Clinically reviewed by What is pelvic floor exercises
Your pelvic floor is a sling of muscle running from the pubic bone to the tailbone. It holds the bladder, bowel and uterus in place, and it closes the bladder off when you cough or lift.
When those muscles are weak or badly coordinated, urine leaks with a cough, a laugh or a heavy lift. Many women also feel a heaviness low down, as though something is coming down. In Urdu it is described as peshab ka control na hona.
Roughly one in three women who have had a baby leak urine at some point. In Pakistan it is almost never treated. It is not a normal part of being a mother, and supervised pelvic floor training works.
Symptoms you might have
- Urine escaping when you cough, laugh, sneeze, lift or run
- A sudden urge to pass urine that is hard to hold, and rushing to the toilet
- Passing urine very often, or getting up more than once at night
- A heaviness, dragging or bulging feeling low down, usually worse by evening
- Leaking wind, or difficulty holding on until you reach the toilet
- Feeling no squeeze at all when you try to tighten those muscles, which is itself a useful sign
Why it happens
- Pregnancy itself, because the baby's weight loads the pelvic floor for months, whether you deliver vaginally or by caesarean
- A long second stage of labour, a large baby, forceps or a tear
- Several children close together, which is common here and leaves the muscles little time to recover
- Chronic constipation and straining on the toilet
- Heavy lifting at home: water, washing, children and gas cylinders
- A long standing cough, including from cooking smoke
- Menopause, as the tissue becomes thinner and less elastic
When you should see a physiotherapist
Come in as soon as you notice leaking, even if it is only a few drops. Weakness caught early responds faster, but leaking that began years ago still improves with proper training. It is never too late to start.
After delivery, get your doctor's clearance first. Gentle squeezes are usually safe within the first days, and fuller training starts after the six week check.
See a doctor before starting if there is blood in your urine, burning when passing urine with fever, if you cannot pass urine at all, if you feel a bulge that will not go back in, or if you have lost bowel control since delivery.
Go to a hospital the same day if new leaking comes with numbness around the groin or back passage, severe back pain, or weakness in both legs.
Al-Shama Physiotherapy Clinic
Ask about an appointment
اپائنٹمنٹ کے بارے میں پوچھیںAppointment ke liye poochein
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یہ فارم پُر کریں؛ واٹس ایپ پر آپ کی تفصیلات کے ساتھ پیغام تیار ہو جائے گا۔Yeh form bharein, WhatsApp aap ki tafseel ke saath khul jaye ga.
How it is treated
Assessment comes first, because leaking with a cough and leaking with a sudden urge need different treatment. It also matters that the right muscles are working: many women bear down instead of lifting up, then wonder why months of exercises changed nothing.
Dr. Zahra is a female physiotherapist and the assessment starts with a conversation. An internal examination is the most accurate check, and it is your choice, not a requirement.
- Teaching the correct contraction, with feedback, so you know you are using the pelvic floor and not the buttocks, thighs or breath
- Supervised pelvic floor muscle training, long holds and quick squeezes, progressed over at least three months. This is the first line treatment and the evidence is strong
- Bladder retraining for urgency and frequency, lengthening the gap between toilet visits
- Breathing and deep abdominal work, because the pelvic floor works with the diaphragm and lower abdomen
- Manual therapy to the hips, lower back and pelvis where they are part of the problem
- Electrotherapy where no contraction can be produced at all, decided case by case
Most women do not need surgery. A sling or a prolapse repair is a surgeon's decision, considered after a genuine trial of supervised training.
Exercises, and what to avoid
What helps
- Finding the muscles: the feeling of stopping wind and stopping urine mid flow, lifting up and in
- Long holds: hold up to ten seconds, rest the same length, building to ten repeats three times a day
- Quick squeezes: ten fast, strong squeezes, which is what catches a cough
- Squeezing before and during a cough, a lift, or standing up from a chair
What to avoid
- Stopping and starting your urine as an exercise. Done repeatedly it can leave urine in the bladder and cause infection
- Holding your breath, clenching the buttocks and thighs, or bearing down instead of lifting up
- Sit ups, crunches and heavy lifting while the pelvic floor is weak. They push down on it
- Drinking less to leak less. Concentrated urine irritates the bladder and makes urgency worse
What you can do at home
Attach the exercises to something you already do every day, such as feeding the baby or sitting down to eat, so they happen without planning.
Take constipation seriously. Water, fruit, vegetables, and a stool under your feet on the toilet. Do not strain. If it stays hard, ask your doctor about a stool softener.
Drink normally, around two litres a day. Cut down strong tea if you are rushing to the toilet, because caffeine irritates the bladder.
Breathe out as you lift. Lifting with a held breath drives pressure straight down onto the weakest point.
Pads keep you comfortable but they treat nothing. Do not let them become the plan.
Heat and ice have no role here.
How long it takes
Most women notice less leaking within six to eight weeks of doing the exercises daily and correctly. Real strength takes at least three months, which is also the recognised minimum before anything else is considered.
Leaking with a cough, a sneeze or a lift responds best. Urgency and frequency take longer, usually a full three months with bladder retraining alongside.
Mild to moderate prolapse symptoms improve with training, although the bulge itself may not disappear.
It goes faster when the technique is confirmed early and constipation is dealt with, slower with several deliveries, years of leaking and continued heavy lifting. Like any muscle it fades if you stop, so a short daily set carries on afterwards.
Urdu / Roman Urdu
Choose your reading script / اپنی پسند کا رسم الخط منتخب کریں
اردوUrdu script
بچے کی پیدائش کے بعد کھانسنے، چھینکنے یا وزن اٹھانے پر پیشاب نکل جانا بہت عام ہے، لیکن یہ ماں بننے کا نارمل حصہ نہیں ہے۔
وجہ پیڑو کے پٹھے، یعنی نیچے والے پٹھوں کی کمزوری ہوتی ہے۔ یہ پٹھے مثانے کو سنبھالتے ہیں۔
اچھی خبر یہ ہے کہ علاج موجود ہے۔ صحیح ورزش سے چھ سے آٹھ ہفتے میں فرق محسوس ہوتا ہے، اور آپریشن کی ضرورت زیادہ تر نہیں پڑتی۔
ورزش کا صحیح طریقہ سیکھنا ضروری ہے۔ سانس روک کر یا زور لگا کر کرنا فائدہ نہیں دیتا۔ ڈاکٹر زہرہ خاتون فزیوتھراپسٹ ہیں، اس لیے بے جھجک بات کی جا سکتی ہے۔
قبض سے بچیں۔ زچگی کے بعد ورزش شروع کرنے سے پہلے ڈاکٹر سے اجازت لے لیں۔
Roman Urdu
Bachay ki paidaish ke baad khansne, chheenkne ya wazan uthane par peshab nikal jana bohat aam hai, lekin ye maa banne ka normal hissa nahi hai.
Wajah pelvic floor, yani neeche wale pathon ki kamzori hoti hai. Ye pathay masane ko sambhalte hain.
Achi khabar ye hai ke ilaj mojood hai. Sahi warzish se chhe se aath hafte mein farq mehsoos hota hai, aur operation ki zaroorat zyada tar nahi parti.
Warzish ka sahi tareeqa seekhna zaroori hai. Saans rok kar ya zor laga kar karna faida nahi deta. Dr. Zahra khatoon physiotherapist hain, is liye be jhijak baat ki ja sakti hai.
Qabz se bachen. Delivery ke baad warzish shuru karne se pehle doctor se ijazat le len.
Treatment at the clinic, and online
INFORMATION → INDIVIDUAL CARE
A plan built around you.
Talk with Dr. Zahra Fatima, DPT. Understand your next steps, with guidance for your own symptoms and daily routine.
Talk it through
Discuss your symptoms, what you find difficult and what you want to get back to.
Understand your next steps
Use the consultation to discuss which care and exercises fit your situation.
Take your plan with you
Your online consultation includes a written plan you can refer to afterwards.
Questions people ask
Can leaking urine after childbirth be cured?
Am I doing pelvic floor exercises correctly?
My baby is five years old. Is it too late?
Do I need an internal examination?
Is heaviness low down the same as prolapse?
Related conditions
- Back pain in pregnancy
- Diastasis recti treatment
- Lower back pain in women
- Recovery after a C-section
- Pelvic girdle pain treatment