Urinary leakage affects millions of women across the UK, yet many suffer in silence because they feel embarrassed or believe it is simply part of getting older or having children. The truth is far more encouraging: most cases of urinary incontinence respond well to physiotherapy, and seeking help early often leads to better outcomes.
As a pelvic health physiotherapy clinic in Bloomsbury, we see women every week who wish they had come sooner. Some have been managing symptoms for years, thinking nothing could be done. Others tried pelvic floor exercises from online videos but saw no improvement. Understanding when and why to seek specialist help makes all the difference.
Is urinary leakage normal in women?
Urinary leakage is common but not normal. Around one in three women experience some form of incontinence during their lifetime, particularly after childbirth or during menopause. Although widespread, it reflects a treatable issue with the pelvic floor, bladder, or surrounding structures rather than an inevitable part of being female.
The confusion between “common” and “normal” leads many women to accept symptoms they do not need to tolerate. Yes, pregnancy stretches and weakens pelvic floor muscles. Menopause changes tissue quality and hormone levels. High-impact exercise places extra demand on the system. These are explanations, not reasons to resign yourself to leaking.
Younger women sometimes leak too. Athletes, especially runners and CrossFit enthusiasts, may experience stress incontinence during training. Women with chronic coughs, constipation, or jobs involving heavy lifting can develop symptoms in their twenties or thirties. Age is a factor, but it is far from the only one.
What causes urinary incontinence in women?
Urinary incontinence in women stems from pelvic floor dysfunction, bladder overactivity, or both. Common triggers include pregnancy and childbirth, hormonal changes during menopause, chronic straining from constipation, high-impact exercise, persistent coughing, and poor pressure management during daily activities. Weakness, overactivity, or coordination problems can all contribute.
The causes fall into several overlapping categories. Pregnancy and postnatal changes top the list. Growing a baby stretches pelvic tissues, and vaginal birth can injure muscles and nerves. Some women notice leaking during pregnancy itself due to increased weight and pressure. Others develop symptoms months or years after delivery, when they return to running or lifting heavier weights.
Menopause brings hormonal shifts that affect tissue elasticity and strength. Lower oestrogen levels make the urethra and bladder lining thinner and less supportive. Women who had mild symptoms before menopause often find them worsening during this transition. Pelvic physiotherapy for menopause addresses these changes with tailored exercises and lifestyle strategies.
Constipation deserves more attention than it usually gets. Chronic straining weakens the pelvic floor over time and trains poor pressure patterns. The same downward push you use to empty your bowels can become a default pattern during other activities, which undermines pelvic support.
High-impact exercise challenges the pelvic floor, particularly if you have not built foundational strength or if your breathing and core coordination are off. Runners often leak during long runs or sprint intervals. Trampolining, jumping jacks, and box jumps create sudden spikes in abdominal pressure that the pelvic floor must manage.
Types of urinary incontinence
Understanding which type you have helps guide treatment. The three main categories are:
- Stress urinary incontinence: Leaking during physical activities that increase abdominal pressure, such as coughing, sneezing, laughing, running, or lifting. This type suggests the pelvic floor cannot withstand sudden force.
- Urge incontinence: A sudden, intense need to urinate that you cannot delay, sometimes leading to leakage before reaching the toilet. This points to bladder overactivity or heightened bladder sensitivity.
- Mixed incontinence: A combination of both stress and urge symptoms, which requires addressing multiple factors in treatment.
Knowing your type matters because the treatment differs. Stress incontinence often needs strengthening and coordination work. Urge incontinence may involve calming an overactive bladder and retraining your response to urgency. Mixed incontinence requires a flexible approach that tackles both.
Can physiotherapy stop urine leakage?
Yes, physiotherapy can significantly reduce or eliminate urine leakage in most women. Studies show that women’s health physiotherapy improves symptoms in around 70 to 80 per cent of cases. Treatment targets the root cause through pelvic floor training, bladder strategies, pressure management, and lifestyle modifications tailored to your specific needs.
The effectiveness depends on the type and severity of incontinence, how long you have had symptoms, and your commitment to the programme. Mild to moderate stress incontinence responds particularly well when caught early. Urge incontinence improves with bladder retraining and techniques to manage urgency without rushing.
What makes physiotherapy different from generic pelvic floor advice is the individualised assessment. Not everyone needs strengthening. Some women have pelvic floors that are too tight or overactive, which also causes symptoms. Doing more squeezes in these cases makes things worse, not better. A specialist physiotherapist identifies whether you need strengthening, relaxation, coordination work, or a combination.
Treatment might include pelvic floor muscle training when appropriate, but it goes beyond that. You learn how to breathe properly during exertion, how to manage intra-abdominal pressure during exercise and daily tasks, and how to retrain your bladder if urgency is an issue. If constipation contributes, we address bowel habits. If you are returning to running or high-impact sport, we guide you through a graded progression.
When should you see a physiotherapist for urinary leakage?
You should see a pelvic floor physiotherapist if urinary leakage affects your daily life, limits physical activity, or causes distress. Early intervention leads to better outcomes, so do not wait for symptoms to worsen. Whether you leak occasionally during exercise or struggle with frequent urgency, specialist assessment identifies the underlying issue and creates an effective treatment plan.
Many women delay seeking help because they assume leaking is minor or will resolve on its own. Unfortunately, symptoms often worsen over time without intervention. The sooner you address the issue, the easier it tends to be to fix.
Consider booking an assessment if you experience any of the following:
- Leaking urine when you cough, sneeze, laugh, or exercise
- Sudden, strong urges to urinate that are difficult to delay
- Needing to urinate frequently throughout the day or night
- Leaking on the way to the toilet or not making it in time
- Avoiding certain activities or social situations due to fear of leaking
- Using pads daily to manage leakage
- Postnatal symptoms that have not resolved after a few months
- Worsening symptoms during perimenopause or menopause
You do not need a GP referral to see a pelvic health physiotherapist privately. If you prefer NHS treatment, speak to your GP, who can refer you to a local service, although waiting times vary. At our Central London clinic near Tottenham Court Road, we offer appointments within days, which allows you to start treatment without delay.
What to expect from a pelvic health physiotherapy assessment
First appointments typically last around an hour. The physiotherapist takes a detailed history, asking about your symptoms, medical background, bowel and bladder habits, exercise routine, and any relevant surgeries or pregnancies. This conversation builds a picture of what might be contributing to your symptoms.
The external assessment looks at your posture, breathing patterns, and how you move. These factors influence pelvic floor function more than most people realise. For instance, chronic breath-holding during exertion or excessive abdominal bracing can interfere with pelvic floor coordination.
An internal vaginal examination is usually offered but always optional. It provides the most accurate information about pelvic floor muscle strength, tone, and coordination. However, if you decline, the physiotherapist can still assess you externally and through functional tests, then offer treatment based on those findings. Consent and comfort are paramount. If you choose to proceed with an internal exam, the physiotherapist explains each step and you remain in control throughout.
Following the assessment, you receive a clear explanation of what is happening and why, along with a tailored treatment plan. This might include exercises to do at home, strategies for managing urgency or leakage, advice on fluid intake and bowel habits, and guidance on returning to activities you have been avoiding.
How long does pelvic floor physio take to work for incontinence?
Most women notice some improvement within two to six weeks of starting pelvic floor physiotherapy, with more significant results developing over six to twelve weeks. Progress depends on the severity of symptoms, consistency with exercises, the type of incontinence, and any underlying factors such as constipation or hormonal changes that also need addressing.
Setting realistic expectations matters. Pelvic floor muscles are skeletal muscles, just like your biceps or quads, and they respond to training over time rather than overnight. If your symptoms developed gradually over months or years, they will take weeks to resolve, not days.
Bladder retraining for urge incontinence sometimes shows quicker results because you are changing behavioural patterns rather than building muscle strength. Women often notice they can delay urgency longer or reduce bathroom frequency within a couple of weeks. Stress incontinence takes longer because you need to rebuild muscle strength and retrain coordination patterns during dynamic activities.
Consistency is everything. Doing your exercises most days yields better results than sporadic effort. That said, the exercises should fit into your life rather than dominate it. Most programmes require 10 to 15 minutes daily at first, which then reduces as you progress.
Self-help strategies: what works and what does not
Some general advice helps, but much of the generic guidance online oversimplifies the issue. Reducing caffeine and alcohol can ease urgency for some women, although it is not a cure. Drinking adequate water matters, too. Restricting fluids to avoid leaking often backfires because concentrated urine irritates the bladder, increasing urgency.
Kegel exercises can help if done correctly and if strengthening is what you need. Many women perform them incorrectly, bearing down instead of lifting, or holding their breath and tensing their whole body. Others do endless repetitions without actually challenging the muscle, which is like doing bicep curls with no weight.
Some women do not need more strength at all. If your pelvic floor is overactive or too tense, adding more squeezes worsens the problem. This is why assessment matters. Guessing leads to frustration when exercises do not work, or worse, make things worse.
Pelvic floor physiotherapy in London provides the individualised approach that generic advice cannot offer. The physiotherapist assesses your specific situation, then designs a programme that addresses your actual needs rather than a one-size-fits-all protocol.
When to see your GP urgently
Whilst most urinary leakage is a musculoskeletal issue suited to physiotherapy, certain symptoms require medical investigation. Contact your GP if you experience:
- Blood in your urine
- Pain or burning when urinating, especially with fever or feeling unwell
- Sudden severe changes in bladder control
- Numbness or tingling in your pelvic area, legs, or feet
- New weakness in your legs
- Recurrent urinary tract infections (three or more in a year)
- Difficulty emptying your bladder completely
These symptoms may indicate an infection, neurological issue, or other medical condition that needs prompt attention. Your GP can run tests and refer you to a specialist if necessary.
Why location matters: accessing specialist care in Bloomsbury
Finding a pelvic health physiotherapist you feel comfortable with makes a significant difference to your treatment experience. Our clinic is located in Bloomsbury, Central London, just a short walk from Tottenham Court Road station. The area is well connected by the Northern and Central lines, making appointments accessible whether you live in London or commute in from surrounding areas.
We designed our clinic space with privacy and comfort in mind. Appointments are scheduled to avoid overlap in the waiting area, and treatment rooms are quiet, private spaces where you can discuss sensitive symptoms without worry.
Being based in Central London also means we work with women from diverse backgrounds and professions. We understand that your schedule may be demanding, which is why we offer early morning and evening appointments. Our physiotherapists have extensive experience treating urinary incontinence in women at all life stages, from athletes in their twenties to women navigating menopause and beyond.
Taking the next step
Urinary leakage does not have to be something you manage or work around. With the right assessment and treatment, most women see significant improvement. Whether your symptoms are recent or longstanding, mild or severe, there are evidence-based strategies that can help.
If you are ready to address your symptoms, or if you simply want to discuss whether physiotherapy might be right for you, we are here to help. You can read more about our approach to women’s health physiotherapy in London or learn what happens during your first visit in our guide on what to expect from a pelvic health physiotherapy session.
Book an assessment at our Bloomsbury clinic
Our specialist pelvic health physiotherapists are here to help you regain confidence and control. We offer comprehensive assessments and individualised treatment plans tailored to your needs.
You can book online at physioreform.uk3.cliniko.com/bookings or contact our team if you have questions before booking.
References
NHS: Urinary incontinence
Pelvic, Obstetric and Gynaecological Physiotherapy (POGP)