Women’s Health

Pelvic Floor Health

A woman in a pink sports shirt is giving a presentation in front of a large screen. The screen displays a summary with tips on pelvic floor exercises, bladder habits, and seeking advice

1 in 3 women in the general population, and over 50% of female rugby players experience urine incontinence.

Tackling, running and jumping are the most common causes

Whilst it’s really common, it doesn’t mean it’s something we should accept, so we’ve teamed up with Sale Sharks Women’s Lead Phsyiotherapist Abi Okell to help understand the role of the pelvic floor and to recognise pelvic floor issues.

why it matters for female rugby players

The pelvic floor is a hammock of muscles that sits at the bottom of the pelvis ands provides support for our pelvic organs (bladder, uterus, bowels).

Its job is to prevent urine and bowel leakage by contracting, and to enable us to go to the toilet by relaxing. It’s also involved in sexual function and satisfaction.

So What is the pelvic floor?

Diagram of the human lower back and abdomen showing the spine, spinal muscles, multifidus muscle, diaphragm, abdominal wall muscles, transversus abdominis, and pelvic floor muscles.

Pelvic Floor Dysfunction

What it is

  • Urinary incontinence

  • Urinary urgency

  • Pelvic organ prolapse

  • Faecal incontinence

  • Pelvic pain

  • Constipation

  • Sexual dysfunction

risk factors

  • Being female!

  • Age

  • Hormonal contraception

  • Child-birth

  • Increased BMI

  • High impact activities

  • Constipation

  • Low energy availability

Tension

  • Incontinence

  • Pain

  • Heaviness

  • Pressure

  • Frequency

  • Painful sex

  • Constipation

  • Not fully emptying bladder

  • Difficulty with tampons/menstrual cups

  • Difficulty starting flow of urine

Symptoms

Weakness

  • Incontinence

  • Pain

  • Heaviness

  • Pressure

  • Frequency

  • Reduced sensation

  • Nocturia

  • Dragging

Comparison of regular toilet and squatting potty, highlighting differences in body position for bowel movement, with text explaining squatting may allow for easier defecation.

Prevention & Management

Pelvic Floor Muscle Training

    1. Get into a comfortable sitting or lying position

    2. Relax all other body parts: your tummy, your glutes, even your face

    3. Have a good breath in

    4. As you breathe out, imagine picking up a small magic bean with your anus and vagina and pull it up towards your belly button for two seconds

    5. Drop it, relax and let go as you take another breath in

    6. Repeat x 10

    • We can’t rely on general physical exercise to improve pelvic floor strength

    • Pelvic floor muscle training should be a key part of treatment for all pelvic floor dysfunction

  • A great way to understand why a pelvic floor that is too tight can cause issues is the Spring Analogy.

    TIGHT PELVIC FLOOR
    A tight pelvic floor like a tightly coiled spring which is unable to absorb shock or impact. You can’t make a coiled up spring contract any further, so when you need more support, it’s got nothing to give.

    NORMAL PELVIC FLOOR
    A normal pelvic floor (like a loosely coiled spring) should have enough give to absorb shock. It should also have the capacity to contract, so that it can effectively manage pressure around your pelvic organs.

Breathing Techniques

Diagram showing the process of breathing, with inhaling on the left and exhaling on the right. It labels the diaphragm and pelvic floor muscles, with arrows indicating movement during each phase.

As you breathe in focus on expanding your belly, then as you exhale focus on contracting it again. You can find a video which helps you to visualise this breathing technique here.

Key Takeaways

✔ Start exercising your pelvic floor regularly!

✔ Track your bowel and bladder habits and recognise changes

✔ Don’t accept leaking as part of being active

✔ Ask for help and seek expert advice and assessment when needed

A woman with long brown hair, smiling, wearing a white T-shirt with Adidas logo and British flag sleeve, standing against a plain white background.

Meet your coach

Abi is currently the Lead Physiotherapist for Sale Sharks Women and specialises in Female Athlete Health, covering topics like the menstrual cycle, breast health, pelvic floor health and more.

As well as rugby-specific knowledge, Abi also has a huge amount of experience working with elite athletes across sport including with British Wheelchair Basketball and British Para Snowsport, the Olympic Alpine, Moguls, Ski Cross and Snowboard Cross teams.

Learn more

  • Bø et al. (2017). An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for the conservative and nonpharmacological management of female pelvic floor dysfunction. Int Urogynecol J; 28:-213.

    Campbell et al (2023). Prevalence of pelvic floor dysfunction in recreational athletes: a cross-sectional survey. International Urogynecology Journal 34:2429–2437.

    Donnelly, G., Bo, K., Forner, L., Rankin, A. and Moore, I. (2025) Up for the tackle? The pelvic floor and rugby. A review. European Journal of Sport Science, 24: 1719-1734.

    McCarthy‐Ryan, Molly, Joanna Perkins, Gráinne M. Donnelly, Yeomans Caithriona, Mairead Liston, Karina Leahy, Kari Bø, Patrick O'Hal loran, and Isabel S. Moore. 2024. “Urinary Incontinence Prevalence and Risk Factors in Female Rugby Union Players: A Common Health Problem across Four Nations.” BMJ Open Sport & Exercise Medicine 10(1): e001832. https://doi.org/10.1136/bmjsem‐2023 001832.