It might happen at the start of a run, on the trampoline with the kids, or when a fit of laughter catches you off guard. A small leak of urine when you cough, sneeze, laugh, jump or exercise is something many people quietly put up with for years. Often that’s because it feels awkward to talk about, or because they assume it’s simply part of life after having children or getting older.
It has a name, stress urinary incontinence, and it’s very common. It’s especially likely during pregnancy, after having a baby and around the menopause, and it affects men too, particularly after prostate surgery. But common doesn’t mean you have to live with it. For many people, the right exercises, taught properly, make a real difference.
Why it happens
Your pelvic floor is a group of muscles that sits like a supportive sling across the base of your pelvis. It holds up your bladder, your bowel and, in women, the womb, and it helps keep everything closed until you’re ready to go to the toilet.
Every time you cough, sneeze, laugh or land from a jump, the pressure inside your tummy rises suddenly and pushes down on the bladder. A well-working pelvic floor tightens quickly and strongly enough to meet that pressure. If it can’t, because it’s weaker, slower to switch on or not working well with the rest of your core, a little urine can escape.
Lots of things can affect how well these muscles work. Pregnancy and birth are the most familiar, but ageing and hormonal changes around the menopause play a part too, as do a long-term cough, constipation and straining, regular heavy lifting and carrying extra weight. Often it’s a combination rather than one single cause.
Why supervised pelvic floor training comes first
NICE, which sets clinical guidance in England, recommends supervised pelvic floor muscle training for at least three months as the first treatment for women with stress incontinence.
The word “supervised” matters more than it might seem. Pelvic floor muscles are hidden, so it’s hard to tell whether you’re using them correctly. Many people try exercises from a leaflet or an app and, without realising, squeeze their buttocks or thighs, hold their breath, or even bear down instead of lifting. Understandably, they then decide the exercises don’t work. A physiotherapist can check what your muscles are actually doing and build a programme that fits you, which is often the difference between giving up and getting results.
What happens at your first appointment
We know booking this kind of appointment can take some courage, so we keep the first visit relaxed, confidential and at your pace. Most of it is a conversation. We’ll ask when leaks happen and how much they affect you, about your bladder and bowel habits, including what and how much you drink, about any pregnancies, births or surgery, and about the exercise or activities you’d like to get back to.
With your consent, your physiotherapist may offer an internal examination to see how your pelvic floor muscles contract and relax. This gives the most accurate picture, but it’s always your choice. Everything is explained beforehand, you can say no or stop at any time, and you’re welcome to bring someone with you. If you’d rather not be examined, we can still help.
You can read more about appointments in Pelvic floor physiotherapy: what it is and what to expect.
What treatment may include
Treatment centres on a pelvic floor exercise programme matched to your current strength and endurance, usually practised little and often through the day. We’ll also teach you a simple technique sometimes called “the knack”: tightening your pelvic floor just before you cough, sneeze or lift, so the muscles are ready before the pressure arrives.
Alongside the exercises, small changes to daily habits can help a great deal. We’ll talk through fluids and bladder habits, and how to avoid constipation, since straining puts extra load on the pelvic floor. If running, the gym or impact sport is your goal, we’ll build a gradual plan to get you back to it without leaking, with regular reviews to progress your exercises and check how things are going.
Take a common example. A woman who stopped running after her second baby, because she leaks in the first kilometre, might start with short, precise contractions lying down, then progress to standing, then to hopping and jogging on the spot. Only then would she build back up to running outdoors. It isn’t quick, but each step gives her confidence that the next one will hold.
Muscles take time to get stronger, so most people need to keep going for a few months to see the full benefit. Many notice small improvements sooner, and that helps keep them going.
When to see your GP as well
Some symptoms need checking by your GP alongside physiotherapy. Speak to your GP if you notice blood in your urine, pain when passing urine, leaks that started suddenly, or a feeling of something coming down in your vagina. If you can’t control your bladder at all, or have new numbness around your genitals or bottom, seek urgent medical help.
Support for women and men
Leaking isn’t only a women’s issue, and we see people at every stage of life. Crestwell Medical offers pelvic floor rehabilitation, a continence clinic, postnatal rehabilitation and men’s pelvic health physiotherapy, so whatever is behind your symptoms, there’s a place to start.
Book a confidential assessment
We have clinics in Stratford, Harrow, Finchley and Wood Green, open Monday to Saturday. Book an appointment or call 0203 916 5453.
Reviewed by Lorenzo Cavallaro, HCPC-registered physiotherapist
This article is general information, not a diagnosis. If you’re worried about your symptoms, speak to a healthcare professional.
