretch for you to birth your baby. Some births may cause an injury to the perineum and pelvic floor muscle which will take time to heal.
This can affect how well the muscles work. During birth, the nerves that control the pelvic floor muscles will have been compressed and after birth they may take time to recover. During this time the muscles are likely to feel weaker than normal.
Pelvic floor dysfunction (PFD) is used to describe conditions that are caused by the pelvic floor muscles not working as they should.
Symptoms can include:
We prefer to say symptoms of pelvic floor dysfunction can be common but they do not have to be your new normal and it should not be accepted that it's a normal part of pregnancy and giving birth. Symptoms can occur but should only last for a short time and should be mild.
The most common symptom to experience during pregnancy and after birth is urinary incontinence (leaking wee).
This is the most common symptom that occurs during pregnancy and after birth. It happens when you do something that increases the pressure in your tummy such as:
This is usually because the pelvic floor muscles aren't able to fully support the closure of the tube leading to the bladder (urethra), during these activities to prevent any wee from escaping.
Video: Bladder and vaginal problems during and after pregnancy
This is when your bladder has become sensitive to the feeling of filling with wee and will give you sensation to wee more often and sometimes more urgently.
You may find you don't get a break overnight and the urge to go can wake you up. Sometimes with strong urges, you may leak wee when trying to get to the toilet that you're not able to control.
Try to avoid drinks that can irritate the bladder such as fizzy or caffeinated drinks. It is normal to go more often towards the end of pregnancy and should settle down in the weeks after birth. If things don't improve, support from a pelvic health physiotherapist may help.
A prolapse, sometimes called pelvic organ prolapse, is when one or more of the vaginal walls or the top of the vagina weakens and moves downwards causing pressure, bulging or heavy feeling inside the vagina or at the vaginal entrance. Whether the bulge stays within the vagina or starts to come out will depend on the factors causing the prolapse.
A prolapse is common (around one in 12 people) if you have had a vaginal birth although this is not the only cause, it can occur at any time even in someone who hasn't had children.
The symptoms you will most likely feel are:
Having a prolapse can also affect how your bladder and bowel function and can also make sex uncomfortable.
For more information, read the pelvic organ prolapse leaflet
Anal incontinence is leaking wind or poo, sometimes with urgency and sometimes without warning. It is less common than any bladder symptoms, however it will still affect around one in ten adults and will have a higher impact on quality of life and can be very upsetting.
Your vagina can sometimes feel different during pregnancy or after birth. This can be due to the changes that occur to your body during pregnancy and birth. However, sex should never be painful. Should you experience any pain with sex that does not settle, please access further support from your GP or pelvic health physiotherapist.
There are medications that can help with bladder and bowel symptoms if it is required. Most commonly for overactive bladder, which can calm down the urgency, and medications can be given to speed up or slow down transit of poo through the bowel for constipation or leaking poo.
However, all conservative treatment with physiotherapy advice and/or support should be followed first and this is often the most helpful treatment.
Pelvic floor exercises involve squeezing the muscles around your vagina and anus. You can do this by imagining you are desperate to pass urine and you are trying to stop yourself. Hold this for as many seconds as you can, up to a maximum of 10 seconds. Release and rest for 5 seconds.
Repeat this 'tighten, hold and release' movement as many times as you can. Aim to do 10 in a row. These exercises will increase your stamina. They can be completed in different positions such as lying with your knees bent, sitting or standing - however feels most comfortable for you. If it feels too difficult to do the exercises while standing, you could start in the lying or seated positions and gradually build to standing.
Pelvic floor exercises are known as the silent exercises, whilst you should feel a contraction of your pelvic floor muscles, no one else should know you are doing them. This means that your tummy, bottom and thighs should not be visibly moving and it is important that you do not hold your breath.
You should work at your own speed, and you will need to determine your own 'starting level'. For example, if you can hold the contraction for 2 seconds and repeat 4 times, this is your starting level.
To increase the reaction of your pelvic floor muscles you should also do some 'fast squeezes'. To do this, tighten your muscles as before, but stronger and faster. Then release straight away. Aim to do 10 of these in a row.
You should try and do these exercises at least twice a day.
Watch our videos to find out more about the pelvic floor, and how it is affected by pregnancy and childbirth, and how to exercise these muscles.
The bladder is a storage organ in your pelvis that is continuously filling until it reaches its full capacity when you would then go to the toilet for a wee.
Most people will recognise they need to go for a wee when the bladder has about 150ml in it, but usually this signal can be comfortably ignored. Then you may get another signal around 300ml, and could may well ignore it still. But it is usually when the bladder is approximately 400 to 500ml that you can't hold any longer and have to go for a wee.
If you aim to drink one and a half to two litres of water per day, you can expect around five to eight visits to the toilet a day.
There are several things that can affect bladder health, these include:
Common bladder symptoms include
Having good bowel health and function is really important to keep you feeling healthy and usually when things aren't working as they should be, it starts to have an impact on your day-to-day life.
The two most common problems with bowels are anal incontinence (leaking of wind or poo) and constipation (difficulty in having a poo and causing regular straining).
The best way to poo:
Constipation during and after pregnancy
For information on Weight Management in Pregnancy, please visit
Maintaining a healthy weight in the long-term will help to support your pelvic health and reduce your risk of developing bothersome pelvic health symptoms.
Maintaining an overall healthy lifestyle will support many aspects of your health and achieving recommended levels of physical activity will reduce your risk of developing bothersome pelvic health symptoms.
The hormonal life cycle of the female body is complex and continual via the menstrual cycle, until menopause. Symptoms of pelvic floor difficulties are often reported to be worse during certain parts of the menstrual cycle, and they can sometimes develop, or worsen, during perimenopause or after the menopause.
Hormonal changes during perimenopause can lead to a weaker pelvic floor muscle complex, reducing pelvic organ support and function. This can be experienced as urinary incontinence, anal incontinence (of wind or stool) or pelvic organ prolapse. The drop in oestrogen levels can make the vaginal and urethral tissues less robust, sore and easily irritated. This can be experienced as vaginal dryness or soreness, urinary urgency and pain, or discomfort, with sexual activity.
Maintaining a recommended level of activity, including some strength training, and following the advice given to support your pelvic health can be useful. You may also want to speak with your GP about options for HRT- vaginal oestrogen is a safe and topical form of HRT that can help with some of these symptoms directly. Additions and alternatives to vaginal oestrogen include use of a lubricant with sexual activity (water-based is generally a good place to start) or vaginal moisturisers.
Remember, pelvic floor difficulties are never considered normal, even if you've had a baby or you are of a certain age; there is often support available that may help to improve your symptoms, and therefore, your quality of life- get in touch with your GP for your local referral pathways.