What to expect from pelvic floor physiotherapy for stress urinary incontinence

Stress urinary incontinence is leakage with pressure on the bladder, such as during a cough, sneeze, laugh, lift or jump. The pelvic floor should contract and release in coordination with breathing and movement. A physiotherapist asks when leakage occurs, how often you exercise, and whether urgency, pain or bowel symptoms are also present.

Assessment may include breathing, posture, abdominal and hip movement, and a pelvic floor contraction. With your consent, an internal examination can check strength, endurance, relaxation and technique. You may be shown how to feel the correct muscles without tightening the buttocks, thighs or abdomen unnecessarily.

A home plan may combine longer holds, shorter squeezes and a deliberate release, with the dose matched to your findings. You may practise a pelvic floor contraction before a cough or lift, exhale during effort, and build activity gradually. Bladder habits, fluid patterns, constipation and high-impact exercise may also be reviewed.

Quality matters more than adding repetitions. Avoid practising by repeatedly stopping urine flow, because that can interfere with normal emptying. Tell your physiotherapist if contractions cause pelvic pain, worsening pressure, difficulty emptying or more leakage.

Seek medical advice for blood in the urine, fever, burning with urination, new severe pelvic pain, difficulty passing urine, or leakage that begins suddenly with numbness or leg weakness. Mention urgency, night-time urination or bowel changes because these may point to a mixed or different bladder problem. Urgent symptoms should not wait for a routine physiotherapy session.

Ask whether your leakage pattern is stress, urgency or mixed incontinence, how to measure progress, whether high-impact activity should be modified, and when other treatments should be considered.