WHAT IS PELVIC FLOOR DYSFUNCTION?

Stress Urinary Incontinence — Leaking During Sport

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This is the most recognised symptom, urinary leakage when activity increases abdominal pressure: coughing, sneezing, jumping, running, lifting heavy. Studies suggest between 25 and 50 percent of female athletes experience stress urinary incontinence during sport. The vast majority manage around it: wearing pads, avoiding certain exercises, never mentioning it to their coach or doctor. That is not a solution. And it is absolutely not inevitable.

Urge Incontinence and Urgency

A sudden, intense urge to urinate that is difficult to defer, sometimes resulting in leakage before reaching the bathroom. This can occur in women with a hypertonic pelvic floor, not just weakness, and needs a completely different treatment approach. This is exactly why proper assessment matters before starting any treatment.

Pelvic Pain During or After Exercise

Pain in the pelvis, lower abdomen, groin, or perineum during or after training. For cyclists, saddle pressure is a common cause. For runners, pelvic pain may be mistaken for hip flexor issues. For weightlifters, pain may present during heavy squats or deadlifts. All of these presentations are assessable and treatable.

Core Weakness that Does not Respond to Training

Many active women have done extensive core work, hours of planks, Pilates, heavy
compound lifts and still feel fundamentally unstable through the trunk or have persistent lower back pain. When the pelvic floor is the weakest link in the core chain, adding load above it without addressing the base achieves limited results. You cannot build a strong core on an unstable foundation.

Diastasis Recti — Abdominal Separation

During pregnancy, the two halves of the rectus abdominis can separate along the midline connective tissue. This affects around 60 percent of pregnant women. The issue for active women is returning to high intensity training postpartum before this has been properly assessed and rehabilitated. A physiotherapy assessment identifies whether diastasis is present, its degree, and what training is genuinely safe to resume and when.

Pelvic Organ Prolapse

Prolapse occurs when pelvic organs descend from their normal position, often creating sensations of heaviness, pressure, or something falling out, particularly noticeable after exercise or prolonged standing. Crucially, prolapse does not mean the end of exercise. With appropriate physiotherapy, load management, and technique adjustments, most women with prolapse can continue active training.

Pain During Intercourse

Pain during or after sexual intercourse can be caused by pelvic floor hypertonicity, vaginismus, scar tissue from delivery or surgery, or vulvodynia. This is profoundly underreported because of shame and embarrassment. It is a genuine medical condition — and physiotherapy can address it effectively.

The Postnatal Athlete

The pressure on women to bounce back after pregnancy is real, socially pervasive, and physiologically problematic. The pelvic floor, abdominal muscles, and connective tissue need time to recover from pregnancy and birth — whether vaginal or by caesarean section. The current evidence-based guidance for return to sport is:

• Walking is fine from the early postnatal period
• Pelvic floor physiotherapy assessment at 6 weeks — before or alongside your standard GP check
• Low-impact exercise for at least the first 12 weeks
• Return to running: no earlier than 12 weeks, and only after physiotherapy clearance
• Return to heavy lifting and high-impact training: 16 weeks or beyond, guided by
  assessment

These timelines apply even for women who had uncomplicated births and feel absolutely
fine. The absence of symptoms is not the same as readiness for load.