Pelvic Floor - FAQs
Answered by Sophie Fogarty - Pelvic Health Physio & Clinical Pilates Instructor
How do I know if my pelvic floor is weak or strong?
The only way to truly understand what’s happening with your pelvic floor is through a vaginal assessment by a pelvic floor physiotherapist.
In my experience, most clients with a weak or overactive (tight) pelvic floor already suspect that something isn’t quite right. They often find pelvic floor exercises difficult and may notice symptoms such as urinary urgency or leakage, a feeling of heaviness in the vagina, difficulty controlling wind, or pelvic pain.
What does a pelvic floor/ vaginal examination involve?
Your physiotherapist will give you privacy to undress and lie comfortably on a plinth, with a towel provided for cover. The assessment begins with an external check of the vulva and vagina, looking at the health of the tissues and any scar tissue. You will be asked to cough or bear down so the physio can check for signs of prolapse.
With your consent, they will then carry out an internal assessment using a gloved, lubricated index finger inside the vagina. This should not be painful, and your physio will check in with you throughout to ensure you feel comfortable. The assessment looks at your pelvic floor muscles in detail – including their tone, strength, endurance, speed, and coordination – so that you can be given a personalised exercise programme.
We understand that a vaginal examination can feel a little daunting. However, many clients say it was much easier than they expected, and they often leave feeling reassured and empowered, with a clear diagnosis and plan moving forward.
How do I know if I’m doing my pelvic floor exercises correctly?
Again, you can only know for sure by having a vaginal examination. The pelvic floor is made up of two layers:
- The superficial muscles, which create a squeezing action around the passages.
- The deeper muscles, which create a lifting sensation.
To contract the pelvic floor, try imagining that you’re stopping yourself from passing wind and urine. You should feel a gentle squeeze around the passages, followed by a lift.
When the muscles fully relax, you should notice a soft drop or widening sensation. To help with this, picture a closed rosebud at the entrance of the vagina slowly opening.
Are pelvic floor exercises safe in pregnancy?
Yes – pelvic floor exercises are both safe and strongly recommended during pregnancy.
Pregnancy hormones make the pelvic floor tissues more stretchy, and as your baby grows there is increasing pressure from above. Over time, this extra load can weaken the pelvic floor and lead to symptoms such as urinary leakage, a feeling of heaviness, or pelvic girdle pain.
Doing pelvic floor exercises daily in pregnancy helps to maintain strength and support, reducing the risk of these symptoms and preparing your body for birth and recovery afterwards. It’s especially valuable to learn how to do the exercises correctly during pregnancy. During a vaginal birth, the pelvic floor muscles need to stretch up to 2.5 times their resting length. Afterwards, it’s common to feel less sensation, which can make the exercises harder to learn if you’ve never done them before. By practising and building good technique during pregnancy, you’ll create muscle memory that makes postnatal recovery quicker and easier.
I’ve heard that pelvic floor exercises make your pelvic floor tighter and a vaginal birth more difficult?
When done correctly, pelvic floor exercises will not make birth more difficult. In fact, they can help support both pregnancy and recovery afterwards. The key is ensuring that you fully relax your pelvic floor between each squeeze, so the muscles don’t become overactive or “too tight.”
If you’re finding the exercises difficult, it’s important to see a pelvic floor physiotherapist. Sometimes people accidentally do the wrong thing—for example, bearing down instead of lifting, which can weaken the pelvic floor, or focusing only on strengthening when what they really need is to improve relaxation.
It’s not uncommon to have an overactive pelvic floor, where the muscles struggle to fully relax and let go. In this case, the focus would be on downtraining the muscles, often using breathing and relaxation techniques. Having an overactive pelvic floor can increase the likelihood of needing assistance during birth (such as forceps or ventouse).
This is why seeing a pelvic floor physiotherapist during pregnancy is so valuable—they can create a personalised programme to suit your body and goals, helping you prepare for birth in the best way possible.
What is a prolapse and how to I know if I have one?
A prolapse occurs when one or more of the pelvic organs (such as the bladder, uterus, or rectum) drop down from their normal position and bulge into the vagina. This happens when the pelvic floor muscles and connective tissues that support these organs become weakened or overstretched, and when the ligaments that suspend the organs from above are stretched.
Common symptoms include:
- A feeling of vaginal heaviness or dragging
- A noticeable bulge in the vagina
- The sensation that a tampon is sitting out of place
- Urinary urgency or leakage
- Difficulty fully emptying the bladder or bowel
Symptoms can range from very mild to more significant. If you notice any of these changes, it’s important to see a pelvic floor physiotherapist for a vaginal examination and proper diagnosis.
What does a pelvic floor ultrasound involve?
A pelvic floor ultrasound is a non-invasive way to assess how your pelvic floor is working. It can be a good alternative if you’re not comfortable having a vaginal examination, although it doesn’t provide quite as much detail.
For the scan, you’ll need to have a moderately full bladder. The ultrasound probe is placed on the lower abdomen, just above the pubic bone, which allows the physiotherapist to view the pelvic floor beneath the bladder.
During the assessment, you’ll be asked to practise pelvic floor exercises. On the screen, you should be able to see your pelvic floor lifting and lowering. If there isn’t much movement, this may be due to the muscles being too tense to relax, or too weak to contract—an ultrasound can give clues, but a vaginal examination is needed to confirm this.
However, it’s important to note that ultrasound cannot diagnose prolapse.
Is it safe to exercise in pregnancy?
Yes! The World Health Organisation recommends that all women without medical contraindications take part in regular physical activity during and after pregnancy. The guidelines suggest aiming for:
- 150 minutes of moderate-intensity exercise per week, or
- 75 minutes of vigorous-intensity exercise per week, or
- a combination of both.
This could look like 30-minute sessions, five times per week. Try to include a mix of aerobic activity (e.g. walking, swimming, running) and resistance training (e.g. strength training or pregnancy Pilates). A simple way to monitor your effort is the talk test:
- Moderate intensity = you can talk but not sing.
- Vigorous intensity = you can only say a few words before needing a breath.
If you’re new to exercise, check with your Lead Maternity Carer (LMC) before starting, and gradually build up towards the recommended 150 minutes of moderate-intensity activity.
What are the benefits of exercising in pregnancy?
Exercising during pregnancy offers many benefits for both you and your baby.
For you (the mum):
- Boosts endorphins, improves mood, reduces anxiety, and promotes better sleep
- Reduces pregnancy-related aches, pains, and pelvic floor symptoms
- Helps maintain a healthy weight, lowering the risk of gestational diabetes and pre-eclampsia
- Improves stamina and endurance for labour, potentially shortening the length of active labour
- Supports faster postnatal recovery
For your baby:
- Promotes healthy growth and development
- Supports brain development
- May reduce the future risk of obesity, diabetes, and cardiovascular issues
- Supports healthy placental function, improving oxygen and nutrient delivery
Can I go back to running at 6 weeks postnatal?
In most cases, no. Current postnatal return-to-running guidelines recommend waiting until at least 12 weeks before resuming running. That said, every recovery is different—some women may be ready a little earlier, while others may take one year to return.
From 6 weeks postpartum, it’s safe to start low-impact exercise such as cycling, Pilates, or yoga to improve posture, pelvic floor, and abdominal strength.
Return-to-running assessments are usually performed from 12 weeks. These assessments include exercises like single-leg squats, hopping, and jogging on the spot to evaluate pelvic floor function and overall strength. If there are no symptoms—such as urinary leakage, urgency, heaviness, dragging, or pain—running can then be gradually reintroduced.
Using a structured program, like a Couch to 5K app, can help prevent doing too much too soon and reduce the risk of injury.
Is it ok to leak when running?
No. While it’s common, leaking during running is not considered normal.
This type of leakage is called stress incontinence—involuntary urine loss during activities that put pressure on the bladder, such as coughing, sneezing, or running. It occurs when the muscles and connective tissues that support the bladder and urethra become weakened, preventing the bladder neck and urethra from staying closed under pressure.
Pelvic floor exercises can improve stress incontinence in approximately 50–60% of women. For those who do not see improvement, a pessary (a support device) may be recommended.
What is a pessary?
A pessary is a support device worn inside the vagina to help manage prolapse and incontinence. Pelvic floor physiotherapists are increasingly trained to fit pessaries because they are a safe and effective option.
Pessaries are made of medical-grade silicone and come in a variety of shapes and sizes. During a fitting, the physiotherapist will perform a vaginal examination, take measurements, and teach you how to insert and remove the pessary yourself.
When fitted correctly, a pessary should relieve heaviness and leaking and feel virtually unnoticeable —similar to wearing a tampon. Some women choose to wear their pessary all the time, while others may only use it during exercise or certain activities.