We are delighted to have a guest blog from Dianne MacKenzie, Specialist Pelvic Health Physiotherapist and NHS Education for Scotland AHP Fellow. Her expertise in pelvic health gives us all confidence to be more active and exercise in a way that works for us. The information in this post is not intended as medical advice. Please seek advice from a Pelvic Health Physiotherapist or your GP for personalised information.

Are issues with your pelvic floor holding you back from being physically active?

You are not alone.

I am a Physiotherapist specialising in Pelvic Health, and a large part of my role is to assess and treat people who present with Pelvic floor dysfunction. Pelvic floor dysfunction commonly presents as leaking urine or faeces (poo), or pelvic organ prolapse. Pelvic organ prolapse (POP) is a gynaecological condition in which the pelvic organs bulge into the vagina due to ligament or muscular weakness.

Stress urinary incontinence (SUI) is the complaint of involuntary leakage on effort or exertion, or on sneezing or coughing (1).
Urge urinary incontinence (UI) is the complaint of involuntary leakage accompanied by or immediately preceded by urgency (1).
Mixed urinary incontinence is the complaint of involuntary leakage associated with urgency and also with exertion, effort, sneezing or coughing (1)

The people I see often hang their heads when I ask them to talk about their hobbies. They will recall a sport or exercise class that they once enjoyed but now feel afraid to do because of pelvic pain, urinary leakage, or embarrassment, to name only a few signs and symptoms. This is one of the hardest things to hear. These issues are affecting these people in terms of their quality of life because they avoid doing the physical activities that they would typically enjoy.

Worse still, if people can’t be physically active, they are also missing out on the protection this gives against chronic health problems, such as diabetes, heart disease, and osteoporosis.

Many people “do not seek help for [pelvic floor dysfunction] and deliberately avoid physical and social activity, which increases sedentary behaviour and social isolation” (1)

There are many reasons why people find it hard to exercise:

But if they also have PFD, they may be afraid of making their condition worse, leaking during exercise, or struggling with embarrassing pads.

31% of 18-65 year olds with PFD report that their symptoms are a substantial barrier to exercise, with urinary incontinence being most frequently reported (2). Pelvic floor symptoms, or fear of PFD, are the most significant barrier to exercise for women with current or past PFD, or a fear of PFD (3).

The surprising thing is that, in reality, mild to moderate physical activity and being less sedentary actually decreases the odds of having or developing PFD and most physical activity does not harm the pelvic floor (4). Most symptoms during physical activities tend to be associated with repetitive jumping or bouncing and tend to be with extreme training. So being active could improve your PFD symptoms if you do it correctly!
Physical Activity with PFD, where do we start?
The physical activity guidelines are as follows:
• Undertake 150 minutes of moderate physical activity or 75 minutes of vigorous activity over the course of a week
• Reduce the amount of time you spend sitting, as sedentary behaviour is a risk factor even if you reach the physical activity guidelines
• Include two sessions of strengthening activity each week if you can
• Incorporate some balance and flexibility work each week if you are an older adult
First, think about your current levels of activity and then work out what you might need to do to improve this.
• Perhaps start by seeking help for your PFD if you feel ready.
Your GP can often give you advice or refer you to a specialist pelvic floor physiotherapist. Many physiotherapy services are now accepting self-referrals. Your physiotherapist will assess you fully and hopefully be able to improve the function of your pelvic floor and give you guidance on how to be more active. Check out the following links if you want some ideas of how to get started, but always seek the advice of a physiotherapist if you are unsure of what you are doing:

• Ask your gym instructor for pelvic floor safe modifications

If they don’t know you are struggling it is hard for them to help. If you are brave enough to allow your fitness professional the knowledge of your problem, that empowers them to support and modify what they teach so it can improve your problem, rather than potentially make it worse.

• Look for alternatives to exercises that cause straining or bearing down (if they cause your symptoms).
Here 5 examples of exercises that might make your symptoms worse, with a more pelvic floor friendly alternative.

• If the exercise causes vaginal pressure or leakage of wind, urine or faeces, change it
• If you are strength training; only increase resistance if it does not aggravate your symptoms
• Only increase impact if it does not aggravate your symptoms
• For peace of mind and security you could consider some of the continence devices which might make you more comfortable, make your urinary leakage less severe or help to contain it better.

Continence Devices
Vaginal devices can be used to increase confidence and reduce leakage during physical activity.

Contiform, efemia and diveen are all available on prescription from your GP. Contrelle is currently not available on prescription.

Containment Products

Support Underwear.

There are specialist underwear and clothing also available that can offer increased pelvic support, brands such as EVB and SRC can often help make you more comfortable when exercising.

Don’t let your pelvic floor dysfunction hold you back from being active! Take the first steps to moving more and feeling better!


  1. Bo K Urinary incontinence, pelvic floor dysfunction, exercise and sport. Sports Med. 2004;34(7): 451-64
  2. Cook et al Pelvic floor symptoms are an overlooked barrier to exercise participation: a survey of 4556 symptomatic women. Journal of Science in medicine and sport S1-S80 2021
  3. Dakic et al The impact of pelvic floor dysfunction on exercise in women. 2020
  4. Nygaard and Shaw Physical Activity and the pelvic floor. American Journal of Obstetrics and Gynaecology 2016; 214(2) 164-171