Extremely common, rarely mentioned, and genuinely fixable in most cases.
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The pelvic floor is a sling of muscle supporting the bladder, bowel and — in women — the womb. When it stops working properly you get leaking, urgency, a dragging sensation, prolapse, or pain.
The first thing to say is that none of this is a normal part of being a woman, of having had children, or of getting older. Around one in three women has some degree of urinary incontinence, and most wait years before mentioning it — because they have been told, or have concluded, that it is simply what happens. It is not, and it is treatable.
Two things matter more than anything else here.
1. Pelvic floor exercises work — but almost everyone does them wrong. Supervised training for at least three months is genuinely first-line treatment, with good evidence. Done briefly, incorrectly, or for a fortnight, it does nothing, and people conclude the exercises are useless.
2. Not every pelvic floor problem needs strengthening. Some pelvic floors are too tight, and that causes pain, constipation, painful sex and difficulty passing urine. In those people, Kegel exercises make things distinctly worse. Being handed a leaflet about squeezing when the muscle is already overactive is a common and genuinely harmful mistake.
And one instruction to correct now: do not practise by stopping your urine mid-flow. It is widely repeated and it is harmful.
Many people have both. Which one dominates determines the treatment.
Frequently missed, and made worse by the standard advice:
Leaking wind or stool, urgency, or difficulty controlling the bowel. Under-reported to a striking degree, and treatable.
Most commonly after prostate surgery, where pelvic floor training genuinely helps recovery and is most effective started before the operation — which is worth asking about rather than waiting until afterwards.
Caffeine, alcohol and fizzy drinks all irritate the bladder. So does drinking too little — concentrated urine irritates more, and people commonly restrict fluids in an attempt to leak less, which backfires.
This is diagnosed largely from the history — and a video consultation is often easier than a face-to-face appointment for a subject people find difficult to raise.
Three days recording times, volumes, what you drank and every leak. It is the single most useful thing you can bring, it distinguishes stress from urge incontinence more reliably than description alone, and it frequently reveals that fluid restriction or caffeine is driving the problem.
Prolapse is assessed by examination, and we cannot do that. A suspected prolapse, unexplained pain, or symptoms not responding to proper treatment need seeing — and we arrange it rather than working around it.
Specialist pelvic health physiotherapy is the treatment with the best evidence, and in many areas you can self-refer without going through anyone. It is worth asking about locally — a great many people do not know it exists.
First-line for stress incontinence and prolapse, with strong evidence — and it needs to be supervised and sustained for at least three months. Technique matters more than effort:
Never practise by stopping your urine mid-flow. It is a common instruction and it is harmful — it disrupts normal bladder emptying and can cause infection and retention.
Squeeze the pelvic floor before you cough, sneeze, laugh or lift. A simple, immediate technique that reduces leaking straight away, and it is very rarely taught.
Gradually extending the time between visits, using distraction and pelvic floor squeezes to suppress the urge. Over six weeks this genuinely retrains the bladder, and combined with reducing caffeine it works for many people without any medication.
Strengthening is the wrong treatment. This needs relaxation work, breathing, stretching and specialist pelvic health physiotherapy — sometimes with internal release techniques or dilators. If exercises make your symptoms worse, stop and say so, because that finding changes the direction of treatment entirely.
Go to A&E or call 999 for:
Seek prompt assessment for:
Book a routine consultation for:
Squeeze as if stopping wind, then lift up and in. Place a hand on your abdomen — it should stay relaxed. Breathe normally throughout.
The three errors that mean it is not working: holding your breath, squeezing your buttocks, and tensing your thighs. If you are doing any of those, you are exercising the wrong muscles.
Do slow holds — building to ten seconds — and quick squeezes. Three times a day. Attach it to something you already do, such as every time you boil the kettle; that is what makes it stick.
Do not stop your urine mid-flow to practise. It is repeated everywhere and it is harmful — it interferes with normal bladder emptying and increases the risk of infection and retention.
The treatment with by far the best evidence for pelvic floor problems is supervised pelvic floor muscle training, and it is free on the NHS. NHS women's health physiotherapy takes referrals, and in many areas self-referral is possible without seeing a GP at all — which is worth knowing, because it is the fastest route to the thing that actually works.
That is the central point: this is a physiotherapy problem before it is a medical one. At least three months of properly taught, supervised pelvic floor exercises is first-line for stress incontinence, and it is effective — substantially more so than most people expect.
Why supervision matters: a large proportion of women doing pelvic floor exercises from a leaflet are doing them incorrectly, often bearing down rather than lifting. A physiotherapist checking technique is the difference between three months of effort working and three months achieving nothing.
The NHS Squeezy app is inexpensive and genuinely useful for adherence.
Where a private consultation is worth paying for is arranging the referral quickly, excluding a urinary infection or other cause, and reviewing medicines and factors — constipation, caffeine, chronic cough, weight — that make everything worse and are often the missing piece.
What needs prompt assessment: visible or palpable prolapse causing symptoms, difficulty emptying the bladder or bowel, or any blood in the urine.
NICE NG123, Urinary incontinence and pelvic organ prolapse in women, is the governing guideline. It recommends a trial of supervised pelvic floor muscle training of at least three months' duration as first-line treatment for stress or mixed urinary incontinence.
NG123 specifies the training should be supervised rather than provided as written information alone, and that women should be taught to contract correctly — the basis for the point above about technique.
NG123 recommends bladder training for at least six weeks as first-line for urgency incontinence, before considering medication.
NG123 also recommends pelvic floor muscle training for symptomatic prolapse, and covers vaginal pessaries as an alternative to surgery.
NG123 advises addressing modifiable factors — weight, caffeine intake, constipation and chronic cough — which is why those are named above.
POGP (Pelvic, Obstetric and Gynaecological Physiotherapy) resources support self-referral pathways where these exist.
No. It is common — around one in three women — but common is not the same as normal, and it is not something to accept. Most women wait years before mentioning it, and treatment works considerably better earlier than later. Leaking, urgency and dragging are all treatable, usually without surgery.
Possibly not — most people are not. Squeeze as though stopping yourself passing wind, then lift up and in, while breathing normally. The three giveaways that you are using the wrong muscles: holding your breath, clenching your buttocks, or tensing your thighs. And give it three months, not three weeks.
No — please do not. This advice is repeated everywhere and it is harmful. It disrupts normal bladder emptying and increases the risk of infection and urinary retention. It is a way of identifying the muscle once, at most — never a way of exercising it.
Then stop, and say so — this is important information rather than a failure. It suggests an overactive, tight pelvic floor rather than a weak one, which causes pain, constipation, painful sex and difficulty passing urine. Strengthening makes that worse; it needs relaxation work and specialist pelvic health physiotherapy instead.
No — it backfires. Concentrated urine irritates the bladder and makes urgency worse. Keep fluids normal and cut caffeine instead, which is usually the single most effective change. If night-time is the issue, move your fluid earlier rather than reducing the total.
Stop and stay still rather than rushing. Squeeze the pelvic floor several times quickly, breathe, let the urge pass — then walk calmly. Rushing to the toilet intensifies the urge and increases leaking. Combined with bladder training over about six weeks, this works for many people without any medication.
No. Pelvic floor training helps milder prolapse, and a vaginal pessary — a support device fitted in clinic — is effective, reversible and considerably under-offered. Many women are never told it exists. It is worth asking about specifically before considering an operation.
Yes — most commonly after prostate surgery. Pelvic floor training genuinely helps recovery, and it works best when started before the operation rather than afterwards. If you have surgery planned, ask about it now rather than waiting.
August 23, 2026
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Same-day access is usually available, from 6am to 10pm, seven days a week. You choose a time that suits you rather than waiting on hold at 8am.
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Yes, with your consent. We can access your Summary Care Record during the consultation, so your current medications, allergies and significant history are in the room. That means fewer questions you have already answered elsewhere, and safer prescribing.
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Twenty unhurried minutes and a comprehensive assessment. A written treatment plan is included, along with any prescription, sick note or referral letter arising from the consultation, at no extra charge.
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It means the diagnosis can usually be made from your history and photographs, and that treatment can be arranged safely without examining you. Where a condition is not marked treatable online, it is because examination is the diagnosis — listening to a chest, feeling an abdomen, examining an ear or a joint — or because a procedure or device is needed.
Yes, where there is a genuine bacterial infection — cellulitis, impetigo, bacterial urine infections, confirmed strep throat. We will also frequently tell you that you do not need one. Most sore throats, coughs, colds and earaches are viral, and an antibiotic gives you the side effects with none of the benefit.
If your problem turns out to be genuinely outside what we can do remotely, the doctor will tell you straight away, point you to the right service, and refund your fee in full. We would rather do that than fill twenty minutes to justify the charge.
Call 999 or go to A&E — do not book an online appointment and do not wait for a reply to an email. For urgent problems that are not emergencies, NHS 111 is available 24 hours a day, online or by phone, and can direct you to the right service.
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