Pelvic Floor Problems in the UK: Physiotherapy and Where to Get Help

The NHS describes urinary incontinence as the unintentional passing of urine, and lists several types: stress incontinence (leaks when your bladder is under pressure, such as when you cough or laugh), urge incontinence (a sudden, intense urge to pee, or a leak soon after), overflow incontinence (you cannot fully empty your bladder) and total incontinence. Stress incontinence is usually the result of weakening of, or damage to, the pelvic floor muscles and the muscle that stops urine leaving the bladder. Pregnancy and vaginal birth, obesity, a family history and increasing age can make it more likely, though the NHS says incontinence is not an inevitable part of ageing. Source: NHS: urinary incontinence.

The NHS describes pelvic organ prolapse as when the womb, bladder or bowel bulge into the vagina. Symptoms can include a feeling of heaviness, discomfort or pressure, a bulge or lump, discomfort during sex, and problems peeing or pooing. It says to see a GP if you have a lump in or around your vagina or any other symptoms. Source: NHS: pelvic organ prolapse.

The NHS says to see a GP if you have any type of urinary incontinence, and that this can be the first step to managing it. The GP will ask about your symptoms, may examine you, and may suggest keeping a diary of how much you drink and how often you pee. Conservative treatments, which do not involve medicines or surgery, are tried first: lifestyle changes (such as adjusting caffeine and fluid intake), pelvic floor muscle training and bladder training.

The NHS says NHS continence services are staffed by specialist continence advisers and specialist physiotherapists, who can diagnose your condition and start treatment, and that a GP can refer you to your local continence service and in some cases you can refer yourself. It says a GP may refer you to a specialist to start a pelvic floor muscle training programme: the specialist assesses whether you can squeeze your pelvic floor muscles and gives you an exercise programme based on that assessment. The NHS says the programme should include a minimum of 8 muscle contractions at least 3 times a day and last for at least 3 months, and that bladder training usually lasts at least 6 weeks. Source: NHS: non-surgical treatment for urinary incontinence.

For pelvic organ prolapse, the NHS lists physiotherapy and pelvic floor muscle training, usually with a specialist women's health physiotherapist, among the treatment options, alongside hormone treatment, vaginal support pessaries and surgery. Whether you can refer yourself to an NHS pelvic health physiotherapy service varies by area and service, so check your local service's website or ask your GP surgery.

If you want to be seen sooner or choose who you see, you can see a private physiotherapist without a referral. Pelvic health is a specialism rather than a separate protected title: the protected title is physiotherapist, so check the HCPC register and then ask about their training and experience in pelvic health. Ask what an assessment involves, including whether an internal examination might be suggested, and whether you can bring someone with you or have a chaperone; you can always say no or stop. The Chartered Society of Physiotherapy runs a find a physiotherapist directory of its members.

Whoever you choose, check their register: physiotherapists must be on the HCPC register (HCPC: check the register). Ask about fees, session length and what progress will look like. See questions to ask a private allied health professional. On Therapist Circle, each practitioner's registration is checked when they join, and their profile shows the register and number so you can check it yourself.

• Physiotherapists are the main profession for pelvic floor muscle training and rehabilitation; see how to find a physiotherapist.
• Occupational therapists can help with daily routines, toilet access and equipment when a health condition affects continence.
• Dietitians can advise on diet when constipation, bowel symptoms or weight are part of the picture; see IBS and dietitians.
• Counsellors, psychotherapists and practitioner psychologists can support you with embarrassment, anxiety, intimacy worries or low mood that can come with pelvic floor problems.